scholarly journals Surgical intervention in ectopic pregnancies

2019 ◽  
Vol 26 (06) ◽  
Author(s):  
Fouzia Rasool Memon ◽  
Mini Poothavelil ◽  
Samreen Memon
Keyword(s):  
Ectopic Pregnancy ◽  
Surgical Management ◽  
Surgical Intervention ◽  
University Hospital ◽  
Time Interval ◽  
Presenting Symptoms ◽  
Beta Hcg ◽  
Ultrasound Findings ◽  
Ectopic Pregnancies ◽  
Study Setting

Objectives: To find out the negative laparoscopy rate for suspected ectopic pregnancy. Study Design: Retrospective cohort study. Setting: Electronic medical record databases in North Cumbria University Hospital, Carlisle, United Kingdom. Period: August 2014 to August 2018. Material and Methods: The data of total 150 laparoscopies performed for ectopic pregnancy management was collected for gestational age at presentation, symptoms, serial beta human chorionic gonadotrophic hormone (HCG) levels, ultrasound findings, time interval for diagnosis, time to surgery and histology. Results: One hundred and fifty patients (52 under 5 weeks and 98 over 5 weeks’ gestation) were incorporated into this study. The primary presenting symptoms were pain and vaginal bleeding. Suboptimal rise in serial beta HCG (performed 48 hours apart) was seen in 69 patients (46%) while other 81 patients (54%) had confirmed ectopic on USS and were offered surgical management after the scan. One hundred forty for women (96%) went for surgical management and one patient had conservative management as she was asymptomatic with low HCG(less than 1000IU) at the first visit and rapid drop in serial BHG results. Fifty three women (35%) had surgery on the same day when they had ectopic pregnancies seen on USS, 63 (42%) went to theatre for surgery between 0-6 days, while 34 patients (23%) had surgery between 7-14 days of USS. All women were operated through laparoscopic route and tubal ectopic pregnancies were confirmed at laparoscopy. There was no negative laparoscopy in our study period. Conclusion: Judicious and timely surgical intervention made it possible to treat every case through laparoscopic route with zero negative laparoscopy rate.

scholarly journals Utility of a routine ultrasound for detection of ectopic pregnancies among women requesting abortion: a retrospective review

2020 ◽  
pp. bmjsrh-2020-200888
Author(s):  
Clara I Duncan ◽  
John J Reynolds-Wright ◽  
Sharon T Cameron
Keyword(s):  
Risk Factors ◽  
Ectopic Pregnancy ◽  
Clinical Care ◽  
Significant Risk ◽  
Intrauterine Pregnancy ◽  
Retrospective Case ◽  
Case Record ◽  
Ultrasound Findings ◽  
Ectopic Pregnancies ◽  
Record Review

IntroductionRoutine ultrasound may be used in abortion services to determine gestational age and confirm an intrauterine pregnancy. However, ultrasound adds complexity to care and results may be inconclusive, delaying abortion. We sought to determine the rate of ectopic pregnancy and the utility of routine ultrasound in its detection, in a community abortion service.MethodsRetrospective case record review of women requesting abortion over a 5-year period (2015–2019) with an outcome of ectopic pregnancy or pregnancy of unknown location (PUL) at a service (Edinburgh, UK) conducting routine ultrasound on all women. Records were searched for symptoms at presentation, development of symptoms during clinical care, significant risk factors and routine ultrasound findings.ResultsOnly 29/11 381 women (0.25%, 95% CI 0.18%, 0.33%) had an ectopic pregnancy or PUL (tubal=18, caesarean scar=1, heterotopic=1, PUL=9). Eleven (38%) cases had either symptoms at presentation (n=8) and/or significant risk factors for ectopic pregnancy (n=4). A further 12 women developed symptoms during their clinical care. Of the remaining six, three were PUL treated with methotrexate and three were ectopic (salpingectomy=2, methotrexate=1). In three cases, the baseline ultrasound indicated a probable early intrauterine pregnancy.ConclusionsEctopic pregnancies are uncommon among women presenting for abortion. The value of routine ultrasound in excluding ectopic pregnancy in symptom-free women without significant risk factors is questionable as it may aid detection of some cases but may provide false reassurance that a pregnancy is intrauterine.

