Ectopic Pregnancy Research Articles

Association of Activin A Levels and Body Mass Index with Human CGB (Chorionic Gonadotrophin Beta) in Ectopic Pregnancies and Missed Abortion Patients

Background: An ectopic pregnancy occurs when a fertilized egg implants itself—typically in one of the fallopian tubes—outside of the womb. Connecting the ovaries to the womb are tubes called fallopian tubes. An egg lodged in them won't develop into a baby, and if the pregnancy goes on, it could be dangerous for your health. When symptoms do appear, they usually appear between weeks four and twelve of pregnancy. Missed abortion refers to the clinical state in which there is still an intrauterine pregnancy but it is not progressing normally. Only if the diagnosis of an incomplete abortion or an inevitable abortion was ruled out would the gestation be referred to be a missed abortion. Activin A is a protein that participates principally in reproductive functions. In the adult brain, Neuroprotective effects of activin. Pituitary follicle-stimulating hormone (FSH) release is stimulated by activins, which are separated from gonadal fluids and belong to the The transforming growth factor (TGF-beta) superfamily. Activins are disulfide-linked dimeric proteins. Objectives: To estimate the concentrations in serum of Activin A in women who have been diagnosed with (missed abortion) and ectopic pregnancy, to compare them with non- missed abortion (MA) and ectopic pregnancy (Ep) healthy controls, and to explore the impact of human chorionic gonadotrophin (β-HCG) on the results. Method: The study included 120 participants ranging in age from aged 18-45 years. Thirty of them had Missed abortion and Thirty had ectopic pregnancy were diagnosed by X-ray, whereas sixty were healthy and served as a control group. The Activin A and beta-HcG levels measured by enzyme linked immunosorbent assay method. Body mass index "BMI" was calculated by applying the continuity formula: - Body Mass Index (Kg/m2) = Weight/Height2. Results: Women with ectopic pregnancy and missed abortion had significantly higher levels of ACV-A and human chorionic gonadotropin beta (B-HcG) than the control groups. In addition, patients in the ectopic group had a significantly lower score than patients in the missed abortion group. Conclusion:Serum Activin A can be used as indicators of Ectopic pregnancy and Missed Abortion, Obesity represented by BMI has no significant effect on patients with ectopic pregnancy or missed abortion while Serum Beta-HcG level at cutoff value of >236, ng/ml) may be a novel biomarker for assessment of women with ectopic pregnancy .

