Gestational Sac Research Articles

Is it possible to predict the success of single dose methotrexate in the treatment of tubal ectopic pregnancies?

In this study, the aim was to determine whether the use of endometrial thickness or neutrophil/lymphocyte and platelet/lymphocyte ratio would be useful in predicting the success of methotrexate in the treatment of ectopic pregnancies located in the fallopian tubes. This study was carried out by retrospectively examining 68 study group cases with an ultrasonographically detectable gestational sac in the fallopian tubes and 189 control group cases with an unruptured ectopic pregnancy diagnosis at any location. The cut-off value of endometrial thickness was calculated as a new marker between the cases in which single-dose methotrexate treatment was successful and the cases with treatment failure. Treatment success was evaluated with different models including endometrial thickness, fetal cardiac activity status, measurable crown-rump length, and β-hCG. The cut-off value of β-hCG for treatment success was determined as 2960.5 ng/mL, and the cut-off value for endometrial thickness was determined as 10.5 mm. Although NLR seems to be a marker with a cut-off value of 2.49, it does not provide an extra benefit in combined use as it is not a specific predictor. The highest success in predicting treatment success was achieved in the modeling in which crown-rump length + fetal cardiac activity + β-hCG + endometrial thickness were used together. The use of endometrial thickness as a marker seems to be quite reliable in predicting treatment success. And we think it would be beneficial to thin the endometrium before using methotrexate.

Risk factors associated with the failure of initial treatment for cesarean scar pregnancy.

To explore the factors related to cesarean scar pregnancy (CSP) treatment failure under different treatment strategies. This is a cohort study that consecutively included 1637 patients with CSP. Characteristics including age, gravidity, parity, previous uterine curettages, time since the last cesarean section, gestational age, mean sac diameter, initial serum β-human chorionic gonadotropin, distance between gestational sac and serosal layer, CSP subtype, classification of blood flow abundance, fetal heartbeat presence, and intraoperative bleeding were recorded. Four strategies were performed separately on these patients. Binary logistic regression analysis was used to analyze the risk factors for initial treatment failure (ITF) under the different treatment strategies. The treatment methods failed in 75 CSP patients, and succeeded in 1298 patients. The analysis found that the presence of a fetal heartbeat was significantly associated with ITF of strategy 1, 2 and 4 (P < 0.05); sac diameter was associated with ITF of strategy 1 and 2 (P < 0.05); gestational age was associated with initial treatment failure of strategy 2 (P < 0.05). There was no difference of the failure rate between ultrasound-guided evacuation and hysteroscopy-guided evacuation for CSP treatment with or without uterine artery embolization pretreatment. Sac diameter, fetal heartbeat presence, and gestational age were all associated with CSP initial treatment failure.

Using the embryo-uterus statistical model to predict pregnancy chances by using cleavage stage morphokinetics and female age: two centre-specific prediction models and mutual validation

BackgroundThe predictive capability of time-lapse monitoring (TLM) selection algorithms is influenced by patient characteristics, type and quality of data included in the analysis and the used statistical methods. Previous studies excluded DET cycles of which only one embryo implanted, introducing bias into the data. Therefore, we wanted to develop a TLM prediction model that is able to predict pregnancy chances after both single- and double embryo transfer (SET and DET).MethodsThis is a retrospective study of couples (n = 1770) undergoing an in vitro fertilization cycle at the Erasmus MC, University Medical Centre Rotterdam (clinic A) or the Reinier de Graaf Hospital (clinic B). This resulted in 2058 transferred embryos with time-lapse and pregnancy outcome information. For each dataset a prediction model was established by using the Embryo-Uterus statistical model with the number of gestational sacs as the outcome variable. This process was followed by cross-validation.ResultsPrediction model A (based on data of clinic A) included female age, t3-t2 and t5-t4, and model B (clinic B) included female age, t2, t3-t2 and t5-t4. Internal validation showed overfitting of model A (calibration slope 0.765 and area under the curve (AUC) 0.60), and minor overfitting of model B (slope 0.915 and AUC 0.65). External validation showed that model A was capable of predicting pregnancy in the dataset of clinic B with an AUC of 0.65 (95% CI: 0.61–0.69; slope 1.223, 95% CI: 0.903–1.561). Model B was less accurate in predicting pregnancy in the dataset of clinic A (AUC 0.60, 95% CI: 0.56–0.65; slope 0.671, 95% CI: 0.422–0.939).ConclusionOur study demonstrates a novel approach to the development of a TLM prediction model by applying the EU statistical model. With further development and validation in clinical practice, our prediction model approach can aid in embryo selection and decision making for SET or DET.

