Ectopic Pregnancy Research Articles

A Clinical Study of a Series of Cases of Ectopic Pregnancy in One Year at Rural Tertiary Care Center - Srikakulam

A Clinical Study of a Series of Cases of Ectopic Pregnancy in One Year at Rural Tertiary Care Center - Srikakulam

Construction and Validation of a Clinical Prediction Model for Predicting Tubal Pregnancy Rupture Based on Nomogram

Construction and Validation of a Clinical Prediction Model for Predicting Tubal Pregnancy Rupture Based on Nomogram

Systematic review and meta-analysis on the effect of adjuvant gonadotropin-releasing hormone agonist (GnRH-a) on pregnancy outcomes in women with endometriosis following conservative surgery.

Endometriosis frequently results in pain and infertility. While conservative surgery offers some relief, it often falls short of ensuring satisfactory pregnancy outcomes. Adjuvant GnRH-a is administered post-surgery to mitigate recurrence; however, its impact on pregnancy outcomes remains debated. This study endeavors to assess the efficacy of adjuvant GnRH-a in enhancing pregnancy outcomes post-conservative surgery in endometriosis patients. Databases including PubMed, Embase, the Cochrane Library, Medline (Ovid), Web of Science, and Scopus were rigorously searched up to 02 August 2023, without linguistic constraints. Identified articles were screened using strict inclusion and exclusion criteria. Evaluated outcomes encompassed pregnancy rate, live birth rate, miscarriage rate, ectopic pregnancy rate, multiple pregnancy rate, mean postoperative pregnancy interval, recurrence rate, and adverse reaction rate. The Cochrane risk of bias tool and the Jadad score evaluated the included studies' quality. Subgroup and sensitivity analysis were implemented to analyze the pooled results. A meta-analysis model expressed results as standardized mean difference (SMD) and Risk ratio (RR). A total of 17 studies about 2485 patients were assimilated. Meta-analysis revealed that post-surgery, the GnRH-a cohort experienced a marginally elevated pregnancy rate (RR = 1.20, 95% CI = 1.02-1.41; P = 0.03) and a reduced mean time to conceive (RR = -1.17, 95% CI = -1.70- -0.64; P < 0.0001). Contrarily, other evaluated outcomes did not exhibit notable statistical differences. Incorporating adjuvant GnRH-a following conservative surgery may be deemed beneficial for women with endometriosis, especially before Assisted Reproductive Technology (ART). Nonetheless, owing to pronounced heterogeneity, subsequent research is warranted to substantiate these potential advantages conclusively. CRD42023448280.

Commentary: Three-dimensional transvaginal ultrasound diagnosis of interstitial ectopic pregnancy in a unicornuate uterus: A case report

A rare case of unicornuate uterus with interstitial ectopic pregnancy (IEP) was diagnosed using three-dimensional transvaginal ultrasound (3D-TVUS). The ultrasound revealed a "lancet-shaped" endometrial corona, a gestational sac near the uterus base extending towards the uterine serosa, and visible interstitial lines. The patient underwent laparoscopic surgery for a lesion in the right fallopian tube. 3D-TVUS was crucial in precisely locating the gestational sac, aiding in effective treatment. Interstitial ectopic pregnancies risk severe hemorrhaging upon rupture. Rapid, accurate diagnosis is vital for lifesaving treatment and preventing critical complications.

Surgical Outcomes and Trends in Incidence of Ectopic Pregnancy.

