Normal Intrauterine Pregnancy Research Articles

TAUS versus TVUS in detection early pregnancy complication

Background:Using TVUS(transvaginal ultrasound ) visualization of pelvic organ is limited due to attenuation of ultrasound beam byintervening anterior abdominal wall and pelvic fat while TVUS (high frequency transducers 5-7MHz) now day regard important revolution in diagnosis of early pregnancy and their complications ,because it facilitate high resolution image of target organ uterus , adenaxa and cul de sac.Aim of study:To evaluate TVUS in detection of early pregnancy complication and compare transvaginal approach with TAUS . Patient and Methods :Sixty four patients were included in this study all of them have positive pregnancy test with signs and symptoms of early pregnancy complication .All of those patient examine by TAUS than by TVUS .with good explanation of the procedure to the patients .Results:From sixty four patients a twenty five patients has normal intrauterine pregnancy all of them are diagnosed by TVUS while only 12 diagnosed by TAUS.Five patients have blighted ova all of them are diagnosed by TVUS and only 2 diagnosed by TAUS. All of 6 patient with subchronic hematoma are diagnosed by TVUS only 4 diagnosed by TAUS . Three cases were diagnosed as ectopic pregnancy and all of them are diagnosed by TVUS only 1 diagnosed by TAUS . Two patient that diagnosed only by TVUS had intact gestational sac in the adenaxa with positive heart pulsation in fetal pole.Incomplete abortion diagnosed in 8 patient all of them diagnosed by TVUS , only 3 diagnosed by TAUS Fourteen patients has missed abortion only 8 of them are diagnosed by TAUS .Conclusion and Recommendation:TVUS is more sensitive and more accurate in diagnoses of normal early pregnancy and in detection of early pregnancy complication.Many patient refused TVUS. So good explanation of the procedure to the patient is important.

Different Sonographic Faces of Ectopic Pregnancy.

Vaginal bleeding in the first trimester has wide differential diagnoses, the most common being a normal early intrauterine pregnancy, with other potential causes including spontaneous abortion and ectopic pregnancy. The incidence of ectopic pregnancy is approximately 2% of all reported pregnancies and is one of the leading causes of maternal mortality worldwide. Clinical signs and symptoms of ectopic pregnancy are often nonspecific. History of pelvic pain with bleeding and positive β-human chorionic gonadotropin should raise the possibility of ectopic pregnancy. Knowledge of the different locations of ectopic pregnancy is of utmost importance, in which ultrasound imaging plays a crucial role. This pictorial essay depicts sonographic findings and essential pitfalls in diagnosing ectopic pregnancy.

Pitfalls and tips in the diagnosis of ectopic pregnancy.

Women of reproductive age with pelvic pain, vaginal bleeding, and a positive pregnancy test often require evaluation with pelvic ultrasound. In these situations, the primary role of pelvic ultrasound is to differentiate an ectopic pregnancy from either a normal or abnormal intrauterine pregnancy. While an accurately performed and interpreted pelvic ultrasound results in rapid diagnosis and management, numerous diagnostic pitfalls can lead to negative outcomes. Therefore, familiarity with the appropriate laboratory tests, sonographic technique, and imaging features of ectopic pregnancy is essential for all radiologists. We present a review of ectopic pregnancy cases from our institution with attention to common pitfalls and troubleshooting tips for physicians who perform and interpret pelvic ultrasounds. We also present recently published literature to aid in the management of first trimester pregnancy.

正常子宮内妊娠と判断されたが卵管間質部妊娠であった一例

正常子宮内妊娠と判断されたが卵管間質部妊娠であった一例

IMELDA transvaginal approach to ectopic pregnancy: diagnosis by transvaginal hydrolaparoscopy and treatment by transvaginal natural orifice transluminal endoscopic surgery

