scholarly journals Management of Bilateral Ectopic Pregnancies after Ovulation Induction Using Unilateral Salpingectomy and Methotrexate for the Remaining Ectopic with Subsequent Intrauterine Pregnancy

2018 ◽  
Vol 2018 ◽  
pp. 1-4
Author(s):  
Quinton Katler ◽  
Lindsey Pflugner ◽  
Anjali Martinez
Keyword(s):  
Ectopic Pregnancy ◽  
Management Strategies ◽  
Surgical Techniques ◽  
Standard Of Care ◽  
Reproductive Technology ◽  
Surgical Removal ◽  
Intrauterine Pregnancy ◽  
Bilateral Ectopic Pregnancy ◽  
Ectopic Pregnancies ◽  
Poor Efficacy

Bilateral ectopic pregnancy is a rare phenomenon which is found with increased frequency when using assisted reproductive technology (ART). This diagnosis is most often made incidentally and intraoperatively, as ultrasound and serial β-hCG trends have shown poor efficacy for accurate diagnosis. Management of bilateral ectopic pregnancies is most commonly reported using bilateral surgical removal of the ectopic pregnancy (salpingostomy and/or salpingectomy). We present a case of an ART patient with incidentally found bilateral tubal ectopic pregnancies, where multiple management strategies including medical and surgical techniques were used concurrently which resulted in a subsequent spontaneous intrauterine pregnancy. While the standard of care is difficult to establish, we recommend individualizing management decisions based on the patient’s reproductive goals and overall risk profile.

scholarly journals Unilateral Atraumatic Expulsion of an Ectopic Pregnancy in a Case of Bilateral Ectopic Pregnancy

2017 ◽  
Vol 2017 ◽  
pp. 1-4
Author(s):  
Victoria Sampson ◽  
Oluremi Mogekwu ◽  
Ammar Ahmed ◽  
Farida Bano
Keyword(s):  
Ectopic Pregnancy ◽  
Blue Dye ◽  
Good Recovery ◽  
Common Site ◽  
Tubal Ectopic Pregnancy ◽  
Beta Hcg ◽  
Reproductive Techniques ◽  
Bilateral Ectopic Pregnancy ◽  
Ectopic Pregnancies ◽  
Poor Efficacy

Ectopic pregnancy occurs in 1-2% of pregnancies. The fallopian tube is the most common site; however, bilateral tubal ectopic pregnancy is an extremely rare phenomenon, seen in approximately 1/200,000 pregnancies. It is usually the result of assisted reproductive techniques (ART). Ultrasound (USS) and serial beta-hCG levels have shown poor efficacy for accurate diagnosis. Laparoscopy is the diagnostic gold standard. The majority of cases are managed surgically with bilateral salpingectomy. A 26-year-old female presented to our early pregnancy unit with pain and vaginal bleeding at 5-week gestation after IVF. USS was inconclusive and her b-hCG levels rose with worsening pain; therefore, a decision was made for diagnostic laparoscopy. Although there was a clear right sided ectopic pregnancy, the left tube was swollen and therefore a methylene blue dye test was carried out to confirm blockage. Atraumatic milking, to expose the dye, expelled necrotic tissue which histology confirmed to be a second ectopic pregnancy. She made a good recovery with falling beta-hCG levels and left tubal preservation. As the use of ART increases, bilateral ectopic pregnancies will become more common. Novel and established techniques should be used to help confirm the diagnosis and assist in tubal preservation.

scholarly journals Utility of a routine ultrasound for detection of ectopic pregnancies among women requesting abortion: a retrospective review

2020 ◽  
pp. bmjsrh-2020-200888
Author(s):  
Clara I Duncan ◽  
John J Reynolds-Wright ◽  
Sharon T Cameron
Keyword(s):  
Risk Factors ◽  
Ectopic Pregnancy ◽  
Clinical Care ◽  
Significant Risk ◽  
Intrauterine Pregnancy ◽  
Retrospective Case ◽  
Case Record ◽  
Ultrasound Findings ◽  
Ectopic Pregnancies ◽  
Record Review

