Advertisement

Association between ultrasound findings and serum levels of vascular endothelial growth factor in ampullary pregnancy

      Objective

      To assess the association between ultrasound images and serum concentrations of vascular endothelial growth factor (VEGF) in ampullary pregnancies.

      Design

      Prospective study.

      Setting

      University hospital.

      Patient(s)

      Fifty patients with ampullary pregnancy.

      Intervention(s)

      Criteria for inclusion in the study were: singleton pregnancy from spontaneous conception; diagnosis of tubal pregnancy in the ampullary region; radical surgical treatment (salpingectomy); and measurement of serum VEGF, human chorionic gonadotropin, and progesterone on the day of surgery. An additional criterion was description of an ectopic mass by transvaginal ultrasound, as follows: [1] ectopic gestational sac containing an embryo with cardiac activity; and [2] tubal ring: a paraovarian formation similar to a gestational sac, not containing a viable embryo (an anechoic structure surrounded by a peripheral hyperechogenic halo); an empty ectopic gestational sac; a sac containing an embryo without cardiac activity; or a vitelline vesicle.

      Main Outcome Measure(s)

      Association between ultrasound images and serum concentrations of VEGF.

      Result(s)

      An association was found between ultrasonographic images and VEGF serum concentrations. Ectopic embryos with cardiac activity were associated with higher levels of serum VEGF.

      Conclusion(s)

      In ampullary pregnancy, higher serum levels of VEGF are associated with the finding of an embryo with cardiac activity on transvaginal ultrasound. Greater production of VEGF likely creates development conditions more conducive to ectopic embryos.