scholarly journals Ectopic pregnancy managed medically at St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia

2021 ◽  
Vol 14 (3) ◽  
pp. 85-88
Author(s):  
Jok Thikuiy Gang ◽  
Sisay Kirba Kea ◽  
Samson Gebremedhin
Keyword(s):  
Ectopic Pregnancy ◽  
Medical Records ◽  
Selection Criteria ◽  
Surgical Intervention ◽  
Addis Ababa ◽  
Safe Alternative ◽  
Medical College ◽  
Endometrial Cavity ◽  
Emergency Surgical Intervention ◽  
Ectopic Pregnancies

Background: Ectopic pregnancy, a pregnancy in which the embryo implants outside the endometrial cavity, is an important cause of maternal mortality, especially in developing countries. It can be managed medically using methotrexate. In Ethiopia, limited evidence exists regarding the treatment outcome of this approach.Methods: This retrospective study was conducted based on medical records of ectopic pregnancies managed medically using methotrexate. The data of women who had unruptured ectopic pregnancy and who were managed medically in the study period at St. Paul’s Hospital Millennium Medical College were included. Data were extracted from patients’ medical records and analysed using SPSS software.Results: During the 5-year period 2015 to 2019, 81 women with unruptured ectopic pregnancy were managed medically using methotrexate with 93.8% (n=76) success. Methotrexate was administered intramuscularly to all patients in either single dose or multiple doses. Five out of the 81 patients underwent surgical intervention for either ectopic rupture or persistent ectopic mass. There were no fatal complications.Conclusion: Methotrexate is a successful and safe alternative to surgical management of unruptured ectopic pregnancy in our settings. It should be given a trial in patients who meet the selection criteria in a setting ready for emergency surgical intervention and blood transfusions.

scholarly journals Non-surgical management of unruptured tubal ectopic pregnancy

2017 ◽  
Vol 6 (7) ◽  
pp. 3041
Author(s):  
Anjali Choudhary ◽  
Priyanka Chaudhari ◽  
Neeta Bansal
Keyword(s):  
Ectopic Pregnancy ◽  
Medical Management ◽  
Expectant Management ◽  
First Trimester ◽  
Response To Treatment ◽  
Surgical Trauma ◽  
Tubal Ectopic Pregnancy ◽  
Beta Hcg ◽  
Surgical Options ◽  
Ectopic Pregnancies

Background: Ectopic pregnancy is still the leading cause of pregnancy related morbidity in the first trimester. Since majority of the women who present with ectopic pregnancies are sub fertile and young, there is a role for non-surgical options of managing these pregnancies. Expectant and medical management not only serves to conserve the fallopian tubes but also saves women from surgical trauma and morbidity. The objective of this retrospective study was to share our experience of treating un-ruptured tubal ectopic pregnancies conservatively.Methods: Women diagnosed with un-ruptured tubal ectopic pregnancy, fit for conservative /medical management were included. Women with serum beta HCG levels less than 1000 mIU/L were treated expectantly and women with Bet HCG levels >1000 but <10,000 mIU /L were given Injectable methotrixate. Response to treatment was monitored by serial beta HCG levels.Results: Total 37 women included in the study.12% women showed complete resolution with expectant treatment alone and 88% resolved after a single dose methotrixate.Conclusions: Many women with un-ruptured tubal ectopic pregnancies would benefit from expectant management, or methotrixate therapy. Methotrixate used in carefully selected women is safe and effective in resolving these cases with good post treatment reproductive outcome.

scholarly journals Use of FloSeal Sealant in the Surgical Management of Tubal Ectopic Pregnancy

