Case Of Ectopic Pregnancy Research Articles

Clinical and Histopathological Findings of Ectopic Pregnancy Cases- A Retrospective Study from a Tertiary Care Hospital, Andhra Pradesh, India

Introduction: Ectopic Pregnancy (EP) is defined as a pregnancy that occurs in ectopic location, that is, outside the cavity of uterus. It is one of the leading causes of mortality in the first trimester of pregnancy and one of indication for emergency laparotomy. Timely diagnosis is extremely crucial as delay in diagnosis can lead to mortality. Diagnosing ectopic pregnancy is quiet challenging as there are many conditions which have similar presentation and may not require surgical management. Histopathology is required for confirmation of ectopic pregnancy by identifying trophoblastic tissue in ectopic location since there are other conditions like haematosalpinx, ruptured hemorrhagic corpus luteum which can have similar presentation clinically. Aim: To analyse the clinicopathological features of cases clinically diagnosed as ectopic pregnancy and estimate the percentage of cases which were confirmed on histopathology and assess the percentage of cases which were negative on histopathology. Materials and Methods: This was a retrospective observational study conducted on three years data collected retrospectively between July 2017 and June 2020. Clinical details like age of the patient, parity, gestational age, previous history of any associated risk factors for ectopic pregnancy, were obtained from patient requisition forms and pathology records. Hematoxylin and Eosin (H & E) stained sections were reviewed. Descriptive analysis was done. Data entry was made in Microsoft (MS) excel sheet. Frequencies and percentages were calculated. Results: Total of 128 cases (mean age 25.8±4.87 years) data was analysed in this study, most women were between 21 to 30 years (97 out of 128 (75.7%), with mean age of 25.8 years and presented in 2nd pregnancy (40 out of 86 cases where details were known (46.5%) and in 6th week of gestation (28 out of 78 cases where details were known) (35.8%)) with mean gestational age of 7.2 weeks. Most common risk factors were previous abortions and previous caesarean section (36 out of 82 cases where details were known (43.9% each)). Fallopian tube was the most common site (112 out of 113 cases, 99.1%). On histopathological examination, trophoblastic tissue was identified in 116 cases out of 128 cases. (90.6%). Twelve cases showed no evidence of trophoblastic tissues (11.7%), of these, three cases (25%) showed ruptured corpus luteum, seven cases (40%) showed hematosalpinx, and two cases (13.3%) showed chronic salpingitis changes. Conclusion: Ectopic pregnancy was most frequent in women between 21 to 30 years, in 2nd pregnancy and in 6th week of gestation. Most common risk factors were previous abortions and previous caesarean section. Fallopian tube was the most common site. Ectopic pregnancy was confirmed on histopathological examination, 90.6% cases. A total of 11.7% cases which showed no evidence of trophoblastic tissues, were cases of Haematosalpinx, ruptured hemorrhagic corpus luteum and chronic salpingitis and they presented clinically as ectopic pregnancy.

Diagnosis and management of ectopic ovarian pregnancy: a rare case report.

IntroductionOvarian pregnancy is a rare form of ectopic pregnancy. Its incidence is 0.5% to 1% of all ectopic gestations, or 1 in 7000 to 40,000 live births. The diagnosis is intricate and based on surgical and histopathological observations.Traditional risk factors for ovarian ectopic pregnancy are similar to those for tubal pregnancy, but use of an IUD seems to be disproportionately associated.Case reportWe report a rare case of spontaneous ectopic ovarian pregnancy of a 40-year-old woman, diagnosed with a ovarian pregnancy by ultrasound and treated by laparotomy in emergency obstetrical department of Ibn Rochd University Hospital of Casablanca.Clinical discussionOvarian ectopic pregnancies occur through fertilization of an egg retained in the peritoneal cavity leading to implantation on the surface of the ovary.The increased incidence of ovarian ectopic pregnancies is associated with the increased use of artificial reproductive technologies (ART) and intrauterine contraceptive devices (IUCDs).The diagnosis is difficult and a constant challenge for the gynecologist.Its management remains surgical therapy despite the progress in medical treatment.ConclusionOvarian pregnancy is a rare entity that has some special features. Its diagnosis is difficult and relies on criteria based on intraoperative findings. Its management remains surgical therapy despite the progress in medical treatment.

