Dual extrauterine ectopic pregnancy: double management

2021 ◽  
Vol 14 (11) ◽  
pp. e244417
Author(s):  
Chandana S Bhat ◽  
N Sanjeeva Reddy ◽  
Radha Vembu ◽  
Monna Pandurangi
Keyword(s):  
Ectopic Pregnancy ◽  
Ovulation Induction ◽  
Cardiac Activity ◽  
Ultrasound Guided ◽  
Tubal Ectopic Pregnancy ◽  
Multiple Ovulation ◽  
Beta Hcg ◽  
Beta Human Chorionic Gonadotropin ◽  
Definitive Management

A 30-year-old nulliparous woman was referred with suspected left ovarian ectopic pregnancy. She had undergone laparoscopic left salpingectomy for ruptured tubal ectopic pregnancy 3 weeks earlier, following treatment with medications for ovulation induction. Sonological examination revealed a left ovarian ectopic pregnancy corresponding to 8 0/7 weeks with cardiac activity. She underwent ultrasound-guided intrasac therapy with intrasac instillation of 3 mEq of potassium chloride followed by 50 mg of methotrexate. She was followed with weekly measurements of serum beta human Chorionic Gonadotropin (hCG) which returned to baseline after 65 days of the intrasac therapy. This case not only highlights the need for continued follow-up of the serum beta hCG after definitive management of an ectopic pregnancy in cases with multiple ovulations, but also the option of medical management in cases of advanced ovarian ectopic pregnancy. It also accentuates the necessity for adequate counselling to avoid conception in a multiple ovulation cycle.

scholarly journals Non-surgical management of unruptured tubal ectopic pregnancy

2017 ◽  
Vol 6 (7) ◽  
pp. 3041
Author(s):  
Anjali Choudhary ◽  
Priyanka Chaudhari ◽  
Neeta Bansal
Keyword(s):  
Ectopic Pregnancy ◽  
Medical Management ◽  
Expectant Management ◽  
First Trimester ◽  
Response To Treatment ◽  
Surgical Trauma ◽  
Tubal Ectopic Pregnancy ◽  
Beta Hcg ◽  
Surgical Options ◽  
Ectopic Pregnancies

Background: Ectopic pregnancy is still the leading cause of pregnancy related morbidity in the first trimester. Since majority of the women who present with ectopic pregnancies are sub fertile and young, there is a role for non-surgical options of managing these pregnancies. Expectant and medical management not only serves to conserve the fallopian tubes but also saves women from surgical trauma and morbidity. The objective of this retrospective study was to share our experience of treating un-ruptured tubal ectopic pregnancies conservatively.Methods: Women diagnosed with un-ruptured tubal ectopic pregnancy, fit for conservative /medical management were included. Women with serum beta HCG levels less than 1000 mIU/L were treated expectantly and women with Bet HCG levels >1000 but <10,000 mIU /L were given Injectable methotrixate. Response to treatment was monitored by serial beta HCG levels.Results: Total 37 women included in the study.12% women showed complete resolution with expectant treatment alone and 88% resolved after a single dose methotrixate.Conclusions: Many women with un-ruptured tubal ectopic pregnancies would benefit from expectant management, or methotrixate therapy. Methotrixate used in carefully selected women is safe and effective in resolving these cases with good post treatment reproductive outcome.

scholarly journals Persistent free-floating pelvic trophoblastic cysts following an interstitial ectopic pregnancy

2019 ◽  
Vol 12 (8) ◽  
pp. e229732
Author(s):  
Kaitlin D Crawford ◽  
Melissa J Chen ◽  
Melody Y Hou ◽  
Mitchell D Creinin
Keyword(s):  
Ectopic Pregnancy ◽  
The Novel ◽  
Interstitial Pregnancy ◽  
Heterophilic Antibodies ◽  
Beta Hcg ◽  
Beta Human Chorionic Gonadotropin ◽  
Pathological Evaluation ◽  
Radiologic Investigation ◽  
Interstitial Ectopic Pregnancy ◽  
Trophoblastic Tissue

