Introduction ectopic pregnancy, including: pelvic inflammatory disease (PID),

Introduction

 

Ectopic pregnancy is one
of abnormal patterns of pregnancy in which fertilized ovum implants anywhere
other than the liner of the uterine cavity, almost all ectopic pregnancies
happen in the Fallopian tube in about 98% (1).

Ectopic pregnancy is one of
obstetric emergencies, with an incidence of around 1–2% of all pregnancies (2).
If not done early, it will be a leading case of early maternal morbidity and
death rate. It is the most important case of first-trimester maternal deaths
and responsible for 10-15% of early pregnancy mortalities mainly in the
developing world (3).

There are
multiple elements which lead to the relative risk of ectopic pregnancy,
including: pelvic inflammatory disease (PID), infertility, use of an
intrauterine device (IUDs), tubal surgery, intrauterine surgery, smoking,
previous ectopic pregnancy and tubal ligation (4).

Nearly about
10% of women with ectopic pregnancy have no symptoms. No medical signs have
been launch in nearly one-third. The diagnosis of ectopic pregnancy is hard to
be separated from those of other genitourinary and gastrointestinal disorders
(5).  

Assessing
the degree of beta HCG and ultrasound, either pelvic or trans-vaginal, are
applied to diagnose ectopic pregnancy. Ectopic pregnancy is suspected if mother’s ?-hCG
serum level is 1,500 mIU per ml or more outstanding, and transvaginal
ultrasonography does not show an intrauterine gestational sac by 5.5weeks
gestational age (6).

Some adult
females who are doubted as having an ectopic pregnancy at their first
presentation can be followed as an outpatient with serial ?-hCG analysis and
trans-vaginal ultrasound until a definitive diagnosis can be reached. Improved
clinical prediction of the final result of an ectopic pregnancy can potentially
diminish the number of visits of outpatient as well as shorten the fourth
dimension for any patient to make a definitive diagnosis. It is well recognized
that patient at risk of suffering an ectopic pregnancy require timely and exact
diagnosis as delay in diagnosis of ectopic pregnancy can contribute to
increased morbidity and mortality (7).

During the
past 25 years, the incidence of ectopic pregnancy has progressively increased
while the morbidity and mortality associated with it has decreased, and the
treatment alternatives available have progressed from salpingectomy by
laparotomy to conservative surgery by laparoscopy and medical therapy. This
therapeutic transition from surgical emergency to medical management has been
ascribed to early diagnosis (7).

One
important matter that demands to be noticed is the high frequency of tubal
pregnancies reporting when they have already ruptured; thereby pointing out the
hazard associated with tubal pregnancy, hence the need of a marker which is
sufficiently accessible and dependable enough to detect tubal pregnancy early
(7).

Thither is a
new biochemical marker that has been considered to improve early prediction of
ectopic pregnancy, which is creatine phosphokinase. (CPK) is an intracellular
enzyme that catalyzes the synthesis of adenosine triphosphate from creatine
phosphate & adenosine diphosphate. It is presented at metabolically active
tissues with significant energy demand, especially smooth muscles, skeletal
muscles, myocardium and brain. There are 3 isoenzymes forms of CPK namely
CPK-MM, MB and BB (M for muscle B for brain) (8).

 Increasing the plasma level of CPK always
reflects injury to tissues of high CPK activity ex; evaluation, serum level of
CPK is useful in the diagnosis of myocardial infarction (9).

 In ectopic pregnancy trophoblast invade the
endothelium of Fallopian tube, causing it damage. Levi et al was the 1st to
report the measurement of serum CPK levels was a sensitive and specific test
for prediction of ectopic gestation. Another survey discovered that creatine
kinase may be useful in detection ruptured and unruptured ectopic pregnancy,
whereas it is not useful for primary diagnosis of ectopic pregnancy (10).

The raw value of  CPK isoenzymes
has been measured by two studies: Kurzel et al study estimated that CPK-MM
level has poor sensitivity to predict ectopic pregnancy, while Katsikis et al
study demonstrated that CPK-MB has good sensitivity to ectopic pregnancy
prediction. To our knowledge, this study was never performed in Egypt. 

The aim of this work is evaluating the use of serum CPK (MB) level in
early anticipation of the ectopic pregnancy by which morbidity and mortality
might be shortened, and surgical interference is minimized; both agents that
would further negatively affect fertility in the next years.