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Resumen OBJETIVO: Describir la experiencia en la atención de pacientes con embarazo ectópico no complicado con una inyección local de metotrexato guiada por ecografía. MATERIALES Y MÉTODOS: Estudio retrospectivo, descriptivo y de serie de casos llevado a cabo del 1 de enero del 2021 al 28 de febrero del 2022 en el Instituto Nacional Materno Perinatal, Lima, Perú. Las participantes tuvieron embarazo ectópico no complicado, tratado con inyección local de metotrexato guiada por ecografía. Los datos se obtuvieron de los registros en las historias clínicas. El análisis estadístico se procesó en el programa SPSS 19. RESULTADOS: Se registraron 222 casos de embarazo ectópico y se aplicaron 11 inyecciones locales con metotrexato guiadas por ecografía. De acuerdo con su localización 4 embarazos fueron tubáricos, 1 cervical y 6 en cicatriz de cesárea. La edad promedio de las embarazadas fue de 34.5 años. El promedio de semanas de embarazo fue de 7. La concentración inicial de b-hCG fue de 42812.55 mU/mL. El tamaño promedio del saco gestacional fue de 22.8 mm. El tamaño medio de los embriones fue de 7.81 mm. Se detectó actividad cardiaca embrionaria en 10 casos que recibieron una inyección intratorácica de cloruro de potasio hasta que no se evidenció el latido cardiaco. Un solo caso recibió una dosis sistémica adicional de metotrexato. Otro caso resultó con hemoperitoneo, por rotura de embarazo ectópico luego de la inyección local. CONCLUSIONES: La inyección local de metotrexato, guiada por ecografía, es una alternativa a otras técnicas quirúrgicas aplicadas para tratar pacientes con embarazo ectópico no complicado, con indicación quirúrgica.
Abstract OBJECTIVE: To describe the experience in the care of patients with uncomplicated ectopic pregnancy with ultrasound-guided local injection of methotrexate. MATERIALS AND METHODS: Retrospective, descriptive, case series study conducted from January 1, 2021 to February 28, 2022 at the Instituto Nacional Materno Perinatal, Lima, Peru. Participants had uncomplicated ectopic pregnancy treated with ultrasound-guided local injection of methotrexate. Data were obtained from medical records. Statistical analysis was processed in SPSS 19. RESULTS: 11 ultrasound-guided local methotrexate injections were performed. According to their location 4 pregnancies were tubal, 1 cervical and 6 in cesarean scar. The average age of the pregnant women was 34.5 years. The average number of weeks of pregnancy was 7. The initial b-hCG concentration was 42812.55 mU/mL. The mean gestational sac size was 22.8 mm. The mean embryo size was 7.81 mm. Embryonic cardiac activity was detected in 10 cases that received an intrathoracic injection of potassium chloride until no heartbeat was evident. A single case received an additional systemic dose of methotrexate. Another case resulted in hemoperitoneum, due to rupture of ectopic pregnancy after local injection. CONCLUSIONS: Ultrasound-guided local injection of methotrexate is an alternative to other surgical techniques applied to treat patients with uncomplicated ectopic pregnancy with surgical indication.
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RESUMEN La protuberancia coriónica (del inglés chorionic bump) es una condición que involucra al saco gestacional y que puede ser visualizada en la ecografía de primer trimestre. Ha sido descrita como una convexidad irregular que protruye hacia el saco gestacional y que probablemente corresponda a la formación de un hematoma en la superficie coriodecidual. Nosotros reportamos los hallazgos y el seguimiento ecográfico de un caso, junto con una revisión de la literatura.
SUMMARY Chorionic bump is a condition that involves the gestational sac and can be viewed during the first-trimester ultrasound scan. It has been described as an irregular convexity protruding into the gestational sac and probably corresponds to the formation of a hematoma within the choriodecidual surface. We reported both the sonographic findings and follow-up of a case, along with a review of the literature.