Sonographic Evaluation of Ectopic Pregnancies

This study was carried out in the Radiology Department, District Head Quarter Teaching Hospital (D.H. Qr) and Dera X-Rays / Ultrasound Clinic. Dera Ismail Khan, NWFP, by performing abdominal and pelvic ultrasonography of all the suspected patients and endo-vaginal of selected cases by comparing with other modalities used for the diagnosis of pregnancy especially the ectopic. Eighty-five percent cases of ectopic pregnancies were diagnosed by abdominal / pelvic ultrasonography, while this ratio was increased up to 95% by endo-vaginal ultrasonography in those cases where the abdominal sonography was not helpful for accurate diagnosis. The study concluded that increased availability of ultrasonography leads to improve quality in the detection of ectopic pregnancy. It is necessary to screen all the patients with first trimester cramping and bleeding by ultrasonography.

A case of secondary abdominal ectopic pregnancy in a bitch

AbstractCases of ectopic pregnancy (EP) and associated fetal mumification in bitches have been rarely reported. In this case report, it was aimed to present a case of secondary abdominal EP diagnosed in a 3‐year‐old bitch. Abdominal EP was incidentally diagnosed by radiographic examination of the bitch, which had a traffic accident, for likely possible fractures in the body. This case, which can be classified as secondary abdominal EP, was found to be compatible with the literature. The ectopic fetuses were removed from the body by surgical method, and the bitch was fully recovered.

Surveillance Program of Romiplostim Use Connected to Pregnancy

Surveillance Program of Romiplostim Use Connected to Pregnancy

Variance in clinical presentation of Ectopic pregnancy

Objective: To adjudge the prevalence of distinct presentations in ectopic pregnancy. Research Design: Descriptive cross-sectional. Place and Duration of Study: Emergency Labour Ward Department of Obstetrics & Gynecology, Nishtar Hospital Multan from 1.07.2017 to 31.12.2017. Methodology: Ninety five patients having positive pregnancy tests and uterine cavity with no intrauterine gestational sac on ultrasound were included. Clinical presentation like amenorrhea, vaginal bleeding, acute abdomen, shock or asymptomatic were assessed. Results: Amenorrhea observed in 73(76.8%) women, vaginal bleeding was seen in 32 (33.7%) women, 88 (92.6%) patients presented with acute abdomen and vitals instability was seen in 8 (8.4%) patients and 6(6.3%) patients were without symptoms. Conclusion: The two most common clinical presentations in patients included in study were amenorrhea and acute abdomen. Thorough evaluation of the patients with sub-acute or chronic presentation should be adopted to diagnose the cases of ectopic pregnancy. Key words: Ectopic pregnancy; Clinical presentation; Variations

A case of pregnancy in the free abdomen

Cases of ectopic pregnancy in the free abdominal cavity are extremely rare (according to A.D. Alovsky - 0.4%). The diagnosis of pregnancy in the free abdominal cavity is very difficult. The diagnosis is more often made at the operating table. In the light of these facts, the case of abdominal pregnancy observed by us is of interest.

