scholarly journals A case of hybrid medical management of advanced cornual ectopic pregnancy

2020 ◽  
Vol 9 (12) ◽  
pp. 5179
Author(s):  
Shilpa Bajpai ◽  
Prasad Lele
Keyword(s):  
Ectopic Pregnancy ◽  
Hybrid Approach ◽  
Cardiac Activity ◽  
High Serum ◽  
Transvaginal Sonography ◽  
Excessive Bleeding ◽  
Vascular Area ◽  
Future Fertility ◽  
Magnetic Resonance Imaging Mri ◽  
Ectopic Pregnancies

Cornual ectopic pregnancy is perilous and treacherous entity which accounts for 2-4% of all ectopic pregnancies and has a maternal mortality of 2-2.5%. There is always a dilemma in diagnosis due to the area being in close proximity to the endometrial cavity. The precise localisation is difficult till the gestation is advanced, which poses problems in its subsequent management. Surgical approach in this highly vascular area leads to excessive bleeding is a daunting nightmare for a surgeon and also imposes a great threat to the future fertility of the patient. Here we present a case of 26 year old spontaneously conceived primigravida who presented for booking visit at 10 week period of gestation. On transvaginal sonography, there was a suspicion of right cornual ectopic pregnancy which was later confirmed on magnetic resonance imaging (MRI). Despite due to advanced viable gestation, with an evident cardiac activity and very high serum β-human chorionic gonadotropin (βhCG) (more than 1 lakh mIU/ml), we tried a pioneering technique of conservative hybrid approach with intracavitary instillation and systemic antimetabolite drug methotrexate, in view to safeguard her future fertility by diminishing the likelihood of hysterectomy. While on the treatment, patient developed hyper reaction to methotrexate, which was managed with a multidisciplinary approach. She responded very well to the therapy with complete resolution of the cornual ectopic pregnancy.

Predictors of Success of Methotrexate Treatment for Tubal Ectopic Pregnancies

2021 ◽  
pp. 267-271
Author(s):  
Mary Louise Fowler ◽  
Paul Hendessi ◽  
Nyia Noel
Keyword(s):  
Single Dose ◽  
Ectopic Pregnancy ◽  
Cardiac Activity ◽  
Predictors Of Success ◽  
Therapy Failure ◽  
Methotrexate Treatment ◽  
Ectopic Pregnancies

This study reviewed the use of a single dose of intramuscular methotrexate as therapy in women with an ectopic pregnancy. Therapy failure was more likely in women with higher hCG level and presence of cardiac activity at time of treatment. Age, parity, size of pregnancy, and the presence of intraperitoneal fluid were not found to correlate with treatment failures.

scholarly journals LETROZOLE - NOVEL DRUG FOR MEDICAL MANAGEMENT FOR TUBAL ECTOPIC PREGNANCY

2020 ◽  
pp. 1-2
Author(s):  
Rana Choudhary ◽  
Seema Pandey ◽  
Priyanka Vora
Keyword(s):  
Ectopic Pregnancy ◽  
Medical Management ◽  
Maternal Morbidity ◽  
First Trimester ◽  
Tubal Ectopic Pregnancy ◽  
Future Fertility ◽  
Life Threatening ◽  
Diagnostic Modalities ◽  
Ectopic Pregnancies ◽  
Novel Drug

Ectopic pregnancy is one of the most common life-threatening conditions leading to increased maternal morbidity and mortality in the first trimester. With advances in diagnostic modalities, one can now diagnose most ectopic pregnancies before their rupture and other catastrophic events. Methotrexate is the most common drug used for medical management but has adverse effects and needs strict monitoring. We report a case of tubal ectopic pregnancy which was successfully managed with letrozole. We were able to prevent maternal morbidity, reduce cost of therapy and preserve future fertility in our patient.

scholarly journals A retrospective study of ectopic pregnancy at a tertiary care centre

2017 ◽  
Vol 6 (12) ◽  
pp. 5241 ◽  
Author(s):  
Archana Mehta ◽  
Shehla Jamal ◽  
Neerja Goel ◽  
Mayuri Ahuja
Keyword(s):  
Risk Factors ◽  
Retrospective Study ◽  
Ectopic Pregnancy ◽  
Clinical Presentation ◽  
Tertiary Care ◽  
Fetal Loss ◽  
Tubal Pregnancy ◽  
Tertiary Care Centre ◽  
Future Fertility ◽  
Ectopic Pregnancies

