الفهرس 
Ectopic pregnancyOnly 14 pages are availabe for public view
 |  | from | 131 |  |  |
| | | from | 131 | | |
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 .