Conservative surgical management of ectopic pregnancy and its role in preservation of future fertility

2021 ◽  
Vol 12 (6) ◽  
pp. 64-68
Author(s):  
Indranil Dutta ◽  
Dilip Kumar Dutta ◽  
Rumpa Banerjee Dutta
Keyword(s):  
Ectopic Pregnancy ◽  
Surgical Management ◽  
West Bengal ◽  
Induced Abortion ◽  
Segmental Resection ◽  
Ectopic Gestation ◽  
Future Fertility ◽  
History Of ◽  
Related Mortality

Background: Maternal Mortality is one of the most important issues in our country. Ectopic Gestation is one of the few reasons which contribute to it. The first successful surgical management of a tubal ruptured ectopic pregnancy occurred in 1883. In those times mortality was approximately 60%. Since then lot of development in management of ectopic pregnancy has taken place which has resulted in reduction of related mortality. But still it remains as one of the important topics as now due to more infections (i.e PID) and resulting ectopic gestations and further operative salphingectomies, there is a reduced chance of patient to conceive naturally afterwards. Hence role of conservative surgeries comes to the front. Aims and Objectives: Role of Conservative Surgical Management of Ectopic pregnancy and its relation to future fertility. Materials and Methods: This Study was undertaken at GICE Clinic, Cure Hospital, Kalyani, West Bengal India from January, 2008 to January 2019. During this period 64 patients were diagnosed and operated for Ectopic pregnancy. Results: Forty (62.5%) cases were in between 20-30 years of age. Forty-four (68.7%) cases had no issue. Forty-eight (75.0%) cases were from low socio-economic group. Sixty patients (93.7%) had the history of amenorrhea. It was also observed that history of induced abortion was in 20 (31.2%) cases, PID in 12 (18.7%) cases, appendectomy – 6 (9.4%) cases and history of previous IUCD insertion - 4 (6.3%) were found to be common amongst ectopic gestation cases. Twenty-four (37.5%) cases underwent linear salpingostomy, 8 (12.5%) cases had segmental resection with end to end anastomosis whereas 16 (25.0%) cases had salpingectomy and 16 (25.0%) cases had salpingo-opherectomy with tubectomy [opposite tube] were advocated. In 4(6.3%) cases of linear salpingostomy and 4 (6.3%) cases of segmental resection, the cases had to be re-operated again for unstable haemodynamic condition within 24 hours and were subsequently advocated to salpingectomy. Conclusion: Linear Salpingostomy was found to be a better option for women who desire to become future mother, than that of segmental resection and salpingectomy on affected tube (although pregnancy was reported as opposite tube)

scholarly journals Role of Laparoscopy in Management of Ectopic Pregnancy

2015 ◽  
Vol 5 (3) ◽  
pp. 170-174
Author(s):  
Hasina Banu ◽  
Ju Wen Hui ◽  
Liu Hua
Keyword(s):  
Ectopic Pregnancy ◽  
Gold Standard ◽  
Literature Search ◽  
Operating Time ◽  
Review Article ◽  
Laparoscopic Treatment ◽  
Gold Standard Method ◽  
Delay In Diagnosis ◽  
Future Fertility

Ectopic pregnancy means implantation of fertilized ovum outside the endometrial lining of the uterus. It remains the leading cause of early pregnancy-related death. Delay in diagnosis and treatment puts the life of women at risk. Laparoscopic surgery is increasingly becoming the preferred approach for ectopic pregnancy management. Laparoscopic treatment in ectopic pregnancy raises question of safety and feasibility when compared to laparotomy. In this review article our objective is to summarize the role of laparoscopy in management of ectopic pregnancy in comparison to laparotomy. For this, a literature search was done by using Google and PubMed. The selected articles were analyzed on laparoscopic treatment outcomes such as surgery success rate, operating time, intraoperative and postoperative complications, hospital stay, future fertility, postoperative recurrent ectopic pregnancy, cost-effectiveness in comparison to laparotomy. After analyzing all selected articles, it can be concluded that the laparoscopic management of ectopic pregnancy is safe, effective, and economical in comparision to laparotomy. So, for the patients’ benefit, laparoscopy should be considered as the gold standard method in management of ectopic pregnancy and is worthy to be popularized in clinical practice.J Enam Med Col 2015; 5(3): 170-174

scholarly journals Laparoscopic Management of Interstitial Ectopic Pregnancies

2014 ◽  
Vol 6 (3) ◽  
pp. 163-166
Author(s):  
Shyam V Desai ◽  
Gaurav S Desai ◽  
Jessi Levi
Keyword(s):  
Ectopic Pregnancy ◽  
Operative Time ◽  
Laparoscopic Management ◽  
Ectopic Gestation ◽  
Estimated Blood Loss ◽  
Laparoscopic Excision ◽  
Interstitial Ectopic Pregnancy ◽  
Ectopic Pregnancies