Background: Ectopic pregnancy is a global problem and is the most common life-threatening emergency in early pregnancy leading to significant morbidity and fetal loss. It occurs in variable presentations. The rate of ectopic pregnancies has increased from 0.5% in 1970 to 2% today. The aim of this study was to determine the incidence, clinical presentation, risk factors, treatment, and morbidity and mortality associated with ectopic pregnancy.Methods: The present retrospective study was conducted over a period of three years in the department of obstetrics and gynecology at SMS and R, Greater Noida, UP from Feb 2014 to Jan 2017.A total of 80 patients with ectopic pregnancy were analyzed regarding clinical presentation, risk factors, operative findings and treatment modality.Results: Total number of 80 cases of ectopic pregnancies were admitted during this period against 2645 deliveries representing frequency of 3%. Majority of cases (43.75%) were in the age group of 25-29 years and 41.25% were gravida 4 and above. Risk factors were identifiable in 66.25% of cases. Previous abortion was the most common risk factor (31.25%). The classical triad of amenorrhea, pain abdomen and vaginal bleeding was present in 71.25% of cases. More than half of case (55%) had ruptured tubal pregnancy on admission. Unruptured tubal pregnancy was seen in 10% case. Interestingly we found one rare case of bilateral ectopic pregnancy. Salpingectomy by open method was the mainstay of treatment (86.25%).Conclusions: Ectopic pregnancy is still a major challenge in gynecological practice. In our country most of the cases present late after tubal rupture requiring radical surgical treatment. Early diagnosis and timely intervention in the form of medical treatment or conservative surgery not only reduces maternal morbidity but also preserves future fertility.

scholarly journals Surgical management of caesarean scar pregnancy: a case report

2020 ◽  
Vol 9 (4) ◽  
pp. 1769
Author(s):  
Savita Singh Gautam ◽  
Manmeet Kaur
Keyword(s):  
Early Diagnosis ◽  
Medical Literature ◽  
Histopathological Examination ◽  
Resonance Imaging ◽  
Caesarean Scar ◽  
Future Fertility ◽  
Maternal Morbidity And Mortality ◽  
Caesarean Scar Pregnancy ◽  
Magnetic Resonance Imaging Mri ◽  
Ectopic Pregnancies

Caesarean scar ectopic is one of the rarest of all ectopic pregnancies. The incidence of caesarean scar pregnancy (CSP), which was extremely rare till recent times, has been rising steadily. Case have more of such cases being published in medical literature now. It is defined as when a blastocyst implants on a previous caesarean scar. The incidence of caesarean scar ectopic has increased due to increase in number of caesarean deliveries. Early diagnosis of this can be done by using ultrasound. It is very important because a delay can lead to increased maternal morbidity and mortality. Early diagnosis leads to prompt management and improves the outcome by allowing preservation of future fertility. Magnetic resonance imaging (MRI) has important role when sonography is equivocal or inconclusive before therapy or intervention. Case are reporting a rare case of G2P1l1 with previous one caesarean delivery, diagnosed as caesarean scar ectopic pregnancy with the help of sonography. Patient underwent laparotomy and on histopathological examination caesarean scar pregnancy was confirmed. Due to the rarity of this condition, there are no specific guidelines available for its management.

scholarly journals Ectopic pregnancy treatment by combination therapy

Open Medicine ◽  
2016 ◽  
Vol 11 (1) ◽  
pp. 530-536
Author(s):  
Aneta Cymbaluk-Płoska ◽  
Anita Chudecka-Głaz ◽  
Sławomir Kuźniak ◽  
Janusz Menkiszak
Keyword(s):  
Serum Level ◽  
Combination Therapy ◽  
Ectopic Pregnancy ◽  
Systemic Treatment ◽  
Beta Hcg ◽  
Future Fertility ◽  
Choice Of Treatment ◽  
Ectopic Pregnancies ◽  
Hyperosmolar Glucose

AbstractDetectability of early stages of ectopic pregnancies has increased due to improvements in ultrasonographic and biochemical techniques. Since the patients’ future procreative plans must be taken into consideration when commencing treatment, the goal of this work was to compare the effects of treatment methods and their impact on fertility. The study included 91 patients treated surgically for ectopic pregnancy. The choice of treatment depended on patients’ general condition, ultrasonographic evaluation and serum level of beta-hCG. A combination of laparoscopic and conservative systemic treatment was applied in 70% of cases. More rapid beta-hCG reduction was noted when laparoscopy and intra-oviductal injection of hyperosmolar glucose or methotrexate (MTX) were combined with intramuscular administration of MTX at a dose of 50 mg/m2. Follow-up examination of 66 patients revealed that the greatest number of spontaneous pregnancies (48%) resulted after this combination therapy. We conclude that this combination treatment is safe and provides satisfactory results in terms of future fertility.

scholarly journals Abortive Retroperitoneal Ectopic Pregnancy Followed Up by Ultrasound: A Case Report

