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Rev. bras. ginecol. obstet ; 43(4): 311-316, Apr. 2021. tab, graf
Article in English | LILACS | ID: biblio-1280049


Abstract A cesarean scar pregnancy (CSP) is a scary and life-threatening complication of cesarean section (CS). Nevertheless, the incidence of CS is constantly growing. The CSP incidence is 0,15% of pregnancies after CS which represents 6,1% of all ectopic pregnancies in women with condition after CS. Therefore, it should be more present in the clinical daily routine. From mild nonspecific symptoms to hypovolemic shock, diagnosis and therapy must be performed quickly. With the progressive growth of the scar pregnancy, a uterine rupture involves the risk of severe bleeding, and an emergency hysterectomy could be necessary. Prolongation of pregnancy has been successful only in a few cases.We report 11 cases from our hospital in the past 10 years. In the discussion, treatment options of this complication with an increasing incidence, which is associated with serious morbidity and mortality, are presented based on the current literature. Treatment options include drug therapy, but also surgical or combined procedures with radiological intervention.

Humans , Female , Pregnancy , Adult , Young Adult , Pregnancy, Ectopic/diagnosis , Pregnancy, Ectopic/therapy , Cesarean Section/adverse effects , Cicatrix/complications , Uterine Hemorrhage/etiology , Uterine Rupture/etiology , Abortifacient Agents, Nonsteroidal/therapeutic use , Methotrexate/therapeutic use , Risk Factors , Pregnancy, High-Risk , Dilatation and Curettage , Hysterectomy
Rev. méd. Urug ; 37(1): e201, mar. 2021. tab
Article in Spanish | LILACS, BNUY | ID: biblio-1180958


Resumen: Introducción: en los últimos años se viene presentando un fenómeno de disminución en las defunciones vinculadas al embarazo ectópico gracias a los avances en el diagnóstico precoz, lo que a su vez abrió las puertas al tratamiento médico con metotrexate en pacientes seleccionadas. El objetivo del presente trabajo es reportar la experiencia del tratamiento con metotrexate en el departamento de Paysandú y determinar secundariamente la satisfacción de las usuarias frente a éste y su fertilidad posterior. Método: se presenta un estudio retrospectivo, observacional, de los embarazos ectópicos tubarios tratados con metotrexate en Paysandú, durante el período del 1º de enero de 2014 al 31 de diciembre de 2017, comprendiendo cuatro años. Se consideró fracaso del tratamiento médico cuando fue necesario tratamiento quirúrgico y se definió como fertilidad futura al tiempo que transcurrió hasta lograr una gestación intrauterina espontánea. Resultados: se registraron 67 embarazos ectópicos en cuatro años, 13 recibieron metotrexate intramuscular con un porcentaje de éxito de 69,2%. Se determinó una fertilidad posterior de 25%. Conclusiones: el uso de metotrexate en el embarazo ectópico se practica en Paysandú desde hace casi una década con buenos resultados y una buena aceptación por parte de las usuarias.

Summary: Introduction : In recent years there has been a decrease in deaths related to ectopic pregnancy, thanks to progress made in early diagnosis, which in turn allowed for medical treatment with methotrexate in selected patients. The study's first objective is to report the experience of methotrexate treatment in the Department of Paysandú and its secondary objective is to determine users' satisfaction towards this treatment and find about their subsequent fertility. Method: a retrospective, observational study is presented of tubal ectopic pregnancies treated with methotrexate in Paysandú, from January 1, 2014 to December 31, 2017, during a 4-year period. Failure of medical treatment was defined as the cases requiring surgical treatment and subsequent fertility was defined as the time it took to achieve a spontaneous intrauterine gestation. Results: 67 ectopic pregnancies were recorded in four years, 13 of which received intramuscular methotrexate with a success rate of 69.2%. Subsequent fertility was found to be 25%. Conclusions: methotrexate has been used to treat ectopic pregnancies in Paysandú for almost a decade, with good results and acceptable rates of user satisfaction.