3D Ultrasound Preoperative Planning for a Laparoscopic Cornual Wedge Resection

Study Objective The objective of this study was to investigate the role of three-dimensional (3D) ultrasound in preoperative diagnosis and planning for a laparoscopic cornual wedge resection for an interstitial ectopic pregnancy. Design Video case report. Setting Operating room, patient positioned in dorsal lithotomy with Allen stirrups. The case was completed laparoscopically after direct entry in the left upper quadrant, due to the presence of umbilical mesh. Patients or Participants One patient who presented with an interstitial ectopic pregnancy. Interventions 3D ultrasound and a laparoscopic cornual wedge resection. Measurements and Main Results 3D ultrasound was able to quickly diagnose an interstitial ectopic pregnancy. 3D ultrasound was also useful in preoperative planning for a laparoscopic cornual wedge resection. Conclusion Interstitial ectopic pregnancies are difficult to diagnose, frequently requiring MRI for preoperative planning. 3D ultrasound is a promising modality for expedited and accurate diagnosis of interstitial ectopic pregnancies, especially when urgent surgery is indicated. We present a case of an interstitial ectopic pregnancy diagnosed with 3D ultrasound, that was ultimately successfully treated with a laparoscopic cornual wedge resection without complication. The objective of this study was to investigate the role of three-dimensional (3D) ultrasound in preoperative diagnosis and planning for a laparoscopic cornual wedge resection for an interstitial ectopic pregnancy. Video case report. Operating room, patient positioned in dorsal lithotomy with Allen stirrups. The case was completed laparoscopically after direct entry in the left upper quadrant, due to the presence of umbilical mesh. One patient who presented with an interstitial ectopic pregnancy. 3D ultrasound and a laparoscopic cornual wedge resection. 3D ultrasound was able to quickly diagnose an interstitial ectopic pregnancy. 3D ultrasound was also useful in preoperative planning for a laparoscopic cornual wedge resection. Interstitial ectopic pregnancies are difficult to diagnose, frequently requiring MRI for preoperative planning. 3D ultrasound is a promising modality for expedited and accurate diagnosis of interstitial ectopic pregnancies, especially when urgent surgery is indicated. We present a case of an interstitial ectopic pregnancy diagnosed with 3D ultrasound, that was ultimately successfully treated with a laparoscopic cornual wedge resection without complication.

Robotic-Assisted Laparoscopic Resection of a Cornual Ectopic Pregnancy: Video Presentation

Study Objective A cornual ectopic pregnancy is a pregnancy that implants in the cornua, the most proximal portion of the fallopian tube lying within the myometrium. Cornual ectopics comprise only 2-3% of cases of ectopic pregnancy, however, they have a significantly higher risk of maternal death, at 2-2.5%. This is due to the abundant blood supply to the cornua from both uterine and ovarian vessels leading to greater risk of hemorrhage and hypovolemic shock. This video demonstrates how a cornual ectopic pregnancy can be treated using minimally invasive technique with minimal blood loss. We also explore the use of vasopressin as an adjunct in surgery to minimize blood loss. Design Case Report. Setting Tertiary care center outside of a major city in the United States. Patients or Participants We present a case of a 24-year-old G3P1011 at 7 weeks gestation by last menstrual period who presented to the Emergency Department with severe left lower quadrant pain for 1 day. She was found to have a cornual ectopic pregnancy. Interventions The cornual ectopic was treated by robotic-assisted laparoscopy. Her treatment was further enhanced by the use of dilute vasopression injected into the cervix and the cornua. The ectopic was dissected using monopolar scissors and removed from the uterus intact. The defect in the uterus was closed with a barbed suture. Measurements and Main Results The entire procedure took 50 minutes with an estimated blood loss of less than 10cc. Postoperative course was uncomplicated with a negative bhCG at follow-up on postoperative day 27. Conclusion Robotic-assisted laparoscopy is a safe and effective approach for resection of cornual ectopic pregnancies. Vasopressin can be used as an adjunct to minimize blood loss. Future research should continue to explore minimally invasive techniques for cornual ectopic resection, focusing on the use of adjunct procedures and medications to reduce surgical time and minimize blood loss. A cornual ectopic pregnancy is a pregnancy that implants in the cornua, the most proximal portion of the fallopian tube lying within the myometrium. Cornual ectopics comprise only 2-3% of cases of ectopic pregnancy, however, they have a significantly higher risk of maternal death, at 2-2.5%. This is due to the abundant blood supply to the cornua from both uterine and ovarian vessels leading to greater risk of hemorrhage and hypovolemic shock. This video demonstrates how a cornual ectopic pregnancy can be treated using minimally invasive technique with minimal blood loss. We also explore the use of vasopressin as an adjunct in surgery to minimize blood loss. Case Report. Tertiary care center outside of a major city in the United States. We present a case of a 24-year-old G3P1011 at 7 weeks gestation by last menstrual period who presented to the Emergency Department with severe left lower quadrant pain for 1 day. She was found to have a cornual ectopic pregnancy. The cornual ectopic was treated by robotic-assisted laparoscopy. Her treatment was further enhanced by the use of dilute vasopression injected into the cervix and the cornua. The ectopic was dissected using monopolar scissors and removed from the uterus intact. The defect in the uterus was closed with a barbed suture. The entire procedure took 50 minutes with an estimated blood loss of less than 10cc. Postoperative course was uncomplicated with a negative bhCG at follow-up on postoperative day 27. Robotic-assisted laparoscopy is a safe and effective approach for resection of cornual ectopic pregnancies. Vasopressin can be used as an adjunct to minimize blood loss. Future research should continue to explore minimally invasive techniques for cornual ectopic resection, focusing on the use of adjunct procedures and medications to reduce surgical time and minimize blood loss.

