Caution with bilateral salpingectomy and consideration of tubal stump ectopic in IVF

2020 ◽  
Vol 13 (11) ◽  
pp. e235893
Author(s):  
Swee Lin Yip ◽  
Shahul Hameed Mohamed Siraj ◽  
Jerry Kok Yen Chan
Keyword(s):  
Ectopic Pregnancy ◽  
Cystic Mass ◽  
In Vitro Fertilisation ◽  
Beta Human Chorionic Gonadotropin ◽  
Life Threatening ◽  
History Of ◽  
Bilateral Salpingectomy ◽  
Ectopic Pregnancies ◽  
The Right

We report a 35-year-old female patient with a history of bilateral salpingectomy from ectopic pregnancies presenting with a positive serum beta-human chorionic gonadotropin (bhCG) result following in vitro fertilisation (IVF) treatment. Apart from per vaginal spotting, she remained asymptomatic. Initial ultrasound showed an empty uterus with a cystic mass on the right side of the uterus. Serum beta-hCG was trended. A follow-up pelvic ultrasound 1 week later showed a live pregnancy in the right adnexa. A diagnostic laparoscopy was performed, which revealed an unruptured right stump ectopic pregnancy that was successfully removed. As a stump ectopic pregnancy can be a potentially life-threatening occurrence, we emphasise caution with salpingectomy and the consideration of tubal stump ectopic pregnancies following IVF treatment.

Ruptured salpingitis isthmica nodosa: a rare cause for spontaneous haemoperitoneum

2021 ◽  
Vol 14 (1) ◽  
pp. e237860
Author(s):  
Dora Huang ◽  
Sandon Lowe ◽  
Pravena Kumaran ◽  
Kay Tai Choy
Keyword(s):  
Ectopic Pregnancy ◽  
Fallopian Tube ◽  
Diagnostic Laparoscopy ◽  
Lower Abdominal Pain ◽  
Atypical Presentation ◽  
Pelvic Ultrasound ◽  
Beta Human Chorionic Gonadotropin ◽  
History Of ◽  
Ectopic Pregnancies ◽  
The Right

Salpingitis isthmica nodosa (SIN) is the nodular swelling or diverticulum of the isthmus of the fallopian tube. It is most commonly identified when investigating female infertility or in association with ruptured ectopic pregnancies. We experienced a rare and atypical presentation of SIN. A 33-year-old woman presented with a 1-hour history of acute lower abdominal pain associated with nausea and vomiting. CT and pelvic ultrasound revealed haemoperitoneum with no radiological evidence for its aetiology. Initial beta-human chorionic gonadotropin excluded ectopic pregnancy. A diagnostic laparoscopy was performed following clinical deterioration of the patient. Active bleeding of the right fallopian tube was identified and managed with a right partial salpingectomy, with subsequent histopathology revealing ruptured SIN. There have been no reported cases of SIN being a primary cause for an acute abdomen or haemoperitoneum in the absence of an ectopic pregnancy, making this case a surgical novelty.

scholarly journals Retroperitoneal Ectopic Pregnancy: Diagnosis and Therapeutic Challenges

2017 ◽  
Vol 2017 ◽  
pp. 1-4 ◽  
Author(s):  
Salma Ouassour ◽  
Abdelhai Adib Filali ◽  
Mohamed Raiss ◽  
Rachid Bezad ◽  
Zakia Tazi ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Case Report ◽  
Ectopic Pregnancy ◽  
Management Strategy ◽  
Clinical Signs ◽  
Imaging Features ◽  
Resonance Imaging ◽  
Life Threatening ◽  
History Of ◽  
Ectopic Pregnancies

Background. Retroperitoneal ectopic pregnancy is extremely rare. This unusual location represents a great challenge for clinicians due to the difficulties of diagnosis and high risk of life-threatening complications. Case Report. We report the case of a spontaneous early pregnancy of undetermined location in a patient with a history of previous laparoscopic surgery. Diagnosis steps using clinical examination, ultrasound, and magnetic resonance imaging led to the localization of the pregnancy, in the left side of the para-aortic region, in the retroperitoneal space. Conclusion. Retroperitoneal ectopic pregnancy is an uncommon entity with rather complex pathogenesis. Clinicians should carefully interpret clinical signs, biological findings, and imaging features and be aware of unusual locations such as the retroperitoneum for ectopic pregnancies. Early diagnosis and appropriate management strategy are conditio sine qua non for successful treatment outcomes.