To demonstrate a new minimally invasive approach for the diagnosis and treatment of ectopic pregnancy. Stepwise explanation of the technique using original video footage. Hospital. Since 2014, 15 patients were treated transvaginally for ectopic pregnancy and pregnancy of unknown location (PUL). In case of a diagnosis of ectopic pregnancy on ultrasound, a 2.5-cm colpotomy is made under general anesthesia, and the ectopic pregnancy is treated by transvaginal natural orifice transluminal endoscopic surgery (vNOTES) salpingectomy or salpingostomy. In case of a PUL on ultrasound, transvaginal hydrolaparoscopy (TVHL), an established technique for fertility exploration under local or general anesthesia, is used to investigate. If a tubal pregnancy is confirmed on TVHL, the colpotomy is extended to a 2.5-cm incision, and the ectopic pregnancy is treated transvaginally by vNOTES. If the TVHL investigation of the pelvis is negative (fallopian tubes and ovaries are normal), the procedure is stopped and the patient is followed up further. If the TVHL is inconclusive, the NaCl is drained and CO2 is insufflated (requiring general anesthesia) through the 4-mm TVHL port to improve visualization. Again, an ectopic pregnancy is then treated by vNOTES, and in case of a negative investigation the procedure is stopped and the patient is followed up further. Successful diagnosis and treatment of ectopic pregnancies. All patients were successfully operated without complications or conversions to standard laparoscopy. Twelve patients were treated by vNOTES for ectopic pregnancy. Three TVHL explorations for PUL were negative, and these patients were followed up; two patients developed a normal intrauterine pregnancy, and the third patient was treated with methotrexate for persistent asymptomatic raised hCG levels. Transvaginal hydrolaparoscopy and vNOTES are complementary techniques enabling gynecologic surgeons to explore PUL and treat ectopic pregnancies via minimally invasive transvaginal access without abdominal incisions. A negative TVHL investigation leaves only a 4-mm perforation in the pouch of Douglas that does not require suturing. The IMELDA technique for the investigation and treatment of PUL and ectopic pregnancy is a novel approach that requires further investigation. It can provide improved patient comfort and better cosmetic results.

Hematological and Biochemical Changes Associated with Ectopic Pregnancy in Jazan Area Saudi Arabia

Objective: Ectopic pregnancy (EP) is an implantation of fertilized ovum outside the intrauterine cavity. Many cases of EP are not associated with a clinical signs at early stages that makes its diagnosis is difficult. The confirmation of EP needs several investigations as ultrasonography and repeated measurements of serum β-hCG levels every 48 hours that make it very expensive and take a long time so, rupture may be occurred that leads to increased maternal morbidity and mortality rates. Thus, the aim of this study was to investigate the alterations of some hematological and biochemical parameters associated with normal and ectopic pregnancy in addition to evaluate their efficacy in early diagnosis of tubal ectopic pregnancy (TEP) among women living in Jazan area, Kingdom of Saudi Arabia. Subjects and methods: this retrospective study was carried out on 200 women with their ages ranged from 25–37 years old at the Obstetric and Gynecology Department of King Fahd Central Hospital and Sabiya General Hospital during the period between March 2010 and March 2014. The subjects were divided into three groups. Group (1) consists of 69 cases ruptured EP; Group (2) consists of 61 cases non-ruptured by visual examination during surgery and subsequently histopathological examination, where as group (3) consists of 70 women representing the control group having a normal intrauterine pregnancy. Hematological and biochemical measurements were done on all groups. Results: the hematological findings revealed a significant increase in mean platelet volume (MPV), total leukocytic count (WBC) and erythrocyte sedimentation rate (ESR) among TEP patients especially in ruptured cases in comparison with those of normal pregnancy control. A significant decrease in hemoglobin (Hb) and packed cell volume (PCV) in TEP cases either ruptured or non-ruptured and a non-significant changes in total erythrocytic count (RBC). The biochemical findings revealed a significant increase in serum creatine kinase ( CK) but a significant decrease in serum β-hCG in both ruptured and non-ruptured TEP. Conclusion: it could be concluded that theWBCs,MPV count and ESR were significantly increased in TEP especially in ruptured cases. The MPV can differentiate between TEP and normal pregnancy but has less clinical significance to differentiate between ruptured and non-ruptured cases. On the other hand, the level of β-hCG is an important indicator of TEP. Moreover, serum CK cannot be used as a tool for diagnosis of TEP but may differentiate between ruptured and non-ruptured cases.

