ABSTRACT
Introdução: A gravidez heterotópica é um fenômeno obstétrico muito raro em concepções espontâneas no qual gestações tópica e ectópica coexistem. O diagnóstico é difícil, mas, se realizado precocemente, o prognóstico é favorável. Descrição do caso: Paciente do sexo feminino, de 35 anos de idade, admitida com quadro de dor abdominal e pequeno sangramento vaginal. Diagnosticada precocemente e tratada cirurgicamente por gravidez heterotópica naturalmente concebida. Como resultado, a gravidez tópica seguiu sem intercorrências. Conclusão: Esse caso enfatiza a necessidade de considerar esse diagnóstico diferencial e analisar clínica e ecograficamente as características globais da pelve, mesmo na ausência de fatores de risco em gestações tópicas.(AU)
Introduction: Heterotopic pregnancy (HP) is a rare obstetric phenomenon in spontaneous conceptions in which intrauterine and ectopic pregnancies coexist. The diagnosis is difficult, but, if performed early, the prognosis is favorable. Case description: A 35-year-old woman was admitted with abdominal pain and light vaginal bleeding. She was early diagnosed and surgically treated for a naturally conceived heterotopic pregnancy. As a result, the intrauterine pregnancy went on healthily. Conclusion: This case emphasizes the need to regard HP as a differential diagnosis and analyze the global pelvis characteristics both clinically and in ultrasound scans, even in the absence of risk factors when dealing with intrauterine pregnancies.(AU)
Subject(s)
Humans , Female , Pregnancy , Pregnancy Complications/surgery , Pregnancy Complications/diagnostic imaging , Pregnancy, Tubal/surgery , Pregnancy, Tubal/diagnostic imaging , Pregnancy, Heterotopic/surgery , Pregnancy, Heterotopic/diagnostic imaging , Uterine Hemorrhage/complications , FertilizationABSTRACT
Ectopic pregnancy is defined as pregnancy outside uterine cavity. Of all ectopic pregnancy, tubal ectopic is most common. Most cases today are diagnosed early and hence timely treatment is possible. In stable patients, medical line of management with methotrexate can be used. With early diagnosis and medical line of treatment, use of injectable methotrexate is on rise. Being aware of characteristics of methotrexate like mechanism, dosage, side effects and contraindications, appropriate patient selection and watchful monitoring will help reduce methotrexate induced toxicity.
ABSTRACT
Background: When the fertilized ovum gets implanted at site other than normal position of uterine cavity, it is known as ectopic pregnancy. Incidence of ectopic pregnancy is 1-2% of all reported pregnancies. It is an unmitigated disaster of human production and the most important cause of morbidity and mortality in first trimester with major cause of reduced child bearing potential. It is notorious in its clinical presentation, challenging the attending physician.Methods: women with risk factors, signs and symptoms and with confirmed diagnosis. Women discharged against medical advice. Study population is 50. Retrospective analysis for 3 years (2016-2019). Objectives of this study were to study the incidence, risk factors, clinical presentation, diagnosis and changing trends of modern management. Results analysed after entering the information in the excel sheets using descriptive analysisResults: Out of 4940 deliveries, 50 were tubal ectopic pregnancies 1.012%. Women aged 20-25 years were 52%. In our study, multiparous were 68%. Common symptoms were abdominal pain 80.2%, amenorrhea 72%, urine gravindex test positive 92.8%. Etiology was PID 20%, previous ectopic pregnancy 4%, IUCD 4%, LSCS with tubectomy 16%, most common site is ampulla 82%. About 78% were ruptured. Tubal abortions 4%, salpingectomy done in 82%. Laparotomy in 2.43% in hemodynamically unstable. Medical management 8%. Salpingostomy in 4% and expectant management 2%. Morbidity in the form of blood transfusion 23.48%, DIC with ICU admission 2%. No mortality.Conclusions: A high index of clinical suspicion with underlying risk factors may get us early diagnosis for timely intervention.