We aimed to evaluate the surgical results for ectopic pregnancy (EP) treated at Fukushima Red Cross Hospital for over a 20-year period from 2002 to 2021. We evaluated the incidence, surgical procedures, site of implantation, amount of hemoperitoneum, and the proportion of cases with risk factors of EP. Two hundred and fifty-nine cases of EP were treated surgically. The incidence of EP seemed to be gradually decreasing in recent years. By pregnancy site, 235 (90.7%) of EPs were tubal pregnancies (TPs), 13 in interstitial pregnancies (IPs), 7 in ovarian pregnancies, and 4 in peritoneal pregnancies. For IPs, human chorionic gonadotropin (hCG) levels were statistically higher than with TP and intraperitoneal bleeding was less than with other EP sites. Thirty-nine patients (15.0%) were with massive hemoperitoneum (>500 mL), and laparoscopic surgery was performed in all patients with massive hemoperitoneum except in two patients. The proportion of cases with risk factors for EP such as Chlamydia trachomatis infection or history of smoking was 5.4% and 40.6%, respectively. Epidemiological research shows that the number of patients with chlamydia infection, rates of smokers, or the occurrence of EP with assisted reproductive technology has been decreasing in recent years in Japan. Appropriate surgical intervention should be selected while considering such as facility capabilities, context, and surgeon skill, especially in critical cases, such as cases involving massive hemoperitoneum and hemorrhagic shock. The recent presumed decrease in the occurrence of EP may partly be associated with the decrease in the occurrence of risk factors.

The Distribution of Ectopic Pregnancy in Natural Pregnancy and the Comparison of Diagnostic Efficacy between Transabdominal Ultrasound and Transvaginal Ultrasound

Objective: The objective of this study was to analyze the advantages and disadvantages of transabdominal and transvaginal color Doppler ultrasound in the diagnosis of early ectopic pregnancy (EP) and to evaluate the value of two kinds of ultrasonography in the diagnosis of early EP. Patients and Methods: One hundred and ten EP patients who underwent preoperative transvaginal and transabdominal ultrasound examinations and were confirmed by surgical pathology were included in the study. The sonographic findings of different methods were analyzed, and the diagnostic effects of the two ultrasound methods were compared. Results: The positive rate of transvaginal ultrasound for EP masses was 100%, while the positive rate of transabdominal ultrasound was 67.27%, with a significant difference (P &lt; 0.0001). For 53 cases of EP located in the ampulla, the diagnostic rate of transvaginal ultrasound was 100%, while transabdominal ultrasound was only 58.49%, with a significant difference (P &lt; 0.0001). The sensitivity, specificity, positive predictive value, and negative predictive value of ultrasound in diagnosing EP rupture were 94.44%, 58.67%, 52.31%, and 58.67%, respectively. Conclusions: The diagnostic efficacy of transvaginal ultrasound for EP is significantly better than that of transabdominal ultrasound. Therefore, for patients suspected of EP and without contraindication, transvaginal ultrasound is recommended as the first choice. Both peritoneal effusion by ultrasound and intraoperative abdominal hemorrhagic effusion had low specificity in diagnosing EP rupture. The diagnosis of EP rupture requires intraoperative direct vision.

Incidental Gynecological Conditions in Patients Presented with Acute Appendicitis

Abstract Background: Female patients during reproductive age had a high rate of gynecological conditions, such as ovarian cysts, ovarian torsion, uterine fibroids, or endometriosis, that occur and misdiagnosed with acute or chronic appendicitis; these disorders can be without identifiable pathologies and discovered accidentally during appendectomy. Objectives: The aim of this article is to study the most common gynecological conditions that are accidentally encountered in female patients presented with acute appendicitis. Materials and Methods: A cross-sectional study was done on 97 female patients who were admitted to the hospital for open and laparoscopic appendectomy during the period of January–April 2021. Results: The study included 97 patients, 71 (73%) were of the age group 20–49 years, 35 of them had incidental gynecological findings, and the rest 62 were having true acute appendicitis, ovarian cyst, and ectopic pregnancy which were the most common findings (16, 5) cases, respectively. Conclusion: Surgical gynecological conditions in female patients with appendectomy are commonly encountered, and the most common diagnoses were ovarian cysts.

