Management Of Ectopic Pregnancy Research Articles

Intramyometrial Pregnancy

Study Objective Hysteroscopic management of Extra cavitary ectopic pregnancy. Design Case presentation. Setting Operative Hysteroscopy using 1.8 mm 30degree telescope with operative sheath and hand instruments without electrocautery Patients or Participants single case study. Interventions Operative Hysteroscopy at low pressure of 8 mm Hg under trans abdominal ultrasound guidance. Measurements and Main Results A second para patient was referred to our tertiary center with failed attempt to perform dilatation and evacuation for a missed abortion. They did not find and product of conception in curettage specimen. At our center on 3d transvaginal ultrasound we diagnosed it to be an intra myometrial pregnancy. Under trans abdominal ultrasound guidance with full urinary bladder we decided to remove band of fibrotic adhesion near fundus with cold Scissors to release intra myometrial pregnancy in endometrial cavity. It was followed by suction with disposable cannula under trans abdominal ultrasound guidance for ensure complete evacuation. Integrity of fundal myometrium was checked at the end of the procedure. More than 1 cm myometrial thickness was present above ectopic gestation site. Conclusion Hysteroscopy under sonography guidance is safe management option for such complicated intramyometrial ectopic pregnancy. Hysteroscopic management of Extra cavitary ectopic pregnancy. Case presentation. Operative Hysteroscopy using 1.8 mm 30degree telescope with operative sheath and hand instruments without electrocautery single case study. Operative Hysteroscopy at low pressure of 8 mm Hg under trans abdominal ultrasound guidance. A second para patient was referred to our tertiary center with failed attempt to perform dilatation and evacuation for a missed abortion. They did not find and product of conception in curettage specimen. At our center on 3d transvaginal ultrasound we diagnosed it to be an intra myometrial pregnancy. Under trans abdominal ultrasound guidance with full urinary bladder we decided to remove band of fibrotic adhesion near fundus with cold Scissors to release intra myometrial pregnancy in endometrial cavity. It was followed by suction with disposable cannula under trans abdominal ultrasound guidance for ensure complete evacuation. Integrity of fundal myometrium was checked at the end of the procedure. More than 1 cm myometrial thickness was present above ectopic gestation site. Hysteroscopy under sonography guidance is safe management option for such complicated intramyometrial ectopic pregnancy.

Diagnostic and Therapeutic Management of Ectopic Pregnancies

Background : Ectopic pregnancy is the most common cause of death among women during the first trimester of pregnancy despite the progress made with early diagnonsis. It occurs at a rate of 1 to 2 % that of live births. In Mauritania, EP is a public health issue mostly effecting young women. Objective : to evaluate the diagnosic abilities and the management of EP. Methods: This study is transverse descriptive and was carried out in the maternity of Nouakchott’s teaching hospital. The aim of this study was to provide data on the epidemiological profile, dignosis, management and prognosis of ectopic pregnancy. During the period from May 2013 to April 2014, 44 cases of ectopic pregnancies were collected. The collected data was analysed by means of SPSS version 20, Microsoft Excel 2007. Result: The incidence of EP was 0.99% coefficient to 1 EP per 100 live births. EP management represented 7.3% emergency surgery. The average patient age was 29.84 ± 5.988 years. The most affected age group was the 25-34 year olds (61.4%). Multigravida were more affected with a rate of 80%. Patients with an EP commonly presented with pelvic pain (91% of our patients), late in menstruation (86.3%) and vaginal bleeding (61.3%). Pelvic ultrasound was performed in 41 patient coefficient to 93%. The treatment was surgical by laparotomy in all of the cases. The surgical treatment was radical in 93.2% : Salpingectomy was performed in 86.4% of the cases, adnexectomy was performed in 6.8% of the cases.Conservative treatment was performed in 3 patients : 2 cases of salpingotomy and 1 case of tubal expression. In most cases, the postoperative evolution was simple. Conclusion: Until this day, ectopic pregnancy is a severe disease. despite the progress made with early diagnonsis in many cases the treatment is surgical with all its consequences and especially in the developing countries including mauritania. Improving the therapeutic management is above all improving the diagnostic procedure in a very early period. And for decades we keep saying that ectopic pregnancy: thinking about it often is not thinking enough.

