scholarly journals Pregnancy of unknown location: outcome in a tertiary care teaching hospital

2017 ◽  
Vol 6 (7) ◽  
pp. 2787
Author(s):  
A. Shanti Sri ◽  
P. Kalpana
Keyword(s):  
Ectopic Pregnancy ◽  
Early Pregnancy ◽  
Tertiary Care ◽  
Expectant Management ◽  
Transvaginal Sonography ◽  
Intrauterine Pregnancy ◽  
Care Teaching ◽  
Asymptomatic Patients ◽  
Pain Outcome ◽  
Pregnancy Of Unknown Location

Background: A pregnancy of unknown location (PUL) is a descriptive term used to classify a woman when she has a positive pregnancy test but no intra- or extra-uterine pregnancy is visualized on transvaginal sonography. The objective of present study was to find out the outcome of women with pregnancy of unknown location presenting to a tertiary care teaching hospital.Methods: The prospective study was conducted from from 1st October 2015 to 31st September 2016, to antenatal out-patient department, at Princess Esra Hospital, Deccan College of medical sciences, Hyderabad. Data was collected for women with early pregnancy or with history of amenorrhea, bleeding or pain. These women were investigated with serum beta-human chorionic gonadotrophin levels at interval of 48 hrs and transvaginal ultrasonography. Expectant management was done for failing pregnancy of unknown location while medical or surgical management was considered for persistent pregnancy of unknown location and ectopic pregnancy.Results: During study period, 9210 patients were admitted, and, of them, 960 (10.42%) were patients with early pregnancy. Meeting the inclusion criteria were 112 (11.6%) patients who formed the study sample. There were 104 (92.85%) patients presenting with amenorrhea, 98 (87.5%) had bleeding and 78 (69.64%) presented with pain. Outcome of 42 (48.83%) patients was failing pregnancy, 31 (36.04%) had intrauterine pregnancy, 8 (9.3%) converted to ectopic pregnancy, while 5 (5.81%) had persistent pregnancy of unknown location. All patients with persistent pregnancy of unknown location and 3 patients with ectopic pregnancy were medically treated. Three patients having an ectopic pregnancy were managed surgically.Conclusions: Management of choice for asymptomatic patients having pregnancy of unknown location is expectant management. Most of the patients suspected to have PUL resolved either into F-PUL or IUP with expectant management.

Role of Serum β-HCG doubling in Diagnosis of Early Pregnancy and its Management Strategy

2020 ◽  
Vol 16 ◽  
Author(s):  
Divya Mirji ◽  
Shubha Rao ◽  
Akhila Vasudeva ◽  
Roopa P.S
Keyword(s):  
Ectopic Pregnancy ◽  
Early Pregnancy ◽  
Management Strategy ◽  
Transvaginal Ultrasound ◽  
Expectant Management ◽  
First Trimester ◽  
Intrauterine Pregnancy ◽  
Β Hcg ◽  
Pregnancy Of Unknown Location

Background: Pregnancy of unknown location (PUL) is defined as the absence of intrauterine or extrauterine sac and Beta Human Chorionic Gonadotropin levels (β-HCG) above the discriminatory zone of 1500 mIU/ml. It should be noted that PUL is not always an ectopic; however, by measuring the trends of serum β-HCG, we can determine the outcome of a PUL. Objective: This study aims to identify the various trends β-HCG levels in early pregnancy and evaluate the role of β-HCG in the management strategy. Methods: We conducted a prospective observational study of pregnant women suspected with early pregnancy. Cases were classified as having a pregnancy of unknown location (PUL) by transvaginal ultrasound and ß-HCG greater than 1000 mIU/ml. Expectant management was done until there was a definite outcome. All the collected data were analyzed by employing the chi-square test using SPSS version 20. Results: Among 1200 women who had early first trimester scans, 70 women who fulfilled our criteria of PUL and ß-HCG > 1000 mIU/ml were recruited in this study. In our study, the mean age of the participants was 30±5.6yrs, and the overall mean serum ß-HCG was 3030±522 mIU/ml. The most common outcome observed was an ectopic pregnancy, 47% in our study. We also found the rate of failing pregnancy was 27%, and that of intrauterine pregnancy (IUP) was 25%. Overall, in PUL patients diagnosed with ectopic pregnancy, 9% behaved like IUP, and 4% had an atypical trend in their ß-HCG. Those who had an IUP, 11% had a suboptimal increase in ß-HCG. Conclusion: PUL rate in our unit was 6%. Majority of the outcome of PUL was ectopic in our study. Every case of PUL should be managed based on the initial ß-HCG values, clinical assessments and upon the consent of the patient.

scholarly journals Association Of Serial Beta HCG And Progesterone Level With Outcome In Pregnancy Of Unknown Location