Resumo: Introdução: nos últimos anos, observou-se uma diminuição dos óbitos relacionados à gravidez ectópica, graças aos avanços no diagnóstico precoce, que por sua vez abriram as portas para o tratamento médico com metotrexato em pacientes selecionadas. Objetivo: o objetivo deste trabalho é relatar a experiência do tratamento com metotrexato no Departamento de Paysandú e determinar secundariamente a satisfação das usuárias com o mesmo e sua consequente fertilidade. Métodos: apresenta-se um estudo retrospectivo e observacional de gestações ectópicas tubárias tratadas com metotrexato em Paysandú, durante o período de 1º de janeiro de 2014 a 31 de dezembro de 2017. Considerou-se como falha do tratamento médico quando o tratamento cirúrgico foi necessário e definiu-se fertilidade futura como o tempo decorrido até a obtenção de uma gravidez intrauterina espontânea. Resultados: foram registradas 67 gestações ectópicas em quatro anos, 13 receberam metotrexato intramuscular com taxa de sucesso de 69,2%. Uma fertilidade subsequente de 25% foi determinada. Conclusões: o uso do metotrexato na gravidez ectópica é praticado em Paysandú há quase uma década com bons resultados e boa aceitação pelas usuárias.

Pregnancy, Ectopic/therapy , Methotrexate/therapeutic use , Retrospective Studies , Fertility , Observational Study
Rev. bras. ginecol. obstet ; 42(12): 800-804, Dec. 2020. tab, graf
Article in English | LILACS | ID: biblio-1156064


Abstract Objective In recent years, there has been an increase in the incidence of ectopic pregnancies; therefore, it is important for tertiary centers to report their approaches and outcomes to expand and improve treatment modalities. The aim of the present study was to evaluate the general characteristics, treatment and outcomes of cases diagnosed with ectopic pregnancy. Methods In total, 432 patients treated for ectopic pregnancy between February 2016 and June 2019 were retrospectively evaluated. Results Overall, 370 patients had tubal pregnancy, 32 had cesarean scar pregnancy, 18 had pregnancy of unknown location, 6 had cervical pregnancy, and 6 had interstitial pregnancy. The most important risk factors were advanced age (> 35 years; prevalence: 31.2%) and smoking (prevalence: 27.1%). Thirty patients who did not have any symptoms of rupture and whose human chorionic gonadotropin (β-hCG) levels were ≤ 200 mIU/ml were followed-up with expectant management, while 316 patients whose β-hCG levels were between 1,500 mIU/ml and 5,000 mIU/ml did not have an intrauterine gestational sac on the transvaginal or abdominal ultrasound, did not demonstrate findings of rupture, and were treated with a systemic multi-dose methotrexate treatment protocol. In total, 24 patients who did not respond to the medical treatment, 20 patients whose β-hCG levels were > 5,000 mIU/ml, 16 patients who had shown symptoms of rupture at the initial presentation, and 6 patients diagnosed with interstitial pregnancy underwent surgery. Patients with cervical and scar pregnancies underwent ultrasound-guided curettage, and no additional treatment was needed. Conclusion The fertility status of the patients, the clinical and laboratory findings, and the levels of β-hCG are the factors that must be considered in planning the appropriate treatment.

Humans , Female , Pregnancy , Adolescent , Adult , Young Adult , Pregnancy, Ectopic/epidemiology , Ultrasonography, Prenatal , Pregnancy, Ectopic/etiology , Pregnancy, Ectopic/therapy , Pregnancy, Ectopic/diagnostic imaging , Brazil/epidemiology , Abortifacient Agents, Nonsteroidal/therapeutic use , Methotrexate/therapeutic use , Retrospective Studies , Risk Factors , Treatment Outcome , Curettage , Tertiary Care Centers , Middle Aged
Article in English | AIM, AIM | ID: biblio-1268321


Introduction: ectopic pregnancy (EP) is the leading cause of maternal mortality in the first trimester of pregnancy in our environment. This study aimed at evaluating the incidence, risk factors, clinical presentation and treatment of ectopic pregnancy in the Limbe and Buea Regional Hospitals in Cameroon. Methods: this was a retrospective nested case control study carried out from December 2006 to December 2016. A ratio for control vs cases of 3:1 was obtained. Any pregnancy implanted outside the normal uterine cavity was considered as an ectopic pregnancy. Student's t-test was used to compare continuous variables and Pearson's Chi-square test for categorical variables. The association between EP and the demographical and clinical variables was estimated using logistic regression. Statistical significance was set at p-values<0.05.Results: a total of 247 cases of EP were registered out of 17221 deliveries giving an incidence of 1.43% in ten years. History of pelvic inflammatory disease (OR = 3.10, CI (1.76-5.44), p < 0.001), previous EP (OR = 10.22, CI (2.61-14.82), p < 0.001), History of induced abortion (OR = 2.68, CI (3.32-9.73), p< 0.001), history of adnexa surgery (OR = 4.37, CI (2.17-10.32), p < 0.001) and history of appendectomy (OR = 2.16, CI (0.99-6.64) p< 0.001), were also found to be associated with increased risk of EP. More than five percent (5.52%) of the patients were in shock at presentation. Diagnosis was confirmed mainly by use of ultrasound (78.53%) and treatment was principally by laparotomy (97.55%) with salpingectomy (95.60%). Most (90.18%) of ectopic pregnancies were ruptured at presentation. Only 2.45% of cases were manage medically with the use of methotrexate. Conclusion: the incidence of ectopic pregnancy (EP) in our environment is within the global range (hospital-based incidence of 1.43%) and is rising. Late presentation, lack of modern diagnostic and management tools have made laparotomy with salpingectomy the principal method of management of ectopic pregnancy in our environment

