Clinical analysis of 50 patients with heterotopic pregnancy after ovulation induction or embryo transfer.

OBJECTIVES: The purpose of this study was to evaluate the clinical characteristics, prenatal diagnosis, and management of patients with heterotopic pregnancy after ovulation induction or embryo transfer. METHODS: This was a retrospective study of fifty cases with heterotopic pregnancy, in which the fertilization way, type and number of embryo transferred, gestational age, clinical presentation and outcome of intrauterine, ultrasound presentation and site of ectopic pregnancy, bilateral fallopian tube and treatment were evaluated. RESULTS: Six patients had spontaneous pregnancy and two had artificial insemination after ovulation induction. Sixteen had fresh and nineteen had frozen embryo transfer with seven patients unrecorded its embryo type and number. The average days from transplantation (or intercourse/insemination) to diagnosing heterotopic pregnancy was thirty-seven with the earliest eighteen and the latest more than 70 days. Although the most common presentation was vaginal bleeding or abdominal pain, more than 21% was found by ultrasound and rare individuals even presented with gastrointestinal symptom which may imply ruptured EP and hemorrhagic shock. Giving proper treatment (surgery or local drug injection), the majority of them had a successful intrauterine pregnancy with only seven miscarried. CONCLUSIONS: Ovulation induction or embryo transfer increased the risk of HP greatly and clinician should raise high suspicious during the whole first trimester. Although the most ectopic site was ampullary, other sites such as cornual, cervical, abdominal especially interstitial or tubal stumps should also be assessed by ultrasound even in patients with bilateral salpingectomy or tubal obstructed. Repeated ultrasound tests 2 weeks after the diagnosis of intrauterine pregnancy with heart beating was very necessary to find the missed ones in suspicious patients. Compared with surgery, embryo suction with or without proper local drug injection would be more advisable for patients with cervical, cornual, or interstitial pregnancy in order to reserve the intrauterine pregnancy.

Retrospective case study of fetal mummification in cows that did not respond to prostaglandin F2alpha treatment.

Mummification of bovine fetuses is an uncommon condition, and cows do not always respond to treatment with prostaglandin F2alpha. The objective of the present retrospective and descriptive case study was to determine the conception rate and survival time of nonresponsive, prostaglandin F2alpha (PGF2alpha)-treated cows (n = 14), following hysterotomy or medical treatment and manual removal. Animal records from 1990 to 2005 from the Centre Hospitalier Universitaire Vétérinaire (CHUV) of the Université de Montréal were studied. Inclusion criteria were the nonexpulsion of the mummified fetus following PF2alpha treatment and absence of concomitant conditions upon physical examination. Of the animals included in the study, 36% (n = 5) became pregnant after extraction of the mummified fetus by hysterotomy and 0% conceived after medical treatment and manual extraction. In this study, hysterotomy represented an effective approach for extracting mummified fetuses from cows that did not respond to PF2alpha treatment.

[Surgical and conservative methods for removing mummified fetuses in cattle]. / Chirurgische und konservative Methode zur Entfernung von abgestorbenen Feten beim Rind.

The purpose of this study was to describe the findings and therapy in 4 cows and 1 heifer with mummified fetus. All animals were admitted at the clinic after several unsuccessful therapies with prostaglandin F2alpha and local uterine infusions. All animals were in good condition. In case 1, diagnosis of mummified fetus could not be confirmed after manual rectal palpation and ultrasonography whereas cases 2, 4, 5 all had mummified fetus. In case 3, the fetus was in maceration. Initial therapy consisted of administration of prostaglandin F2alpha and prostaglandin E2 followed by repeated administration of prostaglandin E2. Mummies (length from apex to rump 13-32 cm) could be taken out within 3 to 6 days per vias naturales in cases 2, 4, 5 and in case 3, bones (maximal length 4 cm) could be unhinged. The structure in the uterus of case 1 could not be mobilised and was consequently removed under sight control using colpotomy followed by hysterotomy. Animals 2, 3, 4 and 5 were pregnant on the occasion of telephone inquiry. On the basis of our results, we recommend the conservative medical therapy with PGE2 for cases of mummified fetus. Colpotomy and hysterotomy are reserved as therapy feasible if the use of prostaglandin E2 is not successful.

A modified method for complete bovine fetotomy.

A modification of the "Utrecht technique" for complete bovine fetotomy was developed. In cranial presentation, the first step is decapitation, then oblique indirect section through the neck and thorax to remove 1 forelimb with a small part of the thoracic wall. This is followed by thoracic and abdominal evisceration. The final step is direct oblique section of the fetal pelvis or, alternatively, deep detruncation followed by bisection of the pelvis. In caudal presentation, the first step is removal of a hindlimb, then abdominal and thoracic evisceration, followed by thoracic detruncation and oblique section for removal of 1 forelimb and most of the remaining thorax. The neck and remaining forelimb are removed together to complete the procedure.