OA07 Upadacitinib exposure during pregnancy in seronegative Rheumatoid arthritis

Abstract Introduction Targeted therapies have become increasingly prevalent in the management of rheumatoid arthritis (RA), with Janus kinase inhibitors (JAK inhibitors) gaining traction in clinical practice. Upadacitinib, a selective JAK1 inhibitor, is widely used for its efficacy in controlling RA. However, preclinical studies have demonstrated teratogenic effects associated with JAK inhibitors, raising concerns about their safety during pregnancy. Given the limited data on human exposure, current guidelines recommend the immediate discontinuation of JAK inhibitors upon pregnancy detection. This case report details an instance of Upadacitinib exposure during pregnancy. Case description A 36-year-old woman was diagnosed with seronegative RA in January 2020. Her medical history is otherwise unremarkable. She has two children, aged four and two, both of whom were born after uneventful pregnancies. She has no history of spontaneous abortions. At the time of her RA diagnosis, the patient was considering pregnancy and was initially started on sulfasalazine. However, due to the development of a rash, her treatment was switched to certolizumab injections. Despite this treatment, she exhibited only a partial response with ongoing disease activity, leading to a change to etanercept in August 2021. When etanercept proved ineffective, adalimumab was considered in January 2022. Unfortunately, her response to adalimumab was limited. Consequently, she was started on Upadacitinib in July 2022. The patient responded well to Upadacitinib, achieving remission with normal inflammatory markers. In April 2024, the patient reported being six weeks pregnant while on Upadacitinib. Upon confirmation of her pregnancy, Upadacitinib was discontinued at approximately four weeks of gestational age. The parents were informed about the potential risks of teratogenicity. After a detailed discussion with the high-risk pregnancy team, who provided reassurance, the patient decided to continue the pregnancy. She was subsequently started on certolizumab. Unfortunately, the patient experienced a miscarriage at 11 weeks of gestation. Discussion Currently, there are no published human studies available in the literature regarding the effects of upadacitinib during pregnancy. It is crucial to encourage adequate contraception for women of childbearing potential and to verify a negative pregnancy status before initiating therapy. Women with reproductive potential should be advised to use effective contraception during upadacitinib therapy and for at least four weeks after discontinuation. If a patient becomes pregnant while on the drug, they should be informed of the potential risks to the foetus. According to the 2019 product information on upadacitinib, animal studies have shown that the drug, when administered at exposures equal to or greater than approximately 1.6 to 15 times the maximum recommended human dose, resulted in dose-related increases in skeletal and cardiovascular malformations, increased post-implantation loss, and decreased foetal body weights. There are no controlled data on upadacitinib use during human pregnancy, and it is unknown whether the drug can cause foetal harm or adversely affect reproductive capacity in humans. Data about pregnancy while on upadacitinib is limited. There are some unpublished data from the clinical trials and it was noted most of the patients had live births without congenital anomaly. Spontaneous abortions, elective terminations and ectopic pregnancies were among the other outcomes noted. Key learning points • Due to issues such as primary or secondary treatment failures, hypersensitivity reactions, and adverse events, patients often require sequential trials of different agents in management of Rheumatoid Arthritis (RA). Janus kinase inhibitors (JAK inhibitors) have shown remarkable efficacy in managing RA over the last decade. Despite their widespread use, there is limited literature on the safety of upadacitinib exposure during pregnancy in humans. Most of the available data come from unexpected pregnancies documented during clinical trials. • Animal studies indicate that upadacitinib can be harmful to a developing foetus. Furthermore, data suggest that women with RA who experience increased disease activity are at a heightened risk for adverse pregnancy outcomes, including preterm delivery, low birth weight, and infants who are small for gestational age. • It is crucial to emphasize pregnancy contraindications during follow-up appointments for patients on these medications. Access to a medical obstetrician team is invaluable in managing such cases. • While some case reports have documented positive pregnancy outcomes with other JAK inhibitors, such as tofacitinib and baricitinib, there remains a significant gap in knowledge regarding upadacitinib. This case report adds to the limited data on the potential risks associated with upadacitinib exposure during pregnancy. Comprehensive and targeted studies are necessary to better understand the safety of this class of drugs during pregnancy and lactation.

Psychological Distress in Patients With Recurrent Ectopic Pregnancies: A Cross-Sectional Study.

Most patients with ectopic pregnancies experience a high level of psychological distress for various reasons. The psychological state and needs of patients with recurrent ectopic pregnancies need to be seriously addressed. However, psychological distress in patients with recurrent ectopic pregnancy has not been widely studied. The purpose of this study is to investigate and understand the prevalence and factors influencing psychological distress in patients with recurrent ectopic pregnancies. A cross-sectional study. This study follows the STROBE guidelines. The Kessler Psychological Distress Scale (K10) was utilised to assess the level of psychological stress in patients. The Kruskal-Wallis test or Mann-Whitney U test was used to compare the factors influencing psychological stress in patients with different conditions. A total of 134 patients with recurrent ectopic pregnancies completed the survey, and most patients experienced moderate-to-severe psychological distress. The psychological distress experienced by patients with recurrent ectopic pregnancies is complex and dynamic, influenced by various factors. Among them, the main factors affecting the psychological distress of patients were age, education level, number of children, number of abortions, medical insurance and economic pressure (p < 0.05). This study suggests that the psychological distress experienced by patients with recurrent ectopic pregnancies is universal and cannot be ignored. It is necessary to pay attention to the psychological needs of patients with recurrent ectopic pregnancies and carry out scientific and effective psychological care management.

