Total Laparoscopic Conservative Surgery for an Intramural Ectopic Pregnancy

A 38-year-old woman, gravida 3, para 1 with a history of a left salpingectomy for an ectopic pregnancy was admitted for treatment of a presumed ectopic pregnancy. Transvaginal sonography revealed an ill-defined gestational sac and fetal heart beat within the fundal myometrium adjacent to the left cornua. Laparoscopy was performed for a suspected left cornual pregnancy or intramural pregnancy. A cystic mass 3 cm in diameter was visible within the fundal myometrium. Total laparoscopic removal of the gestational sac was performed, and the uterus was preserved. Pathologic evaluation of the excised mass demonstrated chorionic villi involving the myometrium. In the literature, only one other case describing the laparoscopic removal of an intramural pregnancy has been reported. However, in the prior report, the patient still required hysterectomy after conservative surgery. Therefore, this is the first report of the successful treatment of an intramural pregnancy exclusively with laparoscopy.

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Placenta Increta Complicating Persistent Cesarean Scar Ectopic Pregnancy following Failed Excision with Subsequent Preterm Cesarean Hysterectomy

Case Reports in Obstetrics and Gynecology ◽

10.1155/2016/4071840 ◽

2016 ◽

Vol 2016 ◽

pp. 1-5 ◽

Cited By ~ 1

Author(s):

M. F. Malik ◽

L. R. Hoyos ◽

J. Rodriguez-Kovacs ◽

J. Gillum ◽

S. C. Johnson

Keyword(s):

Ectopic Pregnancy ◽

Placenta Increta ◽

Pelvic Mri ◽

Chorionic Villi ◽

Thin Endometrium ◽

Cesarean Scar ◽

Cesarean Hysterectomy ◽

Cesarean Deliveries ◽

History Of ◽

Gestational Sac

Introduction.Cesarean scar pregnancies (CSPs) are one of the rarest forms of ectopic pregnancy. Given their rarity, there is lack of consensus regarding the management and natural course of CSPs.Case.A 37-year-old G10 P3063 female with a history of two prior cesarean deliveries was diagnosed with her second CSP at 6 weeks and 5 days in her tenth pregnancy. The patient underwent vertical hysterotomy, excision of a gestational sac implanted in the cesarean sac, and bilateral salpingectomy via a laparotomy incision. The histopathology report confirmed immature chorionic villi. The patient returned 10 weeks later and was found to be still pregnant. Obstetric ultrasound confirmed a viable fetus of 19 weeks and 4 days of gestational age with a thin endometrium and an anteroposterior and right lateral placenta with multiple placental lakes. The patient ruptured her membranes at 31 weeks of gestation and pelvic MRI revealed an anterior placenta invading the myometrium and extending to the external serosal surface consistent with placenta increta. Following obstetric interventions, a live female infant was delivered by cesarean hysterectomy (because of placenta increta) at 32 weeks of gestation.Conclusion.Development of standardized guidelines for management of CSPs, as well as heightened vigilance for possible complications, is required for proper care and avoidance of potential morbidity and mortality.

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Ceasarean scar pregnancies, diagnosis and management

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20181361 ◽

2018 ◽

Vol 7 (4) ◽

pp. 1592

Author(s):

Atmajit Singh Dhillon ◽

Sandeep Sood

Keyword(s):

