ABSTRACT
Ectopic pregnancy remains an important cause of morbidity and mortality in women of childbearing age. We report a case of a unilateral twin ectopic pregnancy in a fallopian tube remnant after previous ipsilateral salpingectomy. The pregnancy was conceived spontaneously and included two live gestations. Although the presentation of this ectopic pregnancy was unique, the patient's risk factors were not. As an example of the type of patient who would benefit from ultrasound screening for ectopic pregnancy, our patient renews the debate around this controversial issue.
Subject(s)
Postoperative Complications/diagnostic imaging , Pregnancy, Tubal/diagnostic imaging , Pregnancy, Twin , Salpingectomy , Adult , Female , Humans , Pregnancy , Pregnancy, Tubal/etiology , Recurrence , UltrasonographyABSTRACT
Essure sterilization produces a local benign tissue response resulting in bilateral occlusion of the fallopian tubes 3 months after insertion. There is a precautionary warning about performing this procedure on immunosuppressed patients. We present a case of successful bilateral tubal occlusion with Essure in a patient with a history of kidney transplantation and receiving immunosuppressive medications.
Subject(s)
Hysteroscopy/methods , Immunocompromised Host , Immunosuppressive Agents/therapeutic use , Kidney Transplantation/immunology , Sterilization, Tubal/methods , Adult , Female , Humans , Treatment OutcomeABSTRACT
OBJECTIVE: To evaluate limitations of the fetal anatomic survey in obese women. METHODS: Retrospective cohort study of obese gravidas with singleton gestations who had at least one, sonographic fetal evaluation at ≥ 14 weeks between January 2009 and March 2011. The impact of pre-pregnancy body mass index (BMI), placental location, prior cesarean scar and sonographer experience on ability to achieve an adequate ultrasound was evaluated using multilevel modeling. Ability to visualize specific fetal parts by BMI class and gestational age was also evaluated. RESULTS: There were 245 obese women (42% with class III obesity). Senior faculty (>20 years experience) were more likely to achieve adequate visualization (adjusted odds ratio [aOR] 3.27; 95% confidence interval [CI] 1.15-9.25) compared with junior faculty. Among women with BMI > 40.0, odds of inadequate views of the face and spine were 10.0 (95% CI 1.31-76.0) and 5.17 (95% CI 0.65-40.8), when compared with women with a BMI = 30-34.9. Odds for inadequate views of sex (OR 3.83; 95% CI 0.86-17.1) and extremities (OR 4.37; 95% CI 0.99-19.4) were similarly increased with a BMI ≥ 40. The optimal gestational age for a complete anatomic survey was 22-24 weeks (93% completion rate), with an OR of 41.3 (95% CI 7.89-215.8), compared with a survey at 14-16 weeks. CONCLUSIONS: Attending sonographer experience is associated with improved visualization of fetal anatomy among obese gravidas. Face, spine, sex and extremity views are particularly difficult in the highest BMI category.