Sonographic Mimic of Ovarian Ectopic Pregnancy by Point-of-Care Ultrasound

Sonographic Mimic of Ovarian Ectopic Pregnancy by Point-of-Care Ultrasound

Primary abdominal pregnancy with a viable fetus: clinical case of successful management

Abdominal pregnancy, occurring outside typical intrauterine locations, poses substantial risks to maternal health due to the potential for severe bleeding from placental detachment. Despite its rarity, accounting for 1–1.5% of ectopic pregnancies, its mortality rates are significantly higher, with maternal mortality ranging from 2% to 30%.Case report. A 42-year-old woman, pregnant with her third pregnancy at 33 weeks, was admitted to the hospital with abdominal pain. All antenatal visits were performed without the use of ultrasound. Utilizing ultrasound and magnetic resonance imaging (MRI), we diagnosed an abdominal pregnancy, revealing an extrauterine fetus and placenta, and clarified the location of the placenta, and the involvement of nearby structures. Prompt surgical intervention via laparotomy ensured successful delivery and maternal well-being. The male baby was born in good condition, and no congenital abnormalities were observed.Discussion: Ultrasound remains the primary diagnostic tool, complemented by MRI for precise evaluation. Early diagnosis is paramount, emphasizing the need for improved clinical understanding and vigilance, with MRI serving as a valuable adjunct in uncertain cases. Early surgical intervention, guided by diagnostic imaging, improves outcomes, underscoring the importance of a multidisciplinary approach to the management of abdominal pregnancy.

A Case Report of Retroperitoneal Ectopic Pregnancy and Review of Literature

A Case Report of Retroperitoneal Ectopic Pregnancy and Review of Literature

Stone Babies: A Pictorial Essay With Insights From 25 Museal Lithopaedions.

Lithopaedion, or "stone baby," represents an exceptionally rare clinical phenomenon with fewer than 350 documented cases existing in the medical literature. This condition arises when an advanced extrauterine pregnancy ceases its developmental trajectory and undergoes a lithification process, potentially resulting in a calcified mass with fetal-like morphology. Typically, lithopaedions remain asymptomatic for decades, but may occasionally elicit acute symptoms necessitating medical intervention. However, predominantly, these entities are incidental findings discovered during radiological examinations or autopsies. In this article, we present a comprehensive overview of 25 lithopaedion cases, including unreported cases from several European medical museums. When feasible, additional radiological imaging was conducted to enhance diagnostic clarity. Furthermore, this article situates lithopaedions within a broader historical perspective and a detailed etiopathogenetic framework, elucidating the physiological and pathological mechanisms contributing to their formation. The phenomenon of lithopaedion is a testimony to the complex and often enigmatic nature of the human body. By compiling and scrutinizing a substantial number of cases, this review offers valuable insights into the clinical implications of lithopaedions. Furthermore, it highlights the necessity for ongoing research and meticulous documentation of rare medical conditions like this, in order to contribute to a deeper understanding of extraordinary phenomena.

Case Report: Acute Abdomen Due to Ruptured Ovarian Ectopic Pregnancy at 8 Weeks

Background Ovarian pregnancy is a rare type of ectopic pregnancy, accounting for 0.5% to 1% of all ectopic pregnancies, with an incidence ranging from 1 in 2,100 to 1 in 60,000 pregnancies. Due to its rarity and the lack of common risk factors, diagnosing ovarian pregnancy is often challenging and typically occurs during surgical exploration. Case Presentation We present the case of a 40-year-old woman who experienced severe pelvic pain, light vaginal bleeding, and 8 weeks of amenorrhea. Upon arrival at the hospital, she was hemodynamically unstable, with low blood pressure and a rapid heart rate. An ultrasound revealed an empty uterus, an irregular mass on her right ovary, and free fluid in the pelvis. Her beta-hCG level was elevated, and her hemoglobin level was low. Given the suspicion of an ectopic pregnancy, she underwent emergency surgery. During the operation, the surgical team discovered a large amount of clotted blood and a ruptured mass on her left ovary measuring 10 x 9.5 cm. Due to heavy bleeding, they performed a left oophorectomy and salpingectomy. Histopathological analysis later confirmed the diagnosis of ovarian pregnancy. Conclusion This case underscores the challenges in diagnosing ovarian pregnancy and highlights the necessity for prompt surgical intervention, particularly in unstable patients. Early detection and appropriate management are critical to prevent life-threatening complications.