Cameroon , Incidence , Pregnancy, Ectopic/diagnosis , Pregnancy, Ectopic/therapy , Risk Factors
Prensa méd. argent ; 105(2): 76-81, apr 2019. taab, fig
Article in English | LILACS, BINACIS | ID: biblio-1025694


In the past few decades, ectopic pregnancy has been termed by medical practitioners has a global epidemic. With the questions lingering on everbody minds how this menace can be tamed. In a bid to reduce the mortality and financial burden brought by this evolving growing health concern, the medic has developed non-surgical alteratives to deal with ectopic pregnancy, i.e., treatment using methotrexate. In a bid to explore this topic further, these study goals were to share the experience of treating mothers who have un-ruptured ectopic pregnancies traditionally. Mothers who were found to have an ectopic pregnancy and fit the medical care were encompassed in the program, a total of 37 women. For instance, those with serum beta HCG in the range of 1000 mIU per liter were treatment expectantly whereas those with a level more than a thousand were given an injection of methotrexate. To monitor the response of experiment, beta HCG levels were monitored for each mother. The results of the current study established that 88.0% of women who underwent the study, only 12.0% of them exhibited full rsolution while the remaining lot resolved only after a sole dose of methotrexate. From the results of this study, it is evidently clear that a lot of pregnant mothers would be greatly helped if they are enrolled in such therapy at early days

Humans , Female , Pregnancy , Adult , Pregnancy, Ectopic/mortality , Pregnancy, Ectopic/therapy , Methotrexate/therapeutic use , Chorionic Gonadotropin, beta Subunit, Human/administration & dosage , Watchful Waiting/trends
Clinics ; 74: e1111, 2019. graf
Article in English | LILACS | ID: biblio-1039561


Pregnancy of unknown location is a situation in which a positive pregnancy test occurs, but a transvaginal ultrasound does not show intrauterine or ectopic gestation. One great concern of pregnancy of unknown location is that they are cases of ectopic pregnancy whose diagnosis might be postponed. Transvaginal ultrasound is able to identify an ectopic pregnancy with a sensitivity ranging from 87% to 94% and a specificity ranging from 94% to 99%. A patient with pregnancy of unknown location should be followed up until an outcome is obtained. The only valid biomarkers with clinical application and validation are serum levels of the beta fraction of hCG and progesterone. A single serum dosage of hCG is used only to determine whether the value obtained is above or below the discriminatory zone, that means the value of serum hCG above which an intrauterine gestational sac should be visible on ultrasound. Serum progesterone levels are a satisfactory marker of pregnancy viability, but they are unable to predict the location of a pregnancy of unknown location: levels below 5 ng/mL are associated with nonviable gestations, whereas levels above 20 ng/mL are correlated with viable intrauterine pregnancies. Most cases are low risk and can be monitored by expectant management with transvaginal ultrasound and serial serum hCG levels, in addition to the serum progesterone levels. To minimize diagnostic error and intervene during progressive intrauterine gestation, protocol indicates active treatment only in situations when progressive intrauterine pregnancy is excluded and a high possibility of ectopic pregnancy exists.

Humans , Female , Pregnancy , Pregnancy, Ectopic/diagnosis , Pregnancy, Ectopic/therapy , Progesterone/blood , Chorionic Gonadotropin/blood , Biomarkers/blood , Ultrasonography, Prenatal
Rev. bras. ginecol. obstet ; 39(11): 640-644, Nov. 2017. graf
Article in English | LILACS | ID: biblio-898841


Abstract Approximately 1 in every 76,000 pregnancies develops within a unicornuate uterus with a rudimentary horn.Müllerian uterus anomalies are often asymptomatic, thus, the diagnosis is a challenge, and it is usually made during the gestation or due to its complications, such as uterine rupture, pregnancy-induced hypertension, antepartum, postpartum bleeding and intrauterine growth restriction (IUGR). In order to avoid unnecessary cesarean sections and the risks they involve, the physicians should consider the several approaches and for how long it is feasible to perform labor induction in suspected cases of pregnancy in a unicornuate uterus with a rudimentary horn, despite the rarity of the anomaly. This report describes a case of a unicornuate uterus in which a pregnancy developed in the non-communicating rudimentary horn and the consequences of the delayed diagnosis.

