Advanced tubal ectopic pregnancy of 19 weeks gestation: case report and review of the literature

Ectopic pregnancy is a condition in which the fertilized ovum is impacted anywhere other than the uterine cavity, these sites may be uterine tubes, cervix, ovary and abdomen. Ectopic implantation in the uterine tubes occurs up to 98%. The distribution according to its location is: 78% ampullary, 12% isthmic, 5% fibrous, 2-3% interstitial, 1% ovarian, 1-2% abdominal, and more rare in cervix with 0.5%. Ectopic pregnancy occurs 1.2 to 2% of pregnancies, with an associated mortality of 0.5 deaths per 1000 pregnancies. There are multiple risk factors for an ectopic pregnancy, among the most frequent are: women with pelvic inflammatory disease (salpingitis) conditioned mainly by Chlamydia trachomatis and Neisseria gonorrhea, anatomical abnormalities of the tubes, previous surgery in them (including sterilization), masses extrinsic tumors that compress them, endometriosis, zygote anomalies, endocrinopathies (corpus luteum deficiency in late ovulation), use of intrauterine devices, previous ectopic pregnancy (as a result of surgical treatment or due to persistence of the original risk factor), contraceptive users with gestagens in low doses, assisted reproduction techniques, smokers, secondary adhesions to surgical interventions on the uterus, ovaries, and other pelvic or abdominal organs, exposure of the uterus to diethylstilbestrol, among others. The objective of this case is to describe an advanced tubal ectopic pregnancy. The following case report is about a 24-year-old patient with a pregnancy of 19 weeks of gestation by first-trimester ultrasound and a history of recent laparoscopic cholecystectomy secondary to biliary lithiasis. He is in the first trimester of normo-evolutive and without symptoms. Authors present to the emergency department with a 24-hour abdominal pain syndrome that requires exploratory laparotomy and right salpingo-oophorectomy due to the presence of ruptured tubal ectopic pregnancy with average fetometry of 19 weeks of gestation. The patient is discharged after an adequate clinical evolution.

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

Pakistan Journal of Surgery and Medicine ◽

10.37978/pjsm.v1i1.93 ◽

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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Chronic Tubal Ectopic Pregnancy with Diagnostic Conundrum: A Case Report

International Journal of Science and Healthcare Research ◽

10.52403/ijshr.20210435 ◽

2021 ◽

Vol 6 (2) ◽

pp. 192-194

Author(s):

Vishal Sharma ◽

Ravi Dutt Wadhwa

Keyword(s):

Case Report ◽

Ectopic Pregnancy ◽

Gestational Age ◽

First Trimester ◽

Present Case Report ◽

Tubal Ectopic Pregnancy ◽

Threatening Condition ◽

Life Threatening ◽

First Trimester Of Pregnancy ◽

Ectopic Pregnancies

Ectopic pregnancy is a life threatening condition and mostly ectopic pregnancies occurs in fallopian tube. The most common site of ectopic tubal pregnancy is ampulla. Ectopic pregnancy is a complication of pregnancy and usually easy to diagnose by ultrasonography during the first trimester of pregnancy. Due to limited healthcare resources in developing countries, women do not undergo for ultrasound examination during pregnancy which leads to late diagnosis. In most of cases women with ectopic pregnancy are asymptomatic, unless ruptured. The mean gestational age for clinical presentation of ectopic pregnancy is 7.2 weeks after the last normal menstrual period. In rural population, late presentations of ectopic pregnancies are more commonly seen because of lack of modern diagnostic ability. Present case report is a rare case of non-viable, unruptured, tubal ampullary chronic ectopic pregnancy of 12 weeks gestational age. Keywords: Ectopic pregnancy, Unruptured, gestational age, ultrasonography.

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Ovarian Pregnancy

JOURNAL OBGIN EMAS ◽

10.25077/aoj.3.2.142-150.2019 ◽

2019 ◽

Vol 3 (2) ◽

pp. 142-150

Author(s):

Widayat Widayat ◽

Ariadi Ariadi

Keyword(s):