Long-term follow up of fecundability after ectopic pregnancy in Taiwan: a nationwide population-based study

Long-term follow up of fecundability after ectopic pregnancy in Taiwan: a nationwide population-based study

Management of nontubal ectopic pregnancies - single center experience

Aims: Ectopic pregnancies can be defined as pregnancies in which the growing blastocyst implants outside the endometrial cavity. However, it is assumed that 0.5-1% of all pregnancies are ectopic pregnancies. The most common extrauterine implantation site is the fallopian tube. Non-tubal pregnancies (NTG Non-tubal pregnancies) account for less than 5% of all ectopic pregnancies but cause 8 times higher maternal mortality than tubal pregnancies. The study aimed to determine the frequency of nontubal ectopic pregnancies in a tertiary care unit in Turkey and the differences that may differentiate patients from tubal ectopic pregnancies. Methods: The purpose of this retrospective study was to analyze and describe the treatments of patients who were hospitalized for ectopic pregnancy in the Gynecology and Obstetrics Clinic of Mengücekgazi Training and Research Hospital from May 2014 to May 2024. Obstetric/gynecologic history, risk factors for previous ectopic non-tubal pregnancy, serum-hCG levels at the moment of diagnosis, ultrasound findings, surgical or medical treatment and treatment outcomes were presented. Results: In our institutional records, 240 patients received an ectopic pregnancy diagnosis. and n=23 nontubal ectopic pregnancies were identified. Cervical pregnancy (CP) (n=2), interstitial pregnancy (IP) (n=2), cesarean scar pregnancy (ScP) (n=10), ovarian pregnancy (OvP) (n=9) were detected. Conclusion: It emerges from our sample that NT-EP needs to be diagnosed quickly. This can assist in the conservative use of a medical or minimally invasive method. The significant advance in imaging technologies allows for a faster diagnosis, allowing the patient to be transferred to a referred center from where the best procedures can be selected, reducing the potential impact of surgery on the patient’s fertility.

Ultrasonic diagnosis of hepatic ectopic pregnancy: a case report

Hepatic ectopic pregnancy is an extremely rare ectopic pregnancy. Ectopic pregnancy is one of the reasons for acute abdominal pain. Ectopic pregnancy refers to the growth and development of zygotes outside the uterine cavity, and tubal pregnancy is the most common. Abdominal ectopic pregnancy is very rare, accounting for only 1.3% of all ectopic pregnancy including small intestine and large intestine, sigmoid colon, omentum, liver, diaphragm, pancreas, peritoneum and spleen [1], of which the incidence of hepatic ectopic pregnancy is about 1:15,000 per inner uterus pregnancy [2]. The present report describes the case of a 36-year-old woman who presented with continuous brown vaginal secretions after 57 days of amenorrhea. The patient was initially diagnosed with liver ectopic pregnancy by abdominal ultrasound and this was confirmed by laparoscopic exploration. The pathological examination revealed a pregnancy material in the liver tissue. The patient made good progress post-surgery, with serum levels returning to normal during a follow-up examination 1 month later. Overall, ultrasound and β-HCG levels are crucial in diagnosing ectopic pregnancy before patients show clinically consistent symptoms.

