Unilateral Tubal Twin Research Articles

Successful Management of Spontaneous Unilateral Twin Ectopic Pregnancy With Two‐Step Dose of Methotrexate

The incidence of unilateral tubal twin pregnancy is 1/20,000–1/250,000 with about 100 reported cases. Four of the six cases that were medically managed were successful. A 24‐year‐old female presented to the emergency department (ED) with vaginal bleeding and abdominal cramping. She was hemodynamically stable without signs of an acute abdomen. Laboratory evaluation revealed she was pregnant with a serum beta‐human chorionic gonadotropin (b‐hCG) of 798 mIU/mL. Transvaginal ultrasound (TVUS) revealed a single left tubal pregnancy with a yolk sac. The patient elected medical management with body surface area (BSA)–based intramuscular (IM) methotrexate (MTX). On Day 4, the patient returned to the ED; her b‐hCG was 727 mIU/mL. TVUS revealed twin left tubal pregnancies with yolk sacs and fetal poles without cardiac activity. The patient elected to continue medical management with a second dose of BSA‐based IM MTX. On Day 6, the patient returned to the ED with abdominal and rectal pain. She was hemodynamically stable without signs of an acute abdomen. Her b‐hCG was 533 mIU/mL. TVUS showed persistent twin left tubal pregnancies—one at 5 weeks gestational age and the other at 6 weeks gestational age—without evidence of rupture. The patient continued serial b‐hCGs. Thirty‐one days after the first dose of MTX, her b‐hCG was < 1 mIU/mL. TVUS showed resolution of tubal pregnancies. The patient consented to the publication of this case report. This case documents the successful treatment of spontaneous, unilateral tubal twin pregnancies with two‐step dosing of IM MTX.

Ectopic Twin Pregnancy : About A Case

Unilateral tubal twin pregnancies occur in approximately 1 in 125,000 spontaneous pregnancies. Due to the lack of data, there are few recommendations on the appropriate management of a twin tubal ectopic pregnancy. We report a CLINICAL CASE of A 28-year-old woman, with type 1 diabetes on insulin and with no significant surgical or gynaecological history, the patient presented to the emergency room for metrorragia evolving for two days in a context of 6sa-2j amenorrhea. Clinical examination finds a hemodynamically stable patient, a depressible flexible abdomen with sensitivity to the right iliac pit and a slightly painful reversed uterus has mobilization with a moderate bleeding abundance of endo uterine origin. The emergency room urine pregnancy test was positive. Beta Hcg serum was 3,966 mUI/ml. Transvaginal ultrasound showed a reversed empty uterus, a fine and homogeneous endometrium of 7.8 mm with the presence at the right tubal level of two gestational bags measuring (7.2mm5.8mm) and (7mm-5.6 mm) with two embryos of 3.8mm and 3.6mm respectively, both had positive cardiac activity. at the douglas bag cul level, the presence of an effusion blade. the diagnosis of bi-amniotic bi-horoial bi-chorial ectopic pregnancy was made.a laparoscopy was performed with a right salpingectomy. postoperative evolution was favourable. Health care providers should have a high index of clinical suspicion for ectopic pregnancies. Unilateral tubal twin ectopic pregnancies, although rare, can be correctly diagnosed by transvaginal ultrasound. Laparoscopic salpingectomy provides an effective treatment for unilateral tubal twin gestation with a short recovery time. Due to the lack of data in the literature, there are few recommendations on the appropriate management of an ectuous ectopic twin pregnancy.

Spontaneous unilateral twin tubal ectopic pregnancy: A case report

Unilateral tubal twin pregnancy is rare with an incidence of 1: 125,000 spontaneous pregnancies. Majority of cases that occur follow ovulation induction and assisted reproductive technology. A 38-year-old single primipara with a 9-week history of amenorrhea, 2-week history of lower abdominal pain, and a 3-day history of vaginal bleeding. Previous history of ectopic gestation with surgery, as well as repeated elective abortions and pelvic infections, was elicited. She was hemodynamically unstable with features of an acute abdomen. Pelvic examination revealed features suggestive of ectopic gestation. Spot serum pregnancy test was positive and the pelvic ultrasound revealed left tubal twin ectopic gestation with the significant peritoneal fluid collection. An emergency laparotomy with left salpingectomy was performed, with an un-complicated post operation course. The diagnosis was confirmed with histology. A high index of suspicion is required in the diagnosis of ectopic gestation in order to reduce the morbidity associated with it. Unilateral twin tubal ectopic gestation, although rare, has been reported with higher frequencies, and as such, the occurrence should be carefully sought on ultrasound in order to reduce its potential morbidity and mortality.

