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 Review of Gynaecological Diagnoses and Surgeries Performed at a Tertiary Health Facility in Niger-Delta of Nigeria from 2012-2017: Implications for Healthcare Planning and Budgeting

2020 ◽  
pp. 1-10
Author(s):  
P. A. Awoyesuku ◽  
D. A. MacPepple ◽  
B. O. Altraide ◽  
D. H. John
Keyword(s):  
Health Facility ◽  
Uterine Fibroid ◽  
Assisted Reproductive Technologies ◽  
Descriptive Analysis ◽  
Reproductive Technologies ◽  
Reproductive Age ◽  
University Teaching ◽  
Common Cause ◽  
Healthcare Planning ◽  
Pelvic Malignancies

Background: Gynaecological disorders are a particularly common cause of morbidity and mortality among women of reproductive age and a common cause of hospital presentation/admission and surgery. Objective: This study sought to review gynaecological diagnoses and surgeries performed in a tertiary health facility from 2012 to 2017 and its implication for healthcare planning and budgeting. Methodology: This was a retrospective review of all gynaecological diagnoses and surgeries seen in the Rivers State University Teaching Hospital (RSUTH) from 2012 to 2017. Data were retrieved using a proforma comprising of year, gynaecological diagnosis and gynaecological surgeries. Data obtained was entered into Microsoft Excel for descriptive analysis. Results: The proportion of clinic attendees declined from an average of 23% in the first three years (2012-2014) to about 10% in the last three years (2015-2017). The most common gynaecological diagnosis were uterine fibroid (33.3%), infertility 28.1% (primary 5.7%, secondary 22.4%), PID (5.9%), ovarian tumour (4.2%), secondary amenorrhea (3.4%) and pelvic malignancies (3.4%). The commonest major surgeries were myomectomy 441(33.7%), salpingectomy 345(26.4%), hysterectomy 168(12.8%) and cervical cerclage 122(9.3%). The commonest minor surgeries were manual vacuum aspiration 314(41.0%), examination under anaesthesia and biopsy 110(14.3%) and adhesiolysis for synechiae 97(12.6%). The duo of uterine fibroid and infertility made up 50%-70% of all gynaecological diagnoses. Conclusion: This study showed that there has been a steady decline in gynaecological consultations over the years. However, the duo of uterine fibroid and infertility made up half to three-quarter of all gynaecological diagnoses over the 6 years. Infertility and uterine fibroids have a long cause and effect association. Healthcare policies and budgeting should be increased towards tackling these conditions, especially the setting up of a fertility center to provide assisted reproductive technologies and laparoscopy to improve practice and patient outcome.

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 AMH: Could It Be Used as A Biomarker for Fertility and Superovulation in Domestic Animals?

Genes ◽  
2019 ◽  
Vol 10 (12) ◽  
pp. 1009 ◽  
Author(s):  
Saqib Umer ◽  
Shan Jiang Zhao ◽  
Abdul Sammad ◽  
Bahlibi Weldegebriall Sahlu ◽  
YunWei Pang ◽  
...  
Keyword(s):  
Single Dose ◽  
Animal Species ◽  
Assisted Reproductive Technologies ◽  
Antral Follicle ◽  
Reproductive Technologies ◽  
Domestic Animals ◽  
Antral Follicle Count ◽  
Fetal Life ◽  
Factors Affecting ◽  
Potential Predictor

Anti-Müllerian hormone (AMH) is a reliable and easily detectable reproductive marker for the fertility competence of many farm animal species. AMH is also a good predictor of superovulation in cattle, sheep, and mares. In this review, we have summarized the recent findings related to AMH and its predictive reliability related to fertility and superovulation in domestic animals, especially in cattle. We focused on: (1) the dynamics of AMH level from infancy to prepubescence as well as during puberty and adulthood; (2) AMH as a predictor of fertility; (3) the association between antral follicle count (AFC) and plasma AMH level; (4) AMH as a predictor of superovulation; and (5) factors affecting AMH levels in domestic animals, especially cattle. Many factors affect the circulatory levels of AMH when considering the plasma, like nutrition, activity of granulosa cells, disease state and endocrine disruptions during fetal life. Briefly, we concluded that AMH concentrations are static within individuals, and collection of a single dose of blood has become more popular in the field of assisted reproductive technologies (ART). It may act as a potential predictor of fertility, superovulation, and ovarian disorders in domestic animals. However, due to the limited research in domestic animals, this potential of AMH remains underutilized.