Subject(s)
Humans , Female , Pregnancy , Adult , Pregnancy Trimester, First , Pregnancy Outcome , Ultrasonography, Prenatal , Gestational Sac/diagnostic imaging , Chorion/diagnostic imaging , Ultrasonography, DopplerABSTRACT
Objective To study the effect of transvaginal ultrasound on the size of gestational sac and drug abortion, and to explore the relationship between the effect of drug abortion and the gestational sac size.MethodsIn our hospital in July 2016 were treated 50 cases of drug abortion of pregnant women as the research object in the process in February 2015, a retrospective analysis of 50 cases of pregnant women, patients were divided into gestational sac and greater than 10 and less than 10mm to 25mm 25mm three.Transvaginal ultrasound was performed before taking the medicine.After 7 days, the patients were examined by transvaginal ultrasound.The results showed that 7 patients had abortion failure, and the other 5 patients had incomplete abortion.ResultsTransvaginal ultrasound monitoring results can be obtained, the gestational sac size of less than 10 mm in patients with a total of 13 cases, abortion in patients with failure of the 2 cases, incomplete abortion in 4 cases, complete abortion in 7 cases, abortion failure probability was 15.4%.The gestational sac size ranged from 10mm to 25mm in a patient with a total of 25 cases, with a miscarriage of failure in a total of 2 patients, incomplete abortion in a total of 2 patients, complete abortion in a total of 21 patients, and a miscarriage probability of failure of up to & 8%.The gestational sac size is greater than 25 mm in patients with a total of 12 cases, the abortion of the failure of the patients in the 4 cases, incomplete abortion in the 2 cases, complete abortion in the 6 cases, the probability of abortion failure was 33.3%.Therefore, there was a significant difference between the three groups in the rate of abortion failure (P<0.05).ConclusionThe process of drug abortion in pregnant women, the use of transvaginal ultrasound monitoring, can monitor the situation of pregnant women with gestational sac in a certain extent, and that the effect of drug abortion, is conducive to the treatment and the subsequent operation, thereby reducing the pain of patients, improve the success rate of miscarriage.
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Vaginal bleeding in first-half of pregnancy occurs in one-fourth of all pregnant women. This case report mainly highlights the occurrence of large subchorionic hematoma (SH) (area >13.7 cm2/, stripping of >50% of chorionic circumference) in first trimester. Usually, large SHs occur in second trimester, are associated with pregnancy loss but are relatively uncommon in first trimester. This case describes a 32-year-old G2P1L1’ who presented with complaints of vaginal spotting, was misdiagnosed to have threatened abortion with twin gestation. Later, the diagnosis was confirmed to be a large SH. Patients with large SH are at greater risk for eventual fetal death, hence the need for serial scanning to determine final outcome of their gestation.
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A surprising finding at emergency Caesarean Section of an empty sac, along with fetus & placenta , was observed. Retrospectively, when USG reports were reviewed it was a case of Vanishing Twin after 20 wks of gestation. This syndrome is diagnosed more frequently since the use of USG has become a common investigation. Probably the twin which vanishes may be chromosomally abnormal. Prognosis of the surviving twin is generally excellent but depends on the etiology of the death of the dead twin.
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OBJECTIVE: Ultrasonography was used to determine not only the size but also the shape and site of gestational sac (GS) in early pregnancy. This study was performed to evaluate the role of transvaginal ultrasonography to predict placenta previa in early pregnancy, and analyze the correlation of the GS location with pregnancy outcomes. METHODS: From 1995 to 2007, medical records of pregnant women who had diagnosed placenta previa at Kangnam St. Mary's Hospital and Our Lady of Mercy Hospital were reviewed retrospectively. 71 patients with placenta previa had transvaginal ultrasonographic evidences within 7 weeks of gestation. As a control group, randomized sampling among pregnant women without placenta previa was performed, and 102 patients were selected and reviewed. Data was analyzed with SPSS version 11.0 statistically. RESULTS: 23.9% of GS (n=17) were found in lower 1/3 of the uterine cavity, 31.0% (n=22) were in middle 1/3, while 45.1% (n=32) were in upper 1/3. The distribution of GS in placenta previa patients leans to the lower in uterine cavity compared to normal pregnancies significantly (P=0.000). The relationship between the location of GS and differential diagnosis of placental previa was not statistically significant. CONCLUSION: Our results show that there would be higher risk for placenta previa, preterm labor, and early delivery when ultrasonographic finding of GS within 7 weeks of gestation reveals lower implantation in uterine cavity.