IntroductionRoutine ultrasound may be used in abortion services to determine gestational age and confirm an intrauterine pregnancy. However, ultrasound adds complexity to care and results may be inconclusive, delaying abortion. We sought to determine the rate of ectopic pregnancy and the utility of routine ultrasound in its detection, in a community abortion service.MethodsRetrospective case record review of women requesting abortion over a 5-year period (2015–2019) with an outcome of ectopic pregnancy or pregnancy of unknown location (PUL) at a service (Edinburgh, UK) conducting routine ultrasound on all women. Records were searched for symptoms at presentation, development of symptoms during clinical care, significant risk factors and routine ultrasound findings.ResultsOnly 29/11 381 women (0.25%, 95% CI 0.18%, 0.33%) had an ectopic pregnancy or PUL (tubal=18, caesarean scar=1, heterotopic=1, PUL=9). Eleven (38%) cases had either symptoms at presentation (n=8) and/or significant risk factors for ectopic pregnancy (n=4). A further 12 women developed symptoms during their clinical care. Of the remaining six, three were PUL treated with methotrexate and three were ectopic (salpingectomy=2, methotrexate=1). In three cases, the baseline ultrasound indicated a probable early intrauterine pregnancy.ConclusionsEctopic pregnancies are uncommon among women presenting for abortion. The value of routine ultrasound in excluding ectopic pregnancy in symptom-free women without significant risk factors is questionable as it may aid detection of some cases but may provide false reassurance that a pregnancy is intrauterine.

scholarly journals Ruptured Tubal Ectopic Pregnancy at Fifteen Weeks Gestational Age

2019 ◽  
Vol 3 (1) ◽  
pp. 62-64 ◽  
Author(s):  
Justine Stremick ◽  
Kyle Couperus ◽  
Simeon Ashworth
Keyword(s):  
Abdominal Pain ◽  
Ectopic Pregnancy ◽  
Gestational Age ◽  
Vaginal Bleeding ◽  
First Trimester ◽  
Second Trimester ◽  
Intrauterine Pregnancy ◽  
Tubal Ectopic Pregnancy ◽  
Ectopic Pregnancies ◽  
First Trimester Ultrasound

Tubal ectopic pregnancies are commonly diagnosed during the first trimester. Here we present a second-trimester tubal ectopic pregnancy that was previously misdiagnosed as an intrauterine pregnancy on a first-trimester ultrasound. A 39-year-old gravida 1 para 0 woman at 15 weeks gestation presented with 10 days of progressive, severe abdominal pain, along with vaginal bleeding and intermittent vomiting for two months. She was ultimately found to have a ruptured left tubal ectopic pregnancy. Second-trimester ectopic pregnancies carry a significant maternal mortality risk. Even with the use of ultrasound, they are difficult to diagnose and present unique diagnostic challenges.

scholarly journals Use of FloSeal Sealant in the Surgical Management of Tubal Ectopic Pregnancy

2013 ◽  
Vol 2013 ◽  
pp. 1-3 ◽  
Author(s):  
Mara Clapp ◽  
Jaou-Chen Huang
Keyword(s):  
Ectopic Pregnancy ◽  
Surgical Management ◽  
Thermal Injury ◽  
Tubal Pregnancy ◽  
Effective Alternative ◽  
Intrauterine Pregnancy ◽  
Tubal Ectopic Pregnancy ◽  
Tubal Patency ◽  
Ectopic Pregnancies

Background. Surgery is sometimes required for the management of tubal ectopic pregnancies. Historically, surgeons used electrosurgery to obtain hemostasis. Topical hemostatic sealants, such as FloSeal, may decrease the reliance on electrosurgery and reduce thermal injury to the tissue.Case. A 33-year-old G1 P0 received methotrexate for a right tubal pregnancy. The patient became symptomatic six days later and underwent a laparoscopic right salpingotomy. After multiple unsuccessful attempts to obtain hemostasis with electrocoagulation, FloSeal was used and hemostasis was obtained. Six weeks later, a hysterosalpingogram (HSG) confirmed tubal patency. The patient subsequently had an intrauterine pregnancy.Conclusion. FloSeal helped to achieve hemostasis during a laparoscopic salpingotomy and preserve tubal patency. FloSeal is an effective alternative and adjunct to electrosurgery in the surgical management of tubal pregnancy.