scholarly journals An unusual case of interstitial pregnancy: a case report

2021 ◽  
Vol 10 (3) ◽  
pp. 1229
Author(s):  
Nikhil Sebastian ◽  
Abhishek Radhakrishnan ◽  
Vennila Murugesan
Keyword(s):  
Age Groups ◽  
Uterine Cavity ◽  
Reproductive Age ◽  
Interstitial Pregnancy ◽  
Vitro Fertilization ◽  
Beta Human Chorionic Gonadotropin ◽  
Life Threatening ◽  
Threatening Situation ◽  
The Right

Ectopic pregnancy (EP) has been found to be a common cause of morbidity, and on occasion, mortality among women in the reproductive age groups. The incidence of EP is 1-2% of all pregnancies. 93-97% of EP are tubal with the interstitial type consisting only 3-4%. A 31-year-old female patient with primary infertility underwent IVF (In Vitro Fertilization). Pregnancy was confirmed by βHCG (beta human chorionic gonadotropin). Her ultrasonography reported a mass in the right cornual region. The uterine cavity was empty. Laparoscopy was performed followed by resection of the right cornua with tubes. Histopathology report confirmed the diagnosis of Interstitial Pregnancy (IP). The patient had an uneventful post-operative period and was discharged the next day. EP is a common complication seen in cases undergoing IVF, and IP is a rare form of EP. Hence, early diagnosis and prompt intervention is required to avoid a potentially life-threatening situation.

scholarly journals Study of ectopic pregnancy in a tertiary care centre

2017 ◽  
Vol 6 (3) ◽  
pp. 975
Author(s):  
Dhirajkumar B. Shukla ◽  
Sunil V. Jagtap ◽  
Pradnya P. Kale ◽  
Hardik N. Thakkar
Keyword(s):  
Ectopic Pregnancy ◽  
Tertiary Care ◽  
Age Group ◽  
Medical Sciences ◽  
Tertiary Care Centre ◽  
Presenting Symptoms ◽  
Nulliparous Women ◽  
Life Threatening ◽  
Ectopic Pregnancies ◽  
The Right

Background: Ectopic pregnancy is a life threatening emergency leading to maternal death. Incidence of ectopic pregnancies has been increasing in last two to three decades with reduction in mortality. The presenting symptoms include abdominal pain, amenorrhoea and/or irregular vaginal bleeding. The present study was undertaken to study the clinical features of ectopic pregnancies in a tertiary care hospital.Methods: The present study on ectopic pregnancies was carried out in Department of Pathology, Krishna Institute of Medical Sciences, Karad, Maharashtra, India from January 2010 to June 2014. All the cases of ectopic pregnancy managed surgically were included in the study.Results: Total 102 cases of ectopic pregnancy were studied. Proportion of ectopic pregnancy in the present study is 1 in 205 deliveries. Majority of the cases (37) (36.27%) were noted between 21 to 25 years of age group followed by the age group 26 to 30 years. Ectopic pregnancy was most commonly noted in nulliparous women (44/102) (43.14%). Majority of the cases (50/102) (49.02%) had no risk factors. Abortion was the most common risk factor identified, alone as well as in conjunction with other factors. Ampulla was the most common site for ectopic pregnancy. 55% of the cases were on the right side where as 45% on the left side. We had 2 cases of heterotropic pregnancy with tubal ectopic in both the cases. The typical triad of amenorrhoea, pain in abdomen and bleeding was observed in 21.57% cases.Conclusions: The incidence of ectopic pregnancies is on rise as evident in this study. In order to reduce the morbidity and mortality due to ectopic pregnancies, there is need for early diagnosis especially in high risk cases.

scholarly journals Case Report of Spontaneous Bilateral Ovarian Pregnancy in a Nulliparous Lady

