SURGICAL DELIVERY OF LIVE FETUS IN BUFFALO SUFFERING FROM SECONDARY EXTRA-UTERINE PREGNANCY

Ectopic pregnancy located at pelvic wall and liver: Two uncommon case reports from Vietnam and mini-review literature

In recent years, ultrasound has become an essential tool in the assessment of women with suspected early pregnancy complications1. A large number of studies has already been published, describing the value of ultrasound in the diagnosis of ectopic pregnancy2,3. So, why write yet another review on this topic? We run a busy Early Pregnancy Unit in the area with the highest prevalence of ectopic pregnancy in the UK, which also receives many referrals from other hospitals of women with an uncertain diagnosis of ectopic pregnancy. The most interesting fact that we have learned over the years is that the majority of women referred with suspected ectopic pregnancies in fact had intrauterine ones that were either missed on ultrasound examination or misinterpreted as ectopics. This may sound surprising to many, as ultrasound diagnosis of intrauterine pregnancy is considered to be relatively simple and accurate. In many cases, ultrasound examination failed to identify a small amount of retained products of conception, due in part to inconsistencies in the sonographic diagnosis of incomplete miscarriage; this is often based on the use of arbitrary cut-off levels for endometrial thickness4. In other cases, however, sonographers were unable to decide whether a visible gestational sac represented an intrauterine or an ectopic pregnancy. In some cases with uncertain diagnosis, women had already received medical treatment with methotrexate prior to referral, leading to the loss of wanted normal intrauterine pregnancies. Another common problem is difficulty in differentiating between the various types of ectopic pregnancy. An accurate differential diagnosis is important in ectopics, as the management often differs depending on the type and exact location of the pregnancy. The purpose of this review is to summarize the sonographic criteria for the diagnosis of both intrauterine and ectopic pregnancies and to describe the principles of differential diagnosis of various types of ectopic pregnancy. We will not cover management of pregnancies of unknown location, as this issue has been covered extensively in recent publications5.

Cases of ectopic pregnancies in the ipsilateral fallopian tube after salpingectomy are rare. This report presents a unique case of an ectopic twin pregnancy that occurred in the residual isthmus of the ipsilateral fallopian tube after a prior salpingectomy for an ampullary tubal pregnancy. This case led to a live birth following a second ectopic pregnancy surgery.

Objective : To determine the prevalence rate, the major forms of ectopic pregnancy and to correct some of the inadequacies in filling of the laboratory forms. Materials and Methods : Relevant data on 91 ectopic pregnancy specimens received at the Lagos State University Teaching Hospital (LASUTH), Ikeja between May 1 2001 and 30 November 2004 were collected from the laboratory forms and analyzed. Results>/b>: A total of 91 ectopic pregnancy cases were received during the 3 year period. The total gynaecological and pregnancy-related specimens were 613 and 472 respectively. Ectopic pregnancy accounted for 14.4% of all the gynaecological and 19.28% of pregnancy-related specimens received in the laboratory. The ages of the patients presenting with ectopic pregnancies ranged from 17 to 36 years with the age group 25 – 29 years representing the highest percentage of 51.6%. The ages of the patient studied were not recorded in 62.2% of cases. 96.70% of the pregnancy specimens were tubal while ovarian occurred in 3.3% of cases. Each of the fallopian tubes had 50% chance of being involved. The sites of the tubal ectopic pregnancy were not specified in 73.2% of cases. A case of bilateral ectopic pregnancy was received. The tubes were recorded as having ruptured in 37.8% of cases. Results showed that lymphocytes are the commonest inflammatory cells seen in the fibro-muscular wall of the fallopian tubes. Conclusion : The rate of ectopic pregnancy is on the increase in Lagos(1). The high rate of tubal rupture associated with ectopic pregnancy can be reduced through the creation of better awareness of this condition in the society, as this will ensure early presentation and referral of cases to hospital. Doctors should be encouraged to fill the relevant portions of the laboratory forms correctly before sending specimens to the laboratories. Keywords : Ectopic pregnancy, Incidence rate, Histopathological laboratory forms Nigerian Journal of Health and Biomedical Sciences Vol. 5 (2) 2006: 79-82