IJCM_384A: Sudden death due to a ruptured ectopic: An Autopsy case

Background: An Ectopic pregnancy occurs when fertilized ovum is implanted outside the uterine cavity. Typically, the site of this ectopic pregnancy is the Fallopian tube in about 93-97% of ectopic pregnancies. Only 50% of patients present with the classic clinical triad of ectopic pregnancy i.e., pain, amenorrhea, and vaginal bleeding. It is extremely important to diagnose a case of ectopic pregnancy to prevent rupture and internal bleeding Case Report: A 35-year-old Female, was brought to a hospital, gasping, complaining of pain abdomen, and abdominal distension. Pulses could not be felt, GCS was 3/15, blood pressure was not recordable. She was shifted to the Intensive Care Unit and intubated. Fluid correction was attempted and ionotopes were started. USG abdomen showed a hemoperitoneum, pelvic hematoma, and ruptured right adnexa. The patient was taken up for an emergency laprotomy and had a cardiac arrest on table, but could not be resuscitated. Following an Medicolegal case the body was subjected for postmortem examination, the relevant findings at autopsy will be discussed.

Evaluation of Serum Soluble fms-like Tyrosine Kinase-1 as a Biomarker in Ectopic Pregnancy

Evaluation of Serum Soluble fms-like Tyrosine Kinase-1 as a Biomarker in Ectopic Pregnancy

Safety evaluation of single-sperm cryopreservation technique applied in intracytoplasmic sperm injection.

Intracytoplasmic sperm injection (ICSI) is a technique that directly injects a single sperm into the cytoplasm of mature oocytes. Here, we explored the safety of single-sperm cryopreservation applied in ICSI. This retrospective study enrolled 186 couples undergoing ICSI-assisted pregnancy. Subjects were allocated to the fresh sperm (group A)/single-sperm cryopreservation (group B) groups based on sperm type, with their clinical baseline/pathological data documented. We used ICSI-compliant sperm for subsequent in vitro fertilization and followed up on all subjects. The recovery rate/cryosurvival rate/sperm motility of both groups, the pregnancy/outcome of women receiving embryo transfer, and the delivery mode/neonatal-related information of women with successful deliveries were recorded. The clinical pregnancy rate, cumulative clinical pregnancy rate, abortion rate, ectopic pregnancy rate, premature delivery rate, live birth delivery rate, neonatal birth defect rate, and average birth weight were analyzed. The two groups showed no significant differences in age, body mass index, ovulation induction regimen, sex hormone [anti-Müllerian hormone (AMH)/follicle-stimulating hormone (FSH)/luteinizing hormone (LH)] levels, or oocyte retrieval cycles. The sperm recovery rate (51.72%-100.00%) and resuscitation rate (62.09% ± 16.67%) in group B were higher; the sperm motility in the two groups demonstrated no significant difference and met the ICSI requirements. Group B exhibited an increased fertilization rate, decreased abortion rate, and increased safety versus group A. Compared with fresh sperm, the application of single-sperm cryopreservation in ICSI sensibly improved the fertilization rate and reduced the abortion rate, showing higher safety.

Hemi-hysterectomy for rudimentary horn ectopic pregnancy

Hemi-hysterectomy for rudimentary horn ectopic pregnancy

Steps to successful laparoscopic management of cesarean scar ectopic pregnancy

Steps to successful laparoscopic management of cesarean scar ectopic pregnancy

The use of an embryo transfer simulator to compare transfer techniques and pregnancy outcomes among physicians

To evaluate the association between embryo transfer techniques and pregnancy outcomes. This is a prospective observational study with a retrospective cohort. University Clinic. Patients underwent embryo transfers between 2015 and2020. Fourteen physicians performed 25 mock embryo transfers on the embryo transfer simulator and completed a questionnaire assessing preferred embryo transfer techniques. Quantitative performance metrics on the embryo transfer simulator were measured. Individual physician embryo transfer success rates were retrospectively collected from all fresh and cryopreserved embryo transfers between January 1, 2015, and January 1, 2020. Associations between embryo transfer techniques (preferred technique and simulator performance metrics) and each physician's historical patient pregnancy outcomes were assessed. Associations between embryo transfer techniques and live births were assessed. There were significant differences in embryo transfer techniques between physicians, including touches to the fundus, distance to the fundus, duration of embryo transfer, duration of the complete procedure, time spent navigating the cervical canal, velocity of embryo expulsion, time waited after embryo expulsion, and total score on the embryo transfer simulator. After controlling for confounders and multiple transfers per physician, the duration of embryo transfer was significantly associated with live birth, with longer durations associated with decreased live birth rates. Shorter placement distance to the fundus and higher velocity of embryo expulsion were both significantly associated with higher rates of ectopic pregnancy. This study revealed significant differences in transfer techniques among physicians. The use of the embryo transfer simulator for physicians in practice can elucidate differences and create opportunities for data-driven improvement in embryo transfer success rates.