A detective of intramural ectopic pregnancy: The use of pituitrin under hysteroscopy combined with laparoscopy.

Intramural pregnancy is a rare ectopic pregnancy in which the gestational sac is implanted between the muscle walls. Due to the lack of specific clinical manifestations, it is easy to misdiagnose or miss them. If it is allowed to get worse, the uterus will burst, and there will be a lot of bleeding in the later stages, which could lead to the death of the patient. The patient had no history of uterine surgery, embryo transplantation, or any other operations. She complained of having abdominal distention and swelling of the waist but no vaginal bleeding or lower abdomen discomfort. According to her transvaginal ultrasonography, we highly suspected ectopic pregnancy. Hysteroscopy combined with laparoscopy is an effective treatment option that can prevent life-threatening problems. During the surgery, pituitrin helped find the gestational sac, and the pathology report confirmed that it was an intramural pregnancy. Hysteroscopy combined with laparoscopy is an effective treatment option that can prevent life-threatening problems. During the surgery, we used pituitrin to help find the gestational sac. The use of pituitrin can minimize bleeding during a uterine operation and indicate the location of an intramural pregnancy, helping surgeons to complete the operation successfully. The patient recovered quickly and was discharged on the 4th day after surgery, with a significant decrease in human chorionic gonadotrophin (HCG) levels from 14,792.26 mIU/mL before surgery to 1071.40 mIU/mL at discharge. During the follow up, her HCG level dropped to 50.90 mIU/mL on the 14th day after the surgery. She monitored the HCG levels intermittently until they fell within the normal range. Intramural pregnancy is a rare form of ectopic pregnancy, and it is difficult to diagnose early on. This may result in uterine rupture or even life-threatening hemorrhage. If an intramural pregnancy is suspected in early pregnancy, hysteroscopy combined with laparoscopy is advised, and if necessary, low-dose posterior pituitary hormone can enhance uterine contractions and better reveal the position of the gestational sac within the uterine wall.

CESAREAN SCAR ECTOPIC PREGNANCY IN RELATION TO PREVIOUS OBSTETRICAL HISTORY

Background &#x0D; Cesarean scar ectopic pregnancy (CSEP) is the implantation of a gestational sac inside the scar of a previous cesarean section (C/S). CSEP is a life-threatening condition that needs early management.&#x0D; Objectives &#x0D; The study aimed to know the associations between CSEP and previous obstetrical history.&#x0D; Patients and Methods&#x0D; Twenty-seven women with CSEP who were admitted to the Sulaimani Maternity Teaching Hospital from September 2019 to October 2021 were collected for this cross-sectional study. Complete obstetrical history, clinical features, the interval between the last C/S and CSEP, mode of diagnosis, and types of management were recorded.&#x0D; Results&#x0D; The mean of maternal age, gravidity and parity were 32.14±4.63 years (range, 24 to 40 years), 3.73±1.75 (range, 1 to 8) and 2.36±1.33 (range, 1 to 6), respectively. The majority (74.1%) had no significant medical diseases. The mean interval between the last C/S and CSEP was 2.6±1.8 years, and 92.6% complained of vaginal bleeding. The association of gravidity with CSEP presentation was statistically significant. Only 22.2% had a history of one prior C/S alone; however, 74.1, 14.8%, and 3.7% of patients had two, three, and four previous C/Ss, respectively. Besides, the associations of first and second C/Ss with obstetricians’ experience who performed the C/Ss were statistically significant. &#x0D; Conclusion&#x0D; The risk of CSEP increases when the frequency of gravidity and previous C/S increases.