Cesarean Section ◽

Care Service ◽

Tertiary Care ◽

Expectant Management ◽

Transvaginal Sonography ◽

Colour Doppler ◽

History Of ◽

Gestational Sac ◽

Uterine Scar ◽

High Index Of Suspicion

Background: Objective of present study was to describe evaluation and management of pregnancies implanted into uterine Cesarean section scars, Ceasarean scar pregnancies (CSP), is defined as gestational sac implanted in the myometrium at the site of a previous ceasarean scar. Also known as Ceasarean ectopic pregnancy.Methods: In all antenatal patients attending the antenatal outpatient department of a tertiary care service hospital a transvaginal sonography was done for determining the gestational age as well as the viability of the pregnancy. In all patients with a history of previous Cesarean section(s), special effort was made to assess the possibility of implantation into the uterine scar by means of an early transvaginal and colour doppler ultrasound.Results: Twelve Cesarean section scar pregnancies were diagnosed in a five-year period, of a tertiary care service hospital. Five (42%) patients with Cesarean scar pregnancies were treated surgically, four patients medically (33%), and two patients expectantly (17%) and one patient opted to continue the pregnancy. Surgical management was successful in all cases, although two of five (40%) women suffered bleeding (300-500ml). In the group of women who were managed medically the success rate was 3/4(75%). Expectant management was successful in one of two cases (50%). One patient who opted to continue pregnancy, underwent a ceasarean hysterectomy at 33 weeks of gestation for placenta accreta.Conclusions: Incidence of ceasarean section scar pregnancies is increasing as is the increasing rate of ceasarean deliveries. A high index of suspicion in all cases of post ceasarean pregnancies, coupled with early transvaginal ultrasonography along with colour doppler confirmation and institution of early and individualized treatment, optimizes the clinical outcome. Although rare, the patient and her relatives must be made aware of the possibility of recurrent CSP.

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Cesarean Scar Ectopic Pregnancy

International Journal of Health Sciences and Research ◽

10.52403/ijhsr.20210556 ◽

2021 ◽

Vol 11 (5) ◽

pp. 358-361

Author(s):

Sunil V. Jagtap ◽

Nitin Kshirsagar ◽

Ramnik Singh

Keyword(s):

Caesarean Section ◽

Ectopic Pregnancy ◽

Uterine Rupture ◽

Vaginal Bleeding ◽

Hypovolemic Shock ◽

Lower Uterine Segment ◽

Caesarean Scar ◽

Anterolateral Wall ◽

History Of ◽

Gestational Sac

Caesarean Scar Ectopic Pregnancy (CSEP) is one of the rarest forms of ectopic pregnancy. We present a 30 year female presented with 8 weeks of amenorrhea. Her obstetric history was G3P2D2. Her B HCG levels were >10,000 IU/L. She had history of previous 2 lower uterine segment Caesarean section. She was referred to our hospital in stage of severe hypovolemic shock related to vaginal bleeding. USG findings were suggestive of death of fetus of about 6 weeks 5 days. Gestational -sac at lower uterine segment Caesarean section scar level. Radiological diagnosis was? Scar pregnancy. On histopathology diagnosed as Caesarean scar ectopic pregnancy with area of rupture in anterolateral wall of lower uterine segment and upper cervix. The endometrium was unremarkable. We are presenting this case for its rarity, clinical radiological and histopathological findings. Key words: Scar ectopic pregnancy, Uterine rupture, Gestation, Caesarean section.

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

BMJ Case Reports ◽

10.1136/bcr-2020-235893 ◽

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.

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ECTOPIC PREGNANCY : A MAJOR CAUSE OF MATERNAL MORTALITY?

Journal of Nepal Medical Association ◽

10.31729/jnma.823 ◽

2003 ◽

Vol 42 (147) ◽

pp. 151-155

Author(s):

Rajshree Jha ◽

M Singh ◽

A Rana ◽

A Singh ◽

S Bastola

Keyword(s):

Risk Factors ◽

Ectopic Pregnancy ◽

Abnormal Uterine Bleeding ◽

Uterine Bleeding ◽

Pelvic Surgery ◽

Transvaginal Sonography ◽

Pregnancy Risk ◽

Abdominal Tenderness ◽

Presenting Symptoms ◽

History Of

ABSTRACTSeventyeight cases of ectopic pregnancy were studied retrospectively at Tribhuvan University TeachingHospital during April 1993 - December 1996. The overall incidence of etopic pregnancy was 0.86% livebirths. Grandmultipara were found to be at a low risk for ectopic pregnancy. A history of infertility andprevious pelvic surgery were positive risk factors. The most common presenting symptoms were abdominalpain (90%), history of amenorrhoea (46%), abnormal uterine bleeding (40%). On examination adenexaltenderness (72%), abdominal tenderness (68%), pallor (53%) and cervical excitation (33%) were the mostfrequent findings. Adenexal mass was noted in 22% cases and in 35 % cases the size of the uterus could notbe assessed. Ultrasonography and transvaginal sonography proved to be valuable diagnostic aids. Twomaternal deaths (2.6 %) due to ectopic pregnancy occurred in the hospital during this period.Key Words: Ectopic pregnancy, risk factors, sonography.