2013 ◽  
Vol 2013 ◽  
pp. 1-3 ◽  
Author(s):  
Mara Clapp ◽  
Jaou-Chen Huang
Keyword(s):  
Ectopic Pregnancy ◽  
Surgical Management ◽  
Thermal Injury ◽  
Tubal Pregnancy ◽  
Effective Alternative ◽  
Intrauterine Pregnancy ◽  
Tubal Ectopic Pregnancy ◽  
Tubal Patency ◽  
Ectopic Pregnancies

Background. Surgery is sometimes required for the management of tubal ectopic pregnancies. Historically, surgeons used electrosurgery to obtain hemostasis. Topical hemostatic sealants, such as FloSeal, may decrease the reliance on electrosurgery and reduce thermal injury to the tissue.Case. A 33-year-old G1 P0 received methotrexate for a right tubal pregnancy. The patient became symptomatic six days later and underwent a laparoscopic right salpingotomy. After multiple unsuccessful attempts to obtain hemostasis with electrocoagulation, FloSeal was used and hemostasis was obtained. Six weeks later, a hysterosalpingogram (HSG) confirmed tubal patency. The patient subsequently had an intrauterine pregnancy.Conclusion. FloSeal helped to achieve hemostasis during a laparoscopic salpingotomy and preserve tubal patency. FloSeal is an effective alternative and adjunct to electrosurgery in the surgical management of tubal pregnancy.

scholarly journals A study of forty eight patients with ilecoceacal mass presenting as intestinal obstruction requires surgical intervention and their outcome

2020 ◽  
Vol 7 (8) ◽  
pp. 2563
Author(s):  
Himanshu Gupta ◽  
Sumikesh Anand
Keyword(s):  
Intestinal Obstruction ◽  
Surgical Management ◽  
Surgical Intervention ◽  
Secondary Data ◽  
Hand Surgery ◽  
Abdominal Distension ◽  
Favourable Outcome ◽  
Unfavorable Outcome ◽  
Presenting Symptoms ◽  
Adequate Care

Background: Intestinal obstruction is defined as obstruction of the passage of the intestine for its contents. Successful conservative treatment may leave adhesions that could cause recurrence; on the other hand, surgery may be the source of new adhesions like any other abdominal surgery. Hence, the present study was undertaken for assessing the 48 patients with ilecoceacal mass presenting as intestinal obstruction requires surgical intervention and their outcome.Methods: Of a total of 48 patients with ilecoceacal masses who presented with intestinal obstruction and underwent surgical intervention for the same. Surgical management outcome was classified as “favorable” or “unfavorable” outcome according to the retrospective secondary data extracted from their medical records. Unfavorable outcome was considered if the patient died or has one or more postoperative complications. Favorable outcome was considered if the patient was discharged alive and does not have any history of postoperative complications.Results: Abdominal pain, abdominal distension, vomiting and failure to pass faeces were the prominent presenting symptoms among intestinal obstruction patients.  Favourable outcome was seen in 76 percent of the patients while unfavourable outcome was seen in 24 percent of the patients. Mortality occurred in 6 patients. Prolonged ileus was found to be present in 1 patient. Failure to wean from ventilator for more than 48 hours was seen in 2 patients.  Conclusions: Surgical management had high efficacy of more than 75 percent in managing patients with intestinal obstructions. With precise technique and adequate care, complication rate can be reduced.

scholarly journals Impact of SARS-Cov-2 on ectopic pregnancies management in the United Kingdom: a multicentre paired observational study

2020 ◽  
Author(s):  
Sophie Platts ◽  
Jeewantha Ranawakagedon ◽  
Reeba Oliver ◽  
Sayantana Das ◽  
Phalguni Kotabagi ◽  
...  
Keyword(s):  
Ectopic Pregnancy ◽  
Surgical Management ◽  
Expectant Management ◽  
Complication Rates ◽  
University Hospitals ◽  
Length Of Treatment ◽  
Hospital Visits ◽  
Ectopic Pregnancies ◽  
The Impact ◽  
Pregnancy Registry