Is it ethical to provide IVF add-ons when there is no evidence of a benefit if the patient requests it?

2019 ◽  
Vol 45 (5) ◽  
pp. 346-350 ◽  
Author(s):  
Mila Stefanova Zemyarska
Keyword(s):  
Assisted Reproductive Technologies ◽  
Cost Effective ◽  
Reproductive Technologies ◽  
Conclusive Evidence ◽  
Diagnostic Tools ◽  
In Vitro Fertilisation ◽  
Unborn Child ◽  
Effective Adjunct ◽  
Psychological Benefit

In vitro fertilisation (IVF) ‘add-ons’ are therapeutic or diagnostic tools developed in an endeavour to improve the success rate of infertility treatment. However, there is no conclusive evidence that these interventions are a beneficial or effective adjunct of assisted reproductive technologies. Additionally, IVF add-ons are often implemented in clinical practice before their safety can be thoroughly ascertained. Yet, patients continue to request and pay large sums for such additional IVF tools. Hence, this essay set out to examine if it is ethical to provide IVF add-ons when there is no evidence of a benefit if the patient requests it. In order to determine what is ethical—namely, morally good and righteous, the question was considered in relation to three key values of medical ethics—autonomy, beneficence and non-maleficence. It was determined that providing IVF add-ons might be morally acceptable in specific circumstances, if true informed consent can be given, there is a potential of cost-effective physiological or psychological benefit and the risk of harm is minimal, particularly with regard to the unborn child.

scholarly journals Caesarean Scar Pregnancy - A Rare Case Report

2016 ◽  
Vol 27 (2) ◽  
pp. 83-86 ◽  
Author(s):  
Razia Sultana ◽  
Saiful Islam ◽  
Nurjahan
Keyword(s):  
Case Report ◽  
Caesarean Section ◽  
Ectopic Pregnancy ◽  
Transvaginal Sonography ◽  
Emergency Laparotomy ◽  
Colour Doppler ◽  
Caesarean Scar ◽  
Incomplete Abortion ◽  
Rare Case Report ◽  
Life Threatening

Objective:The aim is to publish the case report of the rarely occurring and life threatening ectopic pregnancy developing in a Caesarean section scar causing uterine rupture.Methods and Results: This patient was diagnosed initially as a case of incomplete abortion. Other possible diagnoses were molar pregnancy, mass in the cervix. She was admitted in hospital for evacuation and curettage. During the procedure she developed severe pervaginal bleeding leading to hypovolumic shock. So decision was taken for emergency laparotomy. After opening the abdomen rupture was found in the lower uterine segment extending upto upper part of cervix. So hysterectomy was performed and histopathology confirmed the diagnosis of ectopic pregnancy that developed in a Caesarean section scar Analysis of the women’s obstetric history revealed that she had been previously operated because of breech presentation.Conclusion: Heightened awareness of the possibility of pregnancy in caesarean scar and early diagnosis by means of transvaginal sonography along with colour doppler can improve outcome and minimize the need for emergency extended surgeryBangladesh J Obstet Gynaecol, 2012; Vol. 27(2) : 83-86

scholarly journals Ectopic Pregnancy and Assisted Reproductive Technologies: A Systematic Review

10.5772/20842 ◽  
2011 ◽  
Author(s):  
Anastasia Velalopoulou ◽  
Dimitrios Peschos ◽  
Mynbaev Ospan ◽  
Eliseeva Marina ◽  
Ioannis Verginadis ◽  
...  
Keyword(s):  
Systematic Review ◽  
Ectopic Pregnancy ◽  
Assisted Reproductive Technologies ◽  
Reproductive Technologies

scholarly journals Cost-effectiveness analysis of different methods of treatment of tubal ectopic pregnancy in the south of Iran