Robotic Management of Large and Ruptured Interstitial Ectopic Pregnancy

<h3>Study Objective</h3> To describe management of very advanced and ruptured interstitial ectopic pregnancy, including minimally invasive technique for fertility sparing large wedge resection and surgical techniques to reduce morbidity and mortality <h3>Design</h3> Video Presentation. <h3>Setting</h3> University tertiary care hospital. <h3>Patients or Participants</h3> 22-year-old patient, 12 weeks and 2 days who presented to the emergency department with severe abdominal pain, imaging showed large and viable right interstitial ectopic pregnancy. <h3>Interventions</h3> Interstitial ectopic pregnancies are not common and account for 2-4% of ectopic pregnancies, management of interstitial ectopic pregnancy is a constant challenge due to the lack of general guidelines, a large and viable interstitial ectopic pregnancy could be life threatening due to hemorrhage and delayed diagnosis, The patient underwent Robotically assisted laparoscopic fertility sparing wedge resection and chromopertubation. <h3>Measurements and Main Results</h3> at 1 week follow up patient did well without complications. <h3>Conclusion</h3> Interstitial ectopic pregnancy is not common and a viable and advanced gestational age interstitial ectopic pregnancy is even less common, but robotically assisted laparoscopic fertility sparing wedge resection with surgical techniques to minimize blood loss decrease the risk of infertility and the morbidity associated with large blood loss, patient was counseled regarding the need for cesarean section in future pregnancies due to the increased risk of uterine rupture.

7488 Robotic-Assisted Resection of a Cornual Ectopic Pregnancy: A Focus on Technique and a Discussion on Pathology

<h3>Study Objective</h3> To demonstrate the robotic-assisted laparoscopic surgical technique in the resection of an advanced cornual ectopic pregnancy in a morbidly obese patient. <h3>Design</h3> Video recording of the cornual ectopic resection edited to highlight the principal steps. <h3>Setting</h3> Operating room at an academic medical center. <h3>Patients or Participants</h3> An asymptomatic morbidly obese (BMI 45) 37-year-old G6P1041 at 9 weeks and 5 days gestation by her LMP who was sent to the emergency room for further management after a transvaginal ultrasound confirmed her gestational age and detected a 4.8cm x 4.9cm x 4.8cm right-sided interstitial ectopic pregnancy with cardiac activity. She was hemodynamically stable with a beta-hCG of 47,458. She was considered a poor candidate for medical management and was taken to the operating room. <h3>Interventions</h3> Robotic-assisted laparoscopic resection of a cornual ectopic pregnancy using vasopressin, the purse-string circumferential suture, and resection of the ipsilateral fallopian tube with securement of collateral blood vessels as hemostatic techniques. <h3>Measurements and Main Results</h3> The robotic resection took approximately 98 minutes to complete with no complications and minimal blood loss. The patient met all postoperative milestones and was discharged from the hospital on postoperative day 1 in stable condition. Her follow up beta-hCG on postoperative day 3 was 3,034. Interestingly, the final pathology resulted in myometrium with a placenta increta with negative margins. <h3>Conclusion</h3> Minimally invasive techniques for the management of cornual ectopic pregnancies have continued to advance as more institutions are adopting these methods. Our case demonstrates that robotic-assisted resections of a cornual pregnancy can achieve minimal blood loss, adequate multi-layer myometrial closure, reduced postoperative complications, and overall safety. Our case highlights the necessity for a complete and careful resection of the myometrium given the very small, but possible association of a placenta accreta spectrum disorder even at this early gestational age.

