Background: Ectopic pregnancy (EP) is the leading pregnancy - related cause of death in the first trimester of pregnancy and a major contributor to maternal morbidity. As the tubal pregnancy progresses, it erodes into blood vessels and can cause massive intra-abdominal bleeding. There are limitations in the strategies currently employed to diagnose EP. Even with the use of diagnostic algorithms that systematically evaluate all women at risk for an EP, only 50 percent of women with an EP can be diagnosed upon presentation. Diagnosis in the remaining 50 percent represents a clinical conundrum and can take up to 6 weeks. If the diagnosis of EP is delayed potential rupture, resulting in greater risks of morbidity and mortality, can occur. Moreover, an EP of large size is not amenable to medical therapy, may require major surgery (laparotomy) instead of laparoscopy and can cause greater damage to fallopian tube (and greater impairment of fertility), even if treated before rupture. This application is a competitive continuing renewal of an ROI (Risk Factors as Predictors of Ectopic pregnancy). We have made substantial progress including delineation of the strength of association of risk factors as predictors, development of a clinical prediction rule to aid in diagnosis upon presentations, and preliminary development of a serum molecular diagnosis using a proteomic approach. We have also redefined the use of serial hCG determinations to diagnosis women at risk for EP whose diagnosis was uncertain at presentation. Finally we have established the safety of a novel medical management regimen for women with ectopic pregnancy. The goals of this application focus on further develop and validation of these finding in a larger, diverse and separate population from which they were developed.
Specific Aims and Methods: We plan to extend the systematic evaluation of women at risk for ectopic pregnancy, and collection of serum, form The University of Pennsylvania Medical Center to include to two other centers (The Universities of Miami and Southern California) using a modified existing electronic database that chronicles the clinical course and contains the results of the diagnostic tests used to definitively diagnose women at risk for EP but not diagnosed upon presentation. We plan to use these data to: 1) optimize (and validate) a simple, accurate, non-invasive, diagnosis for the life-threatening condition of ectopic pregnancy using a) clinical factors, b) potential novel serum markers and c) the combination of the two approaches. 2) Identify the proteins that comprise our candidate molecular markers: 3) to validate a decision rule based on serial hCG values for women whose diagnosis was not definitive upon presentation. 4) create a potential test to predict those who will have optimal success with medical management of ectopic pregnancy. This application represents a unique opportunity to combine epidemiologic and basic science methodologies to understand and improve upon important limitations in our ability to diagnose a reproductive disorder with significant public health consequences. We feel that continuation of our translational research has promise to both enhance our understanding of the science of early pregnancy loss as well as to optimize clinical care with potential reduction of morbidity and mortality and therefore fits well into the NIH roadmap strategy to aide interdisciplinary pioneering research to aid in translation from bench to bedside and bedside to practice.

Agency
National Institute of Health (NIH)
Institute
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Type
Research Project (R01)
Project #
5R01HD036455-10
Application #
7906961
Study Section
Special Emphasis Panel (ZRG1-IRAP-Q (01))
Program Officer
Kaufman, Steven
Project Start
1999-05-01
Project End
2012-05-31
Budget Start
2010-06-01
Budget End
2012-05-31
Support Year
10
Fiscal Year
2010
Total Cost
$603,532
Indirect Cost
Name
University of Pennsylvania
Department
Obstetrics & Gynecology
Type
Schools of Medicine
DUNS #
042250712
City
Philadelphia
State
PA
Country
United States
Zip Code
19104
Senapati, Suneeta; Sammel, Mary D; Butts, Samantha F et al. (2016) Predicting first trimester pregnancy outcome: derivation of a multiple marker test. Fertil Steril 106:1725-1732.e3
Cameron, Katherine E; Senapati, Suneeta; Sammel, Mary D et al. (2016) Following declining human chorionic gonadotropin values in pregnancies of unknown location: when is it safe to stop? Fertil Steril 105:953-7
Morse, Christopher B; Barnhart, Kurt T; Senapati, Suneeta et al. (2016) Association of the very early rise of human chorionic gonadotropin with adverse outcomes in singleton pregnancies after in vitro fertilization. Fertil Steril 105:1208-1214.e3
Zee, J; Sammel, M D; Chung, K et al. (2014) Ectopic pregnancy prediction in women with a pregnancy of unknown location: data beyond 48 h are necessary. Hum Reprod 29:441-7
Butts, Samantha F; Guo, Wensheng; Cary, Mark S et al. (2013) Predicting the decline in human chorionic gonadotropin in a resolving pregnancy of unknown location. Obstet Gynecol 122:337-43
Palmer, Stephen S; Barnhart, Kurt T (2013) Biomarkers in reproductive medicine: the promise, and can it be fulfilled? Fertil Steril 99:954-62
Barnhart, Kurt T; Sammel, Mary D; Takacs, Peter et al. (2013) Validation of a clinical risk scoring system, based solely on clinical presentation, for the management of pregnancy of unknown location. Fertil Steril 99:193-8
Bachman, Emelia Argyropoulos; Barnhart, Kurt (2012) Medical management of ectopic pregnancy: a comparison of regimens. Clin Obstet Gynecol 55:440-7
Morse, Christopher B; Sammel, Mary D; Shaunik, Alka et al. (2012) Performance of human chorionic gonadotropin curves in women at risk for ectopic pregnancy: exceptions toýýthe rules. Fertil Steril 97:101-6.e2
Takacs, Peter; Jaramillo, Sindy; Datar, Ram et al. (2012) Placental mRNA in maternal plasma as a predictor of ectopic pregnancy. Int J Gynaecol Obstet 117:131-3

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