Persistent trophoblast after ectopic pregnancy has been demonstrated at the surgical site or as peritoneal implants. A 37-year-old woman (G5P2) experienced persistently low levels of beta-human chorionic gonadotropin (hCG) after surgical treatment for an interstitial pregnancy. Evaluation for persistent trophoblast, gestational trophoblastic neoplasm and heterophilic antibodies was negative. After 15 months without resolution, she elected for hysterectomy. We found four smooth, freely floating avascular cysts intraoperatively; pathological evaluation identified the cysts as trophoblastic tissue. Serum beta-hCG resolved postoperatively and remained negative at 1 year. Our case demonstrates the novel finding of trophoblastic tissue existing as free-floating cysts in the peritoneal cavity. With appropriate suspicion, these cysts can be identified on radiologic investigation and removed laparoscopically.

scholarly journals Case of Ruptured Ectopic Pregnancy in the Uterosacral Ligament and Review of the Literature

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
Yasmin Abedin ◽  
Kanchi Chadha
Keyword(s):  
Ectopic Pregnancy ◽  
Adnexal Mass ◽  
Uterosacral Ligament ◽  
Free Fluid ◽  
Fallopian Tubes ◽  
Review Of The Literature ◽  
Chorionic Villi ◽  
Beta Hcg ◽  
Beta Human Chorionic Gonadotropin ◽  
Potential Risk Factors

Pregnancies that implant on the uterosacral ligament are rare. Here, we describe a case of ruptured ectopic pregnancy in the left uterosacral ligament in a patient with potential risk factors including possible endometriosis and recent hysteroscopic procedure. A 29-year-old female, para 0, presented to the emergency department with generalized abdominal pain. Pelvic examination was significant for fullness in the posterior cul-de-sac. Laboratory values were significant for beta-human chorionic gonadotropin (hCG) level of 6311 mIU/mL. Sonogram findings were significant for no intrauterine gestation, a 6.9×4.6×4.7 cm3 complex left adnexal mass, and moderate free fluid within the posterior cul-de-sac. The patient underwent laparoscopy, which revealed hemoperitoneum and unremarkable bilateral fallopian tubes and ovaries. An abnormal area was noted in the left uterosacral ligament. Tissue was bluntly removed and pathologically confirmed as chorionic villi within the left uterosacral ligament. After one week, her beta-hCG decreased to 784 mIU/mL. After two weeks, she was seen as an outpatient and was doing well without any symptoms. More information is required regarding these unique pregnancies to help understand the pathophysiology and determine the management.

scholarly journals Ectopic pregnancy treatment by combination therapy

Open Medicine ◽  
2016 ◽  
Vol 11 (1) ◽  
pp. 530-536
Author(s):  
Aneta Cymbaluk-Płoska ◽  
Anita Chudecka-Głaz ◽  
Sławomir Kuźniak ◽  
Janusz Menkiszak
Keyword(s):  
Serum Level ◽  
Combination Therapy ◽  
Ectopic Pregnancy ◽  
Systemic Treatment ◽  
Beta Hcg ◽  
Future Fertility ◽  
Choice Of Treatment ◽  
Ectopic Pregnancies ◽  
Hyperosmolar Glucose

AbstractDetectability of early stages of ectopic pregnancies has increased due to improvements in ultrasonographic and biochemical techniques. Since the patients’ future procreative plans must be taken into consideration when commencing treatment, the goal of this work was to compare the effects of treatment methods and their impact on fertility. The study included 91 patients treated surgically for ectopic pregnancy. The choice of treatment depended on patients’ general condition, ultrasonographic evaluation and serum level of beta-hCG. A combination of laparoscopic and conservative systemic treatment was applied in 70% of cases. More rapid beta-hCG reduction was noted when laparoscopy and intra-oviductal injection of hyperosmolar glucose or methotrexate (MTX) were combined with intramuscular administration of MTX at a dose of 50 mg/m2. Follow-up examination of 66 patients revealed that the greatest number of spontaneous pregnancies (48%) resulted after this combination therapy. We conclude that this combination treatment is safe and provides satisfactory results in terms of future fertility.