Resumo Aproximadamente 1 em cada 76 mil gestações se desenvolvememútero unicorno sem comunicação com o colo uterino. Anomalias müllerianas uterinas são, na maioria das vezes, assintomáticas, tornando difícil o diagnóstico, que geralmente é esclarecido durante a gestação ou por conta das complicações gestacionais, como ruptura uterina, hipertensão gestacional, parto pré-termo, hemorragias pós-parto e crescimento intrauterino restrito (CIUR). Com o intuito de evitar cesáreas desnecessárias e os riscos que esse procedimento envolve, considerações devem ser feitas quanto aos diferentes métodos utilizados, e por quanto tempo é viável induzir o parto na possibilidade de útero não comunicante, mesmo sendo uma anomalia rara. Este relato descreve um caso de uma gestação que se desenvolveu em um útero unicorno não comunicante com o colo uterino e as consequências do diagnóstico tardio.

Humans , Female , Pregnancy , Young Adult , Pregnancy, Ectopic/etiology , Urogenital Abnormalities/complications , Uterus/abnormalities , Pregnancy, Ectopic/therapy , Pregnancy, Ectopic/diagnostic imaging , Urogenital Abnormalities/diagnosis , Urogenital Abnormalities/therapy
Kisangani méd. (En ligne) ; 7(1): 255-258, 2016. tab
Article in French | AIM, AIM | ID: biblio-1264662


Introduction: La grossesse extra utérine (GEU) est une affection redoutable du fait de son caractère morbide et d'une mortalité élevée. Elle est considérée comme un problème de santé publique dans tous les pays du monde, quel qu'en soit le niveau de développement, en raison de sa fréquence et ses répercussions sur la fertilité des patientes. Déterminer la fréquence hospitalière et l'issue de la grossesse extra ­utérine (GEU) à l'hôpital de l'Amitié Sino ­Congolaise de N'djili (HASC) sont l'objectif de la présente étude. Matériel et Méthodes: Il s'agit d'une étude transversale descriptive conduite du 1er janvier 2008 au 31 décembre2012. Ont été incluses dans cette étude, toutes les patientes admises pour GEU confirmée par le test de grossesse et l'échographie ou constatée en per opératoire Résultats: La fréquence de la GEU était de 1,56%. L'âge moyen des patientes était de 26,3 ± 4,1 ans. Etaient plus représentées les patientes paucipares. Les antécédents suivants ont été retrouvés: infection sexuellement transmissible, avortement provoqué, GEU antérieure, port de dispositif intra-utérin et chirurgie antérieure. Les GEU ont été le plus souvent de localisation ampullaire ou isthmique et rompues. La chirurgie radicale a été pratiquée dans 78,9% des cas.66,6% des patientes ont bénéficié d'une transfusion.Conclusion: La GEU reste une pathologie assez fréquente. La présente étude a montré que le diagnostic tardif au stade de complication offre peu de choix thérapeutique avec des mutilations lourdes, diminuant ainsi les chances de fécondités ultérieurs des patientes

Democratic Republic of the Congo , Pregnancy, Ectopic/epidemiology , Pregnancy, Ectopic/etiology , Pregnancy, Ectopic/therapy
Einstein (Säo Paulo) ; 13(1): 167-169, Jan-Mar/2015.
Article in English | LILACS | ID: lil-745881


The advent of interventional radiology enabled remarkable advances in diagnosis and treatment of several situations in obstetrics and gynecology. In the field of obstetrics, these advances include temporary occlusion of the iliac arteries to the management of placenta accreta and/or prior, arteriovenous fistulas after embolization of uterine curettage and management of ectopic uterine and extra-uterine pregnancies. The non-tubal ectopic pregnancy, either cervical, abdominal, ovarian or in a cesarean scar, often represents major therapeutic challenge, especially when exists a desire to maintain fertility. Despite the systemic methotrexate therapy and surgical resection of the ectopic gestational sac be the most used therapeutic options, the interventionist approach of non-tubal ectopic pregnancies, direct injection of methotrexate in the gestational sac and intra-arterial chemoembolization of uterine arteries constitute in the currently literature viable, safe, effective modalities with low morbidity, shorter hospital stay, and rapid clinical recovery. Because of little variety of materials used, and the increase in training of specialists in the area, the radiological intervention as a treatment option in ectopic pregnancies is financially viable and present considerable accessibility in the world and at most of Brazilian medical centers.

