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

Introduction Ectopic pregnancy is oneof abnormal patterns of pregnancy in which fertilized ovum implants anywhereother than the liner of the uterine cavity, almost all ectopic pregnancieshappen in the Fallopian tube in about 98% (1).Ectopic pregnancy is one ofobstetric 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 anddeath rate. It is the most important case of first-trimester maternal deathsand responsible for 10-15% of early pregnancy mortalities mainly in thedeveloping world (3).There aremultiple elements which lead to the relative risk of ectopic pregnancy,including: pelvic inflammatory disease (PID), infertility, use of anintrauterine device (IUDs), tubal surgery, intrauterine surgery, smoking,previous ectopic pregnancy and tubal ligation (4).Nearly about10% of women with ectopic pregnancy have no symptoms.

No medical signs havebeen launch in nearly one-third. The diagnosis of ectopic pregnancy is hard tobe separated from those of other genitourinary and gastrointestinal disorders(5).   Assessingthe degree of beta HCG and ultrasound, either pelvic or trans-vaginal, areapplied to diagnose ectopic pregnancy. Ectopic pregnancy is suspected if mother’s ?-hCGserum level is 1,500 mIU per ml or more outstanding, and transvaginalultrasonography does not show an intrauterine gestational sac by 5.5weeksgestational age (6).

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Some adultfemales who are doubted as having an ectopic pregnancy at their firstpresentation can be followed as an outpatient with serial ?-hCG analysis andtrans-vaginal ultrasound until a definitive diagnosis can be reached. Improvedclinical prediction of the final result of an ectopic pregnancy can potentiallydiminish the number of visits of outpatient as well as shorten the fourthdimension for any patient to make a definitive diagnosis. It is well recognizedthat patient at risk of suffering an ectopic pregnancy require timely and exactdiagnosis as delay in diagnosis of ectopic pregnancy can contribute toincreased morbidity and mortality (7).During thepast 25 years, the incidence of ectopic pregnancy has progressively increasedwhile the morbidity and mortality associated with it has decreased, and thetreatment alternatives available have progressed from salpingectomy bylaparotomy to conservative surgery by laparoscopy and medical therapy. Thistherapeutic transition from surgical emergency to medical management has beenascribed to early diagnosis (7).Oneimportant matter that demands to be noticed is the high frequency of tubalpregnancies reporting when they have already ruptured; thereby pointing out thehazard associated with tubal pregnancy, hence the need of a marker which issufficiently accessible and dependable enough to detect tubal pregnancy early(7).Thither is anew biochemical marker that has been considered to improve early prediction ofectopic pregnancy, which is creatine phosphokinase.

(CPK) is an intracellularenzyme that catalyzes the synthesis of adenosine triphosphate from creatinephosphate & adenosine diphosphate. It is presented at metabolically activetissues with significant energy demand, especially smooth muscles, skeletalmuscles, myocardium and brain. There are 3 isoenzymes forms of CPK namelyCPK-MM, MB and BB (M for muscle B for brain) (8).  Increasing the plasma level of CPK alwaysreflects injury to tissues of high CPK activity ex; evaluation, serum level ofCPK is useful in the diagnosis of myocardial infarction (9).  In ectopic pregnancy trophoblast invade theendothelium of Fallopian tube, causing it damage. Levi et al was the 1st toreport the measurement of serum CPK levels was a sensitive and specific testfor prediction of ectopic gestation. Another survey discovered that creatinekinase 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 isoenzymeshas been measured by two studies: Kurzel et al study estimated that CPK-MMlevel has poor sensitivity to predict ectopic pregnancy, while Katsikis et alstudy demonstrated that CPK-MB has good sensitivity to ectopic pregnancyprediction. To our knowledge, this study was never performed in Egypt.  The aim of this work is evaluating the use of serum CPK (MB) level inearly anticipation of the ectopic pregnancy by which morbidity and mortalitymight be shortened, and surgical interference is minimized; both agents thatwould further negatively affect fertility in the next years.