A life-threatening condition—ruptured ectopic pregnancy with negative urine pregnancy test: A case report

@#Ectopic pregnancy is an extra-uterine pregnancy and is a potentially life-threatening condition that can lead to death from intra-peritoneal hemorrhage. This case reports a rare occurrence of ruptured tubal pregnancy in which the patient presented early with abdominal pain and a negative urine pregnancy test but subsequently presented again with evidence of intra-peritoneal hemorrhage. A negative urine pregnancy test is often used to rule out pregnancy, but it is not 100% sensitive. Complete assessment is critical in this important diagnosis in order to plan for the appropriate emergency management.

Incidental finding of thoracic outlet syndrome in a case of right tubal ruptured ectopic pregnancy

A 30-year-old woman, (multigravida) suffering from lower abdominal pain and slight vaginal bleeding was transferred to our hospital. She came with a pelvic ultrasound report. The provisional diagnosis of right tubal ectopic pregnancy was made. A laparotomy was carried out. Intraoperatively, blood pressure in both the arms were taken which revealed different blood pressure in different arms. A diagnosis of thoracic outlet syndrome was made. No postoperative complications were observed.

An analysis of tubal ectopic pregnancy in a rural tertiary care hospital in India: a retrospective study

Background: The objective of this study was to analyse distribution of predisposing risk factors for ectopic pregnancy and to study the various modalities of management instituted along with surgical characteristics.Methods: This is a retrospective data analysis of tubal ectopic pregnancies (EP) managed in a tertiary rural referral centre over three years.Results: A total of 160 women were managed for tubal EP. Majority of the women belonged to the age group of 21-30 years (73%). Multigravidae constituted 71.3% of the women and overall, 90.6% women conceived spontaneously. History of ovulation induction was present in 3.7% of women, IUI in 1.2% and IVF in 4.4%. Risk factors encountered in the study include previous EP (9.4%), history of tubal sterilisation (6.9%), caesarean section (13.1%), PID (7.5%), miscarriage (25%), tubal recanalization (3.7%). Conservative management was instituted in 16.8%. Amongst the women managed surgically, 67.5% underwent laparotomy with the remaining being managed laparoscopically. Of the surgically managed patients 72.9% had ruptured EP. There was a predominance of right sided ectopic in our study (79%) and ampullary region of the fallopian tube was the most common site of tubal EP (81.2%). The most common procedure performed was total salpingectomy (56.4%). Supportive treatment with blood transfusion was required amongst 18.8% of the women who had EP. In the postoperative period, fever was noted in 13.5% of women and 2.5% needed intensive care unit admission for hemodynamic stabilisation. The incidence of wound discharge was 12% of women who underwent surgery.Conclusions: This study underpins the importance of early diagnosis, appropriate clinical managementwith timely intervention to improve outcomes associated with EP and to prevent severe morbidity and mortality.

Study of diagnosis and management of ectopic pregnancy

Background: Diagnosis of ectopic pregnancy was frequently missed. Aim of the study was to determine the clinical presentation, and treatment associated with ectopic pregnancy.Methods: This is a prospective study which was carried out at Obstetrics and Gynaecology department, GMERS SOLA civil hospital from August 2017 to October 2018. Total 416 patients were admitted during study period out of them 50 patients diagnosed with ectopic pregnancy were enrolled in the study and information was collected and analysed.Results: 80% patients were between the age group of 21-30 years. 56% patients were nulliparous. Amenorrhea (92%) with lower abdominal pain (94%) is the most common presenting symptom. 26% of patients show typical triad of amenorrhea, abdominal pain and bleeding per vagina. UPT and USG were most commonly performed investigations. 96% cases showed UPT positive. 100% USG showed adnexal pathology. Serum beta-hCG was done in 37 patients as an aid for diagnosis and to decide the line of management. Conservative medical management with Injection MTX was done in 4 patients of which 1 patients required laparotomy later on. Surgical management was done in 90% of patients. Laparoscopic management was done in 54% of cases.Conclusions: Early diagnosis and timely intervention in the form of conservative or surgical treatment will help in reducing the morbidity and mortality associated with ectopic pregnancy.

Cornual Pregnancy: A Case Report.

Ectopic pregnancy is a condition where gestation sac is located outside the uterine cavity; it is a major life threatening situation in early pregnancy. A cornual pregnancy is an ectopic pregnancy that develops in the interstitial portion of the fallopian tube invading through the uterine wall. As myometrium is more distensible fallopian tube cornual pregnancies often rupture later than other tubal pregnancies. Cornual pregnancy is rare and carries grave consequences to both mother and fetus. Here a case report has been presented where the patient was admitted in Faridpur Medical College Hospital. The case was presented with intra-abdominal haemorrhage at second trimester. In this cases investigation missed the diagnosis, final diagnosis was only made after laparotomy. The need for clinical suspicion and role of ultrasonography, resuscitation and laparotomy is necessary to prevent catastrophe

Pregnancy Following Laparotomy for Ruptured Interstitial Pregnancy.

An interstitial pregnancy is an uncommon type of ectopic pregnancy, accounting for 2-4% of all ectopic pregnancies. We present a patient with history of ruptured interstitial pregnancy who had been managed successfully at our hospital. The patient had refused tubectomy and conceived against medical advice within six months after laparotomy. She was counseled for risk of rupture of uterus and admitted to the hospital at the beginning of 9th month. She underwent an elective cesarean section and a male baby was delivered. Palpation of the uterine scar revealed that it was papery thin. Had there been any delay, the uterus would have ruptured with resultant maternal and fetal morbidity and mortality.

Death due to ruptured ectopic pregnancy natural death or negligence.

A young adult female of low socio-economic status, and a labourer by profession, was brought dead to the Government Medical College & hospital, Chandigarh. History provided by her husband revealed that she had pain abdomen for the last five days for which she was getting treatment from a private practitioner. She had been prescribed NSAIDs and antispasmodics for the same. However, she was not investigated upon and no attempt was made by the practitioner to arrive at any diagnosis. The autopsy was conducted on the next day and at autopsy, about two-and-a-half liters of blood was present in the abdomen and pelvic cavity. Careful internal examination revealed a ruptured ectopic pregnancy as the source of bleeding. The case is discussed with regard to establishing whether the death could have been natural, due to the negligence of the treating doctor or due to contributory negligence. However, even in cases of contributory negligence, the “last chance doctrine” may not save the physician.

Ruptured Ectopic Hepatocellular Carcinoma Arising from the Left Subdiaphragm

Most hepatocellular carcinomas arise in orthotopic liver tissue as a result of chronic hepatitis B or C infection or cirrhosis secondary to other chronic liver disease. There have been reports of ectopic liver tissue located in an extrahepatic organ such as the gallbladder, spleen, hepatoduodenal ligament and subdiaphragm. However, the incidence of hepatocellular carcinoma originating from ectopic liver is very low. There have been 22 cases of ectopic HCCs (hepatocellular carcinoma) reported in the literature, and ruptured HCC has not yet been reported in the literature. As for the pathogenesis, the development of an ectopic HCC may be result of a compromised vascular supply or biliary drainage. We report here on a case of ruptured ectopic hepatocellular carcinoma arising in the left subdiaphragm in a 76-year-old man who was treated with surgical resection. The patient was followed up for 1 year after surgery and he remained free of recurrence. Therefore, the unique localization and growth pattern of ruptured ectopic HCC may give the physician and patient the chance to achieve a curative resection.