Efficacy of Treatment of Cesarean Scar Ectopic Pregnancies with Alcohol Injection to the Gestational Sac and Dilatation Curettage with or without Systemic Methotrexate: A Case-Control Study

Efficacy of Treatment of Cesarean Scar Ectopic Pregnancies with Alcohol Injection to the Gestational Sac and Dilatation Curettage with or without Systemic Methotrexate: A Case-Control Study

Ovarian Ectopic Pregnancy: A Rare Case Report

Ovarian ectopic pregnancy is rare and constitutes around 3% of all ectopic pregnancies. Its presentation is similar to tubal ectopic pregnancy and is difficult to diagnose based on the presentation and ultrasound findings. Here, we describe one such case which we encountered in our practice. Primigravida patient at early gestation presented with vaginal spotting and pain in lower abdomen. She was suspected as ruptured ectopic pregnancy based on examination and ultrasound findings. Immediate laparotomy was performed and patient was diagnosed to have ruptured ovarian pregnancy intraoperatively. Partial ovariotomy was performed and the case was successfully managed. Histopathology confirmed the diagnosis. Surgery is the mainstay of definitive diagnosis and treatment. Identifying these cases early is imperative as such patients can collapse suddenly and there are high chances of maternal morbidity and mortality.

Caesarean Scar Ectopic Pregnancy: 11 Case-Series Study in 2 Years at a Tertiary Care Hospital

Objective: The objective of this study was to evaluate the management, clinical features and outcome of caesarean scar pregnancies. Study Design: Descriptive case series. Settings: Department of Obstetrics &amp; Gynecology, Faisalabad Medical University, Faisalabad Pakistan. Duration: Two years from 1st June 2019 to 31st May 2021. Methods: Medical records of the women with diagnosis of CSP were retrieved. The study included cases with gestational ages ranging from 5 weeks to 9 weeks who were referred to us. All the information regarding demographics, age, gestational age, symptoms at presentation, number of Caesarean sections, obstetric and gynecological history, ultrasound images, treatment given to the patients and hospital stay were retrieved from charts of the patients. Results: In this study, 11 cases of CSP were treated. One patient had pain in lower abdomen, two of 11 patients had no symptoms, 3 had lower abdominal pain with vaginal bleeding and 5 had vaginal bleeding only. All patients had history of caesarean sections. Gestational age of these patients was from 5 to 9 weeks. Five patients were treated with Methotrexate (MTX), 3 underwent emergency laparotomy and 3 were managed conservatively. Conclusion: Early diagnosis and management of patients having caesarean scar ectopic pregnancies can reduce the complications associated with this condition.

Effect of Single and Multiple Methotrexate Doses Treatment on Ovarian Reserve in Ectopic Pregnancy Women: A Prospective Cohort Study

Effect of Single and Multiple Methotrexate Doses Treatment on Ovarian Reserve in Ectopic Pregnancy Women: A Prospective Cohort Study

Ruptured Ectopic Pregnancy with IUD in Situ

An ectopic pregnancy is any pregnancy which has implanted outside of the womb. There are several types of ectopic pregnancies for example tubal, cervical, ovarian. Ectopic pregnancies can also implant on caesarean scars. The most common sites for implantation of an ectopic pregnancy are the fallopian tube (97%), followed by the ovary (3.2%) and the abdomen (1.3%) [1]. Ruptured ectopic pregnancies pose high risk of mortality and morbidity to the patient [2]. This is because of possibility of rupture, intraperitoneal bleeding and subsequent haemodynamic instability of the patient. According to NICE CKS, in the UK, an estimated 12,000 ectopic pregnancies are diagnosed each year [3]. In the UK, 1 in

Study on the optimal time limit of frozen embryo transfer and the effect of a long-term frozen embryo on pregnancy outcome.