A case report on renal metastasis as an unusual presentation of choriocarcinoma

BackgroundChoriocarcinoma is an aggressively invasive neoplasm, characterized by its rapid proliferation and propensity for metastasis to distant organs via hematogenous dissemination. Lungs (80%), vagina (30%), pelvis (20%), liver (10%), and brain (10%) are the most frequently metastasized organs. Renal metastases are very rare. The clinical manifestations of choriocarcinoma varies depending on the site of disease, making diagnosis challenging. In this report, we provide a clinical case of choriocarcinoma with metastases to the renal and pulmonary systems, displaying symptoms akin to those observed in ectopic pregnancy.Case presentationA 27-year-old female, G2P1, with a previous history of full-term pregnancy in 2018, presented to the hospital with the onset of vaginal bleeding and accompanying abdominal aches. Investigations uncovered a left adnexal mass with a human chorionic gonadotropin (hCG) level of 77,4 mIU/mL and a left pulmonary nodule measuring 31 mm x 21 mm. Laparoscopy was performed due to the high suspicion of an ectopic pregnancy. However, no visible villi were identified during the surgery, and postoperative blood hCG levels continued to rise. A diagnostic curettage also failed to reveal any villi, maintaining the suspicion of a persistent ectopic pregnancy. Following two ineffective courses of methotrexate therapy, the patient was referred to our facility. Prior to her referral, an ultrasound had indicated a mass in the right kidney. However, upon arrival at our hospital, subsequent ultrasonography failed to detect any renal masses. Despite two months of outpatient monitoring, there was a sudden and significant increase in her serum hCG levels. An emergency laparoscopy was performed, revealing no pregnancy-related lesion. After surgery, the patient’s hCG levels dropped dramatically to less than one-tenth of the original amount. Multisite enhanced computed tomography(CT)revealed suspicious lesions in both the renal and pulmonary regions. Upon thorough multidisciplinary consultation, a diagnosis of choriocarcinoma was entertained. Consequently, the patient successfully underwent eight cycles of chemotherapy and has remained recurrence-free for the past year.ConclusionsThis case underscores the potential for choriocarcinoma in women of reproductive age who exhibit radiological signs of renal masses. Early and accurate diagnosis, followed by prompt intervention, is essential to prevent needless surgery procedures.

Surgical treatment of cesarean scar pregnancy based on the three-category system: a retrospective analysis

BackgroundCesarean scar pregnancy (CSP), a distinct form of ectopic pregnancy, presents challenges in effective management. It is categorized into three subtypes according to the location of placental implantation and the thickness of the myometrium at the uterine scar. Nevertheless, the optimal choice of treatment modalities for these subtypes remains largely unexamined.MethodsIn this retrospective analysis, we investigated the cases of 130 patients diagnosed with CSP who underwent diverse treatment approaches, namely ultrasound-guided dilation and curettage (D&C), hysteroscopic surgery alone or in combination with laparoscopic surgery (HCoLC), or uterine artery embolization (UAE) followed by curettage. Clinical data were meticulously retrieved from medical records and follow-up data, and a comparative analysis of relevant indicators was carried out across the different CSP subtypes.ResultsFrom January 2017 to December 2021, 35 patients underwent D&C, 85 underwent HCoLC, and 10 received UAE as a pretreatment. In the D&C group, the success rates for Type I and Type II CSP were 64.29% (18/28) and 14.28% (1/7), respectively. Significant differences were observed between the success and failure groups in terms of gestational sac size and clinical classification. Compared to Type I CSP, Type II CSP exhibited significantly longer surgical durations and higher hospitalization costs (P < 0.05). Three patients classified as Type III underwent simultaneous hysteroscopic evacuation of cesarean scar pregnancy and laparoscopic repair of the cesarean scar defect, achieving a 100% success rate in their initial treatment. HCoLC showed no significant differences in surgical duration and hospitalization costs but had higher success rates and shorter hospital stays compared to the D&C and UAE groups (P < 0.05). The UAE group had significantly longer surgical durations, higher hospitalization costs, and a higher incidence of postoperative complications (P < 0.05). However, these factors did not result in improved surgical success rates.ConclusionThe classification of CSP and the measurement of gestational sac are of crucial importance in determining the most appropriate surgical intervention strategy. For patients diagnosed with Type I CSP, D&C and hysteroscopy are reliable treatment choices. In cases with larger gestational sacs or Type II CSP, hysteroscopy, either alone or in combination with laparoscopy, is regarded as a reliable and effective treatment approach. In patients with type III CSP, lesion excision with uterine repair is the recommended treatment.

