A ruptured cornual pregnancy with previous history of salpingectomy: rare case of 3rd ectopic pregnancy

A cornual pregnancy is the most dangerous type of ectopic pregnancy since it can be misdiagnosed easily and has high mortality rate. It is diagnosed when the implantation site is at the junction between the fallopian tube and the uterus. It accounts for 2� of ectopic pregnancies. In a ruptured case, patient usually presents with hypovolemia and shock. For a successful outcome, early diagnosis and management are critical. A 29 years old woman, G3P0A2L0 with 8 weeks 5 days of amenorrhea conceived by IVF-ET with a history of left salpingectomy and right cornual cauterization, presented in emergency with complaints of lower abdominal pain, vomiting, burning micturition and giddiness. Per abdominal examination- soft with mild tenderness. Resuscitation started. All necessary investigations were done. Treatment started considering provisional diagnosis as septic shock following urinary tract infection (UTI). Ultrasound report showed uterus with thickened endometrium with hyperechoic irregular small gestational sac like structure in uterine cavity with hemoperitoneum in pelvis. Emergency laparotomy done considering a diagnosis of hypovolemic shock due to ruptured cornual ectopic pregnancy. Intra-operatively she was found to have hemoperitoneum with left sided ruptured cornual ectopic pregnancy. Early diagnosis is the cornerstone of cornual pregnancy before its rupture and to reduce the chances of maternal mortality. Combination of clinical features, increased serum ?-hCG, high resolution trans-vaginal ultrasonography gives the correct diagnosis in most of the cases. While doing antenatal ultrasonography in the first trimester, high index of suspicion is needed to diagnose cornual ectopic pregnancy. Conservative medical and surgical management is decided on clinical condition of the patient. Our case represents that a history of salpingectomy does not eliminate the potential of ipsilateral ectopic pregnancy.

Pregnancy over caesarean scar site-account of four unusual cases in the form of a case series

Caesarean scar ectopic pregnancy (CSEP) is an ectopic pregnancy located in the lower uterine segment. Although it is one of the rarest types of ectopic pregnancy, the worldwide increasing rate of caesarean sections has made it important for young gynaecologists to be aware of the challenges posed by CSEP and its successful management. Doppler ultrasounds play a major role in its diagnosis. Early diagnosis is the key to a good outcome as untimely delay can lead to life-threatening haemorrhage, uterine rupture and irreversible loss of fertility. We present a case series of 4 patients of caesarean scar site ectopic pregnancy who presented to the gynaecology emergency and were treated successfully with various modalities depending on their patient profile.

Prevalence and diagnostic efficacy of trans-abdominal and trans-vaginal ultrasound for ectopic pregnancies: a longitudinal study

Background: Reducing maternal mortality and morbidity requires an accurate diagnosis of ectopic pregnancy. The fallopian tube is the most frequent location for ectopic pregnancy. Methods: This study was based on a longitudinal analytical design conducted at tertiary care hospitals in Pakistan. Patients in the reproductive age range (20 to 32 years) who underwent clinical examination and investigations and were diagnosed with ectopic pregnancy were included in this study. The ultrasound results of all the patients were evaluated, and data was collected on the existence and positioning of an ectopic pregnancy.Results: In the study, 198 women underwent TVS and TAS. At the time of diagnosis, the age range was 20-32 years old. Our study found that 2.5% of pregnancies resulted in an ectopic pregnancy. 20 women had symptomatic EP that was confirmed. For the initial TVUS, the sensitivity and specificity of ultrasonography were 88.5% and 96.5%, respectively, and with a second rescan, they were 93.1% and 95.7%.Conclusions: Our study showed that an excellent method for identifying ectopic pregnancy is trans-abdominal ultrasonography. Regarding diagnostic accuracy metrics, however, it falls short of trans-vaginal ultrasound. To avoid missing any cases of ectopic pregnancy, early detection can significantly reduce morbidity and mortality. We should employ both ultrasonography modalities sequentially, with TAS being used first.

