scholarly journals An Intrauterine Pregnancy with Tubo-ovarian Torsion mimicking Ruptured Tubal Ectopic Pregnancy

2017 ◽  
Vol 9 (1) ◽  
pp. 56-59
Author(s):  
Khushpreet Kaur ◽  
Navneet Kaur ◽  
Surbhi Saini
Keyword(s):  
Pregnant Woman ◽  
Ectopic Pregnancy ◽  
Surgical Intervention ◽  
Imaging Modality ◽  
Tertiary Care ◽  
Ovarian Torsion ◽  
Adnexal Torsion ◽  
Intrauterine Pregnancy ◽  
Tubal Ectopic Pregnancy ◽  
Early Surgical Intervention

ABSTRACT Aims and objectives Adnexal torsion is a rare gynecological emergency that requires an early surgical intervention to save the adnexa from irreversible damage. Our study is about the clinical presentation and management of adnexal torsion in a pregnant woman in a tertiary care center. Materials and methods This case study was done in a pregnant woman who came with adnexal torsion in the first trimester in the labor room of Government Medical College and Patiala, Punjab, India. Results Torsion ovarian cyst is found in 5 per 10,000 women in pregnancy. The woman was suspected of having heterotopic pregnancy (an intrauterine pregnancy with ruptured tubal ectopic pregnancy). However, she was diagnosed as intrauterine pregnancy with adnexal torsion during laparotomy. Conclusion Adnexal torsion is a rare emergency, which requires a high index of clinical suspicion for diagnosis as the symptoms are nonspecific. Imaging helps in diagnosis, but most of them are diagnosed intraoperatively. Diagnosis is made clinically along with imaging modalities. Ultrasound with color Doppler is the most commonly used imaging modality. An early surgical intervention helps in salvaging the adnexa and prevents further complications. How to cite this article Kaur N, Kaur K, Saini S. An Intrauterine Pregnancy with Tubo-ovarian Torsion mimicking Ruptured Tubal Ectopic Pregnancy. J South Asian Feder Obst Gynae 2017;9(1):56-59.

scholarly journals Ovarian Torsion: A Gynecological Emergency

2015 ◽  
Vol 6 (3) ◽  
pp. 136-140
Author(s):  
Nupur Garg ◽  
Deepika Krishna ◽  
Suvarna Rathor
Keyword(s):  
Clinical Presentation ◽  
Imaging Modality ◽  
Tertiary Care ◽  
Case Series ◽  
Ovarian Torsion ◽  
Reproductive Age ◽  
Management Approach ◽  
Adnexal Torsion ◽  
Ovarian Conservation ◽  
The Difference

ABSTRACT Ovarian torsion is an uncommon gynecological emergency that requires prompt recognition and treatment. Timely investigation and management can make the difference between ovarian loss and salvage, an outcome of great importance in the population of reproductive age females. Our case series is about clinical presentation and management approach of adnexal torsion in a tertiary care fertility center. Adnexal torsion was found mainly in the reproductive age during poststimulation postovulatory period in all cases. Ultrasound was the most commonly used imaging modality. Ovarian stimulation was the risk factor seen in all the patients. Diagnosis of adnexal torsion was mostly clinical. Laparoscopy was the preferred method of surgical intervention. Ovarian conservation was possible in all cases except one. How to cite this article Garg N, Krishna D, Rathor S, Rao K. Ovarian Torsion: A Gynecological Emergency. Int J Infertil Fetal Med 2015;6(3):136-140.

scholarly journals Conservative management of ovarian torsion in pregnancy

2019 ◽  
Vol 8 (11) ◽  
pp. 4606
Author(s):  
Rama Garg ◽  
Sangeeta Rani ◽  
Sambli Garg
Keyword(s):  
Young Women ◽  
Surgical Approach ◽  
Surgical Intervention ◽  
Ovarian Torsion ◽  
Reproductive Capacity ◽  
Adnexal Torsion ◽  
Provisional Diagnosis ◽  
Intrauterine Pregnancy ◽  
Pain Abdomen ◽  
In Pregnancy