Ectopic Pregnancy in a Non-communicating Rudimentary Uterine Horn: A Case of Successful Medical Management and Literature Review

Ectopic Pregnancy in a Non-communicating Rudimentary Uterine Horn: A Case of Successful Medical Management and Literature Review

Impact of prolonged embryo storage on reproductive and neonatal outcomes: a systematic review and meta-analysis.

To analyze the influence of embryo storage on reproductive and neonatal results in patients undergoing in vitro fertilization (IVF) treatment. PubMed, Embase, Cochrane Central Register of Controlled Trials, and BioMed Central databases were searched from inception up to June 2024 for studies comparing reproductive and neonatal outcomes in patients undergoing frozen embryo transfer within 12months from embryo storage versus more than 12months after embryo storage. Data were pooled by meta-analysis using a random effects model. A total of 16 studies, involving 233,315 embryos were included. Patients undergoing frozen embryo within 12months from embryo storage were associated with higher rates of live birth (OR 1.17, 95% CI 1.09-1.26, I2 = 78%) biochemical pregnancy (OR 1.26, 95% CI 1.08-1.47, I2 = 77.8%) clinical pregnancy (OR 1.24, 95% CI 1.12-1.38, I2 = 86.3%) and multiple pregnancy rate (OR 1.26, 95% CI 1.03-1.55, I2 = 69%). No significant differences between groups were shown in terms of survival rate (OR 1.52, 95% CI 0.65-3.58, I2 = 98.5%), miscarriage (OR 1.08, 95% CI 0.91-1.27, I2 = 77%), implantation rate (OR 1.17, 95% CI 0.90-1.52, I2 = 91.7%) and ectopic pregnancy (OR 0.98, 95% CI 0.80-1.20, I2 = 0%). In addition, prolonged embryo storage was not associated with higher rates of preterm delivery (OR 0.86, 95% CI 0.67-1.09, I2 = 8.3%), low weight at birth (OR 1.10, 95% CI 0.88-1.38, I2 = 24.3%) or congenital malformations (OR 0.90, 95% CI 0.65-1.25, I2 = 0.8%). Prolonged embryo storage over 12months is associated with lower rates of live birth, biochemical pregnancy, clinical pregnancy, and multiple pregnancy. However, important covariates such as reasons for delay of transfer, embryo quality, and improper handling of embryos could not be ruled out as causes of this reduction. Given these limitations, these conclusions should be viewed with caution.

Successful Outcome of Secondary Infertility with Multidrug Therapy in a Long-Standing Case of multisystem involvement

A case of secondary infertility with multisystem involvement is being presented herewith. Secondary infertility indicates previous pregnancy but failure to conceive subsequently. Numbers of secondary infertility are growing day by day. Many factors like age, unwholesome lifestyle, disturbed schedule, diet, stress is accountable for it. Due to involvement of these all factors sometimes a female may expose to multiple metabolic disorders resulting into infertility. Aim: To study the outcome of Ayurvedic treatment in management of secondary infertility. Objective: To access the role of Ayurvedic management in secondary infertility. Methodology: It is a single case study of secondary infertility due to multiple metabolic disorders. Case description: A female aged 31years, had pain during menstruation and regular cycles with history of left tube removal due to ectopic pregnancy visited for wants to conceive. She had history of treatment at various private centers and had multisystem metabolic disorders. She was advised Ayurvedic oral medications along with yogabasti. Outcome: After Ayurveda interventions she conceived. Conclusion: Ayurvedic management by improving the health and reproductive ability of a woman may help to conceive. The probable mechanism for the efficacy of multidrug therapy in multisystem disorders gives ray of hope to numerous. Keywords: Infertility, Conception, Menstrual Cycle, Hydrosalpinx

The Effectiveness of Letrozole Alone or in Combination with Methotrexate in the Management of Ectopic Pregnancy, A Systematic Review and Meta-Analysis.