Successful outcome in a ruptured heterotopic pregnancy

A heterotopic pregnancy is a simultaneous intrauterine pregnancy and an ectopic pregnancy. It is a rare condition; however, the increasing use of artificial reproductive techniques is increasing the incidence of heterotopic pregnancy. Most of the patients with heterotopic pregnancy have a previous history of infertility or tubal diseases. Diagnosis of ectopic pregnancy should not be missed out as quite often it is a precious pregnancy and a ruptured ectopic can change the outcome of intrauterine pregnancy as well. A 30-year-old female primigravida with 3 months of gestational age, (in vitro fertilization (IVF) conception) presented to casualty with complaints of bleeding per vaginum since morning. Patient was of gestational age 9 weeks 2 days by a 6 weeks scan at the time of presentation. A Provisional diagnosis of threatened abortion was made, 36 hours later, patient started complaining of acute pain in abdomen. In view of examination findings and ultrasound scan, decision was taken to perform emergency laparotomy. Intra-op findings were consistent with a right ruptured ectopic pregnancy which was missed on previous scans. Histopathology report confirmed findings of right ectopic pregnancy. Heterotopic pregnancy can occur even if the earlier scans are unable to detect the ectopic pregnancy. Patient presenting with symptoms of pain in abdomen and bleeding per vaginum should not be neglected especially in cases of IVF conception. Clinicians should keep in consideration for possibility of heterotopic pregnancy. Early diagnosis and prompt management can increase the survival of intrauterine pregnancy and decrease maternal morbidity and mortality.

Silent ovarian ectopic pregnancy: a case report

In clinical practice, an ovarian pregnancy is considered one of the most challenging diagnoses faced by an obstetrician/gynecologist. In this article, we report a 31-year-old Asian-Pakistani female, who presented to the ObsGynae clinic with 8 weeks of amenorrhea, a positive urine pregnancy test, and very high serum ?-hCG levels. Transvaginal ultrasonography ruled out a tubal pregnancy, and the patient was sent for repeat ?-hCG levels. The patient was hemodynamically stable and displayed no characteristic signs and symptoms of an ectopic pregnancy. Upon repeat scans and ?-hCG levels, a diagnosis of ovarian ectopic pregnancy was made. The patient was managed on medication; a single dose of I/M 50 mg/m2 methotrexate was administered and the resultant decline in ?-hCG levels proved the success of conservative treatment in this case. An ovarian ectopic can present as a life-threatening condition, and a high index of suspicion can prevent morbidity as well as mortality. Ovarian pregnancy, without any alarming signs despite very high ?-hCG levels, as reported in this case, is one of the rarest clinical cases observed.

A successful conservative management of cervical ectopic pregnancy

Cervical ectopic pregnancy is a rare life-threatening condition with an incidence of less than 1% among all ectopic pregnancies. A 27-year-old primigravida presented with spotting per vaginum following 4 weeks 5 days of amenorrhea. Transvaginal ultrasound done at 4 weeks 5 days showed a gestational sac located in the anterior wall of cervix, diagnosis of cervical ectopic pregnancy was made. Initial serum beta hCG titre was 4106 mIU/ml. Serial monitoring of serum beta hCG done showed increasing values. Hence, decided for medical management with single dose of injection methotrexate, as the diagnosis was made at an early gestation and patient was hemodynamically stable. On follow up, serum beta hCG did not fall significantly, hence multidose methotrexate regimen was initiated. She responded to it, but she continued to have persistent bleeding per vaginum with fall in hemoglobin levels, hence sorted for surgical management which included suction and evacuation, after ligation of descending cervical artery and subsequently cervical tamponade. Intraoperative period was uneventful. On follow-up, patient was asymptomatic and vitals stable. Serum beta hCG done 2 weeks post procedure was below 5 mIU/ml and resumed spontaneous cycles after a month. Thus, early detection and accurate diagnosis of cervical ectopic pregnancy using ultrasound and serial beta hCG titre monitoring becomes a cornerstone of management. We present this case as it was her index pregnancy, with a need to preserve future fertility, successful conservative management of Cervical ectopic pregnancy with combination of medical and surgical intervention.