Objective: to describe the impact of COVID-19 on the management of patients with ectopic pregnancy. Design: a multicentre study comparing outcomes from a prospective cohort during the pandemic [Covid-ectopic pregnancy registry (CEPR)] compared to an historical pre-pandemic cohort [non-Covid ectopic pregnancy registry (NCEPR)]. Setting: five London university hospitals. Population and Methods: consecutive patients diagnosed clinically and/or radiologically with ectopic pregnancy (March/2020-Aug/2020) were entered into the CEPR and an exploratory matched analysis was performed comparing results to NCEPR patients (January/2019-June/2019). Main outcome measures: patient demographics, management (expectant, medical and surgical), length of treatment, number of hospital visits (non-surgical management), length of stay (surgical management) and 30-day complications. Results: 341 patients met inclusion: 162 CEPR and 179 NCEPR. A significantly higher percentage of women underwent non-surgical management versus surgical management in the CEPR versus NCEPR (58.6% [95/162] vs 72.6% [130/179]; p= 0.0084]. Amongst patients managed with expectant management the CEPR had a significantly lower mean number of hospital visits compared to NCEPR [3.6 [SD 1.4] vs 13.7 [SD 13.4], p= 0.0053]. Amongst patients managed with medical management, the CEPR had a significantly lower mean number of hospital visits [NCEPR 6.4 [SD 2.3] vs 8.8 [SD 3.9], p= 0.0014]. There was no observed difference in complication rates between cohorts. Conclusion: women were found to undergo significantly higher rates of non-surgical management during COVID-19 first wave vs NCEPR cohort. Women managed non-surgically in CPER cohort were also managed with fewer hospital attendances. This did not lead to an increase in observed complications rates.

scholarly journals An Audit of Management of Ectopic Pregnancy in a Major Tertiary Healthcare Service

2021 ◽  
pp. 1-5
Author(s):  
Krystle Y. Chong ◽  
Yee K. Mak ◽  
Beverley Vollenhoven ◽  
Ben W. Mol
Keyword(s):  
Ectopic Pregnancy ◽  
Surgical Management ◽  
Medical Management ◽  
Expectant Management ◽  
Tertiary Hospital ◽  
Management Options ◽  
Local Hospital ◽  
Retrospective Audit ◽  
Tertiary Healthcare ◽  
Ectopic Pregnancies

Background: Ectopic pregnancy remains the most common cause of early pregnancy mortality, with management options differing according to clinical presentation and investigations. This audit aims to investigate the indications for medical and surgical management of ectopic pregnancy at a tertiary hospital network, in order to assess variances in practice and adherence to local hospital protocols. Methods: A retrospective audit of the management of women with a diagnosis of ectopic pregnancy was performed over 12 months from July 2018 to June 2019, at three hospitals in the largest healthcare network in Victoria, Australia. Information collected included patient demographics, risk factors for ectopic pregnancy, pathology and radiology results, documented indication for surgery, and any complications of treatment. A subgroup analysis of data was done to investigate changes and deficiency in management of ectopic pregnancy compared to local hospital protocol. Results: Over a 12-month period, 138 women were diagnosed with an ectopic pregnancy, of which 99 (72%) received surgical management and 39 (28%) received medical management. Four women within the medical group were excluded from analysis, one due to loss of follow-up and three patients who were diagnosed with nontubal ectopic pregnancies. About 94% (33/35) of women who received methotrexate were within hospital guidelines for medical management and 91% (32/35) were successfully managed without surgery. All women who received surgical management underwent a salpingectomy and 97% (96/99) had clear indications documented for surgery within local protocol. Conclusion: Overall, the majority of women with ectopic pregnancy were treated according to local guidelines. Expectant management and the option of salpingostomy as a surgical alternative could be considered in the local guidelines. The dissemination of this clinical audit data is aimed at continuing clinical governance and improvements in outcomes.