scholarly journals A Case of Live Birth after Uterine Reconstruction for Recurrent Cornual Ectopic Pregnancy following IVF Treatment

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Deivanayagam Maruthini ◽  
Vinay Sharma
Keyword(s):  
Ectopic Pregnancy ◽  
Elective Caesarean Section ◽  
Muscle Thickness ◽  
Singleton Pregnancy ◽  
Intrauterine Pregnancy ◽  
Future Pregnancy ◽  
Ectopic Pregnancies ◽  
The Right ◽  
Pregnancy And Birth ◽  
Myometrial Thickness

We present a case of recurrent ruptured right cornual ectopic pregnancies conceived after IVF. Following the second episode, a sonohysterography was undertaken to identify possible areas of scar weakness that may rupture with uterine distension in a future pregnancy. The scan revealed asymmetrical muscle thickness in the cornual regions, the right (6 mm) being thinner than the left (1.6 cm). Subsequently, an elective laparotomy was undertaken, and the cornua were reconstructed and thickened in several layers by bringing the laterally retracted myometrial fibres onto the reconstruction site. A sono-hysterography after surgery showed satisfactory (3-4 cm) myometrial thickness all around. A further cycle of IVF resulted in a singleton pregnancy. Pelvic scans confirmed normal intrauterine pregnancy without any myometrial thinning. She was delivered by an uneventful elective caesarean section at term. We propose that, in those who intend to have further pregnancies after a cornual ectopic pregnancy, a sono-hysterography is possibly the best investigative tool to assess myometrial integrity. This case demonstrates that in women with areas of muscle weakness it is possible to successfully perform an interval elective reconstructive surgery on the uterus that can result in an uneventful pregnancy and birth.

scholarly journals Heterotopic Pregnancy: A Clinical Case Report

1970 ◽  
Vol 39 (3) ◽  
Author(s):  
S Chowdhury ◽  
T Chowdhury
Keyword(s):  
Abdominal Pain ◽  
Case Report ◽  
Ectopic Pregnancy ◽  
Clinical Examination ◽  
Clinical Case ◽  
Lower Abdominal Pain ◽  
Tubal Pregnancy ◽  
Heterotopic Pregnancy ◽  
Intrauterine Pregnancy ◽  
Ectopic Pregnancies

Heterotopic pregnancy is coexistence of intrauterine and extrauterine pregnancies that is ectopic pregnancies. It is said to be rare. Here we report a case of 27 years old woman with heterotopic pregnancy. Patient had a typical presentation of severe lower abdominal pain following amenorrhoea for 2½ months. On clinical examination, there was suspicion of ectopic pregnancy but ultrasonography revealed early intrauterine pregnancy along with right tubal pregnancy with huge collection in abdomen . Immediate laparotomy was done and diagnosis was confirmed as a case of heterotopic pregnancy.DOI: http://dx.doi.org/10.3329/bmj.v39i3.9950 BMJ 2010; 39(3)

scholarly journals Unruptured tubal pregnancy in early second trimester

2018 ◽  
Vol 146 (9-10) ◽  
pp. 588-592
Author(s):  
Aleksandra Petric ◽  
Radomir Zivadinovic ◽  
Dejan Mitic ◽  
Predrag Vukomanovic ◽  
Milan Trenkic
Keyword(s):  
Pregnant Woman ◽  
Ectopic Pregnancy ◽  
Vaginal Bleeding ◽  
Clinical Presentation ◽  
Second Trimester ◽  
Intrauterine Pregnancy ◽  
Gynecological Examination ◽  
Life Threatening ◽  
Ectopic Pregnancies ◽  
Prenatal Visits