Lithopedion: the calcified marvel

The term lithopedion was derived from the Greek words Lithos and Pedion. It is a rare ectopic pregnancy with incidence as low as 1.5-2.0% of all ectopics. An 80-year old female patient presented to the orthopaedic out-patient department with complaints of lower back pain and mild lower abdominal pain, no history of any trauma. The patient was a known case of Ttype II diabetes and hypertension on medication, no other comorbidities. The patient was referred to the department of radio-diagnosis, for plain radiograph of the lumbo-sacral spine, antero-posterior and lateral view for further evaluation. The plain radiograph revealed a well-defined oval shaped radio-density in the pelvis more towards the right side. Further evaluation was done in the form of ultrasound abdomen and computed tomography. Computed tomography revealed a mummified fetus which is in close proximity to the internal organs and adhering to bowel loop. Low socioeconomic status combined with lack of education of the population are the primary causes for delay in diagnosis resulting in undiagnosed ectopic pregnancy and its later transformation into a Lithopedion.

A rare case report on cervical pregnancy

Cervical pregnancy is a rare type of ectopic pregnancy and it represents <1% of all ectopic pregnancies. Tubal ectopic, Interstital, caesarean scar pregnancy, cornual, ovarian, Intramural are other types of ectopic pregnancy. Timely diagnosis and Treatment are key to management any type of ectopic pregnancy. Cervical ectopic pregnancy is the implantation of blastocyst in the intracervical canal. Cervical pregnancy are high risk cases as they may present with an unexpected life-threatening hemorrhage secondary to the erosion of cervical blood vessels, which may require hysterectomy to save the patient. Here is case of 22yr old primi patient with 6 weeks and 2 days of cervical ectopic pregnancy planned for dilatation and evacuation followed by medical management span; Improved ultrasound resolution and earlier detection of these pregnancies have led to the development of more conservative treatments that attempt to limit morbidity and preserve fertility.

A must know compendium of genital chlamydia for health care providers

Chlamydia comprises the largest proportion of all sexually transmitted infections (STIs) worldwide. It is caused by Chlamydia trachomatis, an obligate intracellular bacterium and exists in two stages; an extracellular elementary body which is an infectious state and an intracellular reticulate body, a dormant state. The elementary body increases the risk of transfer of chlamydial infection during oral, genital or anal sex. On the other hand, the vegetative state of the reticulate body promotes the chance of latent and recurrent infection. In 2020, WHO estimated 129 million new chlamydia infections. Most of the chlamydial infections are asymptomatic (85-90%) which promotes transfer between partners. If untreated, it can lead to an ascending infection which greatly impacts sexual and reproductive health. In addition, it can infect the baby around childbirth and may result in stillbirth or neonatal death. The immuno-pathogenesis of the chlamydial infection is predominantly evoked by major outer membrane protein (MOMP), a dominant chlamydial antigen on the cell wall; along with the chlamydial antigen, heat shock protein 60 (HSP60) triggers host immune responses. The innate and adaptive immune responses result in extensive fibrosis and permanent damage to the fallopian tube resulting in tubal factor infertility and ectopic tubal pregnancy. The improved strategies in screening, diagnosis, treatment and follow up of Chlamydial infection can have noticeable effects on prevention of incidence, retarding the progression and avoiding recurrence of infection leading to a reduction in the global burden of STIs and the consequent adverse neonatal outcome.

Ectopic pregnancies at a tertiary care centre: a five-year retrospective study

Background: Ectopic Pregnancy results in significant morbidity. Our aim during present study was to understand age wise, parity wise distribution of cases, risk factors, clinical presentation and management of ectopic pregnancy which may be useful in lowering morbidity and mortality.Methods: A five-year retrospective study was done from 2019 to 2023; comprising detailed medical records of detected cases of ectopic pregnancies admitted to the tertiary care centre.Results: Incidence of ectopic pregnancy during present study was 0.40%. 65.48% of ectopic pregnancy cases recorded in the age group of 21-30 years. Majority of parity wise cases were multipara (63.95%). There were no risk factors noted in 34.01% cases. Majority of the cases (65.95%) had one or the other distinguishable risk factor. 21.68% cases had history of Tubectomy, while 19.38% ectopic gestation had history of abortion. Most of the patients presented with clinical presentation of amenorrhoea 59.89%. 55.83% cases had bleeding per vaginum, while 47.71% had pain in abdomen. Most common ectopic pregnancy site was ampulla, with 63.95% cases. Ultrasonic findings showed ruptured ectopic pregnancy in 59.39% cases and unruptured in 30.45%. Regarding mode of management in the cases, surgical management with unilateral total salpingectomy (56.79%) was most commonly performed, followed by salpingoopherectomy (14.81%).Conclusions: Ectopic pregnancy is a common obstetric emergency leading to first trimester morbidity and mortality. Diagnosis of these cases requires a high index of clinical suspicion and early intervention often is lifesaving. Hence, knowledge of the disease related trends and timely management is the key for successful outcomes in such cases.