Diagnostic significance of IL-6 and IL-8 in tubal ectopic pregnancy

As there are no specific non-invasive markers for the diagnosis of tubal ectopic pregnancy, our objective in the present study was to explore the role of inflammatory cytokines IL-6 and IL-8 in the diagnosis of ruptured tubal ectopic pregnancy. Twenty-eight women with tubal ectopic pregnancy, 31 patients with intrauterine abortion and 29 gestational age matched women having normal intrauterine pregnancy were included in the study. Five millilitre of blood was collected at the time of admission, serum was separated and stored at −70 °C for subsequent analysis of β hCG, IL-6 and IL-8 levels. The level of IL-6 was a significant increase in the women with tubal ectopic pregnancy compared to intrauterine abortion and normal pregnancy. IL-8 levels decrease significantly in the tubal ectopic pregnancy and in intrauterine abortion patients when compared with the normal pregnancy group. At the cutoff of 26.48 pg/ml IL-6 level predicted the tubal ectopic pregnancy with moderate accuracy. Therefore, it can be concluded that measurement of IL-6 may have relevance in the diagnosis of ectopic pregnancy as a novel inflammatory serum biomarkers.

Papillary Serous Carcinoma of the Peritoneum Mimicking an Ovarian Cyst in Pregnancy

A 32-year-old woman 15 weeks’ pregnant presented with lower abdominal pain for a duration of 1 month. Ultrasonography showed a normal intrauterine pregnancy of 15 weeks and an anechoic right ovarian cyst measuring 13.5 ! 11.3 cm with 2 papillations, 5.5 ! 4.3 cm and 0.8 ! 0.7 cm with no abnormal vascularity. The left ovary was normal. In view of the symptomatic cyst, the patient was planned to undergo laparoscopic cystectomy.

Temporal refinement does not affect predicted human chorionic gonadotropin rise in early pregnancy

To examine the impact of validation and temporal resolution of estimation of hCG increase, because patients' hCG values are not obtained at precise daily increments or always in the same laboratory. Retrospective cohort study of women presenting with nondiagnosed symptomatic first-trimester pregnancies who had serial hCG level measurements over time. Not applicable. A total of 171 women presenting from September 2007 to February 2010 with first-trimester pregnancy pain and/or bleeding for whom a normal intrauterine pregnancy was ultimately confirmed. None. Serial hCG values, time period between hCG measurements, hCG rise. After data verification, 118 subjects contributing 327 values met inclusion criteria and passed data verification for analysis with improved temporal precision. The more precise data showed a steeper hCG rise, and the predicted 2-day hCG increase at the 1st percentile was slightly faster (1.68-fold vs. 1.56-fold) than the "raw" clinical data and previous models. Data verification and improved temporal precision suggested a faster hCG increase in early intrauterine gestation than previously demonstrated. Because laboratory variation and temporal imprecision are common, these data demonstrate that current modeling of the expected rise of hCG in a normal gestation is valid and appropriately conservative in the determination of a nonviable gestation. No change in the minimal threshold for potential viability is recommended.

An incidental finding of heterotopic pregnancy in a patient presented with acute abdomen post D&C of unwanted pregnancy

: Spontaneous heterotopic pregnancy is a rare condition. There is the simultaneous presence of intrauterine and extrauterine pregnancies. Such condition can be a life-threatening. The diagnosis can also be easily missed especially in early pregnancy. We present this case of a 28-year old patient who was misdiagnosed as normal intrauterine pregnancy. She had illegal termination of unwanted 14-week pregnancy in a private hospital. The patient presented to us with acute abdomen two days after D&C. Following clinical examination, uterine perforation was suspected. Abdominal ultrasound showed a coexisting abdominal pregnancy in the right hypochondrium. This heterotopic pregnancy was undiagnosed at her initial presentation to the first hospital. Emergency laparotomy was done, uterine perforation was sutured and abdominal pregnancy was excised.Key words: Heterotopic Pregnancy, Intrauterine Pregnancy, Abdominal Pregnancy, D&C, Uterine Perforation.

