{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,13]],"date-time":"2025-12-13T07:19:17Z","timestamp":1765610357677,"version":"3.37.3"},"reference-count":32,"publisher":"Federa\u00e7\u00e3o das Associa\u00e7\u00f5es de Ginecologia e Obstetr\u00edcia","issue":"04","license":[{"start":{"date-parts":[[2023,5,24]],"date-time":"2023-05-24T00:00:00Z","timestamp":1684886400000},"content-version":"vor","delay-in-days":53,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Rev Bras Ginecol Obstet"],"published-print":{"date-parts":[[2023,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Objective\u2003To evaluate the use of different treatment options for ectopic pregnancy and the frequency of severe complications in a university hospital.<\/jats:p><jats:p>\n          Methods\u2003Observational study with women with ectopic pregnancy admitted at UNICAMP Women\u0301s Hospital, Brazil, between 01\/01\/2000 and 12\/31\/2017. The outcome variables were the type of treatment (first choice) and the presence of severe complications. Independent variables were clinical and sociodemographic data. Statistical analysis was carried out by the Cochran\u2013Armitage test, chi-square test, Mann\u2013Whitney test and multiple Cox regression.<\/jats:p><jats:p>\n          Results\u2003In total 673 women were included in the study. The mean age was 29.0 years (\u00b1\u20096.1) and the mean gestational age was 7.7 (\u00b1\u20092.5). The frequency of surgical treatment decreased significantly over time (z\u2009=\u2009-4.69; p\u2009&lt;\u20090.001). Conversely, there was a significant increase in the frequency of methotrexate treatment (z\u2009=\u20094.73; p\u2009&lt;\u20090.001). Seventy-one women (10.5%) developed some type of severe complication. In the final statistical model, the prevalence of severe complications was higher in women who were diagnosed with a ruptured ectopic pregnancy at admission (PR\u2009=\u20092.97; 95%CI: 1.61\u20135.46), did not present with vaginal bleeding (PR\u2009=\u20092.45; 95%CI: 1.41\u20134.25), had never undergone laparotomy\/laparoscopy (PR\u2009=\u20096.69; 95%CI: 1.62\u201327.53), had a non-tubal ectopic pregnancy (PR\u2009=\u20094.61; 95%CI: 1.98\u201310.74), and do not smoke (PR\u2009=\u20092.41; 95%CI: 1.08\u20135.36).<\/jats:p><jats:p>\n          Conclusion\u2003there was a change in the first treatment option for cases of ectopic pregnancy in the hospital during the period of analysis. Factors inherent to a disease that is more difficult to treat are related to a higher frequency of severe complications.<\/jats:p>","DOI":"10.1055\/s-0043-1768999","type":"journal-article","created":{"date-parts":[[2023,5,24]],"date-time":"2023-05-24T22:48:11Z","timestamp":1684968491000},"page":"192-200","source":"Crossref","is-referenced-by-count":3,"title":["Changing Paradigms in the Initial Treatment of Ectopic Pregnancy at a University Hospital in Brazil"],"prefix":"10.61622","volume":"45","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4060-8515","authenticated-orcid":false,"given":"B\u00e1rbara Virginia Gon\u00e7alves","family":"Tavares","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Universidade Estadual de Campinas, Campinas, SP, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8335-161X","authenticated-orcid":false,"given":"Let\u00edcia Sathler","family":"Delfino","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Universidade Estadual de Campinas, Campinas, SP, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5941-4449","authenticated-orcid":false,"given":"Isabella Silvestre","family":"Ignarro","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Universidade Estadual de Campinas, Campinas, SP, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8837-8061","authenticated-orcid":false,"given":"Luiz Francisco","family":"Baccaro","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Universidade Estadual de Campinas, Campinas, SP, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"47794","published-online":{"date-parts":[[2023,5,24]]},"reference":[{"issue":"02","key":"ref1","doi-asserted-by":"publisher","first-page":"e65","DOI":"10.1097\/AOG.0000000000002464","article-title":"ACOG Practice Bulletin No. 191: tubal ectopic pregnancy","volume":"131","author":"Committee on Practice Bulletins\u2014Gynecology","year":"2018","journal-title":"Obstet Gynecol"},{"issue":"09","key":"ref3","doi-asserted-by":"publisher","first-page":"1932","DOI":"10.1111\/jog.14041","article-title":"Laparoscopic surgery with spleen preservation to treat primary splenic pregnancy: Case report and literature review","volume":"45","author":"M Wang","year":"2019","journal-title":"J Obstet Gynaecol