Diagnosis and management of cases of ectopic pregnancy in a tertiary care centre: our experience

Background: Ectopic pregnancy is a leading cause of maternal morbidity and mortality. With our study, we aim to highlight the importance of risk factors and effect of clinical presentation on the management modalities of ectopic pregnancy and study changing trends of modern management from radical surgical methods to medical and laparoscopic management of ectopic pregnancies.Methods: This prospective study was undertaken at a tertiary care hospital between May 2021 and May 2022.Results: The most common age group of presentation was 26-30 years. The most common risk factor was history of previous abortion. Amenorrhoea and abdominal pain were the most commonly encountered symptoms in this study. Cervical motion tenderness was significantly associated with ruptured ectopic pregnancy. Conservative medical management with injection methotrexate (Mtx), which was successful in 50% cases. Success rate was 100% for laparoscopic management and 100% for laparotomy in this study. No maternal mortality was observed during the present study.Conclusions: Our hospital being a tertiary centre, had to manage a number of cases as surgical emergencies by laparotomy and not conservatively, as they brought in either diagnosed cases of ruptured ectopic pregnancy, or failure of medical management. It is important that in the face of this diagnostic dilemma, all physicians should be should maintain a high level of suspicion and be sensitive to the fact that in the reproductive age group any woman presenting with pain in the lower abdomen, diagnosis of ectopic pregnancy should be considered irrespective of the presence or absence of amenorrhea or tubal sterilisation.

An unusual case of chronic ectopic pregnancy

Thirty-seven years old P3A1L3 patient presented to our outpatient department with pain abdomen for 20 days. Thirty-five days back she had taken MTP kit and then after one week, D&C was done at a primary care centre, presuming incomplete abortion. After this, she developed abdominal distension and couldn’t pass motions. Then she went to some other health care centre and few investigations were done, there. USG showed bulky, excessively enlarged uterus with echogenic material in endometrium, Molar pregnancy, Endometrial mass, Left sided grade 2 hydronephrosis. After exploratory laparotomy, left sided salpingectomy was done. Histopathology report was consistent with ectopic pregnancy.

Características del abdomen agudo quirúrgico gineco-obstétrico en un hospital público de Paraguay (2015-2020)

Introducción: El abdomen agudo gineco-obstétrico es uno de los problemas más desafiantes en la práctica médica y en algunas situaciones pone en peligro la vida de las pacientes. Objetivo: Determinar las características del abdomen agudo quirúrgico gineco-obstétrico en el Hospital Regional de Ciudad del Este durante el periodo 2015 al 2020. Materiales y métodos: Estudio observacional, descriptivo, retrospectivo, con muestreo no probabilístico; que incluyó pacientes con cuadro de abdomen agudo quirúrgico que ingresaron al servicio de gineco-obstetricia durante el periodo comprendido desde 1 de octubre del año 2015 hasta 30 de setiembre del año 2020. Datos sociodemográficos, causas gineco-obstétricas, diagnósticos etiológicos, complicaciones, condiciones al egreso se tuvieron en cuenta. Los datos fueron analizados en el software Stata 12.0®. Resultados: Se estudiaron a 375 pacientes, 55% presentan edades comprendidas entre 20 a 35 años y procedente de zona urbana en un 84%. Se evidenciaron que el 51% fueron de causa obstétrica, el 40% ginecológico y el 9% de causas no gineco-obstétricas. El embarazo ectópico complicado fue del 46% de los casos. El 38% de las complicaciones presentaron sepsis y el 35% shock hipovolémico. Las complicaciones quirúrgicas en el puerperio se registraron que la endometritis/peritonitis fue del 47% y dehiscencia de histerorrafia/absceso de pared con 33%. El 7% de las pacientes fueron derivadas a unidad de cuidados intensivos. Conclusión: El abdomen agudo quirúrgico gineco-obstétrico es más frecuente en edades medias, predomina las causas obstétricas. De entre las etiologías, el embarazo ectópico es la más frecuente. Entre las causas obstétricas de las gestantes con fetos viables sigue siendo la apendicitis aguda. El cuadro séptico y el shock hipovolémico predominan entre las complicaciones. En el puerperio la endometritis y peritonitis. Y, por último, se registraron un porcentaje considerado de requerimiento de cuidados intensivos.