Serum activin B concentration as predictive biomarker for ectopic pregnancy

We evaluated the diagnostic accuracy of activin B in discriminating tubal ectopic pregnancy (tEP) from intrauterine miscarriages (IUM), and normal viable intrauterine pregnancy (IUP). We included 28 women with tEP, 31 women with IUM, and 29 normal IUP, confirmed both by clinical examination and ultrasonography. Serum activin B concentration was measured at the time of admission using the ELISA kit. The median serum activin B concentration was found to be significantly decreased in both tEP (p=0.004) and IUM (p=0.022) compared to normal IUP. When compared between tEP and IUM, activin B concentrations did not differ significantly. ROC analysis of activin B and free β-hCG demonstrated AUC of 0.722 and 0.805, respectively to discriminate tEP from viable IUP. The model including both activin B and free β-hCG improved the discriminating potential with greater AUC (0.824), and specificity (93%) than individual one. To discriminate tEP from IUM, activin B, free β-hCG and combination of both performed poorly. We conclude that serum activin B concentration is lower in tubal ectopic pregnancy, and can discriminate it from normal pregnancy with moderate accuracy. It also shows improved diagnostic potential along with free β-hCG, but cannot distinguish tEP from IUM reliably.

Reproductive outcomes following cesarean scar pregnancy – a case series and review of the literature

ObjectiveTo assess the reproductive outcomes following cesarean scar pregnancy (CSP) in our center and review of published literature on CSP and subsequent reproductive issues. MethodsOver a 3-year period, 28 cases of CSPs were diagnosed in our hospital. Follow up data of 22 cases were available which included the gestational age at diagnosis of CSP, treatments employed and outcomes of previous cesarean scar pregnancy. We also had details on subsequent fertility outcomes in these women, which included intervals between the previous CSP and subsequent pregnancy, maternal and neonatal outcomes of these subsequent pregnancies and mode of delivery. ResultsEight women desired to conceive and amongst them, seven women manage to conceive spontaneously. There were five pregnancies delivered at term, two miscarriages and one recurrent CSP. One patient had placenta accreta diagnosed at cesarean section at term and had massive hemorrhage. The remaining 4 term pregnancies were delivered uneventfully by elective cesarean sections. The mean interval between the cesarean scar pregnancy and subsequent pregnancy was 24.6 months (range 9–48 months). One patient experienced secondary infertility and despite thorough investigations, no abnormalities were detected. One of the women who did not desire future fertility conceived spontaneously at 9 and 18 months respectively after one CSP and had induced abortions twice. There were 3 women who had uterine scar defect repaired, only 1 resulted in a live birth but had placenta accreta with a lower uterine segment defect and suffered from massive hemorrhage, one woman had a subsequent miscarriage with a diverticulum in the lower uterine segment, and one woman had unexplained secondary infertility. ConclusionMost women were able to conceive following CSPs. Reproductive outcomes included normal intrauterine term pregnancy, miscarriage, recurrent CSP, and infertility. Placenta accreta, which could be misdiagnosed antenatally, was a serious complication in subsequent pregnancies. Diverticulum or defect in the lower uterine segment could happen after CSP. Repair of the uterine defect, following a CSP neither guaranteed the healing of the scar, nor the ability to ensure a safe pregnancy outcome. Appropriate counseling to women desiring fertility with a history of CSP is essential and once they conceive early referral to tertiary centers for follow up is pertinent.

Utero-placental vascularisation in normal and preeclamptic and intra-uterine growth restriction pregnancies: third trimester quantification using 3D power Doppler with comparison to placental vascular morphology (EVUPA): a prospective controlled study

IntroductionPreeclampsia (PE) and intra-uterine growth restriction (IUGR) are two major pregnancy complications related to chronic utero-placental hypoperfusion. Three-dimensional power Doppler (3DPD) angiography has been used for the evaluation of utero-placental...

