title: Acute and chronic presentation of ectopic pregnancy may be two clinical entities.
abstract: OBJECTIVE
  The diagnosis of ectopic pregnancy (EP) is often confirmed at presentation (acute), but often requires serial beta-hCG levels to confirm the diagnosis (chronic). The purpose of this study is to analyze whether these clinical presentations represent a spectrum of disease.
  
  
  METHODS
  The retrospective cohort study of 452 patients diagnosed with EP at the University of Pennsylvania in the years 1990-1999.
  
  
  METHODS
  University of Pennsylvania, Philadelphia, Pennsylvania.
  
  
  METHODS
  Four hundred fifty-two patients diagnosed with EP. Patients diagnosed with EP were divided into two groups according to the time of diagnosis.
  
  
  METHODS
  A total of 37 parameters were examined including historic and demographic factors, findings at presentation, and treatment and outcome variables.
  
  
  RESULTS
  The two groups were similar in terms of historic EP risk factors. Multivariable analysis demonstrates that women with a chronic presentation were less likely to have received fertility medications (odds ratio [OR] 0.23; 95% confidence interval [CI] 0.06-0.84), less likely to present with pain (OR 0.29; 95% CI 0.12-0.71), have a lower beta-hCG level at presentation (9,849 mIU/mL +/- 16,726 vs. 1,787 mIU/mL +/- 4,717), lower chance of rupture (OR 0.19; 95% CI 0.05-0.73), and less frequently have blood type 0.
  
  
  CONCLUSIONS
  Women diagnosed with ectopic pregnancy can be categorized into two groups, those with an acute presentation and those with a chronic presentation. Differences in risk factors, presentation, and outcome may reflect differences in trophoblast viability or invasive potential.
authors.affiliation: Center for Reproductive Medicine and Surgery, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania 19104, USA. kbarnhart@mail.obgyn.upenn.edu
authors.forename: Kurt T
authors.initials: KT
authors.lastname: Barnhart
authors.forename: Paolo
authors.initials: P
authors.lastname: Rinaudo
authors.forename: Amy
authors.initials: A
authors.lastname: Hummel
authors.forename: Joseph
authors.initials: J
authors.lastname: Pena
authors.forename: Mary D
authors.initials: MD
authors.lastname: Sammel
authors.forename: Jesse
authors.initials: J
authors.lastname: Chittams
mesh_terms: D000208:Acute Disease; D000328:Adult; D000367:Age Factors; D015415:Biomarkers / Q000097:blood; D018997:Chorionic Gonadotropin, beta Subunit, Human / Q000097:blood*; D002908:Chronic Disease; D004107:Dilatation and Curettage; D005260:Female; D006801:Humans; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000145:classification* / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D015415:Biomarkers; D018997:Chorionic Gonadotropin, beta Subunit, Human