Preface

Ectopic pregnancy is an important cause of morbidity and mortality worldwide, occurring in approximately 2% of all pregnancies, and leading to 2.7%‒5% of maternal deaths in developed countries, mainly from ectopic pregnancy rupture. It is associated with abdominal pain and transvaginal bleeding, and its prevalence in emergency services is 18%. However, with early diagnosis, complications can be avoided. Prenatal screening categorizing pregnancies as high or low risk to prevent maternal complications, and screening the fetus for aneuploidies, anomalies, and growth abnormalities, provides clinicians with evidence for intrauterine treatment or selective termination of pregnancy, and enables the time and mode of safe delivery to be determined and an optimal perinatal outcome to be achieved.

The book is divided into three sections: Diagnosis and Medical Management of Ectopic Pregnancy (Chapters 1‒5), Fetal Malformation (Chapters 6‒8), and Prenatal Diagnosis and Screening (Chapters 9‒11).

Chapter 1 presents a case of heterotopic pregnancy and discusses the endoscopic management of ectopic pregnancy, including incidence and risk factors, clinical presentation and diagnosis, differential diagnosis, treatments, and outcomes.

Chapter 2, on gynecological endoscopy, discusses the endoscopic management of ectopic pregnancy, tubal pregnancy, interstitial or horn pregnancy, ovarian pregnancy, abdominal pregnancy, heterotopic pregnancy, cervical pregnancy, niche, cesarean scar pregnancy, and fertility and ectopic pregnancy.

Chapter 3 reviews the medical management of ectopic pregnancy. Topics addressed include the pharmacology of methotrexate, selection criteria, administration, success, and contraindications for methotrexate. Post-treatment pain, post-methotrexate Anti-D, the role in pregnancy of unknown location, the role of methotrexate in ectopic post-surgical management, and the role of methotrexate in challenging non-tubal ectopic pregnancies are all discussed.

Chapter 4 discusses the diagnosis of ectopic pregnancy, the high index of suspicion of the condition, and the importance of comprehensive training for clinicians.

Chapter 5 examines ectopic pregnancy after ipsilateral salpingectomy, focusing on the pathophysiological, diagnostic, treatment, and prevention aspects. Recurrent ectopic pregnancy in the portion of the tube remaining after ipsilateral salpingectomy has only rarely been reported.

Chapter 6 discusses the prenatal diagnosis of diaphragmatic hernia, including its classification, pathogenesis, antenatal management, postnatal management, and long-term outcomes.

Chapter 7 discusses the etiology and diagnostics of each fetal craniospinal disorder, including ultrasound diagnostics and genetic testing options.

Chapter 8 introduces aspects of spina bifida and myelomeningocele, such as etiology, pathophysiology and methods of diagnosis. The chapter also presents the indications and surgical protocols for both procedures. The author includes statistics on the cases diagnosed and operated on in the Regina Maria Maternity Hospital, Bucharest, the only center in Romania where these procedures are available.

Chapter 9 discusses advances in the application of biomarkers for prenatal diagnosis, along with associated strengths and limitations. Several representative fetal diseases are also analyzed.

Chapter 10 discusses the different screening methods which can be applied to three stages of prenatal care: the pre-pregnancy period; the inverted pyramid of care from 11 weeks till delivery; and the postnatal period.

Chapter 11 highlights common indications for the use of MRI in maternal-fetal medicine, including diagnosis and treatment. An in-depth analysis of the SARS-CoV-2 virus and pregnancy-related complications is also included.

 The completion of this book would not have been possible without the efforts of numerous contributors. We would like to acknowledge the work of our co-authors. We are also grateful to Mrs. Maja Bozicevic, Mrs. Ivana Barac, and Mrs. Ana Simcic at IntechOpen for their continuing support from the inception to the completion of the book.

### **Wei Wu**

Department of Toxicology, School of Public Health, Nanjing Medical University, Nanjing, China

**Panagiotis Tsikouras** Democritus University of Thrace, Greece

**Qiuqin Tang** Department of Obstetrics, Women's Hospital of Nanjing Medical University, Nanjing, China

> **Werner Rath** Kiel University, Kiel, Germany

**Georg-Friedrich Von Tempelhoff** St. Vinzenz Krankenhaus, Hanau, Germany

**Nikolaos Nikolettos**

**1**

Section 1

Diagnosis and Medical

Management of Ectopic

Pregnancy

Democritus University of Thrace, Greece

## Section 1