2017 ◽  
Vol 08 (01) ◽  
pp. 21-25
Author(s):  
Ayesha Ajmi
Keyword(s):  
Ectopic Pregnancy ◽  
Early Pregnancy ◽  
Clinical Signs ◽  
Final Diagnosis ◽  
Progesterone Level ◽  
P Value ◽  
Intrauterine Pregnancy ◽  
Beta Hcg ◽  
Assessment Unit ◽  
Pregnancy Of Unknown Location

Objective: To study the association of change in serial beta HCG level over 48 hours and serum progesterone with final diagnosis i.e. viable intrauterine pregnancy, ectopic pregnancy or failing pregnancy in cases initially labelled as pregnancy of unknown location. Study Design: prospective population based study Place and duration of study: Early Pregnancy Assessment unit of Homerton University Hospital London from December 2013 to February 2014 Methodology: Fifty patients were recruited in the study who presented to early pregnancy assessment unit and had positive urine for pregnancy test but no evidence of pregnancy on transvaginal scan. Initial beta HCG, progesterone and transvaginal scan were done in all cases. Patients were followed up with repeat HCG at 48 hour interval and repeat TVS until final diagnosis was established. Results: Final diagnosis was miscarriage 58%, viable intrauterine pregnancy 24% and ectopic pregnancy 12%. 67% of patients with rise in HCG >60% had viable intrauterine pregnancy whereas all patients with >50% fall in HCG had a miscarriage. A highly significant association of >60% rise of HCG with viable intrauterine pregnancy and of >50% fall in HCG with miscarriage was observed with p-value<0.0001. 58% of patients with progesterone >30 had viable intrauterine pregnancy whereas 83% of patients with progesterone <10 were miscarriage and 17% had ectopic pregnancy. A highly significant association of final diagnosis of viable intrauterine pregnancy and progesterone level >30 was observed with p-value<0.0001. Conclusion: Although there is high association of >60% rise in 48 hour repeat HCG and progesterone >30 with viable intrauterine pregnancy, ectopic pregnancy cannot be ruled out on the basis of biochemical test. Therefore a high index of suspicion is required to diagnose cases of ectopic pregnancy using clinical signs and symptoms, transvaginal scan as well as biochemical tests such as serial beta HCG and progesterone levels.

scholarly journals P067: Ectopic pregnancy outcomes in patients discharged from the emergency department

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S80-S81
Author(s):  
K. Hawrylyshyn ◽  
S. McLeod ◽  
J. Thomas ◽  
C. Varner
Keyword(s):  
Ectopic Pregnancy ◽  
Chart Review ◽  
Surgical Intervention ◽  
Tertiary Care ◽  
Expectant Management ◽  
Retrospective Chart Review ◽  
Missed Abortion ◽  
Ectopic Pregnancies ◽  
Pregnancy Of Unknown Location ◽  
Rule Out

Introduction: The objective of this study was to determine the proportion of women who had a ruptured ectopic pregnancy after being discharged from the ED where ectopic pregnancy had not yet been excluded. Methods: This was a retrospective chart review of pregnant (<12 week gestational age) women discharged home from an academic tertiary care ED with a diagnosis of ectopic pregnancy, rule out ectopic pregnancy, or pregnancy of unknown location (PUL) over a 7 year period. Results: Of the 550 included patients, 83 (15.1%) had a viable pregnancy, 94 (17.1%) had a spontaneous or missed abortion, 230 (41.8%) had an ectopic pregnancy, 72 (13.1%) had unknown outcomes and 71 (12.9%) had other outcomes which included therapeutic abortion, molar pregnancy or resolution of HCG with no location documented. Of the 230 ectopic pregnancies, 42 (7.6%) underwent expectant management, 131 (23.8%) were managed medically with methotrexate, 29 (5.3%) were managed with surgical intervention, and 28 (5.1%) patients had a ruptured ectopic pregnancy after their index ED visit. Of the 550 included patients, 221 (40.2%) did not have a transvaginal US during their index ED visit, 73 (33.0%) were subsequently diagnosed with an ectopic pregnancy. Conclusion: These results may be useful for ED physicians counselling women with symptomatic early pregnancies about the risk of ectopic pregnancy after they are discharged from the ED.

scholarly journals Ruptured corpus luteum cyst in early pregnancy: A case report

2013 ◽  
Vol 141 (9-10) ◽  
pp. 689-692 ◽  
Author(s):  
Snezana Vidakovic ◽  
Milan Dokic ◽  
Zoran Vilendecic ◽  
Maja Djakonovic-Maravic
Keyword(s):  
Ectopic Pregnancy ◽  
Corpus Luteum ◽  
Early Pregnancy ◽  
Lower Abdominal Pain ◽  
Transvaginal Sonography ◽  
Intrauterine Pregnancy ◽  
Positive Pregnancy Test ◽  
Uterine Curettage ◽  
Wait And See ◽  
Corpus Luteum Cyst