Vasopressin Injection Purse-String Ectopic Resection (VIPER) Technique for Laparoscopic Management of Cornual Ectopic

<h3>Study Objective</h3> To describe the VIPER technique for the laparoscopic management of cornual ectopic pregnancy; a technique that minimizes blood loss and mitigates risk of conversion to laparotomy. <h3>Design</h3> Case series. <h3>Setting</h3> High-volume, academic and academic-affiliated medical centers. <h3>Patients or Participants</h3> All patients presenting with cornual ectopic pregnancy managed surgically. <h3>Interventions</h3> Laparoscopic cornual resection by five Minimally Invasive Gynecologic Surgeons. The VIPER technique utilizes four ports (umbilical, left lower quadrant, and ipsilateral right sided) and a 30-degree laparoscope. After obtaining visualization, dilute vasopressin is injected into the myometrium adjacent to the pregnancy. The affected fallopian tube is disconnected distally. A purse-string stitch with uni-directional barbed suture is placed circumferentially around the pregnancy and cinched. This stitch achieves hemostasis regardless of rupture status. The needle is left attached, and a wedge resection of the cornua is performed with an ultrasonic device. The myometrial defect is repaired with the remaining suture. <h3>Measurements and Main Results</h3> 17 patients underwent laparoscopic cornuectomy between 2012 to 2022, with 7 found to be ruptured. The mean patient age was 30 years (range 20-41), mean body mass index was 31.4kg/m² (range 22-52), and mean gestational age was 8 weeks 6 days (range 5 weeks 6 days to 11 weeks 1 day). Patient risk factors included history of prior sexually transmitted infection (3 patients), in vitro fertilization (1 patient), and prior ectopic pregnancy (1 patient). The other twelve patients had no risk factors. The mean operative time was 107 minutes (range 50-229), with mean estimated blood loss of 41mL for non-ruptured and 412mL for ruptured ectopic pregnancies. The mean hemoperitoneum identified was 1117mL, (range 50mL to 3325mL). There were no conversions to laparotomy. 70.6% of patients were discharged on the day of surgery. <h3>Conclusion</h3> The VIPER technique is feasible and effective for the management of both non-ruptured and ruptured cornual ectopic pregnancy.

Multidisciplinary Approach to the Surgical Management of Interstitial Ectopic Pregnancy

<h3>Study Objective</h3> We aim to present a multidisciplinary approach to localize and resect suspected interstitial ectopic pregnancy. <h3>Design</h3> Case report. <h3>Setting</h3> Academic medical center. <h3>Patients or Participants</h3> 28-year-old at 6 weeks gestation by last menstrual period presented to the emergency department with spotting. Although initial ultrasound suggested an eccentric intracavitary pregnancy, follow up imaging two weeks later showed that the pregnancy was located at the uterotubal junction, distinct from the endometrial cavity, and with thin overlying myometrium. This ruled in for suspected interstitial ectopic pregnancy. <h3>Interventions</h3> Given the patient's gestational age, vaginal spotting and pelvic pain, she was recommended to undergo surgical management. Upon laparoscopic entry, the pregnancy was not well visualized as it did not deform the uterine serosa. <h3>Measurements and Main Results</h3> 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: 1) use of multiple minimally invasive modalities (laparoscopy and hysteroscopy) to perform thorough evaluation for pregnancy location, 2) incorporation of intraoperative ultrasound, 3) temporary vessel ligation and injection of intramyometrial vasopressin, 4) complete enucleation of products of conception, and 5) closure of the myometrial defect. <h3>Conclusion</h3> We emphasize the benefits of a multidisciplinary approach to localization and resection of interstitial ectopic pregnancy. This patient was discharged home in good condition with no complications.

Surgical Management of Second Trimester Cesarean Scar Ectopic Pregnancy with Laparoscopic Wedge Resection

<h3>Study Objective</h3> To review the case of a second trimester cesarean scar ectopic pregnancy managed with laparoscopic resection in a patient with a history of renal transplant. <h3>Design</h3> Video demonstration of surgical technique with narrated description. <h3>Setting</h3> Academic tertiary care site. <h3>Patients or Participants</h3> 36yo G5P0221 found to have a 14-week cesarean scar ectopic pregnancy, desiring fertility sparing intervention. <h3>Interventions</h3> In this video, we demonstrate the case of a second trimester cesarean scar ectopic pregnancy resected laparoscopically. We illustrate several key points including: - Safe port placement in the setting of prior renal transplant - Preemptive hemostasis management with temporary uterine artery ligation - Intraoperative strategies for reducing blood loss - Considerations for management of gestational sac rupture and abdominal spill of fetal contents <h3>Measurements and Main Results</h3> A 14-week cesarean scar ectopic pregnancy was successfully resected with minimal blood loss and excellent recovery. <h3>Conclusion</h3> Laparoscopic resection can be safely and effectively utilized even for cesarean scar ectopic pregnancies of more advanced gestational ages.