scholarly journals Profile of Ectopic Pregnancy at Western Regional Hospital

2017 ◽  
Vol 13 (4) ◽  
pp. 397-400
Author(s):  
Rabi Prasad Regmi ◽  
Shyam Sundar Parajuly ◽  
Ananda Bahadur Shrestha ◽  
Dela Joshi Singh ◽  
Sarvesh Gyawali
Keyword(s):  
Ectopic Pregnancy ◽  
Discharge Summary ◽  
Regional Hospital ◽  
Contraceptive Device ◽  
Beta Hcg ◽  
Number Of Patients ◽  
Obstetric Emergencies ◽  
Life Threatening ◽  
Western Regional ◽  
Ectopic Pregnancies

Background & Objective: Ectopic pregnancy (EP) is one of the common life threatening obstetric emergencies which if not recognized and managed on time can be ruptured which could be a cause of death.  Unfortunately, the world wide incidence of EP is in an increasing trend. The main objective of this study is to assess the frequency, trends, blood loss and management aspects of EP at Western Regional Hospital (WRH), Pokhara.Materials & Methods: The study was carried out in the department of Obstetrics and Gynecolgy, WRH. Data were collected and analyzed from patient’s records and discharge summary during the period of 2072-1-1 to 2072-9-30 B.S, retrospectively. Total number of hospital deliveries (7250) during this period was obtained from record section. Diagnosis of EP was made by urine beta- hcg (human chorionic gonado-tropin hormone) test and pelvic ultrasonography.Results:  The incidence of ectopic pregnancy was one in every 168 deliveries. Forty three such ectopic pregnancies were diagnosed and managed during the period, the mean age was 26.34 years, the median being the age of 25-29 years (16 patients). Twenty seven patients had ruptured ectopic pregnancy. Of all the cases, the number of patients with heterotopic pregnancy and intra uterine contraceptive device (IUCD) in situ were one for each (2.3%). All cases were satisfactorily managed with no mortality, and a mean of 6.1 days of hospital stay.Conclusion: Ectopic pregnancies are common cause of hospital admission, irrespective of patient's age all of which were managed at WRH with no mortality.

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 Study of ectopic pregnancy in a tertiary care centre

2019 ◽  
Vol 9 (1) ◽  
pp. 212
Author(s):  
Nitesh Meena ◽  
Radheshyam Bairwa ◽  
Savitri Sharma
Keyword(s):  
Risk Factors ◽  
Ectopic Pregnancy ◽  
Tertiary Care ◽  
Morbidity And Mortality ◽  
High Morbidity ◽  
Tertiary Care Centre ◽  
Presenting Symptoms ◽  
Mortality Incidence ◽  
Ectopic Pregnancies ◽  
The Right

Background: Ectopic pregnancy is an obstetric emergency with high morbidity and mortality. Incidence of ectopic pregnancies has been increasing in last two to three decades with reduction in mortality. The presenting symptoms include irregular vaginal bleeding. The present study was undertaken to study the clinical features of ectopic pregnancies in a tertiary care hospital.Methods: The present study on ectopic pregnancies was carried out in department of obstetrics and gynaecology, jhalawar medical college, Jhalawar, Rajasthan, India from January 2019 to October 2019. All patients admitted with diagnosis of ectopic pregnancy, either ruptured or unruptured where included in the study.Results: Total 52 patient of ectopic pregnancy were studies. Majority (63.46%) of patients belong to the age group 21-30 years. Ectopic pregnancy was most commonly noted in nulliparous woman (44.23%) Majority of the case (31%) had no risk factors among remaining (34.61%), previous MTP (17%), (17-30%) previous ectopic (9%) and PID (15-38%) were identified risk factors. Ampulla (75%) was the most common site for ectopic pregnancy. 57% of the cases were on the right side. The common presenting complaints were pain in abdomen (81%) bleeding/ spotting per vaginal (42%). There was no mortality.Conclusions: Surgical treatment was done more often because of patients reporting late to the hospital screening of high-risk case, early diagnosis and early intervention reduce the morbidity and mortality in ectopic pregnancies.

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