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.

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.

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.

Infrahepatic Implantation of an Ectopic Pregnancy

2021 ◽  
pp. 1-3
Author(s):  
Peter Kern ◽  
Paula Ulrich ◽  
Rainer Kimmig ◽  
Peter Kern
Keyword(s):  
Ectopic Pregnancy ◽  
Close Contact ◽  
Blood Clot ◽  
Abdominal Cavity ◽  
Uterine Cavity ◽  
Greater Omentum ◽  
Free Fluid ◽  
Fallopian Tubes ◽  
Lower Abdomen ◽  
The Right

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.

scholarly journals Clinical study on presentation and management of ectopic pregnancies in a tertiary care centre

2019 ◽  
Vol 9 (1) ◽  
pp. 173
Author(s):  
Anjum Ara ◽  
Indu Chawla ◽  
Rasika Agarwal ◽  
Bangali Manjhi
Keyword(s):  
Risk Factors ◽  
Ectopic Pregnancy ◽  
Treatment Modality ◽  
Adnexal Mass ◽  
Care Center ◽  
Tertiary Care ◽  
Uterine Cavity ◽  
Free Fluid ◽  
Tertiary Care Centre ◽  
Ectopic Pregnancies

Background: Ectopic pregnancy means pregnancy outside the normal uterine cavity. It is the leading cause of maternal morbidity and mortality in first trimester. Early diagnosis and timely intervention can significantly improve the outcomes.Methods: Retrospective observational study done in the department of obstetrics and gynecology ABVIMS and Dr. RML hospital, New Delhi from January 2016 to March 2019. Case records of 76 patients of confirmed ectopic pregnancy were retrieved and studied from the medical record section. The main aims were to see the clinical presentation, mode of diagnosis, predisposing risk factors; treatments offered and associated morbidity and mortality.Results: The incidence of ectopic pregnancy in present study was 1.7%, highest in 21 to 30 years age multiparous patients. 85.1% presented as acute emergencies, 75% patients had classic triad of amenorrhea, pain and bleeding. Pain was the commonest symptom in 96.1%. The commonest clinical sign was adnexal mass and tenderness. Ultrasound findings had adnexal mass in 98.7% and free fluid in 84.7% cases with empty uterus in 100%. 90.7 % case were tubal ectopic and 69.73 % were ruptured. Surgery was the main treatment modality in 96.0% cases. Salpingectomy was the commonest surgery in 80.25%. There was 0% mortality and 78.9% cases required blood transfusions, 44.7% patients had no known risk factors whereas some of the common identifiable risk factors were history of previous abortion, previous pelvic surgeries and pelvic inflammatory disease.Conclusions: ABVIMS and Dr. RML hospital is a tertiary care center so majority of patients with ectopic pregnancies presented late, as such surgery was the main treatment modality but there was 0% mortality in our study. Conservative treatments such as laparoscopy and medical management can also be offered to hemodynamically stable patients.

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

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.

Morphological changes in the fallopian tubes in patients with ectopic pregnancy

GYNECOLOGY ◽  
2020 ◽  
Vol 21 (6) ◽  
pp. 26-30
Author(s):  
Galina P. Titova ◽  
Mihail M. Damirov ◽  
Irina V. Anchabadze ◽  
Alexandr A. Medvedev
Keyword(s):  
Ectopic Pregnancy ◽  
Morphological Study ◽  
Clinical Course ◽  
Tube Wall ◽  
Morphological Changes ◽  
Disease Development ◽  
Fallopian Tubes ◽  
Chorionic Villi ◽  
Intraabdominal Hemorrhage ◽  
Fertilized Egg

Relevance. Ectopic pregnancy is an urgent condition which may lead to intraabdominal hemorrhage and woman death. In recent years, the frequency of this pathology is significantly increasing. However, morphological changes in the fallopian tubes in patients with this disease remain understudied. Aim. To study morphological changes in the fallopian tubes in patients with ectopic pregnancy with various variants of the clinical course. Materials and methods. The morphological study included 130 patients who had laparoscopic surgery for ectopic pregnancy. Comprehensive morphological study of the fallopian tubes removed during surgery was conducted. Results and discussion. The article presents the morphological changes in the fallopian tubes in patients with ectopic pregnancy. Implantation of a fertilized egg in the fallopian tube led to significant changes in its macro- and microstructure, which were due to invasion of the chorionic villi and involved all layers of the tube wall, differing only in depth and prevalence. The most pronounced morphological changes in various segments of the tube were revealed in the endosalpinx. Conclusion. The combination of morphological changes in different layers of the tube is related to a chronic non-specific productive endomyosalpingitis with luminal deformation, which was one of the main causes of this disease development.