Background: The incidence of hydatidiform mole is 1 per 1000 pregnancies (1a).The occurrence of hydatidiform mole in ruptured tubal pregnancy is rare and consequently not often considered as a diagnostic possibility.The present case is an unusual case of ectopic molar pregnancy that highlights the importance of histopathological examination in presumed cases of ectopic pregnancy. Case report: 27 years old female with an obstetric score of G3P2L1 (NVDs) presented with chief complaints of amenorrhea since one and half months with mild abdominal pain since 1 day. Urine pregnancy test was positive. Haemodynamically, the patient was stable with a pulse of 80beats/min and a blood pressure of 120/70mmHg. Soft abdomen with tenderness in the right lower abdomen. Vaginal examination revealed presence of enlarged uterus with right sided adnexal tenderness with tender cervical movements and slight vaginal bleeding. Routine haematological and biochemical examinations were within normal limits. Pelvic ultrasound confirmed presence of a ruptured right tubal ectopic pregnancy with moderate amount of free fluid in POD. The patient was treated surgically and histopathological examination revealed presence ectopic molar pregnancy. The patient was scheduled for close follow up and counseling to reduce progression to Choriocarcinoma. Conclusion: The case highlights the importance of HPE in presumed ectopic pregnancy cases undergoing surgical treatment in-order to diagnose ectopic molar gestations early and their subsequent post treatment surveillance.

Two embryos did not implant into the womb. A rare case of non-iatrogenic bilateral ectopic pregnancy (two-tailed tubal ectopic pregnancy) case report

BackgroundPregnancy begins with a fertilized ovum that normally attaches to the uterine endometrium. However, an ectopic pregnancy can occur when a fertilized egg implants and grows outside the uterine cavity. Tubal ectopic pregnancy is the most common type (over 95%), with ovarian, abdominal, cervical, broad ligament, and uterine cornual pregnancy being less common. As more cases of ectopic pregnancy are diagnosed and treated in the early stages, the survival rate and fertility retention significantly improve. However, complications of abdominal pregnancy can sometimes be life-threatening and have severe consequences.Case presentationWe present a case of intraperitoneal ectopic pregnancy with fetal survival. Ultrasound and magnetic resonance imaging showed a right cornual pregnancy with a secondary abdominal pregnancy. In September 2021, we performed an emergency laparotomy, along with additional procedures such as transurethral ureteroscopy, double J-stent placement, abdominal fetal removal, placentectomy, repair of the right uterine horn, and pelvic adhesiolysis, in the 29th week of pregnancy. During laparotomy, we diagnosed abdominal pregnancy secondary to a rudimentary uterine horn. The mother and her baby were discharged eight days and 41 days, respectively, after surgery.ConclusionsAbdominal pregnancy is a rare condition. The variable nature of ectopic pregnancy can cause delays in timely diagnosis, resulting in increased morbidity and mortality, especially in areas with inadequate medical and social services. A high index of suspicion, coupled with appropriate imaging studies, can help facilitate its diagnosis in any suspected case.

Hysterosalpingograms in cases of ectopic pregnancy

The aim of this study was to share our experience of clinical presentation and ultrasonographic findings in cases of ectopic pregnancy especially in the context of usage of unsupervised medical abortifacients. This is prospective study conducted over a period of 1year extending from August 01, 2009 to July 31, 2010 in a tertiary care Armed Forces Hospital of India. Clinically and or sonologically suspected cases of ectopic pregnancy formed the study group. Detailed clinical, menstrual, and treatment history was obtained for each patient. Ultrasonography (USG) was done with multifrequency convex (2.5-6MHz) followed by transvaginal (6-10MHz) probes. Operative findings were noted and recorded in each case. In the study period, a total of 1958 pregnant patients were admitted and treated, which included 1690 deliveries and 268 abortions. Based on USG findings, 16 cases (0.8%) of ectopic pregnancy were diagnosed. While four patients were treated medically (with methotrexate), 12 cases underwent surgery. Out of 16 cases, 10 cases were suspected clinically as ectopic pregnancy. Features suggestive of menorrhagia, threatened abortion, and pelvic inflammatory disease were present in five, three, and three cases, respectively. History of intake of medical abortifacients (MA) (mifepristone followed by misoprostol) was present in 07 (43.75%) cases. On USG, commonest abnormality was a complex adnexal mass seen in 12 (75%) cases. Gestational sac with definite embryo within and surrounding echogenic rim was seen in five cases. Live ectopic pregnancy was diagnosed in two (12.5%) cases. Endometrial thickness was less than 10mm in all cases who had taken MA. Pseudo gestation sac was seen in 02 (12.5%) cases. Significant hemoperitoneum was present in 10 out of 12 cases operated. Organized hematoma in pelvis masking the presence of adnexal mass was noted in three cases. Over-the-counter availability, failure to strictly follow the guidelines, unsupervised usage of MA along with atypical clinical history have increased diagnostic dilemma in ectopic pregnancy. Sonographic findings are frequently atypical in such cases. Ectopic pregnancy may remain under-diagnosed with potentially serious consequences in patients who have taken MA without prior confirmation of intrauterine gestation.