Case Report ◽

Ectopic Pregnancy ◽

Ovarian Cyst ◽

Ultrasound Examination ◽

First Trimester ◽

Tubal Ectopic Pregnancy ◽

Ovarian Pregnancy ◽

Normal Limits ◽

Laparoscopic Intervention ◽

The Right

Objective: To report cases of ovarian pregnancyMaterials and Methods: This article describes a case report of a 33 year old woman, with a diagnosis of Ovarian Pregnancy at 6-7 weeks gravid G2P0A1H0. The patient came to the emergency room Dr. M. Djamil Padang. The ultrasound examination gives the impression of an ectopic pregnancy in the right ampulla tube. After laparoscopy, an ectopic pregnancy was seen in the right ovary without bleeding. Right ovarian pregnancy impression. Partial Oophorectomy was performed and tissue evacuation with bleeding during the procedure ± 30 cc.Results: Patients receiving laparoscopic intervention showed an ectopic pregnancy in the right ovary without bleeding, the left ovary was within normal limits. Right ovarian pregnancy impression. Partial Oophorectomy was performed and tissue evacuation with bleeding during the procedure ± 30 cc. The tissue was examined for histology of anatomic pathology.Conclusion: Ovarian pregnancy is one of the rarest forms of ectopic pregnancy, it is sometimes difficult to diagnose because it can be confused with tubal ectopic pregnancy or hemorrhagic ovarian cyst. Pregnancy ovaries can rupture in the first trimester of pregnancy.Keywords: Ovarian Pregnancy, Laparoscopy, Partial Oophorectomy

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Case report on toxicity of methotrexate in tubal ectopic pregnancy

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20202769 ◽

2020 ◽

Vol 9 (7) ◽

pp. 3093

Author(s):

Surbhi Lodha ◽

Kimaya Mali

Keyword(s):

Case Report ◽

Side Effects ◽

Early Diagnosis ◽

Ectopic Pregnancy ◽

Patient Selection ◽

Uterine Cavity ◽

Tubal Ectopic Pregnancy ◽

Treatment Use ◽

Medical Line ◽

Timely Treatment

Ectopic pregnancy is defined as pregnancy outside uterine cavity. Of all ectopic pregnancy, tubal ectopic is most common. Most cases today are diagnosed early and hence timely treatment is possible. In stable patients, medical line of management with methotrexate can be used. With early diagnosis and medical line of treatment, use of injectable methotrexate is on rise. Being aware of characteristics of methotrexate like mechanism, dosage, side effects and contraindications, appropriate patient selection and watchful monitoring will help reduce methotrexate induced toxicity.

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A second trimester live tubal ectopic pregnancy: a case report

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20213881 ◽

2021 ◽

Vol 10 (10) ◽

pp. 4005

Author(s):

Kiran Kunwar ◽

Megha Punetha ◽

Geeta Jain

Keyword(s):

Ectopic Pregnancy ◽

Vaginal Bleeding ◽

Uterine Cavity ◽

First Trimester ◽

Final Diagnosis ◽

Emergency Laparotomy ◽

Second Trimester ◽

Lower Abdomen ◽

Tubal Ectopic Pregnancy ◽

High Index Of Suspicion

Ectopic or extra-uterine pregnancy occurs most commonly in fallopian tube. High index of suspicion is key to diagnose ectopic pregnancy in a pregnant-women presenting in first trimester with complains of amenorrhoea, pain in lower abdomen and vaginal bleeding. Such pregnancy can be managed by expectant, medically with methotrexate or surgically via laparoscopy or laparotomy if diagnosed promptly. In this case study, a 36-years-old, G2P1+0 presented in second trimester of pregnancy with pain in lower abdomen and vaginal bleeding. Her vitals were unstable and abdomen tender on palpation. Urgent ultrasound was done suggestive empty uterine cavity, a live 13 weeks 6 days fetus in left adnexa and hemoperitoneum suggestive ruptured tubal ectopic pregnancy. The patient’s final diagnosis was live 13 weeks 6 days ruptured left tubal ectopic pregnancy which was managed by emergency laparotomy with a salpingectomy.

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Unsual Tubal Twin Ectopic Gestation Report of Three Different Cases

Journal of Clinical Cases & Reports ◽

10.46619/joccr.2018.1-1019 ◽

2018 ◽

Vol 1 (3) ◽

pp. 96-103

Author(s):

S Gosavi Maheshgir ◽

Keyword(s):

