**Author details**

Serum Macrophage Inhibitory Cytokine-1 levels were found to be lower in women with histologically confirmed EP compared to women with definite viable intra-uterine pregnancy

Another recent study by Beer et al that screened the proteome of a small group of women with EP and controls identified potential novel biomarkers, including ADAM-12 and ISM2 (Isthmin

As maintenance of a viable pregnancy requires an interplay of multiple factors, no single marker has been used successfully as a biomarker for EP. It seems prudent, therefore, to combine these markers and use them in the multiple marker setting. Rausch et al demonstrated that a four-marker test including Progesterone, VEGF, Inhibin A, and Activin A could predict EP with 100% accuracy in those with an hCG<1500 mIU/mL [28]. Further studies are necessary to fully assess the discriminatory capacity of such a test. Similarly, Feng et al found a combi‐ nation of Δβ-hCG, Progesterone and Oestradiol to be helpful in distinguishing EPs and normal IUPs, facilitating earlier diagnosis and the timely implementation of medical treatment to

Soriano et al found that the combination of inflammatory cytokines IL-6, IL-8, and TNF-alpha

Another group in Switzerland developed a multiple marker test, the "triple marker analysis" [VEGF/(PAPP-A X P)] had a sensitivity of 97.7% with a specificity of 92.4% in diagnosing

In another study, investigators studied serum levels of 17β-estradiol (E2), progesterone (P4), testosterone (T), beta-human chorionic gonadotropin (β-hCG), vascular endothelial growth factor-A (VEGF-A), placental growth factor (PIGF), and a distintegrin and metalloprotease

Novel biomarker of ectopic pregnancy with adequate sensitivity and specificity could assist in early diagnosis and hence timely intervention, thereby dramatically reducing the morbidity and mortality. There are number of potential molecules for use as biomarkers in women at risk for EP. As no single biomarker is ready for use in clinical setting, more prospective cohorts including ectopic pregnancy, normal and abnormal IUPs are required to validate these markers. Also, it would be prudent to concentrate the efforts on developing a panel of markers which include markers of viability, location of implantation and fetal milieu. Recent times have witnessed positive developments in this field, but lot of validation is required before a marker

was able to predict EP with specificity of 100%, but sensitivity of 52.9% [115].

protein 12 (ADAM12) in different patient groups with no definite results [133].

2) as well as five specific isoforms of pregnancy-specific beta-1-glycoprotein 131].

**5. Use of multiple biomarkers in ectopic pregnancy**

by Skubisz et al [130].

64 Contemporary Gynecologic Practice

prevent tubal rupture [132].

EP [38].

**6. Conclusion**

can be used independently in clinical setting.

Soundravally Rajendiren\* and Pooja Dhiman

\*Address all correspondence to: soundy27@yahoo.co.in

Department of Biochemistry, JIPMER, Puducherry, India