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Abstract Bilateral tubal ectopic pregnancy is a very rare form of ectopic pregnancy. The incidence is higher in women undergoing assisted reproductive techniques or ovulation induction. We report the case of bilateral tubal ectopic pregnancy. The patient was 30 years old and had a 3-year history of infertility; she was referred to the in-vitro fertilization (IVF) program because of tubal factor infertility. A pregnancy resulted from the transfer of two embryos during an artificial cycle. Despite the increase in β-hCG values during the follow-up, 22 days after the embryo transfer, the β-hCG levels were 2,408 U/L and the serum progesterone (P4) level was 10.53 ng/ml. After application with methotrexate, β-hCG levels did not decrease effectively. Moreover, the sonographic screening revealed a suspicious bilateral tubal focus for ectopic pregnancy. A mini-laparotomy was performed and a bilateral tubal pregnancy was found. In the case of unilateral tubal pregnancy after the transfer of two embryos, the situation of the other tube should be systematically checked and β-hCG levels should be monitored.
Subject(s)
Humans , Female , Pregnancy , Adult , Pregnancy, Tubal/diagnosis , Prenatal Diagnosis , Sperm Injections, Intracytoplasmic , Embryo Transfer , Pregnancy, Tubal/blood , Pregnancy, Tubal/diagnostic imaging , Ultrasonography, Prenatal , Diagnosis, DifferentialABSTRACT
Se considera embarazo ectópico a todo aquel que anida fuera de la cavidad endometrial. La incidencia global es de 1-2 por ciento del total de gestaciones, y en 97 por ciento de los casos se localiza en la trompa. El objetivo es describir un caso clínico peculiar de una paciente con embarazo ectópico tubárico que alcanzó el segundo trimestre. Se presenta una paciente de 32 años de edad que con 17 semanas de edad gestacional que fue remitida de su área por ecografía con diagnóstico de gemelar con un saco anembriónico. Se realizó laparotomía exploradora y como hallazgos se observó hemoperitoneo de 400 mL, embarazo tubario derecho de 17 semanas fisurado en región ampular, anejo izquierdo normal, útero de consistencia blanda con mioma de dos centímetros en la cara anterior del útero. Se realizó anexectomía derecha. No hubo complicaciones. Anatomía patológica: Biopsia 16-255: Embarazo ectópico tubárico. El embarazo tubárico que cursa de forma asintomática en el segundo trimestre es raro; y las publicaciones médicas sobre este tema son limitadas. La ecografía es útil para el diagnóstico del embarazo ectópico y localización topográfica, sobre todo para diferenciar la gestación tubárica de la abdominal ya que el manejo médico y quirúrgico es diferente en ambas localizaciones(AU)
Ectopic pregnancy is considered to be any which nests outside the endometrial cavity. The overall incidence is 1-2 percent of the total of pregnancies, and in 97 percent of cases is located in the tube. The objective is to describe a peculiar clinical case of a patient with tubal ectopic pregnancy that extended to the second trimester. We present a 32-year-old patient with 17 weeks of gestational age who was referred from her doctor. Twin pregnancy with an anembryonic sac was diagnosed by ultrasound. Exploratory laparotomy was performed. A hemoperitoneum of 400 mL was observed. A 17-week right tubal pregnancy was fissured in the ampullary region, the left annex was normal, the uterus was soft anad there was a 2 cm myoma on the anterior side of the uterus. Right adnexectomy was performed. There were no complications. The results of the pathological anatomical study showed (Biopsy 16-255) tubal ectopic pregnancy. The tubal pregnancy that occurs in the second trimester asymptomatically is rare. Medical publications on this subject are limited. Ultrasound is useful for the diagnosis and topographic location of ectopic pregnancy, especially to differentiate tubal from abdominal gestation since medical and surgical managements are different in both locations(AU)
Subject(s)
Humans , Female , Pregnancy , Adult , Pregnancy, Ectopic/epidemiology , Pregnancy, Ectopic/diagnostic imaging , Pregnancy Trimester, Second , Pregnancy, Ectopic/surgery , Epidemiology, Descriptive , Retrospective StudiesABSTRACT