Introduction. Transvaginal sonography and human chorionic gonadotropin (hCG) testing are cornerstones of modern clinical practice in cases with the suspected ectopic pregnancy. In unclear cases, if the level of hCG is above the discriminatory zones, the use of uterine curettage is recommended. There is an increasing concern that strict observation of the guidelines would potentially harm otherwise normal early intrauterine pregnancies in certain cases. Case Outline. A 35-year-old woman was admitted to hospital due to a severe lower abdominal pain. Based on the positive pregnancy test and sonographic exams which failed to demonstrate intrauterine pregnancy, the diagnosis of ectopic pregnancy was presumed. Laparoscopy revealed ruptured corpus luteum cyst and the diagnosis was confirmed on histopathological finding. Postoperatively, normal intrauterine gestation was visualized. Conclusion. Since the diagnosis of early pregnancy and its complications can be misleading, in unclear cases, we support the expectative ?wait and see? management consisting of serial hCG testing and repeated ultrasound examinations. Avoidance of uterine curettage in such unclear cases would further reduce the possibility of normal early pregnancy interruption.

scholarly journals Ultrasound Evaluation of Pregnancy in the First Trimester

2010 ◽  
Vol 4 (1) ◽  
pp. 17-28 ◽  
Author(s):  
George M Graham
Keyword(s):  
Early Pregnancy ◽  
First Trimester ◽  
Transvaginal Sonography ◽  
List Type ◽  
Intrauterine Pregnancy ◽  
Ultrasound Evaluation ◽  
Early Pregnancy Failure ◽  
Ultrasound Findings ◽  
Ultrasound Technology ◽  
First Trimester Ultrasound

Abstract Improvements in ultrasound technology, including transvaginal sonography and higher frequency probes, have led to a better understanding of early pregnancy development. These advances and the increasing availability of ultrasound allow women to have an earlier and more accurate assessment of their pregnancy. First trimester sonographic signs have been identified that can be used to reassure women that their pregnancy is progressing normally or counsel them that their pregnancy will fail. In addition, first trimester ultrasound can accurately predict the type of twinning in multiple gestations, allowing for appropriate counseling and management. Objectives Know the first trimester ultrasound findings of a normal intrauterine pregnancy Understand the ultrasound findings that diagnose an early pregnancy failure Know the ultrasound criteria used to diagnose a multifetal gestation

scholarly journals Expectant management of incomplete miscarriage, anembryonic pregnancy and early fetal demise: a comparative study

2020 ◽  
Vol 9 (8) ◽  
pp. 3144
Author(s):  
Reshma Sajan K. K. ◽  
Mumtaz P. ◽  
Chandrika C. V. ◽  
Abdul Vahab ◽  
Hassan Sheikh Imrana
Keyword(s):  
Success Rate ◽  
Early Pregnancy ◽  
Tertiary Care ◽  
Expectant Management ◽  
First Line ◽  
Proper Selection ◽  
Fetal Demise ◽  
Incomplete Miscarriage ◽  
Selection Of ◽  
Anembryonic Pregnancy

Background: Expectant management as first line management of early pregnancy miscarriages is less accepted due to failure and increased complications reported in few studies. Proper selection of cases improves outcome of expectant management. Aim of this study was to compare success rate and complications in expectant management in three groups of early pregnancy miscarriages- Incomplete miscarriage, anembryonic pregnancy and early fetal demise.Methods: Prospective observational study conducted in tertiary care centre for 3 years, including 107 patients with USG confirmed pregnancy miscarriage <13 weeks. Patients preferring expectant management were managed as outpatient without intervention for 2 weeks after which repeat USG was done to ascertain complete miscarriage. Failed expectant management patients underwent planned surgical uterine evacuation. Emergency admission and evacuation was done, if symptomatic during waiting period. Success rate and complications like emergency evacuation, vaginal bleeding, abdominal pain, limitation of physical activity and patient satisfaction were assessed and compared in subgroups of anembryonic pregnancy, early fetal demise and incomplete miscarriage. Statistical analysis was done by chi-square test.Results: Incomplete miscarriage group had highest success rate of 88.46%. followed by anembryonic pregnancy (72.5%) and EFD (47.83%) p value = 0.007. Complication rate was highest in EFD, followed by anembryonic and the least in incomplete miscarriage all of which was statistically significant except vaginal bleeding.Conclusions: Expectant management should be offered as first line choice for all types of early pregnancy miscarriages. Proper selection of case as to type of miscarriage especially incomplete miscarriage and selected cases of anembryonic pregnancy and EFD ensures higher success rate with lesser complications. Reserving medical and surgical management for unsuitable/failed cases.

