Analysis of the influencing factors of the outcome of laparoscopic conservative surgery in patients with tubal pregnancy / 中国综合临床

Objective@#To investigate the influencing factors of fertility outcome after laparoscopic conservative surgery for tubal pregnancy.@*Methods@#From October 2010 to October 2016, 253 cases of tubal pregnancy treated by laparoscopic conservative surgery in General Hospital of Jizhong energy Fengfeng Group Hospital were analyzed retrospectively.All patients were followed up from 24 to 36 months after operation to observe the intrauterine pregnancy.Logistic regression was used to analyze the influencing factors of intrauterine pregnancy.@*Results@#After 24-36 months follow-up, the patients were not contraception and pregnant under the guidance of doctors.Among the 253 cases, 182 (71.1%) were intrauterine pregnancy, 37 (14.6%) were ectopic pregnancy, and 34 (13.4%) were not pregnant.The results of logistic regression showed that high level of hCG, severe pelvic adhesions, obstruction of fallopian tube and history of ectopic pregnancy were the risk factors of intrauterine pregnancy (OR (95%CI) 1.982 (1.075-3.149), 2.410 (1.279-5.069), 2.485 (1.071-3.594), 5.071 (1.094-9.081), P<0.05 or P<0.01).@*Conclusion@#The reproductive outcome of laparoscopic conservative surgery for tubal pregnancy is influenced by many factors.The high level of hCG in preoperative blood, severe pelvic adhesions, obstruction of tubal and ectopic pregnancy history are the risk factors of postoperative pregnancy.

Point-of-care ultrasound versus radiology department pelvic ultrasound on emergency department length of stay / 世界急诊医学杂志（英文）

@#BACKGROUND: The study aimed to compare the time to overall length of stay (LOS) for patients who underwent point-of-care ultrasound (POCUS) versus radiology department ultrasound (RDUS).METHODS: This was a prospective study on a convenience sample of patients who required pelvic ultrasound imaging as part of their emergency department (ED) assessment.RESULTS: We enrolled a total of 194 patients who were on average 32 years-old. Ninety-eight (51％) patients were pregnant (<20 weeks). Time to completion of RDUS was 66 minutes longer than POCUS (95％CI 60–73,P<0.01). Patients randomized to the RDUS arm experienced a 120 minute longer ED length of stay (LOS) (95％CI 66–173,P<0.01)CONCLUSION: In patients who require pelvic ultrasound as part of their diagnostic evaluation, POCUS resulted in a signifi cant decrease in time to ultrasound and ED LOS.

Anesthesia Management and Outcomes of Laparoscopic Surgery for Early Pregnant Women with Tubal Pregnancy:a Report of 48 Cases / 中国微创外科杂志

Objective To summarize the anesthesia management in laparoscopic surgery for early pregnant women with tubal pregnancy. Methods Forty-eight women diagnosed as early intrauterine pregnancy combined with tubal pregnancy from January 2010 to July 2014 were enrolled in this retrospective study.All the patients received laparoscopic surgery under endotracheal intubation and total intravenous anesthesia.Their general conditions, perioperative conditions, pregnant complications, pregnant outcomes and newborns status were recorded. Results All the patients were operated successfully and recovered uneventfully.Among the 48 patients, spontaneous abortion occurred in 7 patients (14.6%).Among the remaining 41 patients who continued on their gestation, 39 cases (95.1%) had full term deliveries, 2 cases (4.9%) terminated pregnancy with premature birth, 8 cases (19.5%) got different complications related to pregnancy, and 34 cases (82.9%) received cesarean sections.All the newborns survived, with an average weight of 3429.2 ±499.4 g.There were 2 cases (4.9%) of low birth weight.No asphyxia or congenital malformation was seen in all the newborns. Conclusions Total intravenous anesthesia can be applied to laparoscopic surgery smoothly for early pregnant women with tubal pregnancy.When surgery is indicated during pregnancy, maintenance of marternal oxygenation, perfusion and homeostasis with the minimum effective anesthetic dose will assure the best outcomes for the fetus.