ABSTRACT This illustration describes the successful laparoscopic management of interstitial ectopic pregnancy. Three women underwent laparoscopic excision for interstitial ectopic gestation. Mean operative time was 49.4 ± 8.4 minutes (41- 69 mins). Estimated blood loss was 50 ± 4 ml. There were no intraoperative or postoperative complications. Duration of hospital stay was 24 ± 3 hours. All patients are doing well on follow-up. The authors demonstrate the role of laparoscopic excision and conclude that this technique, when performed by experienced surgeons, allows for improved dexterity and is a safe and effective method in the management of interstitial ectopic pregnancy. How to cite this article Desai GS, Levi J, Desai SV. Laparoscopic Management of Interstitial Ectopic Pregnancies. J South Asian Feder Obst Gynae 2014;6(3):163-166.

scholarly journals The Role of Chemotherapy and Radiotherapy in the Surgical Management of Muscle Invasive Bladder Cancer

2014 ◽  
Vol 2 (3) ◽  
pp. 125-131
Author(s):  
Joshua Luck
Keyword(s):  
Bladder Cancer ◽  
Surgical Management ◽  
Disease Free Survival ◽  
Standard Of Care ◽  
Clinical Staging ◽  
Invasive Bladder Cancer ◽  
Muscle Invasive Bladder Cancer ◽  
History Of ◽  
Muscle Invasive

The management of muscle invasive bladder cancer represents an unresolved clinical challenge. Invasive urothelial carcinomas are associated with high mortality rates and early metastatic disease. Radical cystectomy is a recognized standard of care, although disease-free survival outcomes remain suboptimal. The limitations of pre-operative clinical staging, as well as the complex natural history of the disease, precludes the introduction of simple management protocols. To what degree chemotherapy and radiotherapy may be useful in the surgical management of invasive bladder cancer remains contentious. This literature review critically examines the benefits, risks and difficulties of each approach, with an emphasis on individually tailored therapy.

Early pregnancy problems

2021 ◽  
pp. 467-494
Author(s):  
Fiona Phillips
Keyword(s):  
Ectopic Pregnancy ◽  
Surgical Management ◽  
Early Pregnancy ◽  
Hyperemesis Gravidarum ◽  
Recurrent Miscarriage ◽  
Psychological Care ◽  
Assessment Unit

This chapter covers the role of the early pregnancy assessment unit, the care of women with bleeding or pain in early pregnancy, the definition, causes, assessment, and treatments for miscarriage, as well as caring for the patient who experiences recurrent miscarriage. The diagnosis, assessment, and both medical and surgical management of ectopic pregnancy is explained. Nausea, vomiting, hyperemesis gravidarum, and psychological care in early pregnancy are also all covered.

scholarly journals A Case of Laparoscopically Managed Myometrial Scar Ectopic Pregnancy

2017 ◽  
Vol 1 (1) ◽  
pp. 28-31
Author(s):  
Meenu Agarwal ◽  
Madhuri Kashyap
Keyword(s):  
Ectopic Pregnancy ◽  
Previous History ◽  
Uterine Cavity ◽  
Uterine Wall ◽  
Male Factor ◽  
Missed Abortion ◽  
Ectopic Gestation ◽  
Suction Curettage ◽  
History Of ◽  
Laparoscopic Enucleation

ABSTRACT Intramural pregnancy, an ectopic gestation completely surrounded by the myometrium located within the uterine wall with separation from the uterine cavity, is an extremely unusual form of pregnancy. Complications resulting from intramural pregnancy include inevitable uterine rupture with resultant hemorrhage and possible hysterectomy if the diagnosis is not made early and treatment is not initiated. A patient presented with missed abortion, suction curettage was done but no placental villi were seen in the products. She had a previous history of laparoscopic myomectomy 6 months ago. A provisional diagnosis of myometrial scar pregnancy was made and was confirmed with Doppler and magnetic resonance imaging. Laparoscopic enucleation of ectopic sac was done against medical management with methotrexate. The patient conceived successfully through intracytoplasmic sperm injection for male factor and delivered twins by lower (uterine) segment cesarean section at term. How to cite this article Agarwal M, Kashyap M, Meshram S. A Case of Laparoscopically Managed Myometrial Scar Ectopic Pregnancy. Int J Gynecol Endsc 2017;1(1):28-31.

scholarly journals Non-surgical management of ectopic pregnancy

2021 ◽  
Vol 10 (7) ◽  
pp. 2686
Author(s):  
Vineeta Gupta ◽  
Shweta Nimonkar ◽  
Priyanka Chaudhari ◽  
Namrata Saxena ◽  
Parul Singh
Keyword(s):  
Ectopic Pregnancy ◽  
Surgical Management ◽  
Medical Management ◽  
Uterine Cavity ◽  
Expectant Management ◽  
Clinical Profile ◽  
Close Monitoring ◽  
Mortality And Morbidity ◽  
Future Fertility ◽  
Β Hcg