2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Abdulrahman D. Mahroofi ◽  
Jawaher K. Alsaqer ◽  
Nawal Saad Alabdulla ◽  
Rihab Ismael ◽  
Stephanie Hsu ◽  
...  
Keyword(s):  
Ectopic Pregnancy ◽  
Iliac Fossa ◽  
Specific Patient ◽  
Ovarian Pregnancy ◽  
Products Of Conception ◽  
History Of ◽  
Laboratory Investigations ◽  
Us Findings ◽  
Ectopic Pregnancies ◽  
The Right

Nontubal ectopic pregnancies, especially ovarian ones, are rare. Here, we report a case of spontaneous bilateral ovarian pregnancy in a 23-year-old nulliparous lady who presented with a three-day history of abdominal pain localized to the right iliac fossa. Laboratory investigations and pelvic US and transvaginal US findings were suggestive of a right ovarian ectopic pregnancy and left ovarian cyst. Following the patient’s consent, the gynaecologist laparoscopically removed the right ovarian ectopic pregnancy and performed a left ovarian cystectomy. Histopathology revealed findings of trophoblastic tissue and chorionic villi with products of conception in both ovaries leading to the diagnosis of bilateral spontaneous ectopic pregnancy. Physicians must be mindful in cases that have a similar clinical presentation because an early diagnosis leads to a reduction in the morbidity and mortality of this specific patient population and helps to improve their overall prognosis.

scholarly journals Ectopic pregnancy: a life threatening gynaecological emergency

2016 ◽  
Vol 6 (1) ◽  
pp. 117
Author(s):  
Shruti R. Bhoosanoor ◽  
Sujani BK ◽  
. Urvashi ◽  
Gayatri Devi Sivasambu
Keyword(s):  
Ectopic Pregnancy ◽  
Medical Records ◽  
Maternal Morbidity ◽  
Previous History ◽  
Medical College ◽  
Maternal Morbidity And Mortality ◽  
Life Threatening ◽  
History Of ◽  
The Mean ◽  
Ectopic Pregnancies

Background: Ectopic pregnancy is a life-threatening gynecological emergency, and a significant cause of maternal morbidity and mortality.Methods: This is a retrospective study of ectopic pregnancies managed at M. S. Ramaiah Medical College and Hospital, Bangalore, India over a period of 1 year from March 2015 to March 2016. The medical records of the patients managed for ectopic pregnancy during the period, under review were retrieved and data were collected from registers. There were 30 cases of ectopic pregnancies over one year.Results: Ectopic pregnancy constituted 3% of all gynecological admissions, and its incidence was 2.5%. The mean age of the patients was 26 ± 2 years, 21 of 30 (70%) had ruptured ectopic pregnancies, and the remaining nine (30%) were unruptured. The commonest (20 of 30, 66.6%) clinical presentation was abdominal pain, and the commonest (9 of 30, 30%) identified risk factor was a previous history of induced abortion.Conclusions: Ectopic pregnancy is a recognized cause of maternal morbidity and mortality and has remained a reproductive health challenge to manage.

scholarly journals Targeted Nanoparticle Delivery of Doxorubicin Into Placental Tissues to Treat Ectopic Pregnancies

Endocrinology ◽  
2013 ◽  
Vol 154 (2) ◽  
pp. 911-919 ◽  
Author(s):  
Tu’uhevaha J. Kaitu’u-Lino ◽  
Scott Pattison ◽  
Louie Ye ◽  
Laura Tuohey ◽  
Pavel Sluka ◽  
...  
Keyword(s):  
Ectopic Pregnancy ◽  
Ex Vivo ◽  
Growth Factor Receptor ◽  
Nanoparticle Delivery ◽  
Dependent Inhibition ◽  
Life Threatening ◽  
Choriocarcinoma Cells ◽  
Ectopic Pregnancies