Future Perspectives of Ectopic Pregnancy Treatment-Review of Possible Pharmacological Methods.

Ectopic pregnancy, that is, a blastocyst occurring outside the endometrial cavity of the uterus, affects nearly 2% of pregnancies. The treatment of ectopic pregnancy is surgical or pharmacological. Since surgical management is associated with numerous serious side effects, conservative treatment is sought. The treatment of choice in the majority of cases is based on pharmacotherapy with methotrexate (MTX) in a single- or multi-dose regimen. Although the efficacy of methotrexate reaches between 70 and 90%, its use requires specific conditions regarding both the general condition of the patient and the characteristic features of the ectopic pregnancy. Moreover, MTX can cause severe adverse effects, including stomatitis, hepatotoxicity and myelosuppression. Therefore, clinicians and researchers are still looking for a less toxic, more effective treatment, which could prevent surgeries as a second-choice treatment. Some studies indicate that other substances might constitute a good alternative to methotrexate in the management of ectopic pregnancies. These substances include aromatase inhibitors, especially letrozole. Another promising substance in EP treatment is gefitinib, an inhibitor of EGFR tyrosine domain which, combined with MTX, seems to constitute a more effective alternative in the management of tubal ectopic pregnancies. Other substances for local administration include KCl and absolute ethanol. KCl injections used in combination with MTX may be used when foetal heart function is detected in cervical ectopic pregnancies, as well as in heterotopic pregnancy treatment. Absolute ethanol injections proved successful and safe in caesarean scar pregnancies management. Thus far, little is known about the use of those substances in the treatment of ectopic pregnancies, but already conducted studies seem to be promising.

HOW LONG TO CONCEPTION? AN EXAMINATION OF THE INTERVAL PATIENTS ARE COUNSELED TO WAIT AFTER RECEIVING METHOTREXATE FOR AN ECTOPIC PREGNANCY BEFORE ATTEMPTING CONCEPTION

With more than 100,000 ectopic pregnancies annually in the United States, ectopic pregnancies pose a prevalent and potentially life-threatening risk during the first trimester. Ectopic pregnancies may be treated medically or surgically, with methotrexate (MTX) being the medical management. ACOG and ASRM have published guidelines on the management of ectopic pregnancies. However, there remains a dearth of evidence regarding the minimal period of time between the administration of MTX and the safe conception of a subsequent pregnancy.

Assessment of Clinical Features Responsible for Ectopic Pregnancy

Background: Ectopic pregnancy is a lethal condition and a gynecological emergency. It is associated with maternal morbidity and mortality with pregnancy loss. The incidence of ectopic pregnancy is increasing worldwide. The diagnosis of the ectopic pregnancy can be difficult without the suspicion of the condition. It is confused with the pelvic inflammatory disease and miscarriage. Objective: This study may help on formulating a guiding principle on the diagnosis and management of Ectopic pregnancies in this area. In this research the frequency of clinical presentations and factors responsible for ectopic pregnancy are determined. Methodology: This is a cross-sectional based study. This study was conducted at the Obstetricians and gynecology department of Murshid Hospital and health care Center Karachi. The 125 women diagnosed with ectopic pregnancy for the duration of six months from July 2021 to December 2021were included. Patients were examined for outcome variables (abdominal pain, vaginal bleeding, history of infertility, use of IUCD and previous ectopic pregnancy) noted in predesigned performa. Results: - The women mean age was 9m31 ± 6.6 years. There were 96 (78.4%) women observed with abdominal pain and 72 (57.6%) women with vaginal bleeding in which some of them had both clinical presentations. History of fertility 34 (27.2%), use of intrauterine contraceptive device 58 (46.4%) and previous ectopic pregnancy 33 (26.4%) were responsible for ectopic pregnancy. Conclusion: Majority of the patients attended the hospital were in acute condition. They were diagnosed with classical features of ruptured ectopic pregnancy. The most common clinical features were use of IUD, infertility history, and previous ectopic pregnancy. . For reducing the morbidity and mortality rates associated with the ectopic pregnancy the early diagnosis of the tubal rupture is an essential factor. Keywords: Ectopic pregnancy, vaginal bleeding, intrauterine contraceptive device