Introduction: The acute gynecological-obstetric abdomen is one of the most challenging problems in medical practice and in some situations it endangers the lives of patients. Objective: Determine the characteristics of the gynecological-obstetric surgical acute abdomen at the Ciudad del Este Regional Hospital during the period 2015 to 2020. Materials and methods: Observational, descriptive, retrospective study, with non-probabilistic sampling. All patients with acute surgical abdomen who were admitted to the gynecology-obstetrics service were studied during the period from October 1, 2015 to September 30, 2020. The data were analyzed in the Stata 12.0® software. Results: 375 patients were studied, of which 51% had obstetric causes, 40% had gynecological causes, and 9% had non-gynecological-obstetric causes. It was evident that 55% were between 20 and 35 years old, with 84% coming from urban areas. Complicated ectopic pregnancy was 46% of cases. 38% of the complications presented sepsis and 35% hypovolemic shock. Surgical complications in the puerperium were recorded: Endometritis/peritonitis was 47% and hysterography/wall abscess dehiscence was 33%. 7% of the patients were referred to the intensive care unit. Conclusion: Obstetric-gynecological surgical acute abdomen is more common in middle ages, obstetric causes predominate. Among the etiologies, ectopic pregnancy is the most common. Acute appendicitis continues to be among the obstetric causes of pregnant women with viable fetuses. Septic symptoms and hypovolemic shock predominate among the complications. In the puerperium, endometritis and peritonitis. And finally, a percentage considered to require intensive care was recorded.

An unexpected case of ectopic pregnancy of the mesosalpinx

1.3% of ectopic pregnancies occur in the abdominal cavity and these have 7.7 times higher mortality rates than tubal pregnancies. We presented a case who came at 5 weeks of amenorrhea with lower abdominal pain, vomiting, and vaginal bleeding. Ultrasound imaging showed a heterogenous vascular solid-cystic adnexal structure with hemoperitoneum. She underwent an emergency diagnostic laparoscopy. Intra-operatively, pregnancy was noted to be sited at the left proximal mesosalpinx. Ectopic pregnancy was removed through the ruptured point and the defect was stitched to restore anatomy and secure hemostasis. Risk factors, clinical presentation, and treatment of abdominal pregnancies are similar to that of any ectopic pregnancy. It is not unusual for diagnosis to be made only intra-operatively as in our case. The patient was offered a diagnostic laparoscopy due to a presumptive diagnosis of tubal pregnancy. As conception was early, completion resection was achieved. Abdominal pregnancy is uncommon and challenging to diagnose, therefore requires a high index of suspicion. Surgery is the mainstay treatment.

Cesarean scar ectopic pregnancy management with simultaneous isthmocele repair

Caesarean scar ectopic pregnancy (CSEP) is a very rare form of ectopic pregnancy. If not diagnosed and treated accordingly it can lead to life-threatening complications. Hitherto there is no standardised treatment established because of the rarity and diversity of the disease. We present the case of a 35-year-old third gravida primi para with caesarean scar pregnancy in 7th week of gestation. Since the patient declined a Methotrexate treatment, we performed hysteroscopic and laparoscopic resection of the ectopic pregnancy in combination with repair of the isthmocele. Because human chorionic gonadotrophin (hCG)-level showed no proper decline three weeks after the initial surgery a second look hysteroscopy and laparoscopy were performed with laparoscopic injection of MTX around the uterine suture, resulting in a full decline of hCG-level. The ultrasound performed before discharge shows a well-adapted uterine scar. A pregnancy can be aspired six-month post-surgery.