scholarly journals A clinical study of trends of ectopic pregnancy and its management in a tertiary care hospital

2019 ◽  
Vol 8 (12) ◽  
pp. 4834
Author(s):  
Chandana M. Puttaraju ◽  
Nagothi Nagendra Prasad ◽  
M. P. A. Sailakshmi
Keyword(s):  
Risk Factors ◽  
Ectopic Pregnancy ◽  
Sex Education ◽  
Descriptive Analysis ◽  
Tertiary Care ◽  
Diagnostic Tools ◽  
Care Hospital ◽  
Care Teaching ◽  
Β Hcg ◽  
Ectopic Pregnancies

Background: Ectopic gestation is a gynaecological emergency which culminates in pregnancy loss and causes significant maternal morbidity, mortality besides jeopardizing future conception. The study discusses the incidence, risk factors, symptomatology and management of ectopic pregnancy in a tertiary care teaching hospital.Methods: This was a prospective study of 45 cases of ectopic pregnancies at a tertiary care teaching hospital from January 2012 to December 2013. Information was collected in a structured proforma, tabulated and descriptive analysis was carried out.Results: The incidence of ectopic pregnancy was 1.17%. Majority of the patients (80%) belonged to 20-30 yrs age group. Second gravidas predominated (42.2%). Fallopian tube was the most common site (95.5%). Rudimentary horn ectopic accounted for 4.65%. Previous abdominopelvic surgery (31.1%), IUCD usage (22.2%), PID (20%), abortions (20%), tubectomy (15.5%) were the principal risk factors. 42% of the patients had no risk factor. The triad of amenorrhea, bleeding per vaginum and abdominal pain was seen in 51.1% of cases. Ultrasound, UPT, β-hCG estimation were the diagnostic tools. Ruptured ectopic pregnancy accounted for 64.4%. Nearly 95.5% of patients underwent surgery; salpingectomy (76%). Methotrexate was successful in 4.44%. There was no maternal mortality.Conclusions: Mostly diagnosis, prompt surgical or medical management is cornerstone of treatment. Primary prevention such as improved access to family planning services, sex education, treatment of STI, PID, surgical asepsis  and haemostasis, implementing legislation for dispensing MTP drugs ameliorate risk factors and hence reduce ectopic pregnancy.

scholarly journals Ceasarean scar pregnancies, diagnosis and management

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.

scholarly journals Demographic and clinical analysis of post sterilization failure cases in a tertiary care hospital, Chennai, Tamil Nadu, India

2017 ◽  
Vol 6 (11) ◽  
pp. 4976
Author(s):  
T. S. Meena ◽  
K. S. Ramya ◽  
R. Mothilal
Keyword(s):  
Ectopic Pregnancy ◽  
Failure Rate ◽  
Tertiary Care ◽  
Care Hospital ◽  
Age Group ◽  
Female Sterilization ◽  
Intrauterine Pregnancy ◽  
Open Method ◽  
Laparoscopic Sterilization ◽  
Permanent Method

Background: The most common permanent method of family planning accepted in India is female tubal sterilization as it has a very low failure rate of 0.1- 0.8% in the first year and over all pregnancy chances of 1 in 200. It can be done by open method but laparoscopic method has now gained wide popularity.Methods: Ours was a retrospective study of post female sterilization failure cases admitted to the Department of Obstetrics and Gynecology, Government Kilpauk Medical College Hospital within a 10 year time period between April 2007 and March 2017.Results: Over a decade we had 134 post sterilization failures. 71 patients presented with intrauterine pregnancy whereas 63 presented as ectopic pregnancy following sterilization. Majority of patients belonged to 26-30 year age group and the median age was 28 years. 40.3% ectopic presented at 5-6 weeks gestational age. Over 90% of sterilization failures were done by open method and around 35.8% were done during caesarean section. Around 65.0 % sterilization failures were seen within 5 years of sterilization but 2 patients presented as late as 17 years post sterilization. In four cases (3%) failure was due to improper surgical procedure.Conclusions: Female sterilization may result in failure even after years of sterilization. In the present study, pregnancy after sterilization is higher in the youngest age group (15-30) years than for the age group (31-35) years and stabilized in the oldest age group (36-49) years. Open sterilization had a higher failure rate than laparoscopic sterilization. The most common mode of sterilization failure was intrauterine pregnancy than the ectopic pregnancy and it was almost equal to each other. Therefore, patients undergoing sterilization must be counselled about chances of failure; even though it is a permanent method, and to consult immediately if missed period else at a later stage they may go in for rupture ectopic leading to high maternal morbidity and mortality.

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