scholarly journals Rupture of Ovarian Pregnancy in a Woman with Low Beta-hCG Levels

2012 ◽  
Vol 2012 ◽  
pp. 1-3 ◽  
Author(s):  
Serena Resta ◽  
Eliana Fuggetta ◽  
Federica D’Itri ◽  
Simona Evangelista ◽  
Adele Ticino ◽  
...  

Background. Ovarian pregnancy is a rare form of ectopic pregnancy. It is often difficult to distinguish from tubal pregnancy, and diagnosis and management are frequently a challenge.Case. A 33-year-old nulligravida woman presented with light vaginal bleeding and bilateral lower quadrants abdominal pain. Beta-human chorionic gonadotropin (beta-hCG) level (592 mUI/mL) and clinical and ultrasound (US) findings were suspicious for tubal pregnancy. On the third day, despite beta-hCG decrease (364 mUI/mL), she complained of severe pain in the lower abdomen, and physical examination revealed abdominal rebound tenderness. US showed a large amount of fluid in the abdominal cavity. Because of the unstable clinical condition, emergency laparoscopy and resection of left ovarian ectopic pregnancy were performed. Histology confirmed ovarian gestation.Conclusion. This case shows that ectopic pregnancy rupture may occur despite low levels of beta-hCG. Hemoperitoneum is not contraindication to laparoscopy.

2018 ◽  
Vol 46 ◽  
pp. 5
Author(s):  
Jia-San Zheng ◽  
Zheng Wang ◽  
Jia-Ren Zhang ◽  
Shuang Qiu ◽  
Ren-Yue Wei ◽  
...  

Background: Ectopic pregnancy mainly refers to tubal pregnancy and abdominal pregnancy. Tubal pregnancy presents as an implanted embryo that develops in the fallopian tubes, and is relatively common in humans. In animals, tubal pregnancy occurs primarily in primates, for example monkeys. The probability of a tubal pregnancy in non-primate animals is extremely low. Abdominal pregnancy is a type of ectopic pregnancy that occurs outside of the uterus, fallopian tube, ovary, and ligament(broad ligament, ovarian ligament, suspensory ligament).This paper describes two cases of ectopic pregnancy in cats.Cases: Cat 1. The presenting sign was a significant increase in abdominal circumference. The age and immune and sterilization status of the cat were unknown. On palpation, a 4 cm, rough, oval-shaped, hard mass was found in the posterior abdomen. Radiographic examination showed three high-density images in the posterior abdomen. The fetus was significantlycalcified and some feces was evident in the colon. The condition was preliminarily diagnosed as ectopic pregnancy. Cat 2. The owner of a 2-year-old British shorthair cat visited us because of a hard lump in the cat’s abdomen. The cat had a normal diet and was drinking normally. Routine immunization and insect repulsion had been implemented. The cat had naturally delivered five healthy kittens two months previous. Radiographs showed an oval-shaped mass with a clear edge in the middle abdominal cavity. Other examinations were normal. The case was preliminarily diagnosed as ectopic pregnancy, and the pregnancy was surgically terminated. The ectopic pregnancies were surgically terminated. During surgery, the structures of the uterus and ovary of cat 1 were found to be intact and the organs were in a normal physiological position.Cat 1 was diagnosed with primary abdominal pregnancy. In cat 2, the uterus left side was small and the fallopian tube on the same side was both enlarged and longer than normal. Immature fetuses were found in the gestational sac. Thus, cat 2 was diagnosed with tubal ectopic pregnancy based on the presenting pathology.Discussion: Cats with ectopic pregnancies generally show no obvious clinical symptoms. The ectopic fetus can remain within the body for several months or even years. Occasionally, necrotic ectopic tissues or mechanical stimulation of the ectopic fetus can lead to a systemic inflammatory response, loss of appetite, and apathy. The two cats in our reportshowed no significant clinical symptoms. To our knowledge, there have been no previous reports of the development of an ectopic fetus to maturity, within the abdominal cavity of felines, because the placenta of cats cannot support the growth and development of the fetus outside of the uterus. Secondary abdominal ectopic pregnancy, lacking any signs of uterine rupture is likely associated with the strong regenerative ability of uterine muscles. A damaged uterus or fallopian tube can quickly recover and rarely leaves scar tissue. In the present report, cat 1 showed no apparent scar tissue, nor signs of a ruptured ovary or fallopian tubes. It was diagnosed with primary ectopic abdominal pregnancy, which could arise from the descent of the fertilized egg from the fallopian tube into the abdominal cavity. There was an abnormal protrusion in left of the fallopian tubes in cat 2, to which the gestational sac was directly connected. Based on pathological examination of the uterus, fallopian tubes, and gestational sac, the cat was diagnosed with a tubal pregnancy. Placental tissues and signs of fetal calcification were observed in both the fallopian tube and gestational sac.Keywords: tubal pregnancy, abdominal pregnancy, feline, ectopic fetus, fallopian tube, gestational sac.