Objective To explore the tubal patency after laparoscopic salpingotomy and embryo removal for tubal ectopic pregnancy. Methods A retrospective analysis was made on 28 patients receiving laparoscopic salpingotomy at other hospitals from September 2013 to September 2014.Within their 6 postoperative months, these patients were given hysterosalpingography in this gynecological minimally invasive center to evaluate the tubal patency. Results There were 6 cases of ipsilateral tubal patency (21.4%) and 22 cases of tubal obstruction or dropsy (78.6%), while 19 cases of contralateral tubal patency (67.9%) and 9 cases of tubal obstruction or dropsy (32.1%).Bilateral tubal embryo removal was carried out in 3 cases, with hysterosalpingography showing bilateral tubal obstruction in 2 cases and bilateral tubal dropsy in 1 case.One patient had ipsilateral tubal obstruction after tubal embryo patency and developed contralateral tubal patency after conservative treatment.Follow-up of the 28 cases for 6-15 months showed 4 cases of intrauterine pregnancy, 4 cases of examination of ovulation, 7 cases of preparation of assisted reproduction, 3 cases of laparoscopic salpingoplasty 1-2 months after hysterosalpingography, 1 case of endocrine regulation monitoring ovulation, 1 case of abnormal uterine bleeding 13 months later ( hysteroscopic examination showed endometritis and diagnostic curettage found proliferative phase endometrium that consistent with the menstrual cycle), and 8 cases without further treatment. Conclusion Laparoscopic salpingotomy for tubal ectopic pregnancy does not improve patient’ s tubal patency.
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Objective To assess patient ’ s fallopian tube function after laparoscopic salpingotomy for tubal ectopic pregnancy.Methods We observed the degree of pelvic adhesion and previous tubal patency by laparoscopic secondary exploration. The fallopian tube function were evaluated in 24 cases ( 26 fallopian tubes ) which had experienced laparoscopic salpingotomy. Results There were 4 cases of severe adhesions (16.7%), 4 cases of moderate adhesions (16.7%), 5 cases of mild adhesions (20.8%), and 11 cases of minor adhesions (45.8%).The status of fallopian tubes:tubal rapture and tissue absence were seen in 11 oviducts (42.3%), intact but obviously shortened oviduct with distal hydrops was seen in 11 oviducts (42.3%), and normal oviduct was recorded in 4 oviducts (15.4%).The methylene blue flow test was performed in the 26 tubes, showing 23 (88.5%) occluded and 3(11.5%) patent. Conclusions The fallopian tubes have incomplete shapes after laparoscopic tubal fenestration for ectopic pregnancy in most patients.We confirm that laparoscopic salpingotomy can not preserve the fertility effectively.
ABSTRACT
Twin tubal ectopic pregnancy is rare. Especially the live twin tubal ectopic pregnancy is extremely rare, just 10 cases have been reported until now. There were 9 cases of live twin tubal pregnancy after spontaneous conception and one case after IVF cycle. This is the first report of live twin tubal ectopic pregnancy after ovulation induction with clomiphene citrate. A 31-year-old woman, nulligravida complained of primary infertility and irregular menstruation. After ovulation induction with clomiphen citrate, beta-hCG was 1566 mIU/mL on missed period of 5 weeks 4 days. On 6(+1) weeks, beta-hCG was elevated to 3446 mIU/mL and transvaginal ultrasound revealed two separated gestational sacs, each containing yolk sac in the left tube. The variable dose of methotrexate therapy was tried using 1 mg/kg of methotrexate and 0.1 mg/kg of leukovorin. These were injected alternatively for 8 days. On 7(+3) weeks, beta-hCG was elevated to 8,029 mIU/mL and transvaginal ultrasound revealed two fetal poles with heart beat in each gestational sacs. Laparoscopic salpingectomy was performed. The diagnosis was confirmed by the operative finding and also in the pathologic report. It is needed that careful ultrasonographic examination especially in the case of ovulation induction or IVF-ET. Methotrexate treatment in twin tubal pregnancy was usually failed. There was only one successful report by the direct injection of methotrexate to the fallopian tube combined with single intramuscular injection. Further research for dosage or route of administration will be needed.