Research Article
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Year 2021, Volume: 7 Issue: 6, 566 - 574, 04.11.2021
https://doi.org/10.18621/eurj.938646

Abstract

References

  • 1. Della-Giustina D, Denny M. Ectopic pregnancy. Emerg Med Clin North Am 2003;21:565-84.
  • 2. Greer IA, Lowe GD, Walker JJ, Forbes CD. Haemorrhagic problems in obstetrics and gynaecology in patients with congenital coagulopathies. Br J Obstet Gynaecol 1991;98:909-18.
  • 3. Varma R, Gupta J. Tubal ectopic pregnancy. BMJ Clin Evid 2009;2009:1406.
  • 4. Cunningham FH, MacDonald PC, Grant NF, et al (eds): Williams Obstetrics. 20th ed. Stamford, CT: Appleton & Lange. Prentice-Hall International, Inc., 1997: pp.607-634.
  • 5. Budowick M, Johnson TR, Genadry R, Parmley TH, Woodruff JD. The histopathology of the developing tubal ectopic pregnancy. Fertil Steril 1980;34:169-71.
  • 6. Mhaskar R, Harish M, Jaiprakash T. Unruptured ampullary ectopic pregnancy at 16-week period of gestation with live fetus. J Obstet Gynaecol India 2014;64:73.
  • 7. Kumar V, Gupta J. Tubal ectopic pregnancy. BMJ Clin Evid 2015;2015:1406.
  • 8. Lang H, Würzburg U. Creatine kinase, an enzyme of many forms. Clin Chem 1982;28:1439-47.
  • 9. Jones M, Swaminathan R. The clinical biochemistry of creatine kinase. J Int Fed Clin Chem 1990;2:108-14.
  • 10. Lang H. Creatine kinase isoenzymes: pathophysiology and clinical application. Springer Verlag, 1981.
  • 11. Lavie O, Beller U, Neuman M, Ben-Chetrit A, Gottcshalk-Sabag S, Diamant YZ. Maternal serum creatine kinase: a possible predictor of tubal pregnancy. Am J Obstet Gynecol 1993;169:1149-50.
  • 12. Develioglu OH, Askalli C, Uncu G, Samli B, Daragenli O. Evaluation of serum creatine kinase in ectopic pregnancy with reference to tubal status and histopathology. BJOG 2002;109:121-8.
  • 13. Hsu S, Euerle BD. Ultrasound in pregnancy. Emerg Med Clin North Am 2012;30:849-67.
  • 14. Sivalingam VN, Duncan WC, Kirk E, Shephard LA, Horne AW. Diagnosis and management of ectopic pregnancy. J Fam Plann Reprod Health Care 2011;37:231-40.
  • 15. Senapati S, Barnhart KT. Biomarkers for ectopic pregnancy and pregnancy of unknown location. Fertil Steril 2013;99:1107-16.
  • 16. Barnhart KT. Ectopic pregnancy. N Eng J Med 2009;361:379-87.
  • 17. Vandermolen DT, Borzelleca JF. Serum creatine kinase does not predict ectopic pregnancy. Fertil Steril 1996;65:916-21.
  • 18. Sarı N, Işık H, Başar H, Seven A, Bostancı A. The role of Beta-hCG progesterone and creatine kinase in the early diagnosis of ectopic pregnancies. Gynecol Obstet Reprod Med 2013;19:133-8.
  • 19. Horne AW, Duncan WC, Critchley HO. The need for serum biomarker development for diagnosing and excluding tubal ectopic pregnancy. Acta Obstet Gynecol Scand 2010;89:299-301.
  • 20. Stowall T, McCord ML. Early pregnancy loss and ectopic pregnancy. In: Berek JS. Adashi EY, Hillard PA, eds. Novak's Gynecology. 12th ed. Baltimore: Williams and Wilkins, 1999: p. 487-523.
  • 21. Tawfiq A, Agameya AF, Claman P. Predictors of treatment failure for ectopic pregnancy treated with single-dose methotrexate. Fertil Steril 2000;74:877-80.

Prediction value of creatine kinase level in conservative treated unruptured tubal ectopic pregnancies

Year 2021, Volume: 7 Issue: 6, 566 - 574, 04.11.2021
https://doi.org/10.18621/eurj.938646

Abstract

Objectives: An ectopic pregnancy (EP) occurs when a fertilized ovum implants outside the endometrial cavity. We investigated the creatine kinase (CK) enzyme in conservatively treated EP to determine the resolution time and predict cases that may progress to surgical intervention.


Methods:
We include 43 patients with stable vital signs at recruitment. All participants were examined by using transvaginal ultrasound (TVUS). Beta human chorionic gonadotropin (β-hCG) and creatine kinase (CK) levels were also measured. In cases diagnosed with EP, intramuscular methotrexate (MTX) at a dose of 50 mg / m2 was administered and monitored with β-hCG titers. Follow-up continued until β-hCG titer became negative, or surgery became mandatory due to acute abdominal pain.