Unsual Tubal Twin Ectopic Gestation Report of Three Different Cases

Gestation outside the uterine cavity in which the implantation occurs in any tissue other than the endometrium is referred as ectopic pregnancy. The most places for occurring ectopic pregnancy (97% of cases) are the fallopian tubes including ampulla (55%), isthmus (25%), and fimbria (17%), and in 3% of patient’s ectopic pregnancy occurs in the abdominal cavity, ovary, or cervix. The tubal twin ectopic pregnancy is a rare condition, and the first unilateral tubal twin was reported by De Ott in 1891, and the first live twin tubal ectopic pregnancy was reported in 1944. A live tubal twin ectopic pregnancy is a very rare condition and among >100 reports of tubal twin pregnancies, till now, only 8 cases were live. Early diagnosis and treatment of women with tubal twin ectopic pregnancy is very important and may decrease the risk of tubal rupture. I present three cases of tubal twin ectopic gestation. In the first case, spontaneous unilateral live tubal twin ectopic gestation. The second and third cases spontaneous ruptured twin ectopic gestation. All three cases were successfully managed and there was no history of assisted reproductive techninique fertilization or pelvic inflammatory disease.

Tubal Twin Ectopic Gestation Report of Three Different Cases

Gestation outside the uterine cavity in which the implantation occurs in any tissue other than the endometrium is referred as ectopic pregnancy. The most place for occurring ectopic pregnancy (97% of cases) is the fallopian tubes including ampulla (55%), isthmus (25%), and fimbria (17%), and in 3% of patients ectopic pregnancy occurs in the abdominal cavity, ovary, or cervix.[1]The tubal twin ectopic pregnancy is a rare condition, and the first unilateral tubal twin was reported by De Ott in 1891, and the first live twin tubal ectopic pregnancy was reported in 1944 [2].A live tubal twin ectopic pregnancy is a very rare condition and among >100 reports of tubal twin pregnancies, till now, only 8 cases were live [3]. Early diagnosis and treatment of women with tubal twin ectopic pregnancy is very important and may decrease the risk of tubal rupture.. I present three cases of tubal twin ectopic gestation. In the first case, spontaneous unilateral live tubal twin ectopic gestation .The second and third cases spontaneous ruptured twin ectopic gestation .All three cases were successfully managed and there was no history of assisted reproductive techninique fertilization or pelvic inflammatory disease .

Unilateral spontaneous tubal twin ectopic pregnancy: A rare occurrence

Unilateral tubal twin pregnancy remains rare despite a rise in the incidence of singleton ectopic pregnancies. A 27-year-old Gravida 1 Para 0+0 at 12 weeks gestation, presented to our institution with a 1-month history of lower abdominal pain, that progressively worsened and became very severe. An abdominal ultrasound revealed an extrauterine gestational sac that looked like a single viable fetus in the right adnexa at about 12 weeks by crown rump length. Free fluid was noted in the right iliac fossa and Morrison’s pouch. A conclusion of a right-ruptured ectopic pregnancy was made. The patient underwent laparotomy and a diagnosis of twin right-sided fimbrial ectopic pregnancy was made. The crown rump lengths of the twins were 6cm and 4cm. We present this case because unilateral tubal twin pregnancy is still a rare phenomenon, and clinicians as well as clinical embryologists need to acknowledge its existence considering the diagnosis of this case was not made pre-operatively.Key words: Twin Tubal, ectopic pregnancy, unilateral

Unilateral Tubal Twin Ectopic Pregnancy: A Case Report of Failed Systemic Methotrexate Management Requiring Surgical Intervention

Abstract Background: Tubal twin ectopic pregnancy is extremely rare, with an incidence of 1:125,000 spontaneous pregnancies. We present a case of unilateral tubal twin pregnancy with fetal heartbeats that occurred in a patient submitted to in vitro fertilization. Case: A 26-year-old woman was referred to our hospital with increasing β-human chorionic gonadotropin (β-hCG) levels without an intrauterine gestation. The serum β-hCG level was 17,641 mIU/mL and ultrasound revealed two separate gestational sacs within the Lt. adnexa, each containing a live embryo. Due to stable vital signs and the small size of the gestational sacs, the patient was treated with methotrexate (MTX). Despite two courses of treatment with MTX, the therapy failed in the resolution of viable ectopic pregnancy. Conclusion: Therapy of MTX in cases of tubal twin ectopic pregnancy with fetal cardiac activity should be reconsidered. (J GYNECOL SURG 31:272)

Spontaneous Unilateral Tubal Twin Ectopic Pregnancy: A Case-Based Discussion and Assessment

ABSTRACT Introduction Two percent of all 1st trimester pregnancies in the United States are ectopic. Transvaginal ultrasound is considered the mainstay in diagnosis. Color Doppler ultrasound can prove to be an added helpful modality in identifying ectopic pregnancies. Case report An 18-year-old nulliparous female presented with vaginal bleeding and lower abdominal pain. Pelvic exam revealed tenderness in the right adnexal region with elevated quantitative serum beta-hCG. A transvaginal ultrasound showed an echogenic ring adjacent to the right ovary and M-mode and color Doppler revealed two fetal heart tones. Color Doppler enabled visualization of randomly dispersed tubal arteries and heart activity of both embryos. A right salpingectomy was performed without complications and beta hCG levels returned to undetectable levels. Conclusion B mode ultrasound is a vital diagnostic tool in the detection of ectopic pregnancy. Color Doppler provides both morphologic and functional information essential for determining the optimal therapeutic strategy. Three-dimensional ultrasound with color and/or power Doppler has proven useful in both the initial diagnosis and follow-up of ectopic pregnancies especially in patients following assisted reproduction treatment.