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Female , Humans , Pregnancy , Diagnosis, Differential , Gestational Sac , Medical Records , Obstetric Labor, Premature , Placenta , Placenta Previa , Pregnancy Outcome , Pregnant Women , Retrospective StudiesABSTRACT
OBJECTIVE: The purpose of this study is to verify the correlation between gestational sac volume (GSV) from automatic tracing mode the VOCAL-imaging program and gestational age and to construct the nomogram of gestational sac volume as the new biometric parameter in early pregnancy. METHODS: The cross-sectional study has been conducted in 242 uncomplicated singleton pregnancies. 47 cases were excluded due to early pregnancy failure, fetal malformations, elective abortion, age discrepancy, etc. In 195 uncomplicated singleton pregnancies from 5 to 12 weeks' menstrual age, gestational sac volume, mean sac diameter and crown-lump length were measured for the assessment of gestational age. Gestational sac volumetry was carried out with automatic method and manual method of the VOCALTM (Virtual Organ Computer- aided AnaLysis) for the comparison between two methods. The collected data were analyzed for mean, standard deviation, 90% reference interval, 5th, 50th and 95th percentiles of gestational sac volume, mean sac diameter and CRL, and the nomogram were constructed. RESULTS: Polynomial regression analysis demonstrated the statistically significant positive correlation between gestational age and gestational sac volume by automatic tracing mode (R2 0.826, p<0.001), gestational sac volume by manual tracing mode (R2 0.844, p<0.0001), mean sac diameter (R2 0.763, p<0.0001) and crown-lump length (R2 0.950, p<0.0001). The 5th, 50th and 95th percentiles of the gestational sac volume were calculated and the nomogram was tabulated. In determining gestational age, the standard deviation (SD) of gestational sac volume by automatic tracing mode is 5.6 days, the SD of gestational sac volume by manual tracing mode is 5.2 days and the SD of MSD is 6.6 days. CONCLUSION: we can conclude that three-dimensional GSV with automatic tracing mode of the VOCAL-imaging program can be used as the new biometric measurement in determining gestational age. Gestational sac volumetry with automatic tracing mode of the VOCAL-imaging program have been proven available and convenient method and it can be recommended in 5-7 weeks' of gestation, when CRL is not clearly visualized.
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Pregnancy , Cross-Sectional Studies , Gestational Age , Gestational Sac , NomogramsABSTRACT
OBJECTIVE: To evaluate the efficacy and predictors of success of methotrexate (MTX) treatment in selected cases of unruptured tubal pregnancies. METHODS: This study was retrospectively performed in 36 women who had diagnosed unruptured tubal pregnancies. Patients received intramuscular MTX. Serial beta-hCG measurement was performed weekly, and success was defined as the achievement to beta-hCG concentration of 10 mIU/mL without surgical intervention. Surgical intervention was performed for presumed tubal rupture. Pretreatment serum concentration of beta-hCG, the size of tubal mass and gestational sac by transvaginal ultrasonography were measured to evaluate the predictors of MTX therapy. RESULTS: 29 patients (81%) were successfully treated by MTX systematic treatment. There were not significant differences in the patient's age, parity, gestational age and the size of tubal ectopic mass, but significant differences in the gestational sac size and serum beta-hCG concentration between success group and failure group of MTX treatment. The mean time for achieving successful treatment was 33.8 days. The success rate of systemic MTX was significantly decreased and resolution time was prolonged if the initial pretreatment serum beta-hCG was 10,000 mIU/mL or gestational sac size was >or=1 cm. CONCLUSION: Pretreatment serum beta-hCG concentration and gestational sac size are important predictors of success of MTX treatment in women with unruptured tubal pregnancy.