O advento da radiologia intervencionista tornou possível avanços notáveis no diagnóstico e no tratamento de diversas situações, na área de ginecologia e obstetrícia. No campo da obstetrícia, esses avanços incluem oclusão temporária das artérias hipogástricas para o manejo de placenta acreta e/ou prévia, embolização de fístulas arteriovenosas após curetagem uterina e manejo de prenhezes ectópicas uterinas e extrauterinas. A gravidez ectópica não tubária, seja cervical, abdominal, ovariana ou na cicatriz de cesárea, muitas vezes representa grande desafio terapêutico, principalmente quando há desejo de manutenção da fertilidade. As opções terapêuticas mais utilizadas para o tratamento de prenhez ectópica não tubária, são: terapia sistêmica com metotrexato e ressecção cirúrgica do saco gestacional ectópico; porém a abordagem intervencionista com injeção direta de metotrexato no saco gestacional ou quimiembolização intra-arterial das artérias uterinas, apresentam-se na literatura recente, como modalidades terapêuticas viáveis, seguras, eficazes, com baixa morbidade, menor tempo de internação e rápida recuperação clínica. Devido ao diminuto arsenal de materiais utilizados e à crescente formação de especialistas na área, a intervenção radiológica, como opção de tratamento nas prenhezes ectópicas, é financeiramente viável e apresenta acessibilidade considerável no mundo e na maioria do centros médicos brasileiros.

Female , Humans , Pregnancy , Pregnancy, Ectopic/therapy , Radiology, Interventional/methods , Uterine Artery/surgery , Abortifacient Agents, Nonsteroidal/therapeutic use , Chemoembolization, Therapeutic/methods , Methotrexate/therapeutic use , Uterine Artery Embolization/methods
Femina ; 42(1): 19-26, jan-fev. 2014.
Article in Portuguese | LILACS | ID: lil-749137


Entre as complicações de longo prazo da operação cesariana, destacam-se o acretismo placentário (placenta acreta, increta e percreta) e, mais recentemente, a implantação embrionária na cicatriz uterina de cesárea prévia. A denominada gravidez ectópica em cicatriz de cesárea persiste como um evento pouco divulgado em função da sua raridade; porém, apresenta incidência crescente devido principalmente ao aumento global das taxas de cesariana. Os atrasos no diagnóstico e no tratamento podem resultar em ruptura uterina, hemorragia grave, necessidade de histerectomia e elevada mortalidade materna. Dessa forma, os objetivos principais na condução dos casos de gravidez ectópica em cicatriz de cesárea devem incluir o diagnóstico ultrassonográfico precoce e acurado e a prevenção de hemorragias graves, além da preservação da fertilidade. Entretanto, devido à sua raridade, ainda não há consenso acerca da melhor forma de tratamento dessa complicação.(AU)

Among the long-term complications of cesarean section stand out the pathologically adherent placenta (accreta, increta and percreta) and, more recently, the embryonic implantation in the uterine scar from previous cesarean. The so-called cesarean scar ectopic pregnancy remains a little known event due to its rarity. But it shows increasing incidence due mainly to the overall increase in cesarean rates. The delay in diagnosis and treatment can result in uterine rupture, severe hemorrhage, need for hysterectomy and high maternal mortality. Thus, the main objectives in the management of cesarean scar ectopic pregnancy should include early and accurate ultrasound diagnosis and prevention of severe blood loss, and the preservation of fertility. However, due to its rarity, there is no consensus about the best treatment for this complication.(AU)

Humans , Female , Pregnancy , Pregnancy, Ectopic/etiology , Pregnancy, Ectopic/therapy , Pregnancy, Ectopic/diagnostic imaging , Cesarean Section/adverse effects , Ultrasonography, Prenatal , Prognosis , Cesarean Section/statistics & numerical data , Databases, Bibliographic
Rev. bras. ginecol. obstet ; 35(5): 233-237, May 2013. ilus
Article in Portuguese | LILACS | ID: lil-679406


A implantação da gravidez na cicatriz de cesárea é considerada uma forma rara de gestação ectópica com uma alta taxa de morbidade e mortalidade. Este tipo de gestação ectópica pode causar complicações graves, em função dos riscos de ruptura e hemorragia volumosa, que pode resultar em histerectomia e comprometimento do futuro reprodutivo da mulher. Reportamos um caso de uma gestação ectópica em cicatriz de cesárea em uma mulher de 28 anos que foi tratada com sucesso com a combinação de três métodos: metotrexate, embolização da artéria uterina e curetagem guiada por ultrassom. Dessa forma foi preservada sua fertilidade.