Introduction. Most ectopic pregnancies are tubal pregnancies. They are potentially life-threatening conditions with a high mortality rate if unrecognized. The diagnosis is established when the first warning symptoms occur, or during the first prenatal visits to a gynecologist. The diagnosis in the second trimester is extremely rare, since clinical presentation resulting either from the expulsion of the fetus into the peritoneal cavity or from the tubal rupture is manifested by that time. If there is no rupture or the expulsion of the fetus, the pregnancy is allowed to continue and ectopic pregnancy diagnosis may be established in the second trimester. Case outline. We present a case of a 31-year-old second gravida with a vital intrauterine pregnancy confirmed at the first examination. In the early second trimester, the patient visited her doctor due to vaginal bleeding. After a gynecological examination and ultrasonography, ectopic pregnancy was suspected, so the patient underwent laparotomy. Ectopic pregnancy was confirmed and adnexectomy was performed. Conclusion. Early ultrasound examinations have to confirm whether eutopic pregnancy is present. A misdiagnosis and monitoring of ectopic pregnancy as eutopic one is potentially life-threatening for a pregnant woman.

scholarly journals the Forecast of Weekly β-HCG and Progesterone for Early Pregnancy

2020 ◽  
Author(s):  
Yan Yang ◽  
Jie Duan ◽  
Yan Wang ◽  
Xin Du ◽  
Wei wu ◽  
...  
Keyword(s):  
Ectopic Pregnancy ◽  
Sensitivity And Specificity ◽  
Early Pregnancy ◽  
Pregnancy Outcomes ◽  
Predictive Value ◽  
Intrauterine Pregnancy ◽  
The Status ◽  
Β Hcg ◽  
Ectopic Pregnancies ◽  
Sensitivity Specificity

Abstract Background: Serum beta human chorionic gonadotropin (β-HCG) and progesterone levels are both monitored to assess the status of early pregnancy. Deviations from the expected levels of these hormones may indicate abnormal pregnancy. However; the relationship between progesterone levels and the magnitude of weekly β-HCG increases, as well as their combined predictive value for pregnancy outcome, is still debated. This study evaluated the predictive value of weekly serum β-HCG multiplication and progesterone levels on early pregnancy outcomes. Methods: This retrospective study reviewed patients with pregnancy confirmed by β-HCG in our hospital. Weekly β-HCG and progesterone levels were analyzed and ultrasonography was performed as necessary to determine outcomes at 13 weeks gestation. Results: There were 277 viable intrauterine pregnancies, 102 spontaneous abortions, and 59 ectopic pregnancies. At weeks 5-8, β-HCG was multiplied by 6.76, 6.21, 2.11, and 0.68 respectively. Logit models were established with the logarithm of HCG (LHCG) and progesterone as independent variables to predict viable intrauterine pregnancy. The sensitivity, specificity, and overall accuracy for the models were 85.9% and 90.25%, 44.72% and 72.04%, and 70.77% and 83.6%, respectively. When progesterone was ≥10 ng/ml, the sensitivity and specificity for predicting viable pregnancy were 90.25% and 72.04%, respectively. When progesterone was <10 ng/ml, the sensitivity and specificity for predicting ectopic pregnancy and complete abortion were 94.2% and 81.57%78.86%, respectively. Progesterone values were significantly different for viable pregnancy, abortion, and ectopic pregnancy (p<0.0001). A joint progesterone and LHCG model to predict viable pregnancy had 88.8% sensitivity, 75.2% specificity, and 83.8% overall prediction accuracy.Conclusion: Weekly β-HCG multiplication and progesterone levels can predict early pregnancy outcomes individually or jointly.

scholarly journals Double miss by ultrasound of a cornual ectopic pregnancy

2013 ◽  
Vol 82 (S1) ◽  
pp. 12-13
Author(s):  
Daniel Myran
Keyword(s):  
Ectopic Pregnancy ◽  
Cornual Pregnancy ◽  
Intrauterine Pregnancy ◽  
Sonographic Examination ◽  
Ectopic Pregnancies ◽  
Repeat Assessment

Cornual ectopic pregnancy is a rare subtype of ectopic pregnancy that is associated with later presentation and higher likelihood of mortality. Despite advances in sonography cornual ectopic pregnancies remain a challenging diagnosis. We present a case of a left cornual pregnancy that was initially interpreted as a live intrauterine pregnancy by sonographic examination and found during repeat assessment to be a cornual pregnancy.

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