To the casuistry of ectopic pregnancy

In practical work, we met three rather rare cases of ectopic pregnancy, which we operated on in the surgical department of the Yelabuga hospital.

Rarest of All – A Case of Cesarean Scar Ectopic Pregnancy in an Elderly Woman

One of the most common causes of mortality of females in the first trimester is ectopic pregnancy. Ectopic pregnancy can occur at different anatomic locations of which the fallopian tube is most common. Very rarely implantation of blastocyst can occur in the lower uterine segment at the site of the previous transverse cesarean section; this very rare type of ectopic pregnancy is known as cesarean scar pregnancy. Cesarean scar pregnancy is usually associated with the risk of uterine rupture leading to hemorrhage and hence diagnosis at an early stage and a proper management is necessary to avoid any serious complications. We present an interesting case of a 39-year-old elderly woman of G3P2 L2 who complained of amenorrhea for the past 7 weeks. Her urine tested positive for β-human chorionic gonadotropin, and she was further sent for antenatal ultrasound scan to confirm the pregnancy. On transvaginal ultrasound examination, there was a single gestational sac with yolk sac, fetal pole, and cardiac activity seen at the anterior end of the lower uterine segment near the old healed scar of the previous cesarean section corresponding to the gestational age of 6 weeks and 6 days. A diagnosis of cesarean scar ectopic pregnancy was made. The woman underwent a laparotomy with excision and termination of the pregnancy. Ectopic pregnancy of any location should be promptly diagnosed and adequately treated. In cases where transvaginal ultrasonography is inconclusive, magnetic resonance imaging is performed. Diagnosis is important to avoid any further complications and in young females to preserve fertility.

Profile of Ectopic Pregnancy Cases in a Tertiary Hospital.

An ectopic or extra uterine pregnancy is one in which the blastocyst implants anywhere other than the endometrial lining of the uterine cavity. The objective of the study was to find incidence, risk factors, clinical presentation and mode of management of ectopic pregnancy. Observational study was conducted at Paropakar Maternity and Women's Hospital, Thapathali, Kathmandu. All the relevant data were recorded in performa. The collected data were entered in MS Excel and exported into SPSS 26 version for statistical analysis. About one third of the patients 10 (33.3%) was of 25-29 age group.The most common risk factor was pelvic infection in 23 (76.6%) cases, abortion in 11 (36.7%), and abdominal surgery in 8 (26.7%) of cases. The of classic triad of amenorrhea (100%), pain abdomen (99.7%) and per vaginal bleeding (66.7%). Ruptured ectopic seen in 26 (86.7%) cases, unruptured status in 1 (3.3%) case, tubal abortion in 1(3.3%) case and organized ectopic in 2(6.7%) cases. The most common site was found to be ampulla in 23 (76.7%) cases, fmbria 3(10%) cases, corneal in 3(10%) cases and ithmus in 1 (3.3%) case. All the cases managed surgically, of them unilateral salphingectomy, unilateral salphingo-opherectomy and wedge resection for corneal pregnancy were done in 25(83.3%), 2(6.7%) and 3(10%) cases respectively. Ectopic pregnancy mostly present as ruptured form in young females in our context. Pelvic infection is the commonest risk factor with ampulla being the commonest site. All cases required surgical intervention in form of unilateral salphingo-opherectomy and wedge resection.