Ectopic Pregnancy ◽

Abdominal Cavity ◽

Uterine Cavity ◽

Rare Condition ◽

Fallopian Tubes ◽

Tubal Ectopic Pregnancy ◽

Ectopic Gestation ◽

First Case ◽

History Of ◽

Twin Pregnancies

Gestation outside the uterine cavity in which the implantation occurs in any tissue other than the endometrium is referred as ectopic pregnancy. The most places for occurring ectopic pregnancy (97% of cases) are the fallopian tubes including ampulla (55%), isthmus (25%), and fimbria (17%), and in 3% of patient’s ectopic pregnancy occurs in the abdominal cavity, ovary, or cervix. The tubal twin ectopic pregnancy is a rare condition, and the first unilateral tubal twin was reported by De Ott in 1891, and the first live twin tubal ectopic pregnancy was reported in 1944. A live tubal twin ectopic pregnancy is a very rare condition and among >100 reports of tubal twin pregnancies, till now, only 8 cases were live. Early diagnosis and treatment of women with tubal twin ectopic pregnancy is very important and may decrease the risk of tubal rupture. I present three cases of tubal twin ectopic gestation. In the first case, spontaneous unilateral live tubal twin ectopic gestation. The second and third cases spontaneous ruptured twin ectopic gestation. All three cases were successfully managed and there was no history of assisted reproductive techninique fertilization or pelvic inflammatory disease.

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Ectopic pregnancy in a tertiary care centre of Jharkhand, India

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20193505 ◽

2019 ◽

Vol 8 (8) ◽

pp. 2969

Author(s):

Meetali Parashar ◽

Meena Mehta

Keyword(s):

Ectopic Pregnancy ◽

Clinical Presentation ◽

Previous History ◽

First Trimester ◽

Near Miss ◽

Obstetrics And Gynaecology ◽

Maternal Morbidity And Mortality ◽

History Of ◽

Β Hcg ◽

A Prospective Study

Background: Ectopic pregnancy is one in which the fertilized ovum is implanted and develops outside the endometrial cavity. It is an important cause of maternal morbidity and mortality in first trimester. The present study was conducted to study the risk factors, clinical presentation and management of ectopic pregnancy in RIMS, Ranchi, Jharkhand, India.Methods: This was a prospective study conducted in the department of obstetrics and gynaecology, RIMS, Ranchi, Jharkhand during May 2017 to September 2018. A total of 90 cases were included in the study.Results: 80% of the patients presented with amenorrhoea, 98% had abdominal pain and 69% had vaginal bleeding. Ultrasonography revealed hemoperitoneum in about 93% patients. 16 (18%) patients had history of infertility whereas 10 patients (11%) had taken treatment of infertility.6 (7%) patients had history of STD or PID.14 (16%) had undergone bilateral tubectomy.2 (2%) had history of IUCD insertion and 12 (13%) patients had undergone previously lscs. 54 patients (60%) had undergone D and C and 6 patients (7%) had a previous history of ectopic pregnancy. 68 (76%) underwent only salpingectomy.12 (13%) had salpingo-oophorectomy and 10 (11%) had salpingectomy with contralateral tubectomy.Conclusions:Diagnosis of ectopic pregnancy requires clinical suspicion and supportive investigations like UPT, ultrasonography, β HCG and laparoscopy. It is an important cause of admission to RIMS as maternal near miss cases.Background: Ectopic pregnancy is one in which the fertilized ovum is implanted and develops outside the endometrial cavity. It is an important cause of maternal morbidity and mortality in first trimester. The present study was conducted to study the risk factors, clinical presentation and management of ectopic pregnancy in RIMS, Ranchi, Jharkhand, India.Methods: This was a prospective study conducted in the department of obstetrics and gynaecology, RIMS, Ranchi, Jharkhand during May 2017 to September 2018. A total of 90 cases were included in the study.Results: 80% of the patients presented with amenorrhoea, 98% had abdominal pain and 69% had vaginal bleeding. Ultrasonography revealed hemoperitoneum in about 93% patients. 16 (18%) patients had history of infertility whereas 10 patients (11%) had taken treatment of infertility.6 (7%) patients had history of STD or PID.14 (16%) had undergone bilateral tubectomy.2 (2%) had history of IUCD insertion and 12 (13%) patients had undergone previously lscs. 54 patients (60%) had undergone D and C and 6 patients (7%) had a previous history of ectopic pregnancy. 68 (76%) underwent only salpingectomy.12 (13%) had salpingo-oophorectomy and 10 (11%) had salpingectomy with contralateral tubectomy.Conclusions: Diagnosis of ectopic pregnancy requires clinical suspicion and supportive investigations like UPT, ultrasonography, β HCG and laparoscopy. It is an important cause of admission to RIMS as maternal near miss cases.

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