Implantation of a pregnancy within a cesarean delivery scar is considered to be the rarest form of ectopic pregnancy, with a high morbidity and mortality. Pregnancy in a cesarean delivery scar may cause catastrophic complications which may result in hysterectomy and compromise the reproductive future of a woman. We report an ectopic pregnancy in cesarean scar case in a 28-year old pregnant woman that was treated with success with the association between three treatment modalities (methotrexate, uterine artery embolization and curettage) and preserve her fertility.

Adult , Female , Humans , Pregnancy , Cesarean Section , Cicatrix/complications , Pregnancy, Ectopic/therapy
JSP-Journal of Surgery Pakistan International. 2013; 18 (1): 37-40
in English | IMEMR | ID: emr-132945


To determine the clinical presentations and the management options for ectopic pregnancy. Descriptive study. Department of Obstetrics and Gynecology Liaquat National Hospital Karachi, from 13[th] August 2011 to 12[th] August 2012. A total of 40 cases diagnosed with ectopic gestation were included in this study. Information was retrieved from the case notes and labor ward registers. The data was analyzed with simple descriptive statistics. During the study period the total number of gynecological admissions were 1126 and 1618 deliveries conducted. Forty patients had ectopic gestations accounting for 2.4% of all deliveries and 3.5% of all gynecological admissions. The peak age group was 20-30 year [62.5%]; 95% [n=38] were married. Cases of ectopic pregnancy found more in primigravida 45% [n=18] patients. Abdominal pain was the most common presenting symptom in 92.5% [n=37] of patients whereas history of amenorrhea present in 75% and vaginal bleeding was found in 45% of patients. Commonest clinical sign was cervical excitation present in 82%. Identifiable risk factors were present in 52.5% of cases, the most frequent being previous miscarriages in 22.5%. Surgical management was done in 95% patients while 5% managed medically. Ruptured ectopic pregnancy was seen in 85%. Tubal ectopic pregnancy was present in 92.5% [n=37], ovarian 2.5%, and heterotopic pregnancy in 2.5%. Salpingectomy was performed in 89% while salpingotomy done in 7.8% cases. Hysterectomy was done in one patient. Blood was transfused in 75% [n=30] patients. There was no maternal death related to ectopic pregnancy. Ectopic pregnancy was found more in primigravida. Abdominal pain was the single most consistent feature of ectopic pregnancy. Most cases presented late making tubal conservation treatment inapplicable.

Humans , Female , Adult , Pregnancy, Ectopic/therapy , Pregnancy , Disease Management , Salpingectomy , Fallopian Tubes
Gulf Medical University: Proceedings. 2012; (5-6 November): 188-193
in English | IMEMR | ID: emr-142865


Implantation of the embryo at the site of a previous Caesarean scar is the rarest form of ectopic pregnancy, with a high risk of maternal complications. The incidence of CSP [caesarean scar Pregnancy] is estimated in a recent series as 1:2226 of all pregnancies. A delay in establishing a diagnosis and in starting treatment can result in uterine rupture, massive hemorrhage and serious maternal morbidity, and may require hysterectomy. Several options are available to treat CSP if diagnosed early, although there are no evidence-based guidelines recommended due to its rarity. The management should be tailored to the individual situations. Little is known about the future pregnancies, outcomes and recurrences after fertility-preserving treatments following CSP. We report a case of suspected CSP in a 28 year old Gravida 2, Para one, who was referred to us for the management of incomplete miscarriage. Her previous delivery was six years back and was by Cesarean section. Ultrasound examination revealed that the patient had a large anterior lower uterine segment vascular mass of 9.3x8.2x9cms, suspected to be a persistent trophoblastic tissue invading the anterior uterine wall, though a degenerating fibroid could not be ruled out. The patient underwent dilatation and curettage as she had been bleeding for more than a month and still 3HCG being positive. The procedure was also used to establish a histopathological diagnosis. A follow up MRI and Ultrasound revealed a heterogenous mass. With a strong clinical suspicion based on history and early ultrasound reports, the diagnosis of an anterior uterine wall mass probably due to penetrating trophoblastic tissue on previous caesarean scar was made. The patient has been referred for either uterine artery embolisation or a laparoscopic removal in order to preserve her fertility

