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Serum Markers in the Diagnosis of Tubal Pregnancy

By Fabio Roberto Cabar, Paula Beatriz Fettback, Pedro Paulo Pereira and Marcelo Zugaib


The introduction of highly sensitive methods, such as transvaginal sonography and measurement of serum β-human chorionic gonadotropin, has dramatically improved ectopic pregnancy diagnosis in recent years. Early diagnosis is the key to successful and conservative management of women with ectopic pregnancy; however, approximately 50 percent of such women are initially misdiagnosed, resulting in significant morbidity and mortality. In order to improve diagnosis, several serum markers are being investigated including progesterone, CA 125, pregnancy-associated plasma protein-A, vascular endothelial growth factor, and maternal creatine kinase. Measurement of serum vascular endothelial growth factor, alone or together with other markers, could be a promising method for earlier and more accurate differential diagnosis. However, the clinical applicability of these findings remains to be evaluated in larger prospective studies

Topics: Review
Publisher: Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo
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Provided by: PubMed Central

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  1. (1995). A challenge to the concept of tubal reflux to explain the rise and fall of CA125 in serum during the first trimester. Hum Reprod.
  2. A serum proteomics approach to the diagnosis of ectopic pregnancy.
  3. (1997). Angiogenesis and the expression of vascular endothelial growth factor in endometrium and placenta.
  4. (1985). Circulating and tissue concentrations of pregnancy-associated plasma protein-A (PAPP-A) in tubal ectopic gestation. Clin Reprod Fertil.
  5. (1998). Clinical value of creatinine kinase in the diagnosis of ectopic pregnancy. Gynecol Obstet Invest.
  6. Comparison of serum progesterone as an indicator of pregnancy nonviability in spontaneously pregnant emergency room and infertility clinic patient populations. Fertil Steril.
  7. (1991). Controlled ovarian hyperstimulation as a risk factor for ectopic pregnancy. Obstet Gynecol.
  8. Creatine phosphokinase in ectopic pregnancy revisited: significant diagnostic value of its MB and MM isoenzyme fractions.
  9. (2006). Determining ectopic pregnancy risk using progesterone levels. Am Fam Physician
  10. (1990). Disease Control and Prevention. Ectopic Pregnancy – United States,
  11. Do levels of serum cancer antigen 125 and creatine kinase predict the outcome in pregnancies of unknown location? Hum Reprod.
  12. Early diagnosis of ectopic pregnancy: can we do it accurately using a biochemical profile? J Womens Health Gend Based Med.
  13. (1994). Early screening for ectopic pregnancy in high-risk symptom-free women.
  14. (1990). Ectopic pregnancy: ten common pitfalls in diagnosis. Am J Emerg Med.
  15. Ectopic pregnancy.
  16. (2000). Effects of laparoscopic ovarian drilling on serum vascular endothelial growth factor and on insulin responses to the oral glucose tolerance test in women with polycystic ovary syndrome. Fertil Steril.
  17. Emergency contraception and ectopic pregnancy: report of 2 cases.
  18. (1990). Emergency department diagnosis of ectopic pregnancy. Ann Emerg Med.
  19. (1987). Epidemiology of ectopic pregnancy. Epidemiol Rev.
  20. (1999). Evaluation of serum creatine kinase as a diagnostic marker for tubal pregnancy.
  21. (2004). Expectant management of tubal ectopic pregnancy: prediction of successful outcome using decision tree analysis. Ultrasound Obstet Gynecol.
  22. Increased messenger RNA expression of vascular endothelial growth factor and its receptors in the implantation site of the human oviduct with ectopic gestation. Fertil Steril.
  23. Intrauterine pregnancy after salpingectomy for tubal pregnancy due to emergency contraception: a case report.
  24. (1999). Levels of vascular endothelial growth factor are elevated in patients with ectopic pregnancy: is this a novel marker? Fertil Steril.
  25. (1993). Maternal serum CA125 levels in early intrauterine and tubal pregnancies. Arch Gynecol Obstet.
  26. Maternal serum creatine kinase as a biochemical marker of tubal pregnancy.
  27. (2004). Novel placental and nonplacental serum markers in ectopic versus normal intrauterine pregnancy. Fertil Steril.
  28. Placental proteins in peripheral blood and tissues of ectopic pregnancies.
  29. Placental proteins in the diagnosis and evaluation of the «elusive» early pregnancy. Obstet Gynecol Surv.
  30. (1987). Pregnancy-associated plasma protein A in pregnancy-related gynecologic emergency. Hum Reprod.
  31. Progesterone as a predictor of ectopic pregnancy when the ultrasound is indeterminate.
  32. Prognostic value of repeated serum CA 125 measurements in first trimester pregnancy.
  33. Receiver operating characteristic (ROC) curve analysis of the relative efficacy of single and serial chorionic gonadotropin determinations in the early diagnosis of ectopic pregnancy.
  34. (2008). Receiver operator characteristics and diagnostic value of progesterone and CA-125 in the prediction of ectopic and abortive intrauterine gestations.
  35. Risk factors for ectopic pregnancy: a case-control study in France, with special focus on infectious factors.
  36. Risk factors for ectopic pregnancy: a comprehensive analysis based on a large case-control, population-based study in France.
  37. (1996). Risk factors for ectopic pregnancy: a meta-analysis. Fertil Steril
  38. (1993). Risk factors for ectopic pregnancy. Results of a case-control study in the Rhone-Alpes region. Contracept Fertil Sex.
  39. (1995). Serum CA 125 levels and spontaneous abortion.
  40. (1991). Serum CA-125 levels in women with ectopic and intrauterine pregnancies.
  41. Serum creatine kinase is not a reliable indicator of ectopic pregnancy.
  42. (2000). Serum progesterone testing to predict ectopic pregnancy in symptomatic first-trimester patients. Ann Emerg Med.
  43. (2002). Serum vascular endothelial growth factor as a possible marker for early ectopic pregnancy. Hum Reprod.
  44. (1996). Single serum progesterone as a screen for ectopic pregnancy: exchanging specificity and sensitivity to obtain optimal test performance. Fertil Steril.
  45. (1998). The accuracy of single serum progesterone measurement in the diagnosis of ectopic pregnancy: a meta-analysis. Hum Reprod.
  46. (1989). The CA 125 tumour-associated antigen: a review of the literature. Hum Reprod.
  47. (2000). The frequency of salpingitis and ectopic pregnancy as epidemiologic markers of Chlamydia trachomatis. Acta Obstet Gynecol Scand.
  48. (1980). The histopathology of the developing tubal ectopic pregnancy. Fertil Steril.
  49. The value of a single combined measurement of VEGF, glycodelin, progesterone, PAPP-A, HPL and LIF for differentiating between ectopic and abnormal intrauterine pregnancy. Hum Reprod.
  50. (2008). The value of vascular endothelial growth factor, pregnancy-associated plasma protein-A, and progesterone for early differentiation of ectopic pregnancies, normal intrauterine pregnancies, and spontaneous miscarriages. Fertil Steril.
  51. Vascular endothelial growth factor (VEGF) and discrimination between abnormal intrauterine and ectopic pregnancy. Hum Reprod.
  52. (2004). Why Mothers Die”, Triennial Report 2000-2002.

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