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Rare primary abdominal ectopic pregnancy in the pouch of Douglas

BMJ Case Reports ◽

10.1136/bcr-2018-228547 ◽

2019 ◽

Vol 12 (6) ◽

pp. e228547

Author(s):

Joshua Baji Thomas

Keyword(s):

Ectopic Pregnancy ◽

Chorionic Gonadotrophin ◽

Human Chorionic Gonadotrophin ◽

Pelvic Ultrasound ◽

The Past ◽

History Of ◽

Background History ◽

Pouch Of Douglas ◽

Gestational Sac ◽

Trophoblastic Tissue

A 35-year-old Nepalese woman, referred by her general practitioner for per vaginal spotting and abdominal pain for the past 12 days with a background history of 5 weeks of amenorrhoea and a quantifiable beta-human chorionic gonadotrophin of 18 900 IU/L. Subsequent pelvic ultrasound revealed a cystic lesion with peripheral vascularity in the pouch of Douglas indicating possible ectopic pregnancy with no intrauterine gestational sac seen. Subsequent to that, she underwent a diagnostic laparoscopy that revealed 150 mL of blood in the pouch of Douglas with no other obvious evidence of tubal or ovarian ectopic pregnancy seen. There was, however, a resemblance of trophoblastic tissue noted on the wall of the pouch of Douglas that was further investigated to reveal a primary ectopic pregnancy of the pouch of Douglas with no trophoblastic infiltration.

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Negative Urine B-hCG Pregnancy Test in Chronic Ectopic Pregnancy – a Case Report

Medical Journal of Pokhara Academy of Health Sciences ◽

10.3126/mjpahs.v1i1.22462 ◽

2018 ◽

Vol 1 (1) ◽

pp. 49-50

Author(s):

Shyam Sundar Parajuly ◽

Ananda Bahadur Shrestha ◽

Dela Singh ◽

Rabi Prasad Regmi ◽

Rajesh Adhikari

Keyword(s):

Ectopic Pregnancy ◽

Histopathological Examination ◽

Lower Abdominal Pain ◽

Tubal Pregnancy ◽

Rare Type ◽

Chorionic Villi ◽

Pregnancy Test ◽

Beta Human Chorionic Gonadotropin ◽

History Of ◽

Hcg Test

Ectopic pregnancy (EP) is a gynecological emergency that can bring catastrophic condition leading tubal rupture and hemorrhagic shock. Chronic ectopic pregnancy is a very rare type of tubal pregnancy presenting with a tubal mass with negative B hCG (beta human chorionic gonadotropin test. We present a case in twenty seven years old female with a history of six weeks of amenorrhea with complain of acute lower abdominal pain and per-vaginal bleeding. Urine pregnancy test (UPT) was negative. A total left salpingoectomy was undertaken and the histopathological examination revealed the presence of chorionic villi, suggesting the diagnosis of chronic ectopic tubal pregnancy. It is obvious that ectopic pregnancy could not be excluded with negative urine B-hCG test.

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Scar Pregnancy a Diagnostic Conundrum: A Case Report

Journal of Nepal Medical Association ◽

10.31729/jnma.5202 ◽

2021 ◽

Vol 59 (235) ◽

Author(s):

Manoj Pokhrel ◽

Shreedhar Prasad Acharya ◽

Jyotshna Sharma ◽

Meena Thapa

Keyword(s):