Racial and ethnic disparities in the surgical management of tubal ectopic pregnancy

To evaluate racial and ethnic disparities in the surgical management of ectopic pregnancy over time. Retrospective cohort study. None. Surgically-managed cases of patients with tubal ectopic pregnancy within the American College of Surgeons National Surgical Quality Improvement Program database between 2010 and2019. None. Surgical approach (laparoscopic compared with open) and procedure (salpingectomy compared with salpingostomy/other). Of 7791 patients undergoing surgical management of tubal ectopic pregnancy, 21.8% identified as Hispanic, 24.5% as Black, 9.4% as Asian/other, and 44.3% as White. Use of laparoscopy increased 1.3% per year from 81.4% in 2010 to 91.0% in 2019 (95% confidence interval [CI], 0.010-0.016). Odds of undergoing laparoscopic surgery were lower in Black (adjusted odds ratio [aOR] 0.52; 95% CI, 0.45-0.61) and Hispanic patients (aOR 0.52; 95% CI, 0.44-0.61) compared with White patients and remained similar over time. The use of salpingectomy increased by 1.1% per year from 80.6% in 2010 to 94.7% in 2019 (95% CI, 0.009-0.014). Odds of undergoing salpingectomy were higher among Black (aOR 1.78, 95% CI 1.43-2.23) and Hispanic patients (aOR 1.54; 95% CI, 1.24-1.93) and lower among Asian patients (aOR 0.73, 95% CI, 0.56-0.95) compared with White patients. These ratios remained similar for Black and Asian patients over time. Despite the increased use of laparoscopy and salpingectomy in the surgical management of ectopic pregnancy over time, Black and Hispanic patients remain less likely to undergo minimally invasive surgery and more likely to undergo salpingectomy compared with White patients.

Diagnosis of Cornual Pregnancy in the Emergency Room: a Rare Case Report

Introduction: Ectopic or extrauterine pregnancy is a life-threatening medical condition in which a fertilized egg is implanted elsewhere than in the uterine cavity, commonly in the fallopian tubes. However, it can also occur in the peritoneal cavity, ovaries, and cervix. There are several etiological factors contributing to ectopic pregnancies, such as a history of pelvic inflammatory diseases, habitual abortions, and miscarriages, previous ectopic pregnancies, fertility procedures, as well as increased maternal age that has been correlated with a higher risk of carrying an ectopic pregnancy. Often, the first alerting sign in any ectopic pregnancy is a pain in the pelvic region, along with vaginal bleeding usually spotted between the 6th and 11th gestational week. Other symptoms include vomiting, nausea, tachycardia, and in severe cases hypovolemic shock due to internal bleeding induced by the rupture of the tubes. The key to diagnosing an ectopic pregnancy is transvaginal ultrasound, alongside the measurement of beta human chorionic gonadotropin hormone (beta-hCG) concentrations, which are usually found to be low in such cases. The management of ectopic pregnancy is either medical or surgical. Case report: We are reporting the case of a 32-year-old pregnant woman, who presented to the emergency department for diffuse abdominal pain and recurrent episodes of vomiting and diarrhea of one-week duration. The patient was stable on admission, but later on, she showed a rapid shift in her vital signs. Blood tests were obtained, and pelvic ultrasound was done, followed by a Computed Tomography (CT) scan that revealed the presence of a right cornual ectopic pregnancy. A rapid surgical intervention was carried out to save the patient’s life and alleviate the pain. Conclusion: Ectopic pregnancy is an urgent condition that needs to be treated immediately to avoid its fatal consequences. Several risk factors stand behind it, and a usual history and physical gynecological examinations are insufficient to detect it, hormone screening tests additionally to ultrasounds are highly recommended to decrease the incidence of mortality. A proper follow-up with a specialist could avoid the risk of an ectopic pregnancy as well as its undesirable outcomes.