The Challenge of the Non-Compliant Patient: A Case of Caesarean Section Scar Ectopic Pregnancy

Ectopic pregnancy is a quite common and life-threatening pregnancy. The most common site of ectopic implantation of a fertilized embryo is the fallopian tube. In extremely rare situations, the embryo can implant in other locations, which makes the diagnosis and management even more complex. Although close observation of a new pregnancy is key in the diagnosis and treatment of an ectopic pregnancy, there is still a major risk of life-threatening outcomes. This is a case report of a 31-year-old patient with a history of multiple pregnancies who presented to a community hospital in the spring of 2021 with an ectopic caesarean scar pregnancy. A diagnosis of ectopic pregnancy was on a timely basis, and surgical management was advised. Upon refusal of treatment and admission, pharmacological management was initiated, but patient compliance challenged the success of the therapy. Patient non-compliance to close follow-up resulted in a ruptured uterus. Emergency laparotomy with supracervical hysterectomy was performed as a life-saving procedure.

Effect of endometrial preparation protocols on the risk of ectopic pregnancy for frozen embryo transfer

Studies have consistently reported a significantly reduced incidence of ectopic pregnancy (EP) for frozen-thawed embryo transfer (ET) cycles compared with fresh cycles. However, only a few studies reported an association between endometrial preparation protocols on EP and results were conflicting. A registry-based retrospective cohort study of 153,354 clinical pregnancies following frozen single ETs between 2014 and 2017 were conducted, of which 792 cases of EP (0.52%) were reported. Blastocyst embryo transfers accounted for 87% of the total sample and were significantly associated with a decreased risk for EP compared with early cleavage ET (0.90% vs. 0.46%, adjusted OR = 0.50, 95% CI, 0.41 to 0.60). Compared with natural cycles, hormone replacement cycles (HRC) demonstrated a similar risk for EP (0.53% vs. 0.47%, adjusted OR = 1.12, 95% CI, 0.89 to 1.42). Subgroup analysis with or without tubal factor infertility and early cleavage/blastocyst ETs demonstrated similar non-significant associations. Endometrial preparation protocols using clomiphene (CC) were associated with a significantly increased risk for EP (1.12%, adjusted OR = 2.34; 95% CI, 1.38 to 3.98). These findings suggest that HRC and natural cycles had a similar risk for EP. Endometrial preparation using CC was associated with an increased risk of EP in frozen embryo transfer cycles.

Risk factors, clinical presentation and management of ectopic pregnancy in a rural tertiary care centre- An observational study

: Ectopic pregnancy is a challenging and life-threatening emergency, which can cause significant maternal morbidity and mortality. The present study aims at determining the risk factors, clinical features at presentation, diagnostic tools, management modalities and outcome of ectopic pregnancies in a tertiary care teaching hospital.: This was an observational study of 90 cases of ectopic pregnancies admitted to the Department of Obstetrics and Gynaecology at a tertiary care teaching hospital from February 2019 to August 2020. Relevant data of the 90 patients was tabulated and descriptive analysis was done. : Chi square and Fischer exact test: Majority of the patients belonged to 21-30 yrs age group. Maximum number of cases (57%) had a history of previous abdomino pelvic surgery. The predominant symptom was amenorrhea (96.6%) and classical triad of amenorrhea, bleeding per vagina and abdominal pain was seen in 30% of the study population. Majority of the patients i.e 76.7% underwent surgical intervention.: Most common age group at presentation is 21-30years. History of previous abdominal surgery being the most important risk factor whereas amenorrhea was the most common symptom. Surgical intervention was the main mode of management in ruptured ectopic pregnancy.

Meeting 28/1

Prof. A.I. Timofeev and Dr. A.F.Shlemsky. Several interesting cases of ectopic pregnancies (drug demonstration).

Experience with Ectopic Pregnancies at the Tertiary Care Center and Lessons Learnt

Introduction: Ectopic pregnancy is one of the life-threatening complications that can occur in any sexually active woman during reproductive age. Changing trends have been observed because of the availability of assisted reproductive techniques, better diagnostic facilities, conservative management approach, newer drugs for medical termination of pregnancy, and newer contraceptives. Materials and Methods: This was a cross-sectional study of all cases of ectopic pregnancy managed at the tertiary care center from January 2009 to December 2013. In all, there were 64 cases of ectopic pregnancies. Most of the women were between 20 and 30 years age and all except three were married. Risk factors could be identified in about 50% of women only. Results: The classical triad of amenorrhea, pain, and bleeding per vaginum was seen in 28.12% of subjects. Most of them were tubal ectopic pregnancies but we had one case of secondary abdominal pregnancy, two cases of heterotrophic pregnancy, one case of twin tubal pregnancy, and two cases of cornual pregnancy. All the cases were managed by laparotomy. An unsuccessful attempt to terminate a second-trimester pregnancy by the medical method should arouse suspicion of cornual pregnancy. Conclusion: History of use of levonorgestrel – emergency contraceptive pills should be looked for apart from other risk factors. Though not mandatory, ultrasonography should be done to rule out ectopic pregnancy, before terminating a pregnancy by the medical method.