2020 ◽  
Author(s):  
Bahia Namavar Jahromi ◽  
Elahe esmaili ◽  
Mozhgan Fardid ◽  
Jafari Abdosaleh ◽  
Zahra Kavosi ◽  
...  
Keyword(s):  
Single Dose ◽  
Cost Effectiveness ◽  
Incremental Cost ◽  
Ectopic Pregnancy ◽  
Cost Effective ◽  
Cost Utility ◽  
Double Dose ◽  
Tubal Ectopic Pregnancy ◽  
Dose Methotrexate ◽  
The Cost

Abstract Background: Ectopic pregnancy is one of the most important causes of maternal mortality and infertility that may impose many costs on patients. Today, Surgery and pharmaceutical treatments are the common methods of treating the disease. The aim of this study was to evaluate the cost-effectiveness of different methods of treating tubal ectopic pregnancy in the south of Iran.Methods: This study was an economic evaluation which analysed and compared the cost-effectiveness and cost-utility of three treatment methods, including single-dose methotrexate, double-dose methotrexate, and surgery in patients with tubal ectopic pregnancy. In this study, a decision tree model was used. The outcomes included in the model were the percentage of successful treatment and the average utility score of each treatment method. The study was conducted from the social perspective and a one-way and probabilistic sensitivity analysis was performed to measure the effects of uncertainty. The analysis of the collected data was performed using Excel and TreeAge software.Results: The incremental cost-effectiveness ratio of the surgery versus single-dose methotrexate was positive and equal to $5812 PPP; since it was less than the threshold, surgery was considered as a cost-effective method. The incremental cost-utility ratio also identified surgery as the best option. Moreover, the results of one-way showed the highest sensitivity to the effectiveness of single-dose methotrexate. Scatter plots also revealed that surgery in 82% and 96% of simulations was at the acceptable region compared with a single dose and double-dose methotrexate, respectively and below the threshold. It was identified as a more cost-effective strategy. Furthermore, the acceptability curves showed that in 81.4% of simulations, surgery was the most cost-effective treatment for thresholds less than 21011 PPP dollars.Conclusions: Based on the results of the present study, it is recommended that surgery can be used as the first line of treatment for ectopic. Also, the best drug strategy was single-dose methotrexate. Since these strategies reduce costs and increase treatment success and QALYs compared to double-dose methotrexate.

scholarly journals Successful conservative management of a rare case of ruptured cornual ectopic pregnancy

2020 ◽  
Vol 8 (1) ◽  
Author(s):  
Sreelatha S ◽  
Sumayya Sana ◽  
Pruthvi S ◽  
Yashaswini . ◽  
Shruthi K ◽  
...  
Keyword(s):  
Ectopic Pregnancy ◽  
Severe Pain ◽  
Hypovolemic Shock ◽  
Medical Emergency ◽  
Emergency Laparotomy ◽  
Cornual Pregnancy ◽  
Rare Type ◽  
Pain Abdomen ◽  
Ectopic Pregnancies ◽  
Period Of Gestation

Cornual pregnancy is a rare type of ectopic pregnancy with incidence of about 2-4% of all ectopic pregnancies. The mortality rate is about 2-2.5%. The diagnosis and management is challenging and frequently constitute a medical emergency. We report a case of a 33year old second gravida, para 1, living 1 with previous LSCS with 13weeks 2days period of gestation presenting to the casualty with complaints of severe pain abdomen and signs of hypovolemic shock. Ultrasound revealed gross hemoperitoneum with ruptured right adnexal gestation. Emergency laparotomy was done and cornual end was found ruptured and was sutured successfully and hemostasis achieved. Intra operative two units of packed cells was transfused. Patient was discharged stable on post-op day 7.

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.

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