Outcomes of Cesarean Scar Pregnancies in Early Gestation According to the New Delphi Consensus Criteria.

Clinical evaluation of the new Delphi consensus definition of cesarean scar pregnancy (CSP) in early gestation. A retrospective cohort of 36 women diagnosed with CSP and treated with combined local and systemic methotrexate (MTX) between 2008 and 2021. The CSPs were classified according to the new Delphi consensus criteria into three subgroups based on the depth of the gestational sac herniation in the sagittal plane. Subgroup A included 8 (22.2%) cases in which the largest part of the gestational sac protruded toward the uterine cavity. Subgroup B included 22 (61.1%) cases in which the largest part of the gestational sac was embedded in the myometrium, and subgroup C included 6 (16.7%) cases in which the gestational was partially located outside the outer contour of the cervix or uterus. The β-HCG level upon admission was significantly lower in subgroup A than in subgroups B or C (11,075 ± 7109, 18,787 ± 16,585, and 58,273 ± 55,267 mIU/mL, respectively, P=.01). All subgroup C patients had repeated courses of MTX and surgical interventions (laparotomy, uterine artery embolization, and operative hysteroscopy) at double the rate of subgroups A or B (100, 50, and 40.9%, respectively, P=.036). The duration of hospitalization was significantly shorter in subgroup A than in subgroups B or C (1.9 ± 1.5, 2.1 ± 1.1, and 5.4 ± 4.9 days, P=.01). The outcome according to Delphi consensus criteria for defining CSP in early gestation has implications for clinical decision-making, patient care, and the follow-up of CSP.

"In Situ" Methotrexate Injection Followed by Hysteroscopic Resection for Caesarean Scar Pregnancy: A Single-Center Experience.

We evaluated the efficacy of local methotrexate (MTX) treatment followed by hysteroscopic resection for caesarean scar pregnancy and its impact on future fertility. Monocentric, prospective, observational study performed in the Haykel Hospital between June 2016 and December 2020. Twenty-one women with caesarean scar pregnancy underwent a transcutaneous ultrasound-guided direct injection of MTX into the gestational sac in an outpatient setting. Hysteroscopic resection of residual trophoblastic retention was then performed according to perisaccular blood flow. Two patients had complete spontaneous trophoblast expulsion after MTX injection, and hysteroscopy was performed in 19 patients for residual trophoblastic retention 1 to 12 weeks after MTX injection. Successful preservation of a healthy uterus with the combined procedure was obtained in 94.8% of patients. Hemostatic hysterectomy was required in one patient. Mean hospitalization duration was 1.5 days. Three patients had spontaneous pregnancy after the procedure. Direct MTX injection into the gestational sac for caesarean scar pregnancy followed by hysteroscopic resection was an effective technique with a short hospitalization, fertility preservation and a low major complication rate compared with other modalities of treatment reported in the literature. Further larger prospective comparative studies are needed to confirm the efficacy of this procedure.

Comparative cytogenetics of anembryonic pregnancies and missed abortions in human.