Easy sonographic differential diagnosis between intrauterine pregnancy and cesarean delivery scar pregnancy in the early first trimester

Cesarean scar pregnancy (CSP) is a serious complication of pregnancy, which consists of implantation of the gestational sac in the hysterotomy scar. This condition is increasing in frequency and often poses a diagnostic challenge. Its diagnosis is dependent on visual assessment of the uterus on the longitudinal sagittal ultrasound plane. Misdiagnosing a low intrauterine chorionic sac as a CSP, or a true scar pregnancy as an intrauterine pregnancy (IUP), may lead to adverse outcomes including hysterectomy. The objective of the study is to describe a sonographic method for the differential diagnosis of CSP vs IUP in early gestation. The current study tests the hypothesis that on a first-trimester ultrasound performed between 5-10 weeks of gestation, the relative location of the center of gestational sac to the midpoint of the uterus along a longitudinal line between the external cervical os and the fundus can be used for early detection of CSPs. This is a retrospective review of electronically archived ultrasound images of IUP and CSP between 5-10 weeks of gestation. A total of 242 ultrasound images were analyzed: 185 cases of normal IUPs (including 128 in anteverted uteri, 31 in retroverted uteri, and 26 IUPs with history of cesarean delivery) and 57 cases of CSPs diagnosed from 2004 through 2015 in a single institution. The following measurements were made for each case: distance from the external cervical os to the uterine fundus, the midpoint axis of the uterus, the distance from the external cervical os to the center of gestational sacs, and the distance from the external cervical os to the most distant edge of the gestational sacs from the cervix. The location of the center of the gestational sac relative to the midpoint axis of the uterus between 5-10 weeks of gestation differentiated between IUP and CSP (mean 17.8 vs -10.6 mm, respectively, P= .0001), indicating that most CSPs are located proximally to the midpoint axis of the uterus whereas most normal IUPs are located distally from the midpoint of the uterus. Using location of the center of the gestational sac as a marker of CSPs between 5-10 weeks of gestation yielded the following characteristics of diagnostic accuracy: sensitivity 93.0% and specificity 98.9%. The likelihood ratio of the positive test was 84.5. The likelihood ratio of the negative test was 0.07. The location of the center of the gestational sac relative to the midpoint axis of the uterus can be used as an easy method for sonographic differentiation of IUP and CSP between 5-10 weeks of gestation.

Study of Prevalence of Hetertopic Pregnancies in Rajasthan Population

Out of 500(Five Hundred) pregnancy cases 2 cases of Heterotopic pregnancies.(0.4%)(one tubal, one interstitial) were observed. who undergone Assisted Reproductive Technologies, like IVF, ET. Although transvaginal ultrasonography is performed but Heterotopic pregnancies were ambiguous in early period of pregnancy. As symptoms of normal intra-uterine pregnancy and Heterotopic pregnancy are same. Moreover B-hcG. Levels are also not helpful to differentiate the Hetrotopic pregnancy. As Heterotopic pregnancy is simultaneous occurrence of both intra uterine and Ectopic pregnancy. As it is diagnosed in later period of pregnancy there could be rapture of Falloppian tube may occur leading to life threatening consequences including hypovolmic shock, maternal mortality, fetal loss. If the Hypotopic mass is removed then also it is a great challenge to obstetrician and gynecologist to maintain the normal pregnancy of intra uterine.

Quantitative analysis of hormones and inflammatory cytokines in Chlamydia trachomatis-infected women with tubal ectopic pregnancy and early intrauterine pregnancy.

In this data, non-pregnant women during the menstrual cycle, women with normal intrauterine pregnancy (IUP), and women with tubal ectopic pregnancy (EP) after informed consent were included. The serum levels of 17β-estradiol, progesterone, testosterone, beta-human chorionic gonadotropin, interleukin (IL)-1β, IL-4, IL-6, IL-7, IL-8, IL-10, tumor necrosis factor α (TNFα), and interferon-γ (IFN-γ), epidermal growth factor, the Chlamydia (C.) trachomatis IgG and HSP60 were analyzed. Receiver operating characteristic analysis was used to assess the diagnostic discrimination of tubal EP and gestational age-matched IUP. Our data show that C. trachomatis infection is associated with IL-8 levels, which had excellent discriminative validity in positively identifying tubal EP (concomitant with C. trachomatis infection) from IUP and non-pregnant conditions regardless of C. trachomatis infection.