2020 ◽  
Author(s):  
Tiantian Ye ◽  
Liang Yu ◽  
Yuxin Jiang ◽  
Yu Xia
Keyword(s):  
Ectopic Pregnancy ◽  
Vital Signs ◽  
Uterine Cavity ◽  
Abdominal Ultrasound ◽  
Transvaginal Sonography ◽  
Life Threatening ◽  
Mass Size ◽  
Anechoic Area ◽  
Β Hcg ◽  
Ectopic Pregnancies

Abstract Background: Ectopic pregnancy can be life-threatening. Most of ectopic pregnancy located in the fallopian tube. But retroperitoneal ectopic pregnancies are extremely rare.Results: We report a 29-year-old Chinese woman with amenorrhea for 50 days presented to emergency department for abdominal pain. Her serum β-hCG level was 1675mIU/ml. Transvaginal sonography showed irregular anechoic area in uterine cavity without pregnancy sac echo. And nothing wrong was found in bilateral adnexa. Abdominal ultrasound showed a mixed echo region behind the pancreas. The clinical diagnosis was retroperitoneal ectopic pregnancy. The patient's vital signs remained stable with the mass size continue decreased . Because of the huge surgery risk, the mass was followed up by ultrasound closely.Conclusions: 5 months after bleeding, the fourth ultrasound follow-up examination showed the mass disappeared completely and serum β-hCG level was normal .

scholarly journals Successful use of Single dose of Methotrexate for the treatment of Unruptured Ectopic Pregnancy at Tribhuvan University Teaching Hospital, Kathmandu, Nepal

2013 ◽  
Vol 7 (1) ◽  
pp. 45-49
Author(s):  
Suniti Rawal
Keyword(s):  
Single Dose ◽  
Ectopic Pregnancy ◽  
Assisted Reproductive Technologies ◽  
Cost Effective ◽  
Reproductive Technologies ◽  
University Teaching ◽  
Transvaginal Sonography ◽  
Emergency Laparotomy ◽  
Cost Effective Alternative ◽  
Ectopic Pregnancies

Ectopic pregnancy continues to be one of the most common gynecologic emergencies. The incidence of ectopic pregnancies which are diagnosed much earlier with the help of advanced tools is in the increasing trend, probably due to extensive use of assisted reproductive technologies and increased pelvic infections. A total of 36 ectopic pregnancies were managed from April 2007- March 2008 among which 33 were ruptured ectopics with haemoperitoneum, treated surgically by emergency laparotomy and salpingectomy. Three unruptured cases were treated with single dose of intramuscular methotrexate followed by serum ß hCG measurement. Transvaginal sonography reassured that medical management of unruptured ectopic pregnancies with systemic single dose of methotrexate was successful with few side effects and a cost effective alternative to traditional surgical management for unruptured ectopic pregnancies. Nepal Journal of Obstetrics and Gynaecology / Vol 7 / No. 1 / Issue 13 / Jan- June, 2012 / 45-49 DOI: http://dx.doi.org/10.3126/njog.v7i1.8836

scholarly journals CPK: The new tool in the diagnosis of ectopic pregnancy

2017 ◽  
Vol 6 (6) ◽  
pp. 2507
Author(s):  
Suvarna Jyothi Ganta ◽  
Sunanda R. Kulkarni ◽  
Vidya Muralidhar
Keyword(s):  
Maternal Mortality ◽  
Ectopic Pregnancy ◽  
Diagnostic Dilemma ◽  
Diagnostic Efficacy ◽  
Mortality And Morbidity ◽  
Appropriate Treatment ◽  
Future Fertility ◽  
Maternal Mortality And Morbidity ◽  
The Mean ◽  
Ectopic Pregnancies

Background: Ectopic pregnancy is still a diagnostic dilemma presenting with various complaints. The classic triad of amenorrhea, abdominal pain, vaginal bleeding and /or syncope is not always seen. Misdiagnosis can lead to delay in treatment, blood loss is found to be the major cause of death. Early and accurate diagnosis is critical in bringing down the maternal mortality and morbidity. Prompt and effective treatment of an ectopic pregnancy can help preserve the chances of future healthy pregnancies. Aim of present study was to investigate whether creatinine phosphokinase (cpk) can be used as an effective diagnostic tool in the early diagnosis of ectopic pregnancy which can help in decreasing the maternal mortality and morbidityMethods: This observational comparative three group clinical study was conducted at Chinmaya Mission Hospital, Bangalore, between May 2016 to January 2017.120 women in their early trimester were studied of which 40 were diagnosed cases of ectopic pregnancies, 40 women presented with intrauterine abortive pregnancies and 40 women had normal healthy pregnancies. Serum CPK, serum B-HCG, vaginal scans were done in all, along with routine investigations.Results: The mean CPK values in normal, abortive and ectopic pregnancies were 36.92±6.44, 43.95±11.96 and 91.55±30.43 respectively. It was found to be significantly higher in ectopic Pregnancies. Also, the mean CPK in ruptured and unruptured ectopic pregnancy were 97.26±25.97 and 63.82±34.92 respectively.Conclusions: Present study shows that maternal CPK levels are significantly higher in women with ectopic pregnancies. CPK can serve as the reliable biochemical marker to diagnose ectopic pregnancy particularly ruptured. CPK can be used to increase the diagnostic efficacy in ectopic pregnancy, which followed by rapid and appropriate treatment can reduce the mortality, morbidity and preserve future fertility.