Miscarriage is an important problem in human reproduction, affecting 10-15 % of clinically recognized pregnancies. The cases of embryonic death can be divided into missed abortion (MA), for which the ultrasound sign of the embryo death is the absence of cardiac activity, and anembryonic pregnancy (AP) without an embryo in the gestational sac. The aim of this study was to compare the frequency of chromosomal abnormalities in extraembryonic tissues detected by conventional cytogenetic analysis of spontaneous abortions depending on the presence or absence of an embryo. This is a retrospective study of 1551 spontaneous abortions analyzed using GTG-banding from 1990 to 2022 (266 cases of AP and 1285 cases of MA). A comparative analysis of the frequency of chromosomal abnormalities and the distribution of karyotype frequencies depending on the presence of an embryo in the gestational sac was carried out. Statistical analysis was performed using a chi-square test with a p <0.05 significance level. The total frequency of chromosomal abnormalities in the study was 53.6 % (832/1551). The proportion of abnormal karyotypes in the AP and MA groups did not differ significantly and amounted to 57.1 % (152/266) and 52.9 % (680/1285) for AP and MA, respectively (p = 0.209). Sex chromosome aneuploidies and triploidies were significantly less common in the AP group than in the MA group (2.3 % (6/266) vs 6.8 % (88/1285), p = 0.005 and 4.9 % (13/266) vs 8.9 % (114/1285), p = 0.031, respectively). Tetraploidies were registered more frequently in AP compared to MA (12.4 % (33/266) vs. 8.2 % (106/1285), p = 0.031). The sex ratio among abortions with a normal karyotype was 0.54 and 0.74 for AP and MA, respectively. Thus, although the frequencies of some types of chromosomal pathology differ between AP and MA, the total frequency of chromosomal abnormalities in AP is not increased compared to MA, which indicates the need to search for the causes of AP at other levels of the genome organization, including microstructural chromosomal rearrangements, monogenic mutations, imprinting disorders, and epigenetic abnormalities.

Interstitial Ectopic Pregnancy: Laparoscopic Cornuostomy

To demonstrate and discuss the technique of cornuostomy for surgical management of interstitial ectopic pregnancy. Stepwise demonstration of the technique with narrated video footage. Tertiary referral center in Manchester, United Kingdom. Interstitial ectopic pregnancies are rare but are associated with a higher mortality rate than other ectopic pregnancies [1,2]. It occurs when the fertilized embryo implants in the interstitial portion of the fallopian tube traversing the vascularized myometrium. When undiagnosed they present late in the second trimester associated with rupture and catastrophic bleeding, with a mortality rate of 2% to 2.5%.2 Diagnosis requires a degree of vigilance from the ultrasound operator because it is commonly misdiagnosed as intrauterine pregnancies. Surgical management options include laparoscopic cornual resection or cornuostomy. There is no consensus on the optimal surgical technique but cornuostomy is a more conservative approach associated with less disruption to uterine anatomy and loss of myometrium [3,4]. A 22-year-old gravida 4 woman presented at 7 weeks' gestation with right iliac fossa pain. Initial serum human chorionic gonadotropin was 18136 IU/L. Transvaginal ultrasound scan showed an empty endometrial cavity and an echogenic "donut"-shaped mass within the right interstitial space, within the uterine serosa but outside the endometrial cavity (Supplemental Video 1). At laparoscopy the diagnosis of a right interstitial ectopic pregnancy was confirmed (Supplemental Video 2). Vasopressin 20 IU diluted in 80 mL of normal saline was injected around the base of the ectopic pregnancy. Monopolar diathermy was used to incise the overlying serosa followed by hydrodissection to separate the ectopic gestational sac from the myometrial attachment. The resulting defect was inspected and closed in 2 layers. Total operating time was 46 minutes. Although there is no clear evidence to guide the management of all interstitial ectopic pregnancies, an individualized approach taking into account the woman's previous history and future fertility plans and wishes is essential. In this case, given the woman's previous contralateral salpingectomy and her wishes for a conservative approach, a laparoscopic cornuostomy was likely the best option.