Past History ◽

Transvaginal Sonography ◽

Cesarean Scar Pregnancy ◽

Cesarean Scar ◽

Uterine Incision ◽

History Of ◽

Gestational Sac ◽

High Index Of Suspicion ◽

Prompt Diagnosis ◽

Previous Cesarean

Cesarean scar pregnancy is a rare form of ectopic pregnancy which may lead to uterine rupture and catastrophic hemorrhage. We report a case of cesarean scar pregnancy in a 35-year-old female with the past history of cesarean section presented with complaints of amenorrhoea for 6 weeks and non-specific pain. Two Transvaginal sonography was done 48 hours apart which suggested a cesarean scar pregnancy in one and cervical pregnancy on the other. Magnetic Resonace Imaging showed a well-defined cystic lesion of (21x19)mm2 embedded within the previous cesarean scar which confirmed the diagnosis of cesarean scar pregnancy. Laparotomy unveiled uterus around 6 weeks size and a (3x3)cm2 bulge was noted at the site of previous scar in lower uterine segment, where a small incision was given and the gestational sac was removed following which the uterine incision was closed with 2-0 polyglactin suture. High index of suspicion and prompt diagnosis is ofparamount for reducing morbidity and mortality.

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FREQUENCY OF UNRUPTURED ECTOPIC PREGNANCY IN A TERTIARY CARE HOSPITAL OF HAIL CITY, SAUDI ARABIA

Annals of King Edward Medical University ◽

10.21649/akemu.v21i4.764 ◽

2016 ◽

Vol 21 (4) ◽

pp. 236

Author(s):

Saadia Rasheed ◽

Sehar Shahbaz ◽

Shazia Hammad

Keyword(s):

Ectopic Pregnancy ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Lower Abdominal Pain ◽

First Trimester ◽

Transvaginal Sonography ◽

Care Hospital ◽

Positive Urine ◽

History Of ◽

Urine Pregnancy Test

AbstractAims and Objectives:Determine the frequency of unruptured ectopic pregnancy in a tertiary care hospital of Hail City, Saudi Arabia.Study Design:It was an observational case series.Material and Method:A total of 150 cases between 15 44 years with history of amenorrhea (6 8 weeks) and vaginal bleeding with or without lower abdominal pain, positive urine pregnancy test were enrolled in the study while heterotopic pregnancy, ruptured ectopic pregnancy and patients in first trimester with obstetric problem other than ectopic pregnancy were excluded from the study. All these cases were collected from Maternity and Childrens hospital Hail, Kingdom of Saudia Arabia during 2011 to 2014.Results:In our study, 64.67% (n = 97) of the cases were between 15 30 years of age while 35.33% (n = 53) were between 31 44 years, mean sd was calculated as 26.34 2.67 years, frequency of unruptured ectopic pregnancy was recorded in 14% of the cases.Conclusion:The frequency of un-ruptured ectopic pregnancy is higher and TVS may be used for early detection of this morbidity.Key Words:Ectopic pregnancy, un-ruptured, Transvaginal sonography.

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An advanced cervical ectopic pregnancy

Case Reports in Perinatal Medicine ◽

10.1515/crpm-2015-0022 ◽

2015 ◽

Vol 4 (2) ◽

Author(s):

Ebru Celik ◽

Salih Burçin Kavak ◽

Rasit Ilhan ◽

Selcuk Kaplan ◽

Ozgur Arat ◽

...

Keyword(s):

Pregnant Woman ◽

Ectopic Pregnancy ◽

Growth Retardation ◽

Intrauterine Growth Retardation ◽

Conservative Surgery ◽

Intrauterine Growth ◽

Exact Localization ◽

Tertiary Center ◽

Gestational Sac ◽

Cervical Ectopic Pregnancy

AbstractThe aim of this paper is sharing our experience in an advanced cervical ectopic pregnancy (CEP), which is managed by conservative surgery. We herein report a case of a 24-week pregnant woman with CEP. She was first referred to a tertiary center due to early starting intrauterine growth retardation and oligohydramniosis. Surgery was planned as soon as the diagnosis of CEP was made. By taking measures to reduce bleeding, conservative surgery was succesfully performed, and a hysterectomy was avoided. The fertility of the patient was preserved. The possibilty of CEP must be always be kept in mind, and the exact localization of the gestational sac must be determined in all patients. In advanced pregnancies, ultrasonographic examination must not only focus on examination of the fetus but also focus on the examination of contours of the uterus. These will give us the chance to diagnose CEP as soon as possible and reduce morbidity and mortality.

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