This systematic review and meta-analysis aimed to investigate the effect of letrozole alone or in combination with Methotrexate on the management of ectopic pregnancy. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) were applied for reporting. The EMBASE, PubMed, Scopus, and Web of Science databases were searched for relevant studies focused on women diagnosed with ectopic pregnancy and managed non-surgically with letrozole alone or in combination with methotrexate (MTX) until April 2024. The success rate, laboratory findings, and complications were analyzed and reported. Meta-analysis was done using RevMan 5.4.1 software. Out of 129 unique studies obtained, 7 of them were found eligible for final review; of which, 3 were nonrandomized prospective cohort studies, 2 were randomized clinical trials, and 2 study were case studies. In 5 studies letrozole was used as monotherapy. While in another study letrozole was used with MTX. The meta-analysis showed a significantly lower level of β-HCG in the letrozole group compared to MTX, 7days after initiation of treatment (Fixed effect model, MD = -92.22, 95%CI: [-159.39, -25.04], P = 0.007, I2 = 0%). There was no significant difference in the level of anti-mullerian hormone (AMH) between groups (Fixed effect model, MD = 0.18, 95%CI: [-0.09, 0.45], P = 0.20, I2 = 0%). Success rate, platelet count, and level of liver enzymes seemed to be better or similar among patients receiving Letrozole compared to patients receiving Methotrexate. Letrozole exhibits potential as a therapeutic option for ectopic pregnancies; however, further randomized clinical trials are necessary to establish strong evidence.

Is it necessary to check β-hCG levels on day 4 after single-dose methotrexate treatment of ectopic pregnancy? A retrospective cohort study

Aim: This study aimed to investigate the usefulness of the percentage change in serum β-hCG levels from days 1 to 7 for predicting treatment success in patients treated with a single dose of methotrexate for tubal ectopic pregnancy. Materials and Method: This retrospective observational study investigated 74 patients treated with a single-dose methotrexate regimen for tubal ectopic pregnancy at a tertiary hospital between January 2020 and December 2023. Patients were subdivided into two groups based on reduction in serum β-hCG levels between days 4 and 7:

Rare forms of ectopic pregnancy in the rudimentary horn and ovary. How not to miss the main thing?

This article presents two cases of ectopic pregnancy in the ovary and rudimentary horn, which had a life-threatening course. Despite availability of modern high-quality diagnostics, determining the condition remains challenging, because the definitive diagnosis is established and confirmed only intraoperatively. Hence, the clinical picture can be used primarily in making a diagnosis and choosing an appropriate treatment strategy. Rare localizations, such as in the ovary and rudimentary horn, which cause difficulties in making a diagnosis, should not be overlooked. If an ectopic pregnancy is not detected promptly and the risks are underestimated, death may occur. Two clinical cases clearly demonstrate timely diagnosis, regardless of additional examination methods (e.g., pelvic ultrasound, human chorionic gonadotropin test), and adequate choice of access and scope of surgical intervention. Moreover, the lack of awareness among women about this type of pathology should be considered. Patients often do not complain, do not remember the date of their last menstruation, do not monitor their menstrual cycle, and do not seek medical help in a timely manner. The combination of several factors can lead to fatal events. In this study, both cases of ectopic pregnancy with a rare localization ended favorably.