Ectopic pregnancy with implanted gestational sac in the cesarean scar

Introduction: Implantation of a pregnancy in the cesarean scar is considered a rarest presentation of ectopic pregnancy with high morbidity and mortality. The use of imaging tests is capable of early diagnosing such cases and assisting in the management of pregnancy. The present article reports two cases of ectopic pregnancy in the cesarean scar, illustrating the main aspects in ultrasound tomography (UST) and magnetic resonance imaging (MRI) exams. In addition, a bibliographic search was carried out in a database that presented data about this clinical condition. Case Series: Case 1: A 44-year-old patient, without comorbidities, G2P1cA0, with a pregnancy of 9w4d, admitted with bleeding for 03 days. Ultrasound tomography showed a single gestational sac with an embryo of anomalous morphology, with no heartbeat and in isthmic topography, in an exophytic position, over the topography of a scar from a previous cesarean section. The initial diagnosis was placental accreta. After MRI of the pelvis, an ectopic pregnancy with a gestational sac implanted in the cesarean section scar (type II—exogenous), with signs of trophoblast/placental accreta. Case 2: A 30-year-old patient, without comorbidities, G2P1c, with a 7w3d pregnancy, with abdominal pain. Ultrasound tomography showed a single gestational sac with a gestational sac implanted in the cesarean section scar, transmural type I (endogenous), which was later confirmed by pelvic MRI. Conclusion: It is necessary to highlight the importance of early diagnosis of ectopic pregnancy with implantation in a cesarean scar, given the possibility of making an appropriate therapeutic decision depending on the clinical context, aiming to reduce the possible complications of the condition.

A study of yolk sac diameter in predicting abnormal outcome of pregnancy in rural hospital

Introduction: Early pregnancy loss is the most common complication of early pregnancy. First trimester is crucial, since 80% of pregnancy losses occur spontaneously during this period. There is great difficulty in reliably anticipating which pregnancies will terminate in abortion. The yolk sac is the first extra embryonic structure that becomes sonographically visible within the gestational sac. Aims and Objectives of the present study is to evaluate the size of yolk sac as a predictor of pregnancy outcome.Material and Methods: The present Observational Prospective study was conducted on 104 pregnant woman with gestational age 6 to 10 weeks attending OPD in the department of obstetrics and gynaecology at MVJ Medical college and research hospital from December 2020 to December 2022 Results: In present study Mean age of the study participants was 25.31+4.483 and mean values of radiological findings were gestational age (days)56.28days ±8.120, MSD was 2.2545±0.99, YSD was 2.25±0.99, CRL was 1.29±0.66 and HR was 156.61±13.453. Majority of the study participants 71.2% had normal perinatal outcome. There is steady increase in YSD mean value and difference observed is statistically significant. Statistically significant differences were observed between normal and abnormal perinatal outcome.Conclusion: Abnormalities of YS size or shape, early regression or absence can be used as poor predictor of first trimester pregnancy outcome, even before studying the fetal morphology.

Effects of lauromacrogol injection under contrast-enhanced ultrasound guidance on cesarean scar pregnancy: a prospective cohort study.

Compared with the current commonly used pretreatment approaches, the therapeutic effect of contrast-enhanced ultrasound-guided sclerotherapy with lauromacrogol injection (CEUSL) on cesarean scar pregnancy (CSP) is not clear. This study aimed to investigate the clinical efficacy and safety of CEUSL compared with gelatin sponge uterine artery embolization (UAE) and UAE combined with methotrexate (UAEM) in the pretreatment of CSP to prevent massive bleeding during subsequent curettage. Sixty-four patients were divided into the CEUSL (n=20), UAE (n=22), and UAEM (n=22) groups. All patients with CSP underwent curettage and hysteroscopy after CEUSL, UAE, or UAEM pretreatment. The efficacy and safety indicators after pretreatment were analyzed. Time for pretreatment [95% confidence interval (CI): 31.92-39.28] and hospitalization cost (95% CI: 7,852.32-9,063.23) were significantly decreased in the CEUSL group compared with that in the UAE (95% CI: 53.55-59.99% and 95% CI: 12,901.42-15,166.63, respectively) and the UAEM group (95% CI: 52.90-58.83 and 95% CI: 11,324.66-13,302.69, respectively; P<0.001). The beta human chorionic gonadotropin (β-hCG) percentage decrease 24 hours later and the hospital stay were significantly decreased in the CEUSL group (95% CI: 0.65-0.70 and 95% CI: 3.32-4.58 days, respectively) compared with those in the UAE (95% CI: 0.67-0.74 and 95% CI: 4.06-5.84, respectively) or UAEM (95% CI: 0.62-0.68 and 95% CI: 4.12-5.88, respectively) groups (P<0.05). After pretreatment, there were significantly fewer patients (P<0.05) with fever (95% CI: -0.52 to -0.093), pelvic pain (95% CI: -0.427 to -0.018), increased white blood cell count (95% CI: -0.359 to 0.040), and hypersensitive C-reactive protein (hs-CRP) elevation (95% CI: -0.572 to -0.118) in the CEUSL group than in the UAE or UAEM groups. At follow-up, all patients resumed normal menstruation, with no residual gestational sac on ultrasound imaging or sequel. The pretreatment procedures were all technically successful, with good outcomes in different pretreatment procedures. Compared with UAE with or without methotrexate, CEUSL may be as effective and safe for pretreatment of CSP, with fewer adverse effects and shorter pretreatment time and hospital stay.