Background: Ectopic pregnancy is a condition when a fertilized ovum is implanted outside the uterine cavity. It is one of the important causes of maternal mortality and morbidity in India. Treatment includes expectant management, medical management and surgical management. Expectant and medical management are the treatment of choice for hemodynamically stable patients who do not want surgical treatment and are desirous of future fertility. The aim of study was to analyse the clinical profile, regimen of medical method used and outcome of non-surgical management in patients with ectopic pregnancy.Methods: It was a retrospective observational distributive study conducted at Shri Guru Ram Rai Institute of Medical and Health Sciences from January 2015 to December 2019. There were total 182 diagnosed cases of ectopic pregnancy during this duration. Out of them, 87 patients were given non-surgical management. Data was obtained from their medical records to analyse the clinical profile, outcome of expectant and medical management and efficacy of regimen used.Results: Total 87 patient out of 182 diagnosed cases of ectopic pregnancy were studied. Out of these, 57 (65.5%) patients were in the age group of 20 to 30 years, 44 (50.6%) patients were third gravidas and 32 (36.8%) patients did not have any live issue. Thirty three (37.93%) patients had haemoglobin less than 10 gm%, 41 (47.13%) patients had one or more previous caesarean sections and 73 (83.91%) patients had tubal ectopic pregnancy. Overall success rate with non-surgical management was 94.25%.Conclusions: Our study emphasised the role of expectant and medical management in stable patients of ectopic pregnancy and recommends to use methotrexate as therapy even when initial serum β HCG levels are more than 5000 IU and haemoglobin level less than 10 gm% under close monitoring.

Meningioma: A Historical Study of the Tumor and Its Surgical Management

Neurosurgery ◽  
1990 ◽  
Vol 26 (5) ◽  
pp. 832-847 ◽  
Author(s):  
Nayef R. F. Al-Rodhan ◽  
Edward R. Laws
Keyword(s):  
Surgical Management ◽  
Historical Study ◽  
Surgical Removal ◽  
History Of

Abstract The history of meningioma is reviewed, highlighting the personalities and events that shaped our understanding and management of this tumor. Early descriptions, nomenclature, and the history of surgical removal of meningioma are discussed and the important role of this tumor in the development of neurosurgery as a whole is stressed.

scholarly journals Tubal patency after Laparoscopic salpingostomy versus Methotrexate therapy in undisturbed tubal pregnancy

2021 ◽  
Vol 5 (06) ◽  
pp. 01-05
Author(s):  
Waleed M. Tawfik ◽  
Ali A. Bendary ◽  
Mohamed A. Elgazar
Keyword(s):  
Ectopic Pregnancy ◽  
Dose Regimen ◽  
Tubal Pregnancy ◽  
Tubal Ectopic Pregnancy ◽  
Tubal Patency ◽  
Future Fertility ◽  
Multiple Dose Regimen ◽  
History Of ◽  
Future Pregnancy ◽  
Better Than

Future fertility after ectopic pregnancy is dependent on several factors, including age, history of infertility, history of previous EP, tubal rupture, and contralateral tubal lesion. Thus, it seems reasonable to assess tubal patency following a treatment of an ectopic pregnancy in those women who are willing to have future pregnancy. Aimed to: Compare between tubal patency after methotrexate & laparoscopic salpingostomy. The study included 72 patients equally divided in number into 2 main groups. First group: (36cases) Tubal ectopic pregnancy treated by MXT therapy single or multiple doses. Single dose regimen (MTX 1.0 mg/kg or 50 mg/m2 i.m or multiple dose regimen (MTX 1.0 mg/kg i.m days (0,2,4,6). Second group: - (36 cases) Tubal ectopic pregnancy treated by laparoscopic salpingostomy. After 3 months, we used laparoscopy with administration of methylene blue (MB) as a marker to detect the tubal patency. As regard to tubal patency, of 31 cases (86.1%) from 36 cases that treated by MTX were patent and 5 cases (13.9 %) were blocked. On the other side 21 cases (58.3 %) from 36 cases that treated by laparoscopic salpingostomy were patent and 15 cases (41.7 %) were blocked). Conclusions:Methotrexate is better than laparoscopic salpingostomy in treating undisturbed tubal pregnancy.

scholarly journals Unsual Tubal Twin Ectopic Gestation Report of Three Different Cases

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.

Elaborating the role of reflection and individual differences in the study of folk-economic beliefs

2018 ◽  
Vol 41 ◽  
Author(s):  
Kevin Arceneaux
Keyword(s):  
Decision Making ◽  
Individual Differences ◽  
Cognitive Processes ◽  
Evolutionary History ◽  
Behavioral Responses ◽  
History Of ◽  
Economic Beliefs

AbstractIntuitions guide decision-making, and looking to the evolutionary history of humans illuminates why some behavioral responses are more intuitive than others. Yet a place remains for cognitive processes to second-guess intuitive responses – that is, to be reflective – and individual differences abound in automatic, intuitive processing as well.

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