Humans , Female , Cesarean Section , Cicatrix , Pregnancy, Ectopic/therapy , Uterus/blood supply , Pregnancy, Ectopic/pathology , Magnetic Resonance Spectroscopy , Review Literature as Topic , Pregnancy Complications
Gulf Medical University: Proceedings. 2011; (29-30): 102-106
in English | IMEMR | ID: emr-140772


Cervical ectopic pregnancy is the implantation of a pregnancy in the endocervical canal and is a rare entity. Cervical pregnancy is the least common variant of ectopic pregnancy with a reported incidence of < 1% and 1;18000 live births. Diagnosis and management of cervical ectopic pregnancy is a challenging obstetrical entity both for the obstetrician and the radiologist. Diagnostic dilemma still exist because of close resemblance of clinical presentation between cervical ectopic pregnancy and incomplete abortion. Unexpected diagnosis of cervical ectopic pregnancy following dilatation and curettage for a presumed incomplete abortion was not uncommon. Uncontrolled hemorrhage warranted emergency hysterectomy in majority of cases. Advances in sonological techniques have made the diagnosis easy. Dramatic change has been witnessed over the past two decades in this regard. Fertility sparing treatment options are the ray of hope especially for nulliparous women with cervical ectopic pregnancy. Here is a case report of 24 year old nulliparous presented to emergency room with lower abdominal cramping, burning micturition, bleeding per vagina and vomiting of two days' duration. Her last menstrual period was six weeks back. Pelvic examination revealed eight weeks pregnancy with enlarged cervix and bloody mucous discharge from the cervix with unremarkable adnexa. She was found to be positive for pregnancy test. Clinical and biochemical marker [b HCG] suggested ectopic pregnancy with a possibility of cervical ectopic pregnancy following ultrasound examination. As the patient was keen on immediate symptomatic cure she was managed surgically followed by a good postoperative recovery. Misdiagnosis and mismanagement of cervical ectopic pregnancy carry high maternal mortality and morbidity. Literature was reviewed in view of the enigma surrounding the diagnosis and management of cervical ectopic pregnancy. The review revealed the need of appropriate diagnosis and that fertility sparing treatment options [medical methods] are gaining momentum and are found to be effective. High index of clinical suspicion by the obstetrician, aided with high resolution transvaginal scan, should help in making an early appropriate diagnosis. Timely correct diagnosis and intervention with right therapeutic option should prevent high maternal morbidity and mortality associated with cervical ectopic pregnancy

Humans , Female , Pregnancy, Ectopic/etiology , Pregnancy, Ectopic/therapy , Pregnancy , Cervix Uteri
JSP-Journal of Surgery Pakistan International. 2011; 16 (1): 41-44
in English | IMEMR | ID: emr-110459


The majority of ectopic pregnancies are located within the fallopian tubes. Nevertheless, pregnancies can be implanted in the cervix, interstitial tubal segment, ovary and at various intra-abdominal sites. The diagnosis and treatment of these unusual implantation sites present both diagnostic and therapeutic dilemmas. The majority of data regarding these unusual ectopic pregnancies came largely from case reports. In the past, for the treatment of these ectopic pregnancies various combinations of surgery and systemic and local chemotherapy were used. In this article, we attempt to share our experience with three unusual types of ectopic pregnancies, their presentation, diagnosis and management with limited resources

Humans , Female , Pregnancy, Ectopic/therapy , Pregnancy , Disease Management
Femina ; 37(1): 29-34, jan. 2009. tab
Article in Portuguese | LILACS | ID: lil-521741


A gravidez ectópica é uma importante causa de morbimortalidde materna no primeiro trimestre gestacional. As dosagens hormonais seriadas e a ultrassonografia endovaginal, realizadas atualmente, facilitaram o diagnóstico e tratamento da gravidez ectópica, antes que ocorresse a ruptura tubária. O tratamento clínico medicamentoso com o metotrexato, um antagonista do ácido fólico altamente tóxico a tecidos em rápida replicação, é bastante utilizado em gestações ectópicas íntegras, adequadamente selecionadas. Muitos estudos vêm sendo realizados a fim de tentar definir quais grupos de pacientes se beneficiariam desse tratamento e, qual seria o melhor esquema de administração dessa droga, com redução dos efeitos colaterais e melhores taxas de sucesso. Esta revisão expõe as opções de tratamento medicamentoso mais estudadas para tratamento da gravidez ectópica íntegra, com ênfase nas taxas de sucesso de tratamento (cura, persistência de tecido trofoblástico e permeabilidade tubária) e no prognóstico a longo prazo.