scholarly journals Atypical presentation of molar pregnancy

2018 ◽  
pp. bcr-2018-225545
Author(s):  
Ream Langhe ◽  
Bogdan Alexandru Muresan ◽  
Etop Akpan ◽  
Nor Azlia Abdul Wahab
Keyword(s):  
Hydatidiform Mole ◽  
Abdominal Distension ◽  
Molar Pregnancy ◽  
Complete Hydatidiform Mole ◽  
Beta Hcg ◽  
Beta Human Chorionic Gonadotropin ◽  
Products Of Conception ◽  
Good General Condition ◽  
Uterine Curettage

The classic features of molar pregnancy are irregular vaginal bleeding, hyperemesis, enlarged uterus for gestational age and early failed pregnancy. Less common presentations include hyperthyroidism, early onset pre-eclampsia or abdominal distension due to theca lutein cysts. Here, we present a case of molar pregnancy where a woman presented to the emergency department with symptoms of acute abdomen and was treated as ruptured ectopic pregnancy. The woman underwent laparoscopy and evacuation of retained products of conception. Histological examination of uterine curettage confirmed the diagnosis of a complete hydatidiform mole. The woman was discharged home in good general condition with a plan for serial beta-human chorionic gonadotropin (beta-hCG) follow-up. Complete follow-up includes use of contraception and follow-up after beta-hCG is negative for a year.

scholarly journals Tubal Ectopic Pregnancy after 11 Years of Bilateral Tubal Ligation

2015 ◽  
Vol 7 (1) ◽  
pp. 119-120
Author(s):  
Mosammat Bilkis Parvin ◽  
Kazi Sahnaz Begum ◽  
Naseem Jahan ◽  
Hasina Sultana
Keyword(s):  
United States ◽  
Ectopic Pregnancy ◽  
Caesarean Delivery ◽  
Tubal Ligation ◽  
First Year ◽  
Contraceptive Methods ◽  
Tubal Ectopic Pregnancy ◽  
Medical College ◽  
Permanent Contraception

Tubal ligation is a well excepted method of contraception. Permanent contraception by tubal ligation is one of the most commonly used contraceptive methods in United States, also most popular form of contraception worldwide. Although pregnancy after ligation is uncommon, it can occur and may be ectopic. Surprisingly, failures are not limited to the first year or two but continued to appear even after many years during follow up. In this paper we report a case of ectopic pregnancy in a patient who underwent bilateral tubal ligation11years ago during caesarean delivery for contraception.Northern International Medical College Journal Vol.7(1) Jul 2015: 119-120

scholarly journals Salpingotomy vs salpingectomy – a comparison of women’s fertility after surgical treatment of tubal ectopic pregnancy during a 24-month follow-up study

2013 ◽  
Vol 84 (12) ◽  
Author(s):  
Marta Kostrzewa ◽  
Monika Żyła ◽  
Dorota Kolasa-Zwierzchowska ◽  
Artur Szpakowski ◽  
Grzegorz Stachowiak ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Ectopic Pregnancy ◽  
Tubal Ectopic Pregnancy ◽  
Follow Up Study

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 Ruptured Unilateral Twin Tubal Ectopic Pregnancy. Case Report of an oddity & Literature Review

2020 ◽  
Vol 1 (1) ◽  
pp. 60-63
Author(s):  
Palwasha Gul ◽  
Khanda Gul ◽  
Pari Gul ◽  
Tanzila Parveen
Keyword(s):  
Ectopic Pregnancy ◽  
Transvaginal Ultrasound ◽  
Uterine Cavity ◽  
Lower Abdominal Pain ◽  
Exploratory Laparotomy ◽  
First Trimester ◽  
Maternal Deaths ◽  
Tubal Ectopic Pregnancy ◽  
Beta Hcg ◽  
Ectopic Pregnancies

Background: An ectopic pregnancy (EP) is a type of conception in which, the fertilized egg is lodged outside the uterine cavity. Twin ectopic pregnancies are a rarity, and the reported cases of twin tubal pregnancies are a handful to date.Case Report: We report a case of a 35 years old patient who presented to the emergency with the complaint of lower abdominal pain and intermittent vaginal discharge. She was diagnosed with twin tubal alive gestation, underwent exploratory laparotomy and right salpingectomy.Conclusion: Ectopic pregnancy can occur even in the absence of known risk factors. Its incidence is on the rise. It is a leading cause of first-trimester maternal deaths and can be easily diagnosed with Beta HCG levels and transvaginal ultrasound.

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