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.

scholarly journals Benzodiazepine Use Before Conception and Risk of Ectopic Pregnancy

2020 ◽  
Vol 5 (5) ◽  
Author(s):  
Elizabeth Wall-Wieler ◽  
Thalia K Robakis ◽  
Deirdre J Lyell ◽  
Reem Masarwa ◽  
Robert W Platt ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Ectopic Pregnancy ◽  
Health Care Providers ◽  
Group Analysis ◽  
Care Providers ◽  
Relative Risks ◽  
Increased Risk ◽  
Benzodiazepine Use ◽  
Using Data ◽  
Ectopic Pregnancies

IntroductionEctopic pregnancy occurs in 1% to 2% of the all recognized pregnancies, yet half of women who have an ectopic pregnancy do not have any known risk factors. A potential but unstudied risk factor for ectopic pregnancy is benzodiazepine use, which could affect muscle contraction in the fallopian tube. Objectives and ApproachWe compared the risk of ectopic pregnancy among women with and women without benzodiazepine prescriptions before conception. using data from United States commercial insurance claims (IBM® MarketScan® Databases). We performed a cohort study of 1,691,366 pregnancies between November 1, 2008 and September 30, 2015, and used unadjusted and inverse probability of treatment (IPT) weighted log-binomial models to calculate relative risks (RR) of ectopic pregnancy for pregnant women who did and did not fill any prescriptions for benzodiazepines in the 90 days before conception. Sub-group analysis was conducted on women who had anxiety and women who had insomnia diagnoses in the year before conception. ResultsOf the 1,691,366 pregnant women, 1.06% filled at least two benzodiazepine prescriptions in the 90 days before conception. Among women with a benzodiazepine prescription, there was an excess of 80 ectopic pregnancies per 10,000 pregnancies, and their IPT-weighted risk of ectopic pregnancies was 1.47 (95% CI 1.32 to 1.63) times greater relative to women without benzodiazepine prescriptions before conception. The IPT-weighted RR between ectopic pregnancy and benzodiazepine use was 1.34 (95% CI 1.18 to 1.53) among women with anxiety disorder diagnoses and 1.28 (95% CI 0.99 to 1.68) among women with an insomnia diagnosis. Conclusion / ImplicationsThis study found that women who have a benzodiazepine prescription before conception are at an increased risk of ectopic pregnancy. This information can help women and their health care providers make more fully informed decisions about benzodiazepine use in their reproductive years.

scholarly journals Unilateral spontaneous tubal twin ectopic pregnancy: A rare occurrence

2017 ◽  
Vol 6 (1) ◽  
pp. 819-823
Author(s):  
AN Pulei ◽  
PA Muga ◽  
KW Ongeti ◽  
J Kinuthia ◽  
O Ogutu
Keyword(s):  
Ectopic Pregnancy ◽  
Twin Pregnancy ◽  
Iliac Fossa ◽  
Lower Abdominal Pain ◽  
Abdominal Ultrasound ◽  
Free Fluid ◽  
Crown Rump Length ◽  
History Of ◽  
Ectopic Pregnancies ◽  
The Right

Unilateral tubal twin pregnancy remains rare despite a rise in the incidence of singleton ectopic pregnancies. A 27-year-old  Gravida 1 Para 0+0 at 12 weeks gestation, presented to our institution with a 1-month history of lower abdominal pain, that  progressively worsened and became very severe. An abdominal ultrasound revealed an extrauterine gestational sac that looked like a single viable fetus in the right adnexa at about 12 weeks by crown rump length. Free fluid was noted in the right iliac fossa and Morrison’s pouch. A conclusion of a right-ruptured ectopic pregnancy was made. The patient underwent laparotomy and a diagnosis of twin right-sided fimbrial ectopic pregnancy was made. The crown rump lengths of the twins were 6cm and 4cm. We present this case because unilateral tubal twin pregnancy is still a rare phenomenon, and clinicians as well as clinical  embryologists need to acknowledge its existence considering the diagnosis of this case was not made pre-operatively.Key words: Twin Tubal, ectopic pregnancy, unilateral

scholarly journals Spontaneous Unilateral Tubal Twin Ectopic Pregnancy: A Case-Based Discussion and Assessment