Surgical management of ectopic pregnancy in the morbidly obese patient safety and feasibility of laparoscopy

Background: Ectopic pregnancy mainly refers to tubal pregnancy and abdominal pregnancy. Tubal pregnancy presents as an implanted embryo that develops in the fallopian tubes, and is relatively common in humans. In animals, tubal pregnancy occurs primarily in primates, for example monkeys. The probability of a tubal pregnancy in non-primate animals is extremely low. Abdominal pregnancy is a type of ectopic pregnancy that occurs outside of the uterus, fallopian tube, ovary, and ligament(broad ligament, ovarian ligament, suspensory ligament).This paper describes two cases of ectopic pregnancy in cats.Cases: Cat 1. The presenting sign was a significant increase in abdominal circumference. The age and immune and sterilization status of the cat were unknown. On palpation, a 4 cm, rough, oval-shaped, hard mass was found in the posterior abdomen. Radiographic examination showed three high-density images in the posterior abdomen. The fetus was significantlycalcified and some feces was evident in the colon. The condition was preliminarily diagnosed as ectopic pregnancy. Cat 2. The owner of a 2-year-old British shorthair cat visited us because of a hard lump in the cat’s abdomen. The cat had a normal diet and was drinking normally. Routine immunization and insect repulsion had been implemented. The cat had naturally delivered five healthy kittens two months previous. Radiographs showed an oval-shaped mass with a clear edge in the middle abdominal cavity. Other examinations were normal. The case was preliminarily diagnosed as ectopic pregnancy, and the pregnancy was surgically terminated. The ectopic pregnancies were surgically terminated. During surgery, the structures of the uterus and ovary of cat 1 were found to be intact and the organs were in a normal physiological position.Cat 1 was diagnosed with primary abdominal pregnancy. In cat 2, the uterus left side was small and the fallopian tube on the same side was both enlarged and longer than normal. Immature fetuses were found in the gestational sac. Thus, cat 2 was diagnosed with tubal ectopic pregnancy based on the presenting pathology.Discussion: Cats with ectopic pregnancies generally show no obvious clinical symptoms. The ectopic fetus can remain within the body for several months or even years. Occasionally, necrotic ectopic tissues or mechanical stimulation of the ectopic fetus can lead to a systemic inflammatory response, loss of appetite, and apathy. The two cats in our reportshowed no significant clinical symptoms. To our knowledge, there have been no previous reports of the development of an ectopic fetus to maturity, within the abdominal cavity of felines, because the placenta of cats cannot support the growth and development of the fetus outside of the uterus. Secondary abdominal ectopic pregnancy, lacking any signs of uterine rupture is likely associated with the strong regenerative ability of uterine muscles. A damaged uterus or fallopian tube can quickly recover and rarely leaves scar tissue. In the present report, cat 1 showed no apparent scar tissue, nor signs of a ruptured ovary or fallopian tubes. It was diagnosed with primary ectopic abdominal pregnancy, which could arise from the descent of the fertilized egg from the fallopian tube into the abdominal cavity. There was an abnormal protrusion in left of the fallopian tubes in cat 2, to which the gestational sac was directly connected. Based on pathological examination of the uterus, fallopian tubes, and gestational sac, the cat was diagnosed with a tubal pregnancy. Placental tissues and signs of fetal calcification were observed in both the fallopian tube and gestational sac.Keywords: tubal pregnancy, abdominal pregnancy, feline, ectopic fetus, fallopian tube, gestational sac.

The use of serum human chorionic gonadotropin (hCG) and progesterone to identify patients with ectopic pregnancy (EP) has been shown to have poor clinical utility. Pregnancy-associated circulating microRNAs (miRNAs) have been proposed as potential biomarkers for the diagnosis of pregnancy-associated complications. This proof-of-concept study examined the diagnostic accuracy of various miRNAs to detect EP in an emergency department (ED) setting. This study was a retrospective case-control analysis of 89 women who presented to the ED with vaginal bleeding and/or abdominal pain/cramping and received a diagnosis of viable intrauterine pregnancy (VIP), spontaneous abortion (SA), or EP. Serum hCG and progesterone concentrations were measured by immunoassays. The serum concentrations of miRNAs miR-323-3p, miR-517a, miR-519d, and miR-525-3p were measured with TaqMan real-time PCR. Statistical analysis was performed to determine the clinical utility of these biomarkers, both as single markers and as multimarker panels for EP. Concentrations of serum hCG, progesterone, miR-517a, miR-519d, and miR-525-3p were significantly lower in EP and SA cases than in VIP cases (P < 0.01). In contrast, the concentration of miR-323-3p was significantly increased in EP cases, compared with SA and VIP cases (P < 0.01). As a single marker, miR-323-3p had the highest sensitivity of 37.0% (at a fixed specificity of 90%). In comparison, the combined panel of hCG, progesterone, and miR-323-3p yielded the highest sensitivity (77.8%, at a fixed specificity of 90%). A stepwise analysis that used hCG first, added progesterone, and then added miR-323-3p yielded a 96.3% sensitivity and a 72.6% specificity. Pregnancy-associated miRNAs, especially miR-323-3p, added substantial diagnostic accuracy to a panel including hCG and progesterone for the diagnosis of EP.

