الفهرس | Only 14 pages are availabe for public view |
Abstract Ectopic pregnancy presents a major health problem for women of child bearing age , it is a result of flaw in the human reproductive physiology that allows the conceptus to implant and mature outside the endometrial cavity , which ultimately ends in death of the fetus. Tubal ectopic pregnancy is an important cause of maternal morbidity that can be fatal if left undiagnosed due to the risk of potential tubal rupture and haemorrhage . Ectopic pregnancy most often is associated with risk factors leading to tubal epithelial damage that alters gamete and embryo transport , these risk factors can be divided into high , moderate and low risk factors . The incidence of tubal ectopic pregnancy is increasing worldwide most likely due to arising incidence of pelvic inflammatory diseases caused by Chlamydia-Trachomatis infection and the increased use of assisted reproductive techniques . Ectopic pregnancy is usually diagnosed in the first trimester of pregnancy . the most common gestational age of diagnosis is 6-10 weeks , but fetal viability can be discovered until the time of delivery . The physical findings depend on whether tubal rupture has occurred or not . Women with intraperitoneal haemorrhage present with significant abdominal pain and tenderness along with various degrees of haemodynamic instability . ١٠٨ Initial evaluation of the patient with suspected ectopic pregnancy should include a thorough history and physical examination. Detailed medical , surgical and social histories are important to discover potential risk factors for ectopic pregnancy. An accurate menstrual history provides valuable information regarding gestational age , particularly in women with regular menstrual cycles . Placental growth factor is a protein that is produced by the early embryo to promote the development of a vascular network to support embryonic growth and development. Production and activity of this protein increases as a normal response to the implantation of the embryo into the uterine wall. Serum PLGF concentrations were shown to be significantly lower in women with tubal ectopic pregnancies (too low to be determined) and the non-viable intrauterine pregnancies compared with viable intrauterine pregnancies . Despite similar HCG concentrations, the PLGF assay was sufficiently sensitive to differentiate a tubal ectopic pregnancy from a non-viable intrauterine pregnancy . This is a prospective case control study that was carried out on cases recruited from reception room or outpatient clinics of Ain Shams University Maternity Hospital . this study included 40 pregnant women divided as 15 cases of ectopic pregnancy , 10 women with missed abortion and 15 women of normal intrauterine pregnancy The aim of our study is to evaluate the possible clinical value of placental growth factor as a promising diagnostic biomarker for ectopic pregnancy. ١٠٩ This study demonstrated significant differences in PLGF levels between women with ectopic pregnancy and those with intrauterine pregnancy showing that serum PLGF levels are reduced in cases of ectopic pregnancy ( mean = 8.733 pg/ml ) in comparison to cases of intrauterine pregnancy whether normal intrauterine pregnancy (mean = 21.267 pg/ml ) or cases of missed abortion ( mean = 13.3 pg/ml) . The study also showed that there is a cutoff value for diagnosis of ectopic pregnancy on the basis of PLGF at 11 pg/ml with specificity of 96 % and sensitivity of 86.7 % . Our study demonstrated that measuring B-HCG remains the most important diagnostic tool in diagnosis of ectopic pregnancy . Our study shows that more frequent measurement of PLGF may be useful in diagnosis of ectopic pregnancy and we are in need for further research investigations on larger number of patients for more accurate diagnosis of ectopic pregnancy cases . |