2011 ◽  
Vol 5 (4) ◽  
pp. 416-420
Author(s):  
Vaneesha Vallabh-Patel ◽  
Robert Vera ◽  
Gustavo Martell
Keyword(s):  
Ectopic Pregnancy ◽  
Color Doppler ◽  
Transvaginal Ultrasound ◽  
Power Doppler ◽  
Lower Abdominal Pain ◽  
Color Doppler Ultrasound ◽  
The United States ◽  
Beta Hcg ◽  
Ectopic Pregnancies ◽  
The Right

ABSTRACT Introduction Two percent of all 1st trimester pregnancies in the United States are ectopic. Transvaginal ultrasound is considered the mainstay in diagnosis. Color Doppler ultrasound can prove to be an added helpful modality in identifying ectopic pregnancies. Case report An 18-year-old nulliparous female presented with vaginal bleeding and lower abdominal pain. Pelvic exam revealed tenderness in the right adnexal region with elevated quantitative serum beta-hCG. A transvaginal ultrasound showed an echogenic ring adjacent to the right ovary and M-mode and color Doppler revealed two fetal heart tones. Color Doppler enabled visualization of randomly dispersed tubal arteries and heart activity of both embryos. A right salpingectomy was performed without complications and beta hCG levels returned to undetectable levels. Conclusion B mode ultrasound is a vital diagnostic tool in the detection of ectopic pregnancy. Color Doppler provides both morphologic and functional information essential for determining the optimal therapeutic strategy. Three-dimensional ultrasound with color and/or power Doppler has proven useful in both the initial diagnosis and follow-up of ectopic pregnancies especially in patients following assisted reproduction treatment.

HETEROTOPIC PREGNANCY WITH INEVITABLE ABORTION (RIGHT ADNEXAL LIVE ECTOPIC AND COEXISTING INTRAUTERINE TRIPLETS WITH ABSENT FETAL CARDIAC ACTIVITY)

2021 ◽  
pp. 58-59
Author(s):  
Jayanta Sarkar ◽  
Mini Sengupta
Keyword(s):  
Ectopic Pregnancy ◽  
Abdominal Cavity ◽  
Lower Abdominal Pain ◽  
Cardiac Activity ◽  
Exploratory Laparotomy ◽  
Sudden Onset ◽  
Heterotopic Pregnancy ◽  
Intrauterine Pregnancy ◽  
Short Period ◽  
The Right

Heterotopic pregnancy describes the occurrence of two or more pregnancies in different implantation sites simultaneously, intrauterine pregnancy coexists withectopic pregnancies (ampullary in 80%). A 27-year-old women (P ,L1) presented to the emergency department with a complaint of sudden onset of right-sided lower abdominal pain with 1+1 vaginal bleeding and had a short period of Amenorrhea. Ultrasonography demonstrated three intrauterine gestational sacwith foetal pole noted but Cardiac activity was absent . The right adnexa showed a heteroechoic area andmoderate amount of free uid was present in the lower abdominal cavity. Ectopic pregnancy was disturbed. An emergency exploratory laparotomy was performed under general anesthesia. Haemoperitoneum was found with a ruptured righttubal ectopic pregnancy as well. Both the ovaries appeared normaland a corpus luteal cyst was presentin right ovary. Right sided salpingectomy was performed with removal of the ectopic mass,heamostasis secured ,on table blood transfusion had been given.Suction evacuation had also been performed by manual vacuum aspirationon same sitting.Both the specimen send for histopathology. Histology conrmedGestational sac suggestive of an intra uterine pregnancy coexists with ectopic pregnancy. Left tube and both ovaries were found healthy. Episodes of PID also have a strong correlation with occurrence of ectopic gestation. Once diagnosis of heterotrophic pregnancy has been made the management is essentially surgical.

Midtrimester Cervical Length in Low-Risk Nulliparous Women for the Prediction of Spontaneous Preterm Birth: Should We Consider a New Definition of Short Cervix?