In this retrospective study conducted at Sichuan Jinxin Xinan Women and Children's Hospital spanning January 2015 to December 2021, our objective was to investigate the impact of embryo cryopreservation duration on outcomes in frozen embryo transfer. Participants, totaling 47,006 cycles, were classified into 3 groups based on cryopreservation duration: ≤1 year (Group 1), 1 to 6 years (Group 2), and ≥6 years (Group 3). Employing various statistical analyses, including 1-way ANOVA, Kruskal-Wallis test, chi-square test, and a generalized estimating equation model, we rigorously adjusted for confounding factors. Primary outcomes encompassed clinical pregnancy rate and Live Birth Rate (LBR), while secondary outcomes included biochemical pregnancy rate, multiple pregnancy rate, ectopic pregnancy rate, early and late miscarriage rates, preterm birth rate, neonatal birth weight, weeks at birth, and newborn sex. Patient distribution across cryopreservation duration groups was as follows: Group 1 (40,461 cycles), Group 2 (6337 cycles), and Group 3 (208 cycles). Postcontrolling for confounding factors, Group 1 exhibited a decreased likelihood of achieving biochemical pregnancy rate, clinical pregnancy rate, and LBR (OR < 1, aOR < 1, P < .05). Furthermore, an elevated incidence of ectopic pregnancy was observed (OR > 1, aOR > 1), notably significant after 6 years of freezing time [aOR = 4.141, 95% confidence intervals (1.013-16.921), P = .05]. Cryopreservation exceeding 1 year was associated with an increased risk of early miscarriage and preterm birth (OR > 1, aOR > 1). No statistically significant differences were observed in birth weight or sex between groups. However, male infant birth rates were consistently higher than those of female infants across all groups. In conclusion, favorable pregnancy outcomes align with embryo cryopreservation durations within 1 year, while freezing for more than 1 year may diminish clinical pregnancy and LBRs, concurrently elevating the risk of ectopic pregnancy and preterm birth.

Laparoscopic Approach for Ectopic Pregnancy in a Rudimentary Horn: Stepwise Demonstration of Surgical Technique

ObjectiveTo provide a comprehensive, step-by-step presentation of the laparoscopic resolution of ectopic pregnancy within a rudimentary uterine horn. DesignA detailed demonstration of the laparoscopic technique presented through narrated video footage. SettingPregnancy occurring in the rudimentary horn of a unicornuate uterus represents a rare form of ectopic pregnancy [1]. This condition is associated with a high risk of uterine rupture. Early detection is crucial for effective management and prevention of potential complications [2,3]. In this manuscript, we present a case study of a patient diagnosed with ectopic pregnancy in a rudimentary horn, who underwent successful laparoscopic resection. InterventionsTen main steps were identified and described in detail during the laparoscopic resection: Step 1: identification of the anatomy; Step 2: uterine mobilization; Step 3: Open retroperitoneum; Step 4: Coagulation and section of left round ligament; Step 5: Bladder dissection; Step 6: Identification of vessels; Step 7: Coagulation and section of left utero-ovarian vessels; Step 8: Coagulation and section of uterine vessels; Step 9: Section of uterine septum; Step 10: Specimen removed. ConclusionThis publication offers a detailed and instructive account of the laparoscopic resection of ectopic pregnancy within a rudimentary uterine horn. The stepwise approach demonstrated in the accompanying video contributes to a deeper understanding of this complex surgical technique. Video Abstract [Display omitted]