A case of successful delivery after ultrasound guided hysteroscopic removal of intrauterine device with missing tail during early pregnancy / 대한산부인과내시경학회지

In case of intrauterine pregnancy with an intrauterine device (IUD), it is recommended to remove the device because of the increased risk of abortions, septic complications and premature delivery. But removal of intrauterine devices in early pregnancy remains a troublesome problem for both doctors and patients, especially when IUD threads are not visible at the external os. If the thread of the IUD is not visible, extraction with hysteroscopy and ultrasonic guidance is advised. But due to postoperative complications such as uterine rupture or bleeding and electrolyte imbalance, many doctors prefer not to perform the procedure. IUD removal is scarcely performed that there are only 2 successful cases which were reported in Korea until today. Recently we experienced a case of an early pregnant woman with IUD in whom thread was invisible at the cervical os and IUD removal was attempted and successfully performed by ultrasound guided hysteroscopy. Pregnancy was maintained without complications until 39th week and delivered healthy baby. So we report this case with the review of articles related.

A case of Laparoscopic Removal of Perforated Intrauteirne device / 대한산부인과학회잡지

Intrauterine devices (IUDs) have a low complication rate and minimal side effects and are pervaded contraceptive method. Perforation of the uterus by an IUD is very rare. But perforation of the uterus is one of the most serious complications associated with insertion of IUD. During the puerperium when the uterus is small and the uterine wall is thin the risk of perforation increase. The frequency has been estimated between 0.05 and 13 per 1000 insertions. When the IUD strings are not visible during pelvic examination, physicians make efforts to locate the IUD. We experienced a laparosopic removal of perforated intrauterine device, which had been inserted on postpartum 5 th week, at posterior lower segment of uterus with intrauterine pregnancy. So we report a case with a brief review of the literature.

A Case of Hysteroscopic Removal of Intrauterine Device with Missing Tail during Early Pregnancy: Successful Ongoing Pregnancy / 대한산부인과학회잡지

In case of intrauterine pregnancy with an intrauterine device(IUD), it is recommended, to remove the device because of the risk of abortions or septic complications. If the thread of the IUD is not visible, which often occurs because of growth of the uterus in pregnancy, it is advisible, to perform extraction with hysteroscopy and ultrasonic guidance. We report on one case with hysteroscopic IUD removal in early pregnancy, which pregnancy is continuing without complications.

A case of heterotopic pregnancy / 대한산부인과학회잡지

Heterotopic pregnancy occurs when there are coexisiting intrauterine and ectopic pregnances. It occure, more often, due to assisted reproductive technology such as IVF-ET, GIFT and increased pelvic inflammatory diseases. We present a case of heterotopic pregnancy confirmed by surgical removal of ruptured left ovarian pregnancy and sonographic finding of the intrauterine pregnancy following natural conception.

Histological and Immunohistochemical Findings of the Endometrium in Ectopic and Intrauterine Pregnancy

We reviewed histological and immunohistochemical findings of the endometrium in 28 cases of ectopic pregnancy and 11 cases of intrauterine pregnancy without chorionic villi or syncytiotrophoblast. 1) Twenty cases(71.41/o) of ectopic pregnancy revealed gestational patterns and 8 cases(28.6%) showed non-gestational patterns, which were menstrual phase in 3 cases, proliferative phase in I case, early secretary phase in 3 cases and mid secretary phase in 3 cases, respectively. Implantation sites were present in 36.40/o of intrauterine pregnancy. 2) Endometrial spiral arterioles tend to be more prominent with frequent intimal proliferation and thickening of the wall in intrauterine pregnancy than in ectopic pregnancy although it was not statistically significant(p=0.271). 3) Deposition of fibrinoid material in the endometrium was present in 72.7% of intrauterine pregnancy and 25% of ectopic pregnancy. Thrombosis was present in 72.7% of intrauterine pregnancy and 5% of ectopic pregnancy. Hyalinized vessels were also present in 90.9% of intrauterine pregnancy and 200/o of ectopic pregnancy. These were statistically significant(p=0.0002, 0.0209 and 0.0004), but not diagnostic. 4) On immunohistochemical study for intrauterine pregnancy, the rates of positive reaction to human placental lactogen, cytokeratin and human chorionic gonadotropin were 45.5%, 45.5% and 9%, respectively. We concluded that HFIL and cytokeratin are reliable and sensitive markers for implantation site.