7228 Pregnancy Complications in Women with Lipodystrophy: The Role of Typical and Lipodystrophy-specific risk factors

Abstract Disclosure: B. Tracey: None. T. Neal: None. M. Lightbourne: None. M.S. Startzell: None. E. Cochran: None. P. Stratton: None. R.J. Brown: None. Lipodystrophy (LD) is characterized by partial (PL) or total (generalized, GL) deficiency of adipose tissue, leading to diabetes mellitus (DM), dyslipidemia, and polycystic ovary syndrome. Prior reports suggest increased risk of gestational DM (GDM), preeclampsia, and miscarriage in PL; infertility is common in GL. We explored if pregnancy complications in LD were related to typical risk factors (age, race) and/or LD-specific risk factors (GL vs PL; genotype of PL). Pregnancy data in patients with LD obtained by interview and chart review included: number of pregnancies, use of assisted reproduction technology (ART), miscarriage, GDM or pre-gestational DM (pre-GDM), preeclampsia, and weight gain. 28 patients (22 White, 6 BIPOC) had 74 pregnancies at ages 19-39y. 7 with GL (6 AGPAT2, 1 BSCL2) had 21 pregnancies (3.0±2.4 per person). 13 pregnancies in 6 patients with GL occurred on metreleptin; 1 had 8 pregnancies (3 miscarriages) without metreleptin. 21 patients with PL (7 LMNA, 4 PPARG, 10 unknown genotype) had 53 pregnancies (17 LMNA, 10 PPARG, 26 unknown; mean 2.5±1.3 per person); none were on metreleptin. No pregnancy in GL and 10 (19%) in PL used ART (P=0.053). In PL with LMNA, PPARG, and unknown genotype, ART was used in 3 (18%), 3 (30%), and 4 (15%) pregnancies (P=0.6). 10 (48%) of pregnancies in GL and 18 (34%) in PL ended in miscarriage (P=0.3). 11 patients (3 GL [43%], 8 PL [38%]) had recurrent (≥2) miscarriages. 2 ectopic pregnancies and 1 elective abortion occurred in PL. In PL with LMNA, PPARG, and unknown genotype, miscarriage occurred in 7 (41%), 3 (30%), and 8 (31%) of pregnancies (P=0.7). Pre-GDM preceded all 13 pregnancies in 6 patients with GL; 1 patient had 8 pregnancies without pre-GDM. In all LD, pre-GDM preceded 7 (25%) pregnancies in patients ≤25y and 22 (48%) in those &amp;gt;25y (P=0.08). Among 30 pregnancies continuing ≥20 weeks without pre-GDM, GDM developed in 3 (25%) ≤25y, and 9 (50%) &amp;gt;25y (P=0.3). GDM did not differ by genotype: LMNA 3 (43%), PPARG 4 (57%), unknown 5 (45%); P&amp;gt;0.99. Among 44 pregnancies continuing ≥20 weeks, preeclampsia developed in 5 (45%) in GL and 13 (39%) in PL (P&amp;gt;0.99). Preeclampsia incidence did not differ by genotype in PL (22% LMNA, 14% PPARG, 41% unknown genotype; P=0.4), race (26% White, 56% BIPOC, P=0.1), or age (23% ≤25y, 35% &amp;gt;25y, P=0.7). Gestational weight gain was less in GL than PL (mean 6.8±3.7 kg GL, 14.3±8.3 kg PL, P=0.0002) but was similar by PL genotype (LMNA 13.8±6.2 kg, PPARG 12.1±5.5 kg, unknown 15.4±8.5 kg; P=0.6). In this large study of pregnancy in LD, overall complication rates were high compared with healthy US women (with rates of miscarriage of 20%, recurrent miscarriage of &amp;lt;5%, pre-GDM of 4%, GDM of 15%, preeclampsia of 6%), but few were enhanced by LD-specific or typical risk factors; sample size was small. Gestational weight gain was lower in GL than PL, likely due to low fat mass in GL. These findings provide guidance for monitoring pregnancies in LD. Presentation: 6/1/2024