Unilateral tubal twin ectopic pregnancy treated with single-dose methotrexate

Spontaneous tubal twin pregnancy is a rare condition with an incidence of 1 in every 125,000 pregnancies. We present the case of a unilateral tubal twin ectopic pregnancy treated with single-dose methotrexate. A 26-year-old nulliparous woman was admitted to our clinic with a complaint of vaginal bleeding and leftside pelvic pain. Her serum β-human chorionic gonadotropin (β-hCG) level was 18,780 mIU/mL and ultrasound revealed tubal twin pregnancy of 7 weeks' gestation. Because her vital signs were stable and no sign of tubal rupture was present, we performed single-dose (100 mg) methotrexate intramuscularly. In the follow-up, serum β-hCG levels were found to be 7,600 mIU/ml on day 7, 948 mIU/ml on day 20, 126 mIU/ml on day 26 and <10 mIU/ml on day 42. Methotrexate theraphy may be preferred in tubal twin ectopic pregnancies when the vital signs of the patient are stable and the fetal cardiac activities are negative.

A unilateral tubal twin pregnancy

A unilateral tubal twin pregnancy

Spontaneous unilateral tubal twin pregnancy

In a stable patient with tubal pregnancy, treatment with methotrexate often allows preservation of the tube. In spontaneous tubal twin pregnancy, of which only five cases have been reported, experiences with this method are lacking.

Preoperative diagnosis of unilateral tubal twin ectopic pregnancy with one line twin

"Preoperative diagnosis of unilateral tubal twin ectopic pregnancy with one line twin." Journal of Obstetrics and Gynaecology, 23(3), pp. 313–314

Sonographic diagnosis of a unilateral tubal twin pregnancy with documented fetal heart activity

A 31-year-old woman with 7 weeks’ amenorrhoea presented to casualty with 2 hours history of left iliac fossa pain and vaginal brownish staining. There was no history of shoulder tip pain, urinary or bowel symptoms. A urine beta hCG (Clearview) test was positive. Due to a past history of anovulatory cycles, she had been prescribed clomiphene from day 2 to day 5 of her menstrual cycle. Abdominal examination revealed localized tenderness on gentle palpation in the left iliac fossa associated with guarding, but no rebound tenderness. Pelvic examination revealed a closed cervical os, marked cervical tenderness and a normal sized anteverted uterus with left forniceal fullness and tenderness. Vaginal ultrasound revealed a pseudosac measuring 1 cm in diameter in the uterus. A mass was seen in the left adnexa with two gestational sacs within it. The ® rst sac contained a distinctive fetal pole with a crown rump length (CRL) equivalent to a 8 weeks size fetus and the fetal heart was present. The second sac measured 1´8 cm by 1´4 cm and no fetal pole was

Preoperative sonographic diagnosis of a unilateral tubal twin gestation with documented fetal heart activity.

Preoperative sonographic diagnosis of a unilateral tubal twin gestation with documented fetal heart activity.

Bilateral tubal and twin pregnancies in Ile-Ife, Nigeria

Three cases of unilateral tubal twin pregnancies and four cases of simultaneous bilateral tubal pregnancy recorded in a Nigerian University Teaching Hospital were reviewed. The incidences were 1 in 68 and 1 in 51 ectopic pregnancies respectively. High twinning rates within the environment and tubal damage from pelvic infections were considered as possible etiologic factors.

Unilateral tubal twin pregnancy following laparoscopic tubal diathermy

A case of unilateral tubal twin pregnancy occurred 11 years after laparoscopic tubal diathermy. We believe that this is the first such case to be reported.

Unilateral tubal twin pregnancy following in vitro fertilization and embryo transfer

Unilateral tubal twin pregnancy following in vitro fertilization and embryo transfer

Unilateral tubal twin pregnancy

Abstract Up to Dec. 31, 1957, only 81 well-authenticated cases of unilateral tubal twin pregnancy had been reported. A further case is reported in which the adjacent ovary contained two distinct corpora lutea, suggesting the possibility of a tubal dizygotic twin pregnancy.

Unilateral tubal twin pregnancy

Unilateral tubal twin pregnancy is a rare occurrence. Through 1957 at least 79 authentic cases have been reported. We believe that this case report brings the total to 80.

Unilateral tubal twin pregnancy: Report of a case possibly involving dizygotic twins

Up to Dec. 31, 1957, only 81 well-authenticated cases of unilateral tubal twin pregnancy had been reported. A further case is reported in which the adjacent ovary contained two distinct corpora lutea, suggesting the possibility of a tubal dizygotic twin pregnancy.