Cesarean scar pregnancy: presentation of a clinical case and literature review

Gabija Barkauskaitė1, Gabija Didžiokaitė2, Agnė Marcinkutė3, Gediminas Mečėjus1,3 1Vilnius university, Faculty of Medicine, Vilnius, Lithuania 2Vilnius university hospital Santaros clinics, Vilnius, Lithuania 3Vilnius city clinical hospital, Vilnius, Lithuania Abstract Bacground. Pregnancy in the cesarean section scar is one of the rarest forms of ectopic pregnancy accounting for about 6.1% of all ectopic pregnancies in women who have previously had a cesarean section. Removal of the condition can be treated with medication, surgery, or a combination of the two. Case report. A forty-year-old woman presented to the Emergency Department for lower abdominal pain. A life history marks one pregnancy completed by caesarean section. The pregnancy test was positive. The concentration of human chorionic gonadotropin (hCG) was 1810 IU/l. A vaginal ultrasound performed at the next visit revealed a 1.0 cm diameter gestational sac at the isthmus of the uterus. 5 weeks pregnancy was confirmed, hCG-5391 IU/l. 3 weeks later a transvaginal ultrasound examination revealed a 10 mm diameter echonegative shadow with a thick capsule in the cesarean section site. Caesarean scar pregnancy was diagnosed. Surgical laparoscopy was performed to remove the cesarean scar pregnancy. Within 24 hours after the operation, hCG levels decreased from 5391 to 1189 IU/l. Conclusion. Minimally invasive intervention laparoscopy is an effective treatment method with a low risk of complications in the case of pregnancy in the cesarean section scar. Universal treatment guidelines could ensure more successful treatment of this condition. Keywords: ectopic pregnancy, caesarean section, laparoscopy. Full article https://doi.org/10.53453/ms.2023.2.8

Chorioangioma in Twin Gestation - A Case Report

Large Chorioangioma may be present as a separate mass inside the gestational sac and create fetal complications. We report a case of chorioangioma in twin gestation underwent emergency LSCS in view of ominous NST. Unexpected findings in second amniotic sac with meconium-stained liquor at 34 weeks of gestation. Histopathology confirmed the diagnosis. Though it is a benign tumour, complications can not be excluded. Keywords: chorioangioma, Twin gestation, Fetal complications

Primary omental pregnancy in a subseptate uterus: A novel case report and literature review

Introduction and Importance: Ectopic pregnancy is defined as a pregnancy in which the fertilized ovum implants itself in a location other than the uterine endometrium. Abdominal ectopic pregnancies involve the implantation and development of the embryo within the peritoneal cavity. Primary omental pregnancies are the rarest form of abdominal pregnancy and possibly the rarest extrauterine gestation. Case Presentation: We report the first case of a primary omental pregnancy in a subseptate uterus in literature. Our patient, a 33-year-old female, G8P4+3, presented with nausea, severe abdominal pain, and vaginal spotting at 6 weeks’ gestational age. She had mild tenderness below the umbilicus, with positive cervical and right adnexal tenderness. 2D-ultrasound revealed a subseptate uterus, normal ovaries and fallopian tubes, absence of a gestational sac, and a 4×3×2.5 cm mass in the right adnexa. A mini-laparotomy was performed due to suspicion of ruptured tubal pregnancy, revealing a primary omental pregnancy which was managed via partial omentectomy. Clinical Discussion: Ectopic pregnancies have ambiguous presentations, however correct diagnosis and management is crucial to prevent complications. A high index of suspicion must be exercised to make an accurate diagnosis of primary omental pregnancy. A subseptate uterus is a subtype of the most common uterine anomaly and should be investigated via 3D-ultrasound and magnetic resonance imaging as it causes increased risk of primary omental implantation. Conclusion: Correct identification of subseptate or septate uteri is vital. Greater research is needed to elucidate the association between septate or subseptate uteri and ectopic pregnancy, particularly primary omental pregnancy.