Ectopic pregnancy is a significant cause of morbity and mortality in the first trimester of pregnancy. Serial hormone assays and transvaginal ultrasonography facilitate the diagnosis and treatment of ectopic pregnancy before rupture occurs. Early nonsurgical diagnosis and appropiate treatment have resulted in diversity of management options and decline in mortality, due to this pathology. Treatment with methotrexate, a folic acid antagonist, highly toxic to rapidly replicating tissues, can be applied on selected patients with non-ruptured ectopic pregnancy. Many studies have been developed intending to define which patients would be benefited by this treatment and how to administer this drug, with low side effects and good successful rates. This review refers to the best practice on non-ruptured ectopic pregnancy, with emphasis on treatment success rates (cure rate, incidence of persistent trophoblast and tubal patency) and long-term prognosis.

Female , Pregnancy , Abortifacient Agents, Nonsteroidal/therapeutic use , Pregnancy, Ectopic/diagnosis , Pregnancy, Ectopic/drug therapy , Pregnancy, Ectopic/therapy , Methotrexate/administration & dosage , Methotrexate/adverse effects , Methotrexate/therapeutic use , Single Dose , Treatment Outcome , Ultrasonography, Prenatal , Prognosis
Tunisie Medicale [La]. 2009; 87 (9): 616-620
in French | IMEMR | ID: emr-134796


Cervical pregnancy is the rarest of ectopic pregnancy. The classical treatment remains hysterectomy, in particular when diagnosis is made late. The possibilities of more and more premature diagnoses, sometimes before any clinical expression, let suspect the possibility of conservative treatments. We report two cases of medical treatment for early diagnosed cervical pregnancies. Through a review of the literature, we resume diagnostic criteria and various therapeutic possibilities. The two cases were diagnosed in the first trimester. The treatment consisted in intramuscular administration of methotrexate. The first patient had ultrasound-Guided feticide before the administration of methotrexate. Actually, vaginal ultrasound allows early diagnosis of cervical pregnancies, even before the beginning of vaginal bleeding. This advancement allowed conservative treatment. In this situation, current reference is the methotrexate to which can be associated an intracardiac potassium chloride injection in case of embryo positive heart activity

Humans , Male , Female , Pregnancy, Ectopic/therapy , Cervix Uteri , Methotrexate , Potassium Chloride , Injections, Intramuscular , Prognosis , Risk Factors , Hysterectomy
Rev. obstet. ginecol. Venezuela ; 68(3): 155-159, sept. 2008. tab
Article in Spanish | LILACS | ID: lil-522993


Identificar aspectos de interés del embarazo ectópico, su frecuencia, características maternas, obstétricas, diagnóstico y tratamiento. Estudio retrospectivo y descriptivo de 179 embarazos ectópicos atendidos desde 2000 hasta 2007, sucedidos en 23 030 embarazos; para el análisis de variables se incluyeron las historias clínicas respectivas. Departamento de Obstetricia y Ginecología. Hospital “Dr. Adolfo Prince Lara ”, Puerto Cabello, Estado Carabobo. La frecuencia media global en el período fue 7,77 por 1 000 embarazos, 1 embarazo ectópico por cada 128 embarazos. Fue predominante en el grupo etario de 20 a 29 años (54,69 por ciento), gestaciones de II-V (75,52 por ciento), edad de gestación 5-8 semanas (75,52 por ciento). La clínica más llamativa fue dolor pelviano y amenorrea (47,48 por ciento), amenorrea, dolor y sangrado genital (20,67 por ciento). El diagnóstico de embarazo ectópico al ingreso se hizo en el 80,73 por ciento, combinado a otra patología 15,08 por ciento, no se sospechó en 4,17 por ciento; los métodos diagnósticos importantes fueron la clínica (55,73 por ciento) y ecografía (27,60 por ciento). El embarazo estaba roto en 79,33 por ciento, localizado en las trompas 94,42 por ciento, ovario 2,79 por ciento y resuelto mediante salpingectomía 67,05 por ciento; la morbilidad destacada fue la anemia 77,1 por ciento, no hubo muerte materna. El embarazo ectópico mantiene una incidencia elevada, esto implica incentivar actividades preventivas para afrontar esta situación, y mejorar la metodología diagnóstica y terapéutica.

Humans , Female , Pregnancy , Pelvic Pain/therapy , Pregnancy, Ectopic/diagnosis , Pregnancy, Ectopic/therapy , Obstetrics