Res"},{"issue":"07","key":"ref4","doi-asserted-by":"publisher","first-page":"1098","DOI":"10.1111\/jog.14253","article-title":"Risk factors and clinical characteristics of recurrent ectopic pregnancy: A case-control study","volume":"46","author":"X Wang","year":"2020","journal-title":"J Obstet Gynaecol Res"},{"issue":"06","key":"ref5","doi-asserted-by":"publisher","first-page":"819","DOI":"10.1016\/j.jemermed.2017.08.074","article-title":"Emergency medicine myth: ectopic pregnancy evaluation, risk factors, and presentation","volume":"53","author":"J J Robertson","year":"2017","journal-title":"J Emerg Med"},{"issue":"01","key":"ref6","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1186\/s12963-017-0156-y","article-title":"Cause-specific mortality for 249 causes in Brazil and states during 1990-2015: a systematic analysis for the global burden of disease study 2015","volume":"15","author":"E B Fran\u00e7a","year":"2017","journal-title":"Popul Health Metr"},{"issue":"01","key":"ref7","doi-asserted-by":"publisher","first-page":"e00133115","DOI":"10.1590\/0102-311X00133116","article-title":"Causas m\u00faltiplas de mortalidade materna relacionada ao aborto no Estado de Minas Gerais, Brasil, 2000-2011","volume":"33","author":"E F Martins","year":"2017","journal-title":"Cad Saude Publica"},{"issue":"13","key":"ref8","doi-asserted-by":"publisher","first-page":"e15","DOI":"10.1111\/1471-0528.14189","article-title":"Diagnosis and Management of Ectopic Pregnancy: Green-top Guideline No. 21","volume":"123","author":"C J Elson","year":"2016","journal-title":"BJOG"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"69","DOI":"10.1016\/j.ejogrb.2016.10.037","article-title":"Individualisation of intervention for tubal ectopic pregnancy: historical perspectives and the modern evidence based management of ectopic pregnancy","volume":"210","author":"F Odejinmi","year":"2017","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"issue":"07","key":"ref11","doi-asserted-by":"publisher","first-page":"1480","DOI":"10.1016\/j.jmig.2020.04.008","article-title":"Cornuostomy and cornuectomy: laparoscopic management of interstitial ectopic pregnancies","volume":"27","author":"K Ma","year":"2020","journal-title":"J Minim Invasive Gynecol"},{"issue":"05","key":"ref12","doi-asserted-by":"publisher","first-page":"1066","DOI":"10.1016\/j.fertnstert.2012.09.040","article-title":"Ectopic pregnancy: how the diagnostic and therapeutic management has changed","volume":"98","author":"N M van Mello","year":"2012","journal-title":"Fertil Steril"},{"volume-title":"Designing clinical research. 3rd ed","year":"2007","author":"S B Hulley","key":"ref13"},{"volume-title":"Statistical Power Analysis for the Behavioral Sciences. 2nd ed","year":"1988","author":"J Cohen","key":"ref14"},{"issue":"03","key":"ref15","doi-asserted-by":"publisher","first-page":"295","DOI":"10.1002\/ijgo.12473","article-title":"Systematic review and meta-analysis of single-dose and non-single-dose methotrexate protocols in the treatment of ectopic pregnancy","volume":"141","author":"J S Yuk","year":"2018","journal-title":"Int J Gynaecol Obstet"},{"issue":"03","key":"ref16","doi-asserted-by":"publisher","first-page":"417","DOI":"10.1007\/s00404-014-3266-9","article-title":"Methotrexate for ectopic pregnancy: when and how","volume":"290","author":"G N Cecchino","year":"2014","journal-title":"Arch Gynecol Obstet"},{"issue":"01","key":"ref17","doi-asserted-by":"publisher","first-page":"49.e1","DOI":"10.1016\/j.ajog.2017.03.001","article-title":"Disparities in the management of ectopic pregnancy","volume":"217","author":"J Y Hsu","year":"2017","journal-title":"Am J Obstet Gynecol"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"174","DOI":"10.1016\/j.ejogrb.2018.10.054","article-title":"Ectopic pregnancy hospitalisations: A national population-based study of rates, management and outcomes","volume":"231","author":"I S San Lazaro Campillo","year":"2018","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"145","DOI":"10.1007\/978-1-4939-0659-8_7","article-title":"The endocrinology of the menstrual cycle","volume":"1154","author":"R L Barbieri","year":"2014","journal-title":"Methods Mol Biol"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"1139","DOI":"10.1016\/s0140-6736(95)90977-x","article-title":"A cost-effectiveness study of a randomised trial of laparoscopy versus laparotomy for ectopic pregnancy","volume":"345","author":"D T Gray","year":"1995","journal-title":"Lancet"},{"issue":"06","key":"ref21","doi-asserted-by":"publisher","first-page":"620","DOI":"10.1080\/01443610020001495","article-title":"Laparoscopic surgical management of ectopic pregnancy: a district general hospital experience","volume":"20","author":"V Olagundoye","year":"2000","journal-title":"J