EP40.23: Management of ectopic hepatic pregnancy: a case report

EP40.23: Management of ectopic hepatic pregnancy: a case report

EP40.12: Case series of conservative management of interstitial ectopic pregnancy

EP40.12: Case series of conservative management of interstitial ectopic pregnancy

EP40.27: Relevant ultrasonographic findings for timely surgical management of ectopic pregnancy in Caesarean section scar

EP40.27: Relevant ultrasonographic findings for timely surgical management of ectopic pregnancy in Caesarean section scar

Laparoscopic Management of Partial Molar Caesarean Scar Ectopic Pregnancy

To demonstrate laparoscopic management of a molar scar ectopic pregnancy. Stepwise demonstration of the technique with narrated video footage. Cesarean scar ectopic pregnancy and molar pregnancy are 2 separate extremely rare pathologies with an incidence range from 1/1800 to 1/2500 of all pregnancies for the former [1,2]. The concurrence of both cesarean scar ectopic and molar pregnancy is furthermore exceptionally rare, and there are only 8 reported cases of cesarean scar molar pregnancy in literature till date [3]. There is a high risk of uterine rupture, uncontrolled hemorrhage, hysterectomy, and significant maternal morbidity owing to thin myometrium and fibrous scar after cesarean section [4,5]. Knowledge and awareness about this clinical condition aid in early diagnosis and reduced morbidity. Here, we present a rare case of cesarean scar ectopic pregnancy that was operated for failed medical management and diagnosed to be molar scar ectopic pregnancy intraoperatively. Total laparoscopic approach to molar scar ectopic pregnancy excision involved the following steps, strategies to minimize blood loss, and complete enucleation of tissue: (1) Hysteroscopy to localize the scar ectopic and its type and size (2) Bladder dissection to expose scar (3) Intramyometrial injection of vasopressin (4) Use of harmonic scalpel to delineate the gestational sac (5) Complete evacuation of products of conception (6) Excision of scar tissue (7) Uterine repair in 2 layers CONCLUSION: There are only 8 reported cases of cesarean scar molar pregnancy in literature till date, and all patients had at least 2 previous uterine curettages with abnormally increased β-hCG levels. The clinical manifestations were varied, the most common symptom being vaginal bleeding for a period >1 month, including our case [3]. Considering the limitations of ultrasound, magnetic resonance imaging, and serum hCG levels in the differential diagnosis of molar cesarean scar pregnancy from normal cesarean scar pregnancy, postoperative specimen should be sent for histologic examination [6]. As seen in our case, the possibility of molar pregnancy at cesarean scar ectopic site should be kept in mind in cases with rising β-hCG levels despite continuous medical interventions, which was being medically managed for 3 months. Our case is the first to be successfully managed with laparoscopic surgery as the previously reported cases were managed with suction evacuation, chemotherapy, laparotomy, or hysterectomy [3].

A 10-year retrospective cohort study of non-tubal ectopic pregnancy management outcomes in an Australian tertiary centre.

Non-tubal ectopic pregnancy (NTEP) is a rare but significant early pregnancy complication which can result in maternal morbidity and mortality. There is however a lack of evidence-based guidelines for the management of NTEP. To evaluate the success rates of expectant, medical and surgical management in the treatment of NTEP at our tertiary centre. Retrospective cohort study from 2010 to 2020. All NTEP were classified by ectopic sites. Primary management was classified by expectant, medical [systemic methotrexate (Sys-MTX) and/or local ultrasound-guided injection of MTX and/or KCl intra-sac (L-MTX, L-MTX/KCl)] or surgical. Primary management was considered successful if no change in intervention was required. Treatment complications were compared. Twenty-four NTEP were identified, which included 14 interstitial pregnancies (IP), 9 caesarean scar pregnancies (CSP) and 1 ovarian pregnancy (OP), which gave NTEP an incidence of 7.12% among all EP (4.15% for IP, 2.67% for CSP and 0.30% for OP). The success of primary surgical management was 100% (7/7), primary medical management was 76.9% (10/13) and primary expectant management was 33.3% (1/3). Primary medical management had a non-statistically significant greater mean time to serum ß-human Chorionic Gonadotrophin <5 IU/L, mean length of hospitalisation, mean number of follow-up visits and hospital re-presentation/readmissions compared to primary surgical management. There was no other difference in complication rates between the treatment management groups. Surgery remains the most effective way to manage NTEP. However, medical management can be a safe and effective alternative option in carefully selected cases.