2019 ◽  
Vol 12 (8) ◽  
pp. e229732
Author(s):  
Kaitlin D Crawford ◽  
Melissa J Chen ◽  
Melody Y Hou ◽  
Mitchell D Creinin

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.


2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
Yasmin Abedin ◽  
Kanchi Chadha

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.


2021 ◽  
pp. 1-3
Author(s):  
Peter Kern ◽  
Paula Ulrich ◽  
Rainer Kimmig ◽  
Peter Kern

Background: Ectopic pregnancies occur predominantly in the fallopian tubes or ovaries. Very rarely, the distal part of the greater omentum may have close contact to the fallopian tubes and implantation of the embryo may occur in this part of the greater omentum. In the absence of signs of pregnancy in the uterus or the fallopian tubes, the greater omentum has to be closely examined for ectopic pregnancy. Case Presentation: A 22-year-old woman in her 4th week of pregnancy presents with spotting and severe pain in the right lower abdomen with a history of 2 cesarean sections. The sonographic examination showed a normal uterus with a thin endometrial line. The uterine cavity did not present with any signs of a gestational sac. A great amount of free fluid in the Douglas cavity suspicious of a hemoperitoneum. ßhCG-values in serum was highly elevated up to 16749 mU/ml and confirmed the suspicion of an ectopic pregnancy. A diagnostic laparoscopy was performed, during which a blood clot reaching from the right lower abdomen to the greater omentum was detected. After removing the blood clot, a normal-sized uterus with regular ovaries and no signs of a pregnancy in the fallopian tubes were seen. However, an abdominal adhesion in the right upper part of the omentum close to the liver with bleeding was seen. While examining the abdominal cavity for the cause of bleeding, a small cystic lesion adherent to the greater omentum – close the offspring from the colon – representing an ectopic pregnancy became apparent. A partial omentectomy of 9,5 cm x 5,5 cm x 2,5 cm was performed with the finding of trophoblast and embryoblast implantated in the infrahepatic part of the greater omentum. Conclusion: In cases of ectopic pregnancy with hemoperitoneum, special care has to be taken examining not only the fallopian tubes or ovaries but also the greater omentum, which may harbour an implanted trophoblast and embryoblast – even in the upper part directly beneath the liver – as presented in this case. In cases of ruptured ectopic pregnancy of the greater omentum, the cases may be dealt with laparoscopic partial omentectomy if the case is early detected.


2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Abdulrahman D. Mahroofi ◽  
Jawaher K. Alsaqer ◽  
Nawal Saad Alabdulla ◽  
Rihab Ismael ◽  
Stephanie Hsu ◽  
...  

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.


2021 ◽  
Vol 2 (1) ◽  
pp. 38-42
Author(s):  
Kunal Rathod

The ovarian ectopic pregnancy OPE is one of the most serious and rarest types of extra-uterine pregnancy, where the implantation of the gestational sac occurs in the ovum. Given the rarity of this condition, in addition to the accompanied morbidity, the risk of their complications, and even death, early diagnosis and treatment are crucial. Its diagnosis is not easy and relies on criteria based on preoperative findings, with poor clinical symptomatology and a difficult ultrasound diagnosis. Its management of choice remains surgical therapy despite the progress in medical treatments with fertility preservation. Patients’ symptomatology, radiological and lab findings, addition to her obstetric history and desire for future procreation must also be taken into consideration. Keywords: Ectopic pregnancy; ovarian pregnancy; Treatment; Diagnosis. Abbreviations B-hCG: Beta-Human Chorionic Gonadotropin; EP: Ectopic Pregnancy; HP: Heterotopic Pregnancy; IUCD: Intra-utérine Contraceptive Devices; IUDs: Intra-Utérine Devices; MRI: Magnetic Resonance Imaging; MTX: Methotrexate; OPE: Ovarian Ectopic Pregnancy; PID: Pelvic Inflammatory Disease; TV-US: Transvaginal Ultrasonography.


2018 ◽  
Vol 1 (1) ◽  
pp. 49-50
Author(s):  
Shyam Sundar Parajuly ◽  
Ananda Bahadur Shrestha ◽  
Dela Singh ◽  
Rabi Prasad Regmi ◽  
Rajesh Adhikari

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.