Successful Ultrasound-Guided Methotrexate Intervention in the Treatment of Heterotopic Interstitial Pregnancy: A Case Report and Literature Review

This study aims to share the experience of minimally invasive ultrasound-guided methotrexate intervention in the treatment of heterotopic interstitial pregnancy (HIP) with good pregnancy outcomes, and to review the treatment, pregnancy outcomes, and impact on the future fertility of HIP patients. The paper describes the medical history, clinical manifestations, treatment history, and clinical prognosis of a 31-year-old woman with HIP, and reviews cases of HIP from 1992 to 2021 published in the PubMed database. The patient was diagnosed with HIP by transvaginal ultrasound (TVUS) at 8 weeks after assisted reproductive technology. The interstitial gestational sac was inactivated by ultrasound-guided methotrexate injection. The intrauterine pregnancy was successfully delivered at 38 weeks of gestation. Twenty-five HIP cases in 24 studies published on PubMed from 1992 to 2021 were reviewed. Combined with our case, there were 26 cases in total. According to these studies, 84.6% (22/26) of these cases were conceived by in vitro fertilization embryo transfer, 57.7% (15/26) had tubal disorders, and 23.1% (6/26) had a history of ectopic pregnancy; 53.8% (14/26) of the patients presented with abdominal pain and 19.2% (5/26) had vaginal bleeding. All cases were confirmed by TVUS. In total, 76.9% (20/26) of intrauterine pregnancies had a good prognosis (surgery vs. ultrasound interventional therapy 1:1). All fetuses were born without abnormalities. The diagnosis and treatment of HIP remain challenging. Diagnosis mainly relies on TVUS. Interventional ultrasound therapy and surgery are equally safe and effective. Early treatment of concomitant heterotopic pregnancy is associated with high survival of the intrauterine pregnancy.

Multidisciplinary approach to the surgical management of interstitial ectopic pregnancy

To present a multidisciplinary approach to localize and resect suspected interstitial ectopic pregnancies. Interstitial ectopic pregnancies are distinct from eccentric intracavitary pregnancies and are defined by ultrasound-based criteria, including an empty uterine cavity, gestational sac located >1 cm from the cavity, thin overlying myometrium <5 mm, and the interstitial line sign. Case report. Academic medical center. Here, we present the case of a 28-year-old patient at 6 weeks of gestation by last menstrual period who presented to the emergency department with spotting. Initial pelvic ultrasound findings demonstrated a gestational sac and yolk sac that were believed to be located eccentrically within the uterine cavity. Follow-up imaging was performed 2 weeks later that revealed the pregnancy was located at the uterotubal junction and distinct from the endometrial cavity, consistent with an interstitial ectopic. The patient had ongoing light spotting with mild cramping, a benign clinical exam, and normal laboratory findings. Accurate assessment of pregnancy location is critical given that the mortality rate from interstitial pregnancies is twice that of other ectopics. In contrast, live birth rates for eccentric intracavitary pregnancies may be up to 69%, and some clinicians consider expectant management of asymptomatic patients in the first trimester. The patient was recommended for inpatient admission with expedited surgical management of interstitial ectopic pregnancy. On laparoscopic entry, the pregnancy was not well-visualized because it did not deform the uterine serosa. We present a surgical approach to suspected interstitial ectopic pregnancy that is not well-visualized at the time of laparoscopy. The following principles are explored: the use of multiple minimally invasive modalities (laparoscopy and hysteroscopy) to perform a thorough evaluation of the pregnancy location; incorporation of intraoperative ultrasound; temporary vessel ligation and injection of intramyometrial vasopressin; complete enucleation of the products of conception; and closure of the myometrial defect. We emphasize the benefits of a multidisciplinary approach for the localization and resection of interstitial ectopic pregnancy. This patient was discharged home in good condition with no complications.