A Novel Approach to the Management of Cesarean Scar Ectopic Pregnancy: A Case Report

A Novel Approach to the Management of Cesarean Scar Ectopic Pregnancy: A Case Report

Value of Transvaginal Sonography in Antenatal Management of Ectopic Pregnancy

Introduction: Ectopic pregnancy is a high-risk condition which can lead to mortality and morbidity if not diagnosed and managed promptly. Transvaginal Sonography (TVS) has a major role in diagnosing ectopic pregnancy. Certain signs if identified accurately on TVS examination can help predict or exclude ectopic pregnancy precisely.&#x0D; Aims &amp; Objectives: To determine the diagnostic accuracy of TVS examination in detecting ectopic pregnancy. It also aims to highlight the need of TVS examination in routine antenatal care during early pregnancy.&#x0D; Place and duration of study: The study was carried out at Shaikh Zayed Hospital, Lahore with the collaborated effort of Radiology Department and Department of Gynae &amp; Obs. It was conducted over the period of three years from 1-1- 2017 to 31-12-2019.&#x0D; Material &amp; Methods: In this observational study 160 women with suspected ectopic pregnancy were evaluated with ? - HCG levels and TVS examinations. Per-operative findings were taken as the gold standard for patients who underwent laparoscopy/laparotomy, and a trend of ?-HCG for patients with expectant/medical managements per RCOG guidelines. Statistical analyses were applied to find out diagnostic accuracy of TVS findings. The prospective study pattern with close follow-ups and a managing protocol according to the guidelines were required to reinforce the results.&#x0D; Results: The sensitivity of TVS in diagnosing Ectopic Pregnancies (EPs) in clinically suspected patients were found to be 92.5%, specificity 84.62%, positive predictive value 94.91%, negative predictive value 78.57% and accuracy rate was calculated as 90.62%. Most frequent signs present were empty uterine cavity, blob sign and embryo with or without cardiac activity.&#x0D; Conclusion: TVS examination is quite effective in predicting and excluding ectopic pregnancy in early gestation. Majority of patients with ectopic pregnancy had surgery as part of their management.

Society for Maternal-Fetal Medicine Consult Series #63: Cesarean scar ectopic pregnancy

Cesarean scar ectopic pregnancy is a complication in which an early pregnancy implants in the scar from a previous cesarean delivery. This condition presents a substantial risk for severe maternal morbidity and mortality because of challenges in securing a prompt diagnosis. Ultrasound is the primary imaging modality for cesarean scar ectopic pregnancy diagnosis, although a correct and timely determination can be difficult. Surgical, medical, and minimally invasive therapies have been described for cesarean scar ectopic pregnancy management, but the optimal treatment is unknown. Patients who decline treatment of a cesarean scar ectopic pregnancy should be counseled regarding the risk for severe morbidity. The following are the Society for Maternal-Fetal Medicine recommendations: we recommend against expectant management of cesarean scar ectopic pregnancy (GRADE 1B); we suggest that operative resection (with transvaginal or laparoscopic approaches when possible) or ultrasound-guided uterine aspiration be considered for the surgical management of cesarean scar ectopic pregnancy and that sharp curettage alone be avoided (GRADE 2C); we suggest intragestational methotrexate for the medical treatment of cesarean scar ectopic pregnancy, with or without other treatment modalities (GRADE 2C); we recommend that systemic methotrexate alone not be used to treat cesarean scar ectopic pregnancy (GRADE 1C); in patients who choose expectant management and continuation of a cesarean scar ectopic pregnancy, we recommend repeated cesarean delivery between 34 0/7 and 35 6/7 weeks of gestation (GRADE 1C); we recommend that patients with a cesarean scar ectopic pregnancy be advised on the risks of another pregnancy and counseled regarding effective contraceptive methods, including long-acting reversible contraception and permanent contraception (GRADE 1C).