2021 ◽  
Author(s):  
Paul Guerby ◽  
Mario Girard ◽  
Geneviève Marcoux ◽  
Annie Beaudoin ◽  
Jean-Charles Pasquier ◽  
...  
Keyword(s):  
Preterm Birth ◽  
Health Care Providers ◽  
Gestational Age ◽  
Roc Curve ◽  
Transvaginal Ultrasound ◽  
Cervical Length ◽  
Care Providers ◽  
Operating Characteristics ◽  
Spontaneous Preterm Birth ◽  
Nulliparous Women

Objective The study aimed to estimate the predictive value of midtrimester cervical length (CL) and the optimal cut-off of CL that should be applied with asymptomatic nulliparous women for the prediction of spontaneous preterm birth (sPTB). Study Design This is a prospective cohort study of asymptomatic nulliparous women with a singleton gestation. Participants underwent CL measurement by transvaginal ultrasound between 20 and 24 weeks of gestation. The participants and their health care providers remained blinded to the results of CL measurement. The primary outcomes were sPTB before 35 weeks and sPTB before 37 weeks. Receiver operating characteristics (ROC) curve analyses were performed. Analyses were repeated by using multiples of median (MoM) of CL adjusted for gestational age. Results Of 796 participants, the mean midtrimester CL was 40 ± 6 mm with a 1st, 5th, and 10th percentile of 25, 29, and 32 mm, respectively. ROC curve analyses suggest that a cut-off of 30 mm was the optimal CL to predict sPTB before 35 weeks (area under the ROC curve [AUC]: 0.70, 95% confidence interval [CI]: 0.56–0.85) and before 37 weeks (AUC: 0.70, 95% CI: 0.59–0.80). Midtrimester CL <30 mm could detect 35% of all sPTB before 35 weeks at a false-positive rate of 5% (relative risk: 9.1, 95% CI: 3.5–23.5, p < 0.001). We observed similar results using a cut-off of CL <0.75 MoM adjusted for gestational age. Conclusion A midtrimester CL cut-off of 30 mm (instead of 25 mm), or CL less than 0.75 MoM, should be used to identify nulliparous women at high risk of sPTB. Key Points

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.

Knowledge Based Commissioning: Can a National Clinical Effectiveness Policy Be Compatible with Seeking Local Professional Advice?

1996 ◽  
Vol 1 (1) ◽  
pp. 28-34 ◽  
Author(s):  
Peter Littlejohns ◽  
Carol Dumelow ◽  
Sian Griffiths
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Clinical Effectiveness ◽  
Cost Effective ◽  
Care Providers ◽  
Professional Advice ◽  
Knowledge Based ◽  
Artery Disease ◽  
Health Care Purchasing ◽  
The Right

Objectives: To help develop a means, based on the views of purchasers and providers of health care, of incorporating national research on clinical effectiveness into local professional advisory mechanisms in order to inform health care purchasing and contracting. Methods: Three geographically based multidisciplinary workshops attended by National Health Service (NHS) staff drawn from the principal purchaser and provider groups in one English region were organized around the discussion of three health care purchasing case studies: Coronary artery disease, diabetes and management of clinical depression in general practice. The proceedings were transcribed and analyzed using content analysis methods. Results: 95 people took part. There were major differences between the purchasers' and health care providers' views on the right balance between local and national information and advisory sources for purchasing. In general, providers wanted the provision of advice to purchasers to be local, in which their opinion was sought, either individually or collectively, acted on and the results fed back to them. In contrast, health authority purchasers considered that local professionals were only one source of professional advice, albeit an important one, to be utilized in coming to decisions. General practitioner fundholders as purchasers, however, preferred to rely on their own experiences and contacts with local providers in making purchasing decisions. Conclusions: Professional specialist advisory groups are necessary to inform the purchasing of health care, but should extend beyond advising on the placement of individual contracts. Involving health care providers in all short-term contracting is unlikely to be cost-effective given the time commitment required. The emphasis at purchaser/provider meetings should be on education: Providing an opportunity for purchasers and providers to develop closer relationships to discuss political imperatives and financial constraints; increasing communication and understanding of providers' and purchasers' roles; and providing an environment for professionals and purchasers to share their views on purchasing. As currently presented, elements of the national policies in the NHS advocating the use of both national evidence on clinical effectiveness and local professional advice are contradictory and should be clarified.

scholarly journals Challenges and approaches to implementing master/basket trials in oncology

