Multiple Spontaneous Ectopic Pregnancies Following Bilateral Salpingectomy.

Introduction: Ectopic pregnancy (EP) is a significant cause of gynaecological morbidity and mortality. Salpingectomy is the preferred management modality in recurrent ectopic pregnancies; although they do not eliminate the risk of reoccurrence. The aetiology of recurrent ectopic pregnancies remains unknown but there are identifiable risk factors associated with increased likelihood of occurrence. Case Presentation: We present the case of a 30-year-old woman who attended the emergency unit with her second spontaneous ectopic pregnancy following a previous bilateral salpingectomy. She had prior multiple spontaneous ectopic pregnancies: laparoscopic salpingectomy for a left cornual EP in 2017 followed by laparotomic salpingectomy for a ruptured right EP after failed medical management in 2018. Lastly, she had laparoscopic removal of an EP sac in the scar of a previous left cornual EP in 2019. She presented with a history of missed periods, pelvic pain, and vaginal spotting. Her examination revealed left lower abdominal pain, soft, non-tender abdomen, and no cervical excitation. Pelvic ultrasound revealed a thin endometrium and no intrauterine pregnancy visualised. A suspicious complex mass near the left ovary with a ring-like structure was noted. Her ß-HCG was (251 IU/L) which plateaued after 48 hrs (220 IU/L). She responded well to methotrexate with no need for surgical intervention this time. Conclusion: This case is unique as it highlights the importance of keeping an open mind when managing recurrent ectopic pregnancies, especially when preventative surgical measures have been performed previously.

Surgical treatment of pelvic organ prolapse using colpocleisis: A case series.

Objective: Pelvic organ prolapse (POP) is a common condition. With increasing lifespan and emphasis on quality of life worldwide, older women with POP may prefer surgical treatment, including colpocleisis. We reviewed the outcome of POP in a case series of colpocleisis. Methods: This study was conducted between 2006 and 2011. Patients had confirmed POP on examination and underwent partial and total colpocleisis. We compared patients' demographic characteristics, POP severity and surgical outcomes. Results: In total, 55 patients were included. The patients were aged 78.9 + 6.7 years and had body mass index (BMI) of 26.9 ± 4.2. Among the total, 44 (80%) and 11 patients (20%) underwent partial and total colpocleisis respectively. Patients undergoing partial colpocleisis had procidentia less often than those undergoing total colpocleisis (18% v 64%, p=0.01). Mean blood loss and operative time were 157.6 ml ± 119.0 and 65.1 ± 20.3 minutes respectively. Partial colpocleisis had less blood loss (mean 135.7 v 227.2 ml, p=0.02) and shorter operative time (mean 62.6 v 75.0 min, p=0.18). Conclusion: Partial compared to total colpocleisis was associated with shorter operative time and less blood loss. Colpocleisis is a suitable surgical treatment for POP in elderly women who do not wish to preserve the vagina for sexual intercourse.

Maternal and perinatal outcomes in women conceiving after bariatric surgery: A cohort study.

Obesity in women, a global issue, is being widely managed with bariatric surgery worldwide. According to recommended guidelines, pregnancy should be avoided for 12 to 24 months following surgery due to various risks. We assessed if surgery-to-conception time has a relation with pregnancy outcomes taking into account gestational weight gain. A cohort study between 2015 and 2019 followed-up pregnancies after various types of bariatric surgeries performed (e.g. Roux-en-Y gastric bypass, sleeve gastrectomy, gastric banding, gastric bypass with Roux-en-Y gastroenterostomy) in Tawam Hospital, Al Ain, United Arab Emirates. There were 5 surgery-to-conception groups: <6 months, 6 to 12 months, 13 to 18 months, 19 to 24 months, and >24 months. There were 3 gestational weight gain groups: inadequate, adequate, or excessive (based on the National Academy of Medicine classification). Maternal and neonatal outcomes were compared using analysis of variance and chi-square tests. There were 158 pregnancies. Booking maternal body mass index and weight were higher among mothers who conceived <6 months following surgery (P < .001). Gestational weight gain was not related to the type of bariatric surgery (P = .24), but it was far more often inadequate in mothers who conceived <12 months following surgery (P = .002). Maternal (including pregnancy-induced hypertension and gestational diabetes mellitus) and neonatal outcomes were not statistically significantly associated with surgery-to-conception duration. However, birth weight was lower when gestational weight gain was inadequate (P = .03). There is a negative relationship between shorter bariatric surgery-to-conception interval and gestational weight gain, a feature related to neonatal birth weight. Conception should be delayed to improve pregnancy outcomes following bariatric surgery.

Gynaecologists' views on the management of Vaginal Vault Prolapse: A qualitative study.

Objective: This study examined gynaecologists' experience and views on the management of vaginal vault prolapse (VVP) using laproscopic sarcocolpopexy (LSCP) versus open sarcocolpopexy (OSCP). Methods: In a qualitative study conducted at the University of Surrey and Homerton University Hospital, UK, from 2016 to 2017, semi-structured interviews were conducted with 15 consultants experienced in minimal access surgery or urogynecology. Interviews were recorded and transcripts were analyzed using the qualitative description (QD) approach. Results: Eight broad themes emerged: VVP management, LSCP for management of VVP, OSCP and vaginal surgery with or without mesh use in VVP management, laparoscopic training and support as well as surgeons' attitude towards LSCP. All participants acknowledged the importance of LSCP in the management of post-hysterectomy VVP as benefits outweighed risks in their view. OSCP was considered suitable in very specific circumstances. Vaginal surgery could be an excellent alternative to OSCP bearing in mind long-term efficacy and sexual activity in young women. Most participants agreed with national recommendations to avoid use of mesh in vaginal surgery for VVP and expressed the view that it should be done in specialised centres by trained surgeons who do such operations. Conclusions: This study showed that the acceptability of LSCP was dependent on participants' experience and consideration of the balance between patient's goals and potential risks. It provides useful guidance for future large-scale projects.