scholarly journals Catastrophic presentation of spontaneous heterotopic pregnancy

2020 ◽  
Vol 0 ◽  
pp. 1-4
Author(s):  
Sunita Dubey ◽  
Aayushi Kaushal
Keyword(s):  
Ectopic Pregnancy ◽  
Adnexal Mass ◽  
Final Diagnosis ◽  
Heterotopic Pregnancy ◽  
Healthy Baby ◽  
Spontaneous Conception ◽  
Pain Abdomen ◽  
Beta Human Chorionic Gonadotropin ◽  
Reproductive Techniques

Heterotopic gestation is an uncommon entity with natural conception; however, rising trends have been seen with the use of artificial reproductive techniques. We are reporting a case of 22-year-old G3P1A1L1 who presented to us at 9 weeks of gestation with complaints of mild pain in the left adnexa from 3 days. Subsequently, her pain was increased in intensity and spread over to whole abdomen. She was referred with the left adnexal mass with persistent pain abdomen. On admission, ultrasound revealed single live intrauterine fetus with the left adnexal mass with fetal node along with hemoperitoneum. She underwent laparotomy and successfully managed with the left side salpingectomy along with blood transfusion. Later, she delivered a healthy baby at term. Ectopic pregnancy should be the first differential diagnosis when no other cause suspected in patients with adnexal mass. Follow-up ultrasound should be done in patients with persistent and localized pain in abdomen even in spontaneous conception. Diagnostic laparoscopy may be the reasonable option to make a final diagnosis as beta-human chorionic gonadotropin is not a reliable test to diagnose ectopic pregnancy in heterotopic pregnancy.

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 ◽  
...  
Keyword(s):  
Ectopic Pregnancy ◽  
Abdominal Cavity ◽  
Tubal Pregnancy ◽  
Lower Abdomen ◽  
Rebound Tenderness ◽  
Ovarian Pregnancy ◽  
Beta Hcg ◽  
Beta Human Chorionic Gonadotropin ◽  
Low Levels ◽  
Us Findings

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.

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 Managing Ectopic Pregnancies by Targeting Chorionic Villi with a Transvaginal Injection of Ethanol into the Lacunar Space

Biomedicines ◽  
2020 ◽  
Vol 8 (7) ◽  
pp. 202
Author(s):  
Hisao Osada ◽  
Shokichi Teramoto ◽  
Hirotsune Kaijima ◽  
Tomoya Segawa ◽  
Masaji Nagaishi ◽  
...  
Keyword(s):  
Ectopic Pregnancy ◽  
Average Dose ◽  
Main Mode ◽  
Chorionic Villi ◽  
Surgical Interventions ◽  
Beta Human Chorionic Gonadotropin ◽  
Gestational Sac ◽  
Β Hcg ◽  
Ectopic Pregnancies ◽  
High Beta

Methotrexate has been the main mode of non-surgical treatment for ectopic pregnancies. However, we have developed an easier, repeatable method that can be applied even to patients with a high beta-human chorionic gonadotropin (β-hCG) level and/or positive fetal heartbeat, by targeting chorionic villi with a transvaginal injection of absolute ethanol (AE) into the lacunar space (intervillous space). The efficacy and safety of this method were examined in 242 cases of ectopic pregnancy, including 103 with positive fetal heartbeat. Serum β-hCG level was measured at frequent intervals, and transvaginal ultrasonography was performed to observe the gestational sac and hyperechoic inner ring. Of the 242 patients, 222 (91.7%) were successfully treated. The average number of AE injection(s) required was 1.6 (range: 1–5), and the average dose was 3.2 mL. After the treatment, many of the patients tried to conceive again, and 63 of the traceable 145 patients (43.4%), who had fallopian tube pregnancy, and 7 of the traceable 12 patients (58.3%), who had cervical or cesarean scar pregnancies, successfully conceived and delivered babies with no observed side effects. Therefore, this method could be an effective treatment for ectopic pregnancy with the potential to replace conventional surgical interventions and medical treatment using methotrexate.

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