Obstet Gynaecol"},{"issue":"04","key":"ref22","doi-asserted-by":"publisher","first-page":"559","DOI":"10.1016\/s0015-0282(16)60599-x","article-title":"Conservative management of ectopic gestation","volume":"51","author":"M Vermesh","year":"1989","journal-title":"Fertil Steril"},{"key":"ref23","first-page":"400","article-title":"Management of unruptured ectopic gestation by linear salpingostomy: a prospective, randomized clinical trial of laparoscopy versus laparotomy","volume":"73","author":"M Vermesh","year":"1989","journal-title":"Obstet Gynecol"},{"issue":"03","key":"ref24","doi-asserted-by":"publisher","first-page":"618","DOI":"10.1016\/j.jmig.2019.04.030","article-title":"Laparoscopic management of 42 cases of tubal stump pregnancy and postoperative reproductive outcomes","volume":"27","author":"F Sun","year":"2020","journal-title":"J Minim Invasive Gynecol"},{"issue":"06","key":"ref25","doi-asserted-by":"publisher","first-page":"1671","DOI":"10.1016\/j.fertnstert.2014.08.031","article-title":"Ectopic pregnancy rates and racial disparities in the Medicaid population, 2004-2008","volume":"102","author":"D B Stulberg","year":"2014","journal-title":"Fertil Steril"},{"issue":"06","key":"ref26","doi-asserted-by":"publisher","first-page":"1354","DOI":"10.1016\/s0002-9378(98)70343-6","article-title":"Analysis of three hundred fifteen ectopic pregnancies treated with single-dose methotrexate","volume":"178","author":"G H Lipscomb","year":"1998","journal-title":"Am J Obstet Gynecol"},{"issue":"05","key":"ref27","doi-asserted-by":"publisher","first-page":"731","DOI":"10.1016\/j.jmig.2017.02.020","article-title":"Cesarean scar pregnancy: a systematic review","volume":"24","author":"N Gonzalez","year":"2017","journal-title":"J Minim Invasive Gynecol"},{"issue":"02","key":"ref28","doi-asserted-by":"publisher","first-page":"169","DOI":"10.1002\/uog.17568","article-title":"Outcome of Cesarean scar pregnancy managed expectantly: systematic review and meta-analysis","volume":"51","author":"G Cal\u00ec","year":"2018","journal-title":"Ultrasound Obstet Gynecol"},{"issue":"01","key":"ref29","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1016\/j.ajog.2009.07.054","article-title":"Current diagnosis and treatment of interstitial pregnancy","volume":"202","author":"N S Moawad","year":"2010","journal-title":"Am J Obstet Gynecol"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"Doc16","DOI":"10.3205\/000105","article-title":"Diagnosis and laparoscopic treatment of cornual ectopic pregnancy","volume":"8","author":"M S Walid","year":"2010","journal-title":"Ger Med Sci"},{"issue":"01","key":"ref31","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.jogc.2015.11.008","article-title":"Ovarian Pregnancy","volume":"38","author":"J Papillon-Smith","year":"2016","journal-title":"J Obstet Gynaecol Can"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1016\/j.ejro.2018.01.001","article-title":"MRI findings of complications related to previous uterine scars","volume":"5","author":"L Alamo","year":"2018","journal-title":"Eur J Radiol Open"},{"issue":"02","key":"ref33","first-page":"94","article-title":"Cervical ectopic pregnancy deprived areas: a rare and difficult diagnosis","volume":"51","author":"M Mouhajer","year":"2017","journal-title":"Ghana Med J"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"8017937","DOI":"10.1155\/2017\/8017937","article-title":"Abdominal pregnancy in the small intestine presenting as acute massive lower gastrointestinal hemorrhage","volume":"2017","author":"A Pichaichanlert","year":"2017","journal-title":"Case Rep Surg"}],"container-title":["Revista Brasileira de Ginecologia e Obstetr\u00edcia \/ RBGO Gynecology and Obstetrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journalrbgo.org\/article\/changing-paradigms-in-the-initial-treatment-of-ectopic-pregnancy-at-a-university-hospital-in-brazil\/","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/s-0043-1768999.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,7,18]],"date-time":"2024-07-18T20:57:38Z","timestamp":1721336258000},"score":1,"resource":{"primary":{"URL":"https:\/\/journalrbgo.org\/article\/changing-paradigms-in-the-initial-treatment-of-ectopic-pregnancy-at-a-university-hospital-in-brazil\/"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,4]]},"references-count":32,"journal-issue":{"issue":"04","published-online":{"date-parts":[[2023,5,24]]},"published-print":{"date-parts":[[2023,4]]}},"URL":"https:\/\/doi.org\/10.1055\/s-0043-1768999","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0100-7203","1806-9339"],"issn-type":[{"type":"print","value":"0100-7203"},{"type":"electronic","value":"1806-9339"}],"subject":[],"published":{"date-parts":[[2023,4]]}}}