Results:
The mean β-hCG Level in the presence of an adnexal mass was statistically significantly higher than the mean level in patients in whom TVUS failed to define a mass. The mean β-hCG level in the surgical exploration group of patients was significantly higher than in those who did not require surgery. At a cut-off of 6486 mIU/mL, β-hCG could predict the emergence of acute abdomen with a sensitivity of 75% and a specificity of 94.3%. We examined CK level to contribute the test's specificity, but we found no difference among cases with and without surgical exploration.


Conclusions:
In patients treated conservatively for EP, CK levels at the outset neither predict an acute abdomen to emerge nor shed light on the resolution period in patients who respond to medical therapy.

References

  • 1. Della-Giustina D, Denny M. Ectopic pregnancy. Emerg Med Clin North Am 2003;21:565-84.
  • 2. Greer IA, Lowe GD, Walker JJ, Forbes CD. Haemorrhagic problems in obstetrics and gynaecology in patients with congenital coagulopathies. Br J Obstet Gynaecol 1991;98:909-18.
  • 3. Varma R, Gupta J. Tubal ectopic pregnancy. BMJ Clin Evid 2009;2009:1406.
  • 4. Cunningham FH, MacDonald PC, Grant NF, et al (eds): Williams Obstetrics. 20th ed. Stamford, CT: Appleton & Lange. Prentice-Hall International, Inc., 1997: pp.607-634.
  • 5. Budowick M, Johnson TR, Genadry R, Parmley TH, Woodruff JD. The histopathology of the developing tubal ectopic pregnancy. Fertil Steril 1980;34:169-71.
  • 6. Mhaskar R, Harish M, Jaiprakash T. Unruptured ampullary ectopic pregnancy at 16-week period of gestation with live fetus. J Obstet Gynaecol India 2014;64:73.
  • 7. Kumar V, Gupta J. Tubal ectopic pregnancy. BMJ Clin Evid 2015;2015:1406.
  • 8. Lang H, Würzburg U. Creatine kinase, an enzyme of many forms. Clin Chem 1982;28:1439-47.
  • 9. Jones M, Swaminathan R. The clinical biochemistry of creatine kinase. J Int Fed Clin Chem 1990;2:108-14.
  • 10. Lang H. Creatine kinase isoenzymes: pathophysiology and clinical application. Springer Verlag, 1981.
  • 11. Lavie O, Beller U, Neuman M, Ben-Chetrit A, Gottcshalk-Sabag S, Diamant YZ. Maternal serum creatine kinase: a possible predictor of tubal pregnancy. Am J Obstet Gynecol 1993;169:1149-50.
  • 12. Develioglu OH, Askalli C, Uncu G, Samli B, Daragenli O. Evaluation of serum creatine kinase in ectopic pregnancy with reference to tubal status and histopathology. BJOG 2002;109:121-8.
  • 13. Hsu S, Euerle BD. Ultrasound in pregnancy. Emerg Med Clin North Am 2012;30:849-67.
  • 14. Sivalingam VN, Duncan WC, Kirk E, Shephard LA, Horne AW. Diagnosis and management of ectopic pregnancy. J Fam Plann Reprod Health Care 2011;37:231-40.
  • 15. Senapati S, Barnhart KT. Biomarkers for ectopic pregnancy and pregnancy of unknown location. Fertil Steril 2013;99:1107-16.
  • 16. Barnhart KT. Ectopic pregnancy. N Eng J Med 2009;361:379-87.
  • 17. Vandermolen DT, Borzelleca JF. Serum creatine kinase does not predict ectopic pregnancy. Fertil Steril 1996;65:916-21.
  • 18. Sarı N, Işık H, Başar H, Seven A, Bostancı A. The role of Beta-hCG progesterone and creatine kinase in the early diagnosis of ectopic pregnancies. Gynecol Obstet Reprod Med 2013;19:133-8.
  • 19. Horne AW, Duncan WC, Critchley HO. The need for serum biomarker development for diagnosing and excluding tubal ectopic pregnancy. Acta Obstet Gynecol Scand 2010;89:299-301.
  • 20. Stowall T, McCord ML. Early pregnancy loss and ectopic pregnancy. In: Berek JS. Adashi EY, Hillard PA, eds. Novak's Gynecology. 12th ed. Baltimore: Williams and Wilkins, 1999: p. 487-523.
  • 21. Tawfiq A, Agameya AF, Claman P. Predictors of treatment failure for ectopic pregnancy treated with single-dose methotrexate. Fertil Steril 2000;74:877-80.
There are 21 citations in total.

Details

Primary Language English
Subjects Obstetrics and Gynaecology
Journal Section Original Articles
Authors

Sakine Rahımlı Ocakoglu 0000-0001-8159-9489

Osman Haldun Develioğlu 0000-0002-0446-166X

Publication Date November 4, 2021
Submission Date June 4, 2021
Acceptance Date August 31, 2021
Published in Issue Year 2021 Volume: 7 Issue: 6

Cite

AMA Rahımlı Ocakoglu S, Develioğlu OH. Prediction value of creatine kinase level in conservative treated unruptured tubal ectopic pregnancies. Eur Res J. November 2021;7(6):566-574. doi:10.18621/eurj.938646

e-ISSN: 2149-3189 


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