Laparoscopic surgery for ectopic pregnancies in peripheric hospital: about 7 cases at Amath Dansokho regional hospital in Kedougou, Senegal

We report 7 cases of laparoscopic management of ectopic pregnancy but also the benefits and limitations of laparoscopic surgery in rural areas. This was a series of cases of ectopic pregnancy managed with laparoscopic surgery at the maternity ward of Amath Dansokho regional hospital of Kedougou from January 01 2023 to October 31 2023. We recorded 7 cases of ectopic pregnancy managed by laparoscopy. In 5 patients, it was an ectopic pregnancy complicated with hemoperitonea. The pregnancy was ampullary in most cases and cornual in one patient. The procedure consisted of a total salpingectomy in all 6 patients and a salpingotomy in one patient who had a history of total salpingectomy on the contralateral tube. The average duration of the operation was 45 minutes. Laparoscopic surgery is the gold standard for surgical treatment of ectopic pregnancy. It results in lower morbidity, less impact on reproductive health and a quicker return to normal activity. Through these advantages, it is well adapted in our environment, where the average distance to a health facility is 37 to 42 km.

A clinical study on ectopic pregnancy in a tertiary care hospital over one year

Background: Ectopic pregnancy is a life threatening emergency in obstetrics presenting in the 1st trimester. The incidence is about 1% globally. We have aimed to study the incidence, presentation and management of ectopic pregnancy. Various risk factors were identified which may be helpful in reducing maternal mortality.Methods: A one year retrospective study involving detailed medical records of patients who underwent obstetric hysterectomy between 1st November 2022 and 31st October 2023.Results: The overall incidence of ectopic pregnancy was 0.8% in this study. The incidence was highest in 26-30 year age group (40%) followed by 21-25 year age group (36.4%). 95.2% cases presented with tubal ectopic while 2.4% each of cervical ectopic and caesarean scar ectopic pregnancies. LSCS was the most common risk factor associated with ectopic pregnancy, other risk factors included pelvic inflammatory disease in 33.3% cases, 29.5% patients with infertility treatment. 59% were ruptured ectopic pregnancies, 40% with unruptured ectopic pregnancy and 1% case of chronic ectopic. Multiple signs were seen in majority of patients including tachycardia, hypotension, abdominal tenderness, guarding and rigidity, vaginal forniceal fullness and tenderness. Management included laparotomy (58.8%), laparoscopy (31.7%), dilatation and evacuation (3.5%), medical management (3.5%) and hysterectomy (2.3%). No case of maternal mortality was noted.Conclusions: Ectopic pregnancy is still a major challenge in obstetrical practice because of its bizarre clinical presentation. Maternal outcome depends upon timely diagnosis and urgent management of such patients.

Embarazo pretérmino intrabdominal exitoso: Reporte de caso / Successful intrabdominal preterm pregnancy: A case report

RESUMEN Introducción: El embarazo ectópico es toda gestación, en la que el sitio de implantación del óvulo fecundado se localiza fuera de la cavidad endometria y representa el 1.4 % de estos. Caso clínico: Paciente de 28 años con dos cesáreas previas, sometida a salpingoclasia durante la última intervención. La paciente ingresó al hospital con presión arterial de 180/130 mm Hg, no respondió a tratamiento médico y presentó falla en la progresión de trabajo de parto, por lo que se decidió interrupción por operación cesárea. Durante la cirugía, se observó un pequeño útero con embarazo extrauterino adherido a la serosa del ciego, el colon ascendente y el apéndice. Se obtuvo un producto femenino pretérmino vivo; la madre cursó con evolución favorable y sin complicaciones posoperatorias. Conclusión: La presentación del embarazo abdominal ectópico es rara, por lo que un control prenatal adecuado por personal capacitado puede orientar a la sospecha diagnóstica. La madre y la recién nacida no presentaron ninguna complicación, a pesar de ser un embarazo abdominal avanzado y la inserción multifocal de la placenta. Se resalta la importancia del manejo oportuno y multidisciplinario cuando se enfrentan embarazos con curso anormal para la mejor evolución de la madre y del producto.