scholarly journals Cesarean Scar Ectopic Pregnancy: Treatment Decision Algorithm and Success With Medical Treatment

2021 ◽  
Author(s):  
Lorena Sabonet Lorente ◽  
Ana I. Guzman Leon ◽  
Pilar Espejo Reina ◽  
José Ramón Anderica Herrero ◽  
Ernesto Gonzalez Mesa ◽  
...  
Keyword(s):  
Ectopic Pregnancy ◽  
Transvaginal Ultrasound ◽  
Treatment Options ◽  
Expectant Management ◽  
Treatment Decision ◽  
Maternal Condition ◽  
Decision Algorithm ◽  
Cesarean Scar ◽  
Future Fertility ◽  
Ectopic Pregnancies

Background Cesarean scar ectopic pregnancies are a rare form of extrauterine pregnancies, yet their incidence has increased along with the rise in the number of cesarean deliveries. As with other ectopic pregnancies, cesarean scar ectopic pregnancies pose a greater risk for maternal hemorrhage and ultimately maternal mortality. Case presentation We present a series of clinical cases of cesarean scar ectopic pregnancy diagnosed by transvaginal ultrasonography. Each patient received an individualized treatment: the rate of success depended on the particular maternal condition in each case. Due to the low frequency of this entity, there are no clear protocols for its treatment and thus there are numerous options for treatment and follow up: expectant management, medical therapy, surgical intervention, uterine artery embolization or a combined approach. Each method has different levels of success and is dependent on the surgeon’s skill and patient presentation. The transvaginal ultrasound is necessary to obtain the fine details of the gestation sac and its relation to the scar and must be followed by a meticulous abdominal scan with a full bladder. Conclusion Herein, we present a rare pathological phenomenon whose frequency is on the rise, and for which transvaginal ultrasound and flow doppler provide high diagnostic accuracy. Early diagnosis of cesarean scar ectopic pregnancies offers treatment options to that may help avoid uterine rupture and bleeding, thus preserving the uterus and future fertility.

scholarly journals Ectopic Twin Pregnancy : About A Case

2020 ◽  
Vol 4 (4) ◽  
Keyword(s):  
Emergency Room ◽  
Ectopic Pregnancy ◽  
Health Care Providers ◽  
Twin Pregnancy ◽  
Transvaginal Ultrasound ◽  
Cardiac Activity ◽  
Care Providers ◽  
Ectopic Pregnancies ◽  
Laparoscopic Salpingectomy ◽  
The Right

Unilateral tubal twin pregnancies occur in approximately 1 in 125,000 spontaneous pregnancies. Due to the lack of data, there are few recommendations on the appropriate management of a twin tubal ectopic pregnancy. We report a CLINICAL CASE of A 28-year-old woman, with type 1 diabetes on insulin and with no significant surgical or gynaecological history, the patient presented to the emergency room for metrorragia evolving for two days in a context of 6sa-2j amenorrhea. Clinical examination finds a hemodynamically stable patient, a depressible flexible abdomen with sensitivity to the right iliac pit and a slightly painful reversed uterus has mobilization with a moderate bleeding abundance of endo uterine origin. The emergency room urine pregnancy test was positive. Beta Hcg serum was 3,966 mUI/ml. Transvaginal ultrasound showed a reversed empty uterus, a fine and homogeneous endometrium of 7.8 mm with the presence at the right tubal level of two gestational bags measuring (7.2mm5.8mm) and (7mm-5.6 mm) with two embryos of 3.8mm and 3.6mm respectively, both had positive cardiac activity. at the douglas bag cul level, the presence of an effusion blade. the diagnosis of bi-amniotic bi-horoial bi-chorial ectopic pregnancy was made.a laparoscopy was performed with a right salpingectomy. postoperative evolution was favourable. Health care providers should have a high index of clinical suspicion for ectopic pregnancies. Unilateral tubal twin ectopic pregnancies, although rare, can be correctly diagnosed by transvaginal ultrasound. Laparoscopic salpingectomy provides an effective treatment for unilateral tubal twin gestation with a short recovery time. Due to the lack of data in the literature, there are few recommendations on the appropriate management of an ectuous ectopic twin pregnancy.

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