      Key Words

      To read this article in full you will need to make a payment

      References

        • Murray H.
        • Baakdah H.
        • Bardell T.
        • Tulandi T.
        Diagnosis and treatment of ectopic pregnancy.
        CMAJ. 2005; 173: 905-912
        • Mikolajczyk R.
        • Kraut A.
        • Garbe E.
        Evaluation of pregnancy outcome records in the German Pharmacoepidemiological Research Database (GePaRD).
        Pharmacoepidemiol Drug Saf. 2013; 22: 873-880
        • Centers for Disease Control and Prevention
        Ectopic pregnancy—United States, 1990-1992.
        MMWR Morb Mortal Wkly Rep. 1995; 44: 46-48
        • Yuk J.S.
        • Kim Y.J.
        • Hur J.Y.
        • Shin J.H.
        Association between socioeconomic status and ectopic pregnancy rate in the Republic of Korea.
        Int J Gynaecol Obstet. 2013; 122: 104-107
        • Lewis G.
        • Drife J.
        Why mothers die—Triennial Report 2000-2002. The Sixth Report of the Confidential Enquiries into Maternal Deaths in the United Kingdom.
        RCOG Press, London2004
        • Kamwendo F.
        • Forslin L.
        • Bodin L.
        • Danielsson D.
        Epidemiology of ectopic pregnancy during a 28 year period and the role of pelvic inflammatory disease.
        Sex Transm Infect. 2000; 76: 28-32
        • Job-Spira N.
        • Collet P.
        • Coste J.
        • Brémont A.
        • Lauman B.
        Risk factors for ectopic pregnancy. Results of a case-control study in the Rhone-Alpes region.
        Contracept Fertil Sex. 1993; 21: 307-312
        • Ankum W.M.
        • Mol B.W.
        • Van der Veen F.
        • Bossuyt P.M.
        Risk factors for ectopic pregnancy: a meta-analysis.
        Fertil Steril. 1996; 65: 1093-1099
        • Bouyer J.
        • Coste J.
        • Shojaei T.
        • Pouly J.L.
        • Fernandez H.
        • Gerbaud L.
        • et al.
        Risk factors for ectopic pregnancy: a comprehensive analysis based on a large case-control, population-based study in France.
        Am J Epidemiol. 2003; 157: 185-194
        • Pereira P.P.
        • Cabar F.R.
        • Raiza L.C.
        • Roncaglia M.T.
        • Zugaib M.
        Emergency contraception and ectopic pregnancy: report of 2 cases.
        Clinics. 2005; 60: 497-500
        • Cabar F.R.
        • Pereira P.P.
        • Zugaib M.
        Intrauterine pregnancy after salpingectomy for tubal pregnancy due to emergency contraception: a case report.
        Clinics. 2007; 62: 641-642
        • Senger D.R.
        • Galli S.J.
        • Dvorak A.M.
        • Perruzzi C.A.
        • Harvey V.S.
        • Dvorak H.F.
        Tumor cells secrete a vascular permeability factor that promotes accumulation of ascites fluid.
        Science. 1983; 219: 983-985
        • Leung D.W.
        • Cachianes G.
        • Kuang W.J.
        • Goeddel D.V.
        • Ferrara N.
        Vascular endothelial growth factor is a secreted angiogenic mitogen.
        Science. 1989; 246: 1306-1309
        • Torry D.S.
        • Holt V.J.
        • Keenan J.A.
        • Harris G.
        • Caudle M.R.
        • Torry R.J.
        Vascular endometrial growth factor expression in cycling human endometrium.
        Fertil Steril. 1996; 66: 72-80
        • Shifren J.L.
        • Tseng J.F.
        • Zaloudek C.J.
        • Ryan I.P.
        • Meng Y.G.
        • Ferrara N.
        Ovarian steroid regulation of vascular endothelial growth factor in the human endometrium: implications for angiogenesis during the menstrual cycle and in the pathogenesis of endometriosis.
        J Clin Endocrinol Metab. 1996; 81: 3112-3118
        • Clark D.E.
        • Smith S.K.
        • Sharkey A.M.
        • Charnock-Jones D.S.
        Localization of VEGF and expression of its receptors fit and KDR in human placenta throughout pregnancy.
        Hum Reprod. 1996; 11: 1090-1098
        • Torry D.S.
        • Torry R.J.
        Angiogenesis and the expression of vascular endothelial growth factor in endometrium and placenta.
        Am J Reprod Immunol. 1997; 37: 21-29
        • Neufeld G.
        • Cohen T.
        • Gengrinovitch S.
        • Poltorak Z.
        Vascular endometrial growth factor (VEGF) and its receptors.
        FASEB J. 1999; 13: 9-22
        • Ladoux A.
        • Frelin C.
        Hypoxia is a strong inducer of vascular endothelial growth factor mRNA expression in the heart.
        Biochem Biophys Res Commun. 1993; 195: 1005-1010
        • Evans P.W.
        • Wheeler T.
        • Anthony F.W.
        • Osmound C.
        A longitudinal study of maternal serum vascular growth factor in early pregnancy.
        Hum Reprod. 1998; 13: 1057-1062
        • Daniel Y.
        • Geva E.
        • Lerner-Geva L.
        • Eshed-Englender T.
        • Gamzu R.
        • Lessing J.B.
        • et al.
        Levels of vascular endothelial growth factor are elevated in patients with ectopic pregnancy: Is this a novel marker?.
        Fertil Steril. 1999; 72: 1013-1017
        • Felemban A.
        • Sammour A.
        • Tulandi T.
        Serum vascular endothelial growth factor as a possible marker for early ectopic pregnancy.
        Hum Reprod. 2002; 17: 490-492
        • Cabar F.R.
        • Pereira P.P.
        • Schultz R.
        • Zugaib M.
        Predictive factors of trophoblastic invasion into the ampullary region of the tubal wall in ectopic pregnancy.
        Hum Reprod. 2006; 21: 2426-2431
        • Pereira P.P.
        • Cabar F.R.
        • Schultz R.
        • Zugaib M.
        Association between ultrasound findings and extent of trophoblastic invasion into the tubal wall in ampullary pregnancy.
        Ultrasound Obstet Gynecol. 2009; 33: 472-476
        • Cabar F.R.
        • Pereira P.P.
        • Schultz R.
        • Francisco R.P.
        • Zugaib M.
        Vascular endothelial growth factor and β-human chorionic gonadotropin are associated with trophoblastic invasion into the tubal wall in ectopic pregnancy.
        Fertil Steril. 2010; 94: 1595-1600
        • Timor-Tritsch I.E.
        • Yeh M.N.
        • Peisner D.B.
        • Lesser K.B.
        • Slavik T.A.
        The use of transvaginal ultrasonography in the diagnosis of ectopic pregnancy.
        Am J Obstet Gynecol. 1989; 161: 157-161
        • Levine D.
        Ectopic pregnancy.
        Radiology. 2007; 245: 385-397
        • Yao M.
        • Tulandi T.
        • Falcone T.
        Treatment of ectopic pregnancy by systemic methotrexate, transvaginal methotrexate, and operative laparoscopy.
        Int J Fertil Menopausal Stud. 1996; 41: 470-475
        • Condous G.
        • Okaro E.
        • Khalid A.
        • Lu C.
        • Van Huffel S.
        • Timmerman D.
        • et al.
        The accuracy of transvaginal ultrasonography for the diagnosis of ectopic pregnancy prior to surgery.
        Hum Reprod. 2005; 20: 1404-1409
        • Condous G.
        • Kirk E.
        • Lu C.
        • Van Huffel S.
        • Gevaert O.
        • De Moor B.
        • et al.
        Diagnostic accuracy of varying discriminatory zones for the prediction of ectopic pregnancy in women with a pregnancy of unknown location.
        Ultrasound Obstet Gynecol. 2005; 26: 770-775
        • Brown D.L.
        • Doubilet P.M.
        Transvaginal sonography for diagnosing ectopic pregnancy: positivity criteria and performance characteristics.
        J Ultrasound Med. 1994; 13: 259-266
        • Yang J.
        • Wang X.
        • Fuh G.
        • Yu L.
        • Wakshull E.
        • Khosraviani M.
        • et al.
        Comparison of binding characteristics and in vitro activities of three inhibitors of vascular endothelial growth factor A.
        Mol Pharm. 2014; 11: 3421-3430