Gestational Sac Size, Yolk Sac Size and Embryonic Cardiac Activity as Prognostic Factors of First Trimester Pregnancy Outcome

Background: The accurate difference between normal pregnancy and abnormal pregnancy in early gestation remains a challenge clinically. Different studies have previously described the association between fetal well-being and gestational sac characteristics. Yolk sac first appears at 5 weeks gestation and becomes visible by ultrasound, while fetal heart rate appears at 6 weeks gestation and they can be used as prognostic parameters for first trimester outcome in pregnancy. Study aim: relation of the ultrasound parameters in early pregnancy (gestational sac size, yolk sac and embryonic cardiac activity) to early fetal demise. Methodology: This was hospital based cross sectional study, conducted in the outpatient clinic and Emergency Department – Obstetrics and Gynecology Department – El Monera General Hospital on 100 pregnant women in their first trimester. Patients were subjected to General Examination and Abdominal and local clinical examination. Result; Gestational sac diameter at different gestational ages were significantly higher among Ongoing pregnancy group compared to Pregnancy loss group. Conclusion; Based on our finding we concluded that, yolk sac diameter, gestational sac diameter, CRL in different gestational ages and cardiac activity at 6th and 7th week were significantly higher among ongoing pregnancy group, YSD, GSD and FHR were significant predictors for pregnancy loss.

Predictive factors analysis of cesarean scar pregnancy treated by local injection of Lauromacrogol combined with curettage.

To explore factors related to local injection of Lauromacrogol combined with curettage in the treatment of cesarean scar pregnancy. A total of 24 successful and 8 unsuccessful cases were included. The age, gravidity, parity, times of cesarean section, interval from the last cesarean section, preoperative human chorionic gonadotropin (HCG), HCG on the first day after operation, decreasing rate of HCG on the first day after operation, average diameter of gestational sac, and preoperative vaginal bleeding days were analyzed. There were no significant differences of age, gravidity, parity, previous cesarean section times between groups. The differences of preoperative HCG, HCG on the first day after operation, the decreasing rate of HCG, gestational sac diameter, preoperative vaginal bleeding days were statistically significant between groups. The interval from the last cesarean section and the decreasing rate of HCG were protective factors, while the mean diameter of gestational sac and period of vaginal bleeding before operation were risk factors for the success of the treatment. The mean diameter of gestational sac owned the best predictive value.

A Cautionary Tale of the Tubal Stump

A 22 year-old G2A1 female, with a history of prior right salpingectomy for a ruptured ectopic pregnancy, presented to hospital with diffuse abdominal pain and vaginal spotting. Her b-HCG was over 16 000 mIU/mL. A pelvic ultrasound demonstrated a gestational sac with a fetal pole at the right utero-tubal junction, outside of the endometrial cavity (Figure 1), suggesting a pregnancy contained in the interstitium of the tubal stump remnant. Laparoscopy confirmed imaging findings (Figure 2). Dilute vasopressin was injected into the adjacent myometrium. A transverse incision was made along the most dependent area of the interstitial pregnancy, the products of conception were expressed from the uterine cornua, tubal stump removed, and the defect repaired (Figure 3). Figure 2Laparoscopy confirms an interstitial ectopic pregnancy within the tubal stump from prior salpingectomy. View Large Image Figure Viewer Download Hi-res image Figure 3Image of the pelvis after removal of ectopic pregnancy and repair View Large Image Figure Viewer Download Hi-res image