2018 ◽  
Vol 14 (2) ◽  
pp. 96-99
Author(s):  
A. V. Dovgopolyy ◽  
Yu. V. Popov ◽  
N. S. Vanke ◽  
A. G. Kedrova ◽  
L. M. Kaganovskaya ◽  
...  

Ovarian pregnancy is a rare form of ectopic pregnancy, which causes a great diagnostic problem. One of the important risk factors for the development of ovarian pregnancy is the use of intrauterine spirals. The article presents the clinical case of ovarian pregnancy in a 35-yearold woman who underwent an implantation of fertilized egg in the ovary against the background of the vitreous spiral. Transvaginal ultrasonography showed the presence of echogenic formation in the right ovary, in the absence of data for tubal pregnancy.


2018 ◽  
Vol 78 (07) ◽  
pp. 690-696 ◽  
Author(s):  
Kristin Nicolaus ◽  
Jorge Jimenez-Cruz ◽  
Dominik Bräuer ◽  
Thomas Lehmann ◽  
Anke Mothes ◽  
...  

Abstract Introduction Tubal pregnancy is the most clinically relevant form of ectopic pregnancy. Surgery consisting of laparoscopic salpingotomy is the therapeutic gold standard. This study looked at risk factors for non-tube-preserving surgery. The aim was to determine a cut-off value for beta-hCG levels, which could be used to predict the extent of tubal surgery. Materials and Method 97 patients with tubal pregnancy who underwent primary salpingotomy in the Department of Gynecology and Obstetrics of Jena University Hospital between 2010 and 2016 were retrospectively analyzed. A prior medical history of risk factors such as adnexitis, ectopic pregnancy, tubal surgery, treatment for infertility and intrauterine pessary was included in the analysis. The study population was divided into two subgroups: (1) a group which underwent laparoscopic linear salpingotomy, and (2) a group which had laparoscopic partial tubal resection or salpingectomy. Risk factors for salpingectomy were determined using binary logistic regression analysis. Statistical analysis was done using SPSS, version 24.0, to identify risk factors for non-tube-preserving surgery. Results 68 patients (70.1%) underwent laparoscopic salpingotomy and 29 patients (29.9%) had laparoscopic salpingectomy. The two groups differed with regard to age (p = 0.01) but not with regard to the parameters ‘gestational age’, ‘viability and rupture status of the ectopic pregnancy’ or ‘symptoms at presentation’. Patients who were known to have endometriosis prior to surgery or who were diagnosed with endometriosis intraoperatively were more likely to undergo salpingectomy (OR: 3.28; 95% CI: 0.9 – 10.8; p = 0.05). Calculated mean beta-hCG levels were higher in the salpingectomy group compared to the group who had tube-preserving salpingotomy (3277.8 IU/l vs. 9338.3 IU/l, p = 0.01). A cut-off beta-hCG value of 775 IU/l prior to surgery was predictive for salpingectomy with a true positive rate of 86.2% and increased the probability that salpingectomy would be necessary (OR: 5.23; 95% CI: 0.229 – 0.471; p = 0.005). Conclusion Endometriosis and a beta-hCG value of more than 775 IU/l significantly increased the risk for non-tube-preserving surgery in women with tubal pregnancy.


2004 ◽  
Vol 132 (5-6) ◽  
pp. 163-166
Author(s):  
Milan Dokic ◽  
Dusan Perisic

The evolution of the process can take two different directions. If an intact pregnancy continues to grow, there is a tubal abortion or a rupture of the Fallopian tube. In the oppsote case, there is spontaneous resorption of the tubal pregnancy. In certain cases with the application of methotrexate, the ectopic pregnancy growth can be interrupted and spontaneous resorption can be induced. Nowadays, the international standards of treating patients with early ectopic gravidities and no peritoneal effusions, with ?-HCG values below 6000 Ul/I, gestational sac diameter below 3 cm, and without any visible heart action, imply methotrexate treatment. The objective of this study is to prove the efficiency of methotrexate use in patients who meet the above criteria. The first group did not manifest satisfying decrease of ?-HCG after two measurements, so methotrexate was used, while the second group showed satisfying decrease of ?-HCG, measured on the third day. Comparing the velocity of decrease of ?-HCG level among both groups of patients, it was proved that iatrogenically induced decrease, that is to say the achieved resorption, was equal to the spontaneous resorption, which justified the use of methotrexate in ectopic pregnancy treatment.


Sign in / Sign up

Export Citation Format

Share Document