BackgroundSurveillance of ectopic pregnancy (EP) using electronic databases is important. To our knowledge, no published study has assessed the validity of EP case ascertainment using electronic health records.ObjectiveWe aimed to assess the validity of an enhanced version of a previously validated algorithm, which used a combination of encounters with EP-related diagnostic/procedure codes and methotrexate injections.MethodsMedical records of 500 women aged 15-44 years with membership at Kaiser Permanente Southern and Northern California between 2009 and 2018 and a potential EP were randomly selected for chart review, and true cases were identified. The enhanced algorithm included diagnostic/procedure codes from the International Classification of Diseases, Tenth Revision, used telephone appointment visits, and excluded cases with only abdominal EP diagnosis codes. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall performance (Youden index and F-score) of the algorithm were evaluated and compared to the validated algorithm.ResultsThere were 334 true positive and 166 true negative EP cases with available records. True positive and true negative EP cases did not differ significantly according to maternal age, race/ethnicity, and smoking status. EP cases with only one encounter and non-tubal EPs were more likely to be misclassified. The sensitivity, specificity, PPV, and NPV of the enhanced algorithm for EP were 97.6%, 84.9%, 92.9%, and 94.6%, respectively. The Youden index and F-score were 82.5% and 95.2%, respectively. The sensitivity and NPV were lower for the previously published algorithm at 94.3% and 88.1%, respectively. The sensitivity of surgical procedure codes from electronic chart abstraction to correctly identify surgical management was 91.9%. The overall accuracy, defined as the percentage of EP cases with correct management (surgical, medical, and unclassified) identified by electronic chart abstraction, was 92.3%.ConclusionsThe performance of the enhanced algorithm for EP case ascertainment in integrated health care databases is adequate to allow for use in future epidemiological studies. Use of this algorithm will likely result in better capture of true EP cases than the previously validated algorithm.

Objective To assess the utility of preoperative magnetic resonance imaging (MRI) in the diagnosis of tubal pregnancy. Summary of background data Most cases of ectopic pregnancy are tubal pregnancies. Preoperative accurate diagnosis including the location of the tubal pregnancy is important. Method We performed a retrospective single-center cohort study evaluating patients who underwent surgery for ectopic pregnancy from April 2004 to March 2016 and who underwent preoperative MRI. Sixty patients were enrolled in the study. Chorion confirmed at the tubal pregnancy site detected by MRI was defined as a correct diagnosis. Results Mean estimated gestational age at the time of MRI according to the last menstrual period was 7 weeks (median: 5 weeks; range: 3–10 weeks). Ectopic pregnancy was diagnosed by MRI in 57 cases, and all cases were either left or right tubal pregnancy. In 52 cases, the actual position matched the MRI findings. In 5 cases, the location of tubal ectopic pregnancy was different from that diagnosed by MRI, or no tubal pregnancy was observed intraoperatively. In 2 cases, no ectopic pregnancy site was observed on MRI, but tubal pregnancy was confirmed by surgery. In one case, an ectopic pregnancy site was not found, and the tube showed normal findings on MRI. The sensitivity of MRI diagnosis was 96.2%, specificity was 16.7%, positive predictive value was 91.1%, and negative predictive value was 33.3%. Conclusion In cases of ectopic pregnancy treated surgically, the sensitivity of MRI diagnosis, including identification of the location of ectopic pregnancy, is high.

With the increase in incidence of ectopic pregnancy over the decades, bilateral ectopic pregnancy is also increasing. It is usually associated with assisted reproductive techniques (ART) but in recent years few cases of spontaneous bilateral ectopic pregnancy have been reported. Gynaecologists should be aware of this and that ultrasonography has limitations in diagnosis. In cases of ectopic pregnancy where contralateral adnexa is not clearly identified on ultrasound and fertility needs to be conserved, patient should be managed by experts in well equipped centres. A case of spontaneous bilateral tubal pregnancy that remained undiagnosed till laparotomy, is described.