2019 ◽  
Vol 3 (14) ◽  
pp. 2237-2243 ◽  
Author(s):  
Amy Burd ◽  
Richard L. Schilsky ◽  
John C. Byrd ◽  
Ross L. Levine ◽  
Vassiliki A. Papadimitrakopoulou ◽  
...  
Keyword(s):  
Health Care Providers ◽  
Therapeutic Option ◽  
Clinical Trial Design ◽  
Care Providers ◽  
Rare Mutation ◽  
Medical Institutions ◽  
Number Of Patients ◽  
The Right ◽  
Tumor Types ◽  
Basket Trials

Abstract The appetite for cutting-edge cancer research, across medical institutions, scientific researchers, and health care providers, is increasing based on the promise of true breakthroughs and cures with new therapeutics available for investigation. At the same time, the barriers for advancing clinical research are impacting how quickly drug development efforts are conducted. For example, we know now that under a microscope, patients with the same type of cancer and histology might look the same; however, the reality is that most cancers are driven by genomic, transcriptional, and epigenetic changes that make each patient unique. Additionally, the immunologic reaction to different tumor types is distinct among patients. The challenge for researchers developing new therapies today is vastly different than it was in the era of cytotoxics. Today, we must identify a sufficient number of patients harboring a rare mutation or other characteristic and match this to the right therapeutic option. This summary provides a guide to help inform the scientific cancer community about the benefits and challenges of conducting umbrella or basket trials (master trials), and to create a roadmap to help make this new and evolving form of clinical trial design as effective as possible.

Clinical ethics and law in health care system

2017 ◽  
Vol 3 (1) ◽  
Author(s):  
Abhinav Gorea
Keyword(s):  
Health Care ◽  
Health Care System ◽  
Health Care Providers ◽  
Clinical Ethics ◽  
Ethical Dilemmas ◽  
Care Providers ◽  
Complete Cure ◽  
Law And Ethics ◽  
Good For ◽  
The Right

Different situations arise while treating the patients when there are ethical dilemmas to give one or other type of treatment or not to do anything. Sometimes doctors and nurses consider that what is good for the patient must be done because the patient does not understand the situation and consequences. This may lead to complete cure and patient usually goes back to home happily but sometimes a complication may occur and the patient may sue the health care providers. When such situations are analyzed then principles of ethics and law are considered to see if any of these have been violated or not to reach the conclusion. In this study principles of law and ethics of treatment have been discussed to reach the right conclusion; which will be helpful in situations where there are ethical dilemmas during the treatment.

scholarly journals A Case of Live Birth after Uterine Reconstruction for Recurrent Cornual Ectopic Pregnancy following IVF Treatment

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Deivanayagam Maruthini ◽  
Vinay Sharma
Keyword(s):  
Ectopic Pregnancy ◽  
Elective Caesarean Section ◽  
Muscle Thickness ◽  
Singleton Pregnancy ◽  
Intrauterine Pregnancy ◽  
Future Pregnancy ◽  
Ectopic Pregnancies ◽  
The Right ◽  
Pregnancy And Birth ◽  
Myometrial Thickness

We present a case of recurrent ruptured right cornual ectopic pregnancies conceived after IVF. Following the second episode, a sonohysterography was undertaken to identify possible areas of scar weakness that may rupture with uterine distension in a future pregnancy. The scan revealed asymmetrical muscle thickness in the cornual regions, the right (6 mm) being thinner than the left (1.6 cm). Subsequently, an elective laparotomy was undertaken, and the cornua were reconstructed and thickened in several layers by bringing the laterally retracted myometrial fibres onto the reconstruction site. A sono-hysterography after surgery showed satisfactory (3-4 cm) myometrial thickness all around. A further cycle of IVF resulted in a singleton pregnancy. Pelvic scans confirmed normal intrauterine pregnancy without any myometrial thinning. She was delivered by an uneventful elective caesarean section at term. We propose that, in those who intend to have further pregnancies after a cornual ectopic pregnancy, a sono-hysterography is possibly the best investigative tool to assess myometrial integrity. This case demonstrates that in women with areas of muscle weakness it is possible to successfully perform an interval elective reconstructive surgery on the uterus that can result in an uneventful pregnancy and birth.

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