ABSTRACT Introduction: Ectopic pregnancy is any gestation in which the implantation site of the fertilized egg is located outside the endometrial cavity. Abdominal ectopic pregnancy represents 1.4% of these. Case report: 28-year-old patient with two previous cesarean sections; bilateral tubal obstruction during the last operation. The patient was admitted to the hospital with blood pressure of 180/130 mm Hg that did not respond to medical treatment and not progression to labor so it was decided to interrupt the pregnancy by cesarean section. During surgery, a small uterus with extrauterine pregnancy was observed adhered to the serosa of the cecum, ascending colon, and appendix. A live preterm female product was obtained; the mother had a favorable evolution and no postoperative complications. Conclusion: Ectopic pregnancies are rera. An adequate prenatal control by well trained personnel is essential for an accurate diagnosis. The mother and the newborn did not present any complication. It is very important to have and accurate an opportune diagnosis so trained personnel can offer an adequate management.

Experience of Medicinal Insects for Gynaecological Diseases / 中医杂志

It is believed that all kinds of gynaecological diseases are mostly related to deficiency and stagnation of qi and blood. Medicinal insects are good at running and scurrying， with the effectiveness of activating blood circulation and dispelling blood stasis， moving qi and relieving pain， searching and dredging collaterals， attacking hardness and dissipating mass， and purging foetus and resolving mass， etc. Appropriate prescriptions can enhance the effectiveness of the formula in eliminating blood stasis and eliminating stagnation. In the treatment of menstrual disorders， chronic pelvic inflammatory disease， uterine cavity disease， incomplete miscarriage， ectopic pregnancy， and other gynaecological diseases， medicinal insects including Quanxie （Scorpio）， Wugong （Scolopendra）， Tubiechong （Eupolyphaga/Steleophaga）， Jiuxiangchong （Coridius chinenses）， Shuizhi （Hirudo）， Mangchong （Tabanus）， Dilong （Pheretima） and other insects for medicinal purposes could be used， and the self-prescribed empirical formulas such as Sanhuang Decoction （三黄汤）， Hongteng Decoction （红藤汤）， Penning Decoction （盆宁方）， Shapei Decoction （杀胚方）， and Gongwaiyun Decoction （宫外孕方） and so on， were all applied medicinal insects and showed effective in clinic.

Value of transvaginal ultrasound combined with 3.0T magnetic resonance imaging for the diagnosis of ectopic pregnancy / 中国辐射卫生

Objective To compare the value of transvaginal ultrasound, 3.0T magnetic resonance imaging (MRI) scanning alone and in combination for diagnosis of ectopic pregnancy, so as to provide insights into early screening of ectopic pregnancy. Methods This study enrolled a total of 130 patients with suspected ectopic pregnancy admitted to Dachuan People’s Hospital in Dazhou City, Sichuan Province, China between February 2019 and December 2022. All patients underwent transvaginal ultrasound examination and 3.0T MRI scanning. The consistency of transvaginal ultrasound and 3.0T MRI with clinical diagnostic results was evaluated with surgical pathology or clinical follow-up results as the golden standards. The sensitivity, specificity, and accuracy of transvaginal ultrasound and 3.0T MRI, alone and in combination, were compared for diagnosis of ectopic pregnancy. Results Of the 130 patients with suspected ectopic pregnancy, 108 cases were confirmed with ectopic pregnancy by surgical pathology, and 22 cases were confirmed without ectopic pregnancy by clinical follow-up. The sensitivity, specificity, and accuracy of transvaginal ultrasound were 85.19% (92/108), 54.55% (12/22), and 80.00% (104/130), respectively, with 0.358 consistency with clinical diagnostic results. The sensitivity, specificity, and accuracy of 3.0T MRI were 92.59% (100/108), 81.81% (18/22), and 90.77% (118/130), respectively, with 0.694 consistency with clinical diagnostic results. The sensitivity, specificity, and accuracy of transvaginal ultrasound combined with 3.0T MRI were 98.15% (106/108), 72.73% (16/22), and 93.85% (122/130), respectively, with 0.764 consistency with clinical diagnostic results. In addition, the sensitivity and accuracy of transvaginal ultrasound combined with 3.0T MRI were significantly higher than transvaginal ultrasound alone for diagnosis of ectopic pregnancy (χ2 = 11.88 and 10.96, both P < 0.01). Conclusion Transvaginal ultrasound combined with 3.0T MRI may provide more diagnostic information for ectopic pregnancy, and is highly consistent with the clinical diagnostic results. In addition, transvaginal ultrasound combined with 3.0T MRI improves the diagnostic sensitivity and accuracy for ectopic pregnancy than transvaginal ultrasound alone.