Abnormal trophoblast growth can cause life-threatening disorders such as ectopic pregnancy, choriocarcinoma, and placenta accreta. EnGeneIC Delivery Vehicles (EDVs) are nanocells that can promote tissue-specific delivery of drugs and may be useful to medically treat such disorders. The objective of this study was to determine whether EDVs loaded with the chemotherapeutic doxorubicin and targeting the epidermal growth factor receptor (EGFR, very highly expressed on the placental surface) can regress placental cells in vitro, ex vivo, and in vivo. In female SCID mice, EGFR-targeted EDVs induced greater inhibition of JEG-3 (choriocarcinoma cells) tumor xenografts, compared with EDVs targeting an irrelevant antigen (nontargeted EDVs) or naked doxorubicin. EGFR-targeted EDVs were more readily taken up by human placental explants ex vivo and induced increased apoptosis (M30 antibody) compared with nontargeted EDVs. In vitro, EGFR-targeted EDVs administered to JEG-3 cells resulted in a dose-dependent inhibition of cell viability, proliferation, and increased apoptosis, a finding confirmed by continuous monitoring by xCELLigence. In conclusion, EGFR-targeted EDVs loaded with doxorubicin significantly inhibited trophoblastic tumor cell growth in vivo and in vitro and induced significant cell death ex vivo, potentially mediated by increasing apoptosis and decreasing proliferation. EDVs may be a novel nanoparticle treatment for ectopic pregnancy and other disorders of trophoblast growth.

Ovarian ectopic pregnancy after in vitro fertilisation treated by laparoscopic excision with ovarian preservation

2020 ◽  
Vol 13 (11) ◽  
pp. e236680
Author(s):  
Kelly Ribeiro ◽  
Tarek El Shamy ◽  
Tariq Miskry
Keyword(s):  
Ectopic Pregnancy ◽  
Histopathological Examination ◽  
Early Recognition ◽  
Transvaginal Ultrasound ◽  
Lower Abdominal Pain ◽  
In Vitro Fertilisation ◽  
Free Fluid ◽  
Laparoscopic Excision ◽  
Life Threatening

A 42-year-old woman presented with lower abdominal pain and fainting episodes 36 days after in vitro fertilisation and embryo transfer. Transvaginal ultrasound revealed a large amount of free fluid in the pouch of Douglas and no evidence of an intrauterine gestational sac or adnexal mass suggestive of ectopic pregnancy. A presumed haemorrhagic corpus luteal cyst was seen in the left ovary. Laparoscopic exploration revealed a left ovarian haemorrhagic mass, which was excised with preservation of the ovary. Histopathological examination confirmed an ovarian ectopic pregnancy (OEP). OEP is rare but potentially life-threatening, as it can lead to internal haemorrhage. Its diagnosis is challenging as preoperative and intraoperative findings can be evocative of the far more frequent haemorrhagic corpus luteal cyst and histopathology is often necessary to confirm the diagnosis. Early recognition of OEP is crucial to reduce maternal morbidity and mortality, and allow treatment that preserves fertility as much as possible.

scholarly journals Unilateral spontaneous tubal twin ectopic pregnancy: A rare occurrence

2017 ◽  
Vol 6 (1) ◽  
pp. 819-823
Author(s):  
AN Pulei ◽  
PA Muga ◽  
KW Ongeti ◽  
J Kinuthia ◽  
O Ogutu
Keyword(s):  
Ectopic Pregnancy ◽  
Twin Pregnancy ◽  
Iliac Fossa ◽  
Lower Abdominal Pain ◽  
Abdominal Ultrasound ◽  
Free Fluid ◽  
Crown Rump Length ◽  
History Of ◽  
Ectopic Pregnancies ◽  
The Right

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

Heterotopic pregnancy; case report

2019 ◽  
Vol 7 (05) ◽  
Author(s):  
Vipul R. Khandagale
Keyword(s):  
Risk Factors ◽  
Ectopic Pregnancy ◽  
Adnexal Mass ◽  
Heterotopic Pregnancy ◽  
Free Fluid ◽  
Threatening Condition ◽  
Life Threatening ◽  
Ectopic Pregnancies ◽  
High Index Of Suspicion ◽  
Low Risk Women

Heterotopic pregnancy is a rare clinical condition in which intrauterine and extrauterine pregnancies occur at the same time. It can be a life threatening condition and easily missed with the diagnosis. We present the case of a 37 year old patient who was treated for a heterotopic pregnancy with live intrauterine gestation and ruptured left adnexal gestation.The ectopic pregnancy was not suspected at her initial presentation. A high index of suspicion is needed in women with risk factors for an ectopic pregnancy and in low risk women who have free fluid with or without an adnexal mass with an intrauterine gestation.It is difficult to estimate exactly the incidence of ectopic pregnancies, but on an average it is approximately 1:300 normal pregnancies worldwide.

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