A rare Case of Cesarean Section Scar Ectopic Pregnancy Managed by Laparotomy

Cesarean section scar ectopic pregnancy (CSEP) is defined as a pregnancy in which blastocyst is implanted within the scar of previous cesarean section. It is a rare form of ectopic but its frequency is increasing due to increasing rate of cesarean section. In this case, a 36 years old G3P2A0, married for 10 years, previous II C/Sections, LCB 7 years back, presented with ultrasound report of the viable pregnancy at 11+1 weeks with gestational sac incorporating into previous scar of cesarean section. She was otherwise asymptomatic and stable. Serum Beta hCG was 73664.78 IU/L. Laparotomy was done as an elective procedure. Dense adhesions were noted on opening the abdomen between anterior abdominal wall, uterus, bladder and gut. Scar ectopic pregnancy was excised after dissecting the adhesions. Her Serum Beta hCG 48 hour post-operatively was 1397.0 IU/L.Patient was discharged home on 2nd post-operative day in good condition. She was counselled about risk of a recurrent scar ectopic and rupture of uterus in next pregnancy. Her serum Beta hCG declined to normal by 4 weeks post operatively. Keywords: Cesarean section, scar ectopic, laparotomy

Ultrasound guided vacuum aspiration treatment of caesarean scar ectopic pregnancy

To describe the case of ectopic pregnancy in the scar after caesarean section and its successful treatment using the technique of sonographically controlled vacuum aspiration. The case of a 35-year-old patient with a history of two caesarean sections referred by a district gynecologist in the 6th week of pregnancy with suspected pathological localization of pregnancy in a scar after a previous caesarean section. The procedure for the diagnosis and treatment of ectopic pregnancy in the scar after previous caesarean sections has been successfully resolved using sonographically controlled vaginal vacuum aspiration. Caesarean scar pregnancy occurs as a complication of previous caesarean section or other uterine instrumental performances. The use of the sonographically controlled vacuum aspiration technique appears to be a successful method of treating pregnancy in a scar after a caesarean section.

Management of Cervical Ectopic Pregnancies: A Scoping Review.

To investigate published cases of cervical ectopic pregnancy between 2000 and 2018 and compare management strategies and treatment success rates based on initial patient characteristics. PubMed, EMBASE, and Web of Science were searched to capture peer-reviewed citations published between 2000 and 2018. Cases reporting either β-hCG level, crown-rump length, or gestational sac diameter for each individual patient were included. Data regarding the article information, patient characteristics, treatment used, and outcomes were collected. Initial success was defined as resolution of the cervical ectopic pregnancy with the predefined treatment plan. Initial failure was defined as the requirement of additional unplanned interventions due to the predefined treatment plan not being successful. End success was defined as resolution of the cervical ectopic pregnancy without hysterectomy. A total of 204 articles from 44 countries comprising 454 cases were reviewed. The initial β-hCG level ranged from 9 to 286,500, with a median of 14,773, and gestational age ranged from 4 to 18 weeks, with an average of 7 4/7 weeks (±2 0/7 weeks). In looking at initial success, compared with methotrexate alone, dilation, and curettage (odds ratio [OR] 2.26; 95% CI 2.64-10.45), dilation and curettage combined with uterine artery embolization (OR 4.85; 95% CI 2.06-11.44) and uterine artery embolization (OR 5.17; 95% CI 1.14-23.53) were more effective options. More than half of patients (50.2%) required multiple interventions, and 41 (9%) resulted in hysterectomy. Management of cervical ectopic pregnancies should be guided by patient stability, β-hCG level, size of pregnancy, and fetal cardiac activity but may benefit from a planned multimodal approach.