Don’t discriminate: even a discriminatory zone as high as 4000 can result in interruption of an IUP

The discriminatory zone (DZ) is the level of hCG above which one can be assured the pregnancy outcome will be ectopic pregnancy (EP) or miscarriage (SAB) if a normal intrauterine pregnancy (IUP) is not visualized by ultrasound (US). In this study, we assess how often the use of a DZ may misclassify an IUP as a non-viable pregnancy.

Cornual Ectopic Pregnancy: Case Series

Three cases of cornual pregnancies encountered within three weeks at Paropakar Maternity and Women’s Hospital had diverse presentations. Fortunately, in all three case series, cornual resection was performed successfully. Cornual pregnancy is difficult to diagnose preoperatively with low ultrasonographic sensitivity and is easily confused with tubal ectopic pregnancy or a normal intrauterine pregnancy. Diagnosis before rupture is essential to prevent mortality and potential loss of fertility. The surgical management of diagnosed cornual pregnancy consists of hemostasis, resection, repair and reconstruction.

Serum progesterone levels in early pregnant women and its relation to luteal maintenance therapy for pregnancy protection

Objective To investigate serum levels of β-human chorionic gonadotrophin (β-HCG) and progesterone (P) in early pregnant women, and their relation to luteal maintenance therapy for early pregnancy protection. Methods One hundred and thirty five infertility women treated in Department of Gynecology and Obstetrics of Beijing Chaoyang Hospital from January 2007 to December 2011. Total 150 pregnancy cycles, including 84 with intrauterine insemination (IUI) and 66 with natural conception, were divided into two groups: normal intrauterine pregnancy group (group A, n=80) and early pregnancy loss group (group B, n=70). Medical history, ultrasonic findings, serum female hormone, P and β-HCG levels at early pregnancy stage were analyzed. Results The age of group A and group B was (30.0±3.9) years and (30.7±4.9) years, respectively (P>0.05). The follicle-stimulating hormone/luteinizing hormone in group A and group B was 1.57±0.96 and 1.56±1.08; the estradiol levels in two groups were (152±66) pmol/L and (147±69) pmol/L, respectively (both P>0.05). There were no differences in dominant follicles and endometrial thickness between groups A and B (P>0.05). Ovulation promotion and luteal support treatments were adopted in both groups: 50%(40/80) of cycles in group A received ovulation promotion, 73%(58/80) of cycles received luteal support, while 44%(31/70) and 76%(53/70) received in groups B, respectively. The levels of serum progesterone in group A during 14-21 d, 22-27 d and ≥28 d after ovulation were higher than those in group B at each time points (P 0.05). Conclusion Dynamic monitoring of serum progesterone level in early pregnancy may be used as an auxiliary index for prediction of pregnancy outcome, but it may not be an indicator for luteal maintenance therapy. Key words: Pregnancy trimester, first; Intrinsic factor; Abortion, spontaneous; Progesterone; Corpus luteum maintenance

Expression and Influence of Galectin-3 on Missed Abortion

Objective To explore the influence of galectin-3 on missed abortion. Methods Forty cases of normal intrauterine early pregnancy were randomly divided into 2 groups: surgical abortion group (group A, n=20) and medical abortion group (group B, n=20). The third group was missed abortion group (group C, n=20) with the gestational age less than 13 weeks. Serum was isolated from the blood samples, collected and used for ELISA quantification of galectin-3. Villus and decidua tissues were collected from the abortus for immunohistochemical examination and real-time fluorescence relative quantitative PCR. Results The level of galectin-3 in the serum was the lowest in missed abortion group (P Conclusion Galectin-3 is related to the development of villus and decidua during early pregnancy. The decreased expression of galectin-3 may promote the occurrence of missed abortion.