Adnexal torsion or other cyst accidents encountered during pregnancy carries a risk to intrauterine foetus. Delays or misdiagnosis can result in the loss of the affected ovary and subsequent reduced reproductive capacity. In this report, a 23-year-old second gravida with viable 9 weeks pregnancy with acute pain abdomen; presented in OPD and sent to labor room. Emergency laprotomy was done with provisional diagnosis of left adnexal torsion. We did detorsion and cystectomy followed by ovarian reconstruction. Repeat scan shows continuing intrauterine pregnancy. So, timely diagnosis and intervention reduces risk to ovary; along with some risk of the antepartum surgical intervention. Also, in place of oophorectomy; de-torsion is more conservative surgical approach that should be considered in all young women with ovarian torsion.

Timing of robotic hysterectomy after cervical excisional procedure

2019 ◽  
Vol 29 (7) ◽  
pp. 1110-1115
Author(s):  
Anna K. Melnikoff ◽  
David W. Doo ◽  
Alexander C. Cohen ◽  
Emily Landers ◽  
Christen Walters-Haygood ◽  
...  
Keyword(s):  
Surgical Intervention ◽  
Care Center ◽  
Tertiary Care ◽  
Complication Rates ◽  
Robotic Hysterectomy ◽  
Operative Complication ◽  
Operative Outcomes ◽  
Gynecology And Obstetrics ◽  
Estimated Blood Loss ◽  
Early Surgical Intervention

IntroductionWhile traditional teaching has been to wait 6 weeks between cervical excisional procedure and hysterectomy, studies have produced conflicting evidence, with data supporting a delay of anywhere between 48 hours to 6 weeks depending on surgical approach. Our study sought to evaluate if the time between cervical excisional procedure and robotic hysterectomy impacts peri-operative complication rates.MethodsA retrospective cohort of patients who underwent robotic hysterectomy from August 2006 to December 2013 for cervical dysplasia or International Federation of Gynecology and Obstetrics (FIGO) 2009 stage IA1–B1 cervical cancer at a single tertiary care center was performed. Patients were categorized into three groups: early surgical intervention (<6 weeks from excisional procedure), delayed surgical intervention (≥6 weeks from excisional procedure), and no excisional procedure. Secondary analysis was performed by hysterectomy type (simple vs radical). Peri-operative outcomes and complications were compared. Statistical analysis included Chi-square, Fisher’s exact test, and Wilcoxon rank sum test.ResultsA total of 160 patients were identified. Of these, 32 (20.0%) had early surgical intervention, 52 (32.5%) had delayed surgical intervention, and 76 (47.5%) had no excisional procedure. There was no difference between groups in complication rates, including average estimated blood loss (82 vs 55 vs 71 mL; p=0.07), urologic injury (0% in all groups; p=1.0), anemia (3% vs 0% vs 1%; p=0.47), infection (0% vs 2% vs 3%; p=1.0), vaginal cuff separation (0% in all groups; p=1.0), or venous thromboembolism (0% vs 0% vs 1%; p=1.0). Additionally, there were no differences in length of stay (p=0.18) or 30-day readmission rates (p=1.0). Finally, there were no significant differences in peri-operative outcomes when stratified by radical versus simple hysterectomy.DiscussionWaiting 6 weeks between cervical excisional procedure and robotic hysterectomy does not impact peri-operative complication rates. This suggests that the time from excisional procedure should not factor into surgical planning for those who undergo robotic hysterectomy.

scholarly journals Demographic and clinical analysis of post sterilization failure cases in a tertiary care hospital, Chennai, Tamil Nadu, India

2017 ◽  
Vol 6 (11) ◽  
pp. 4976
Author(s):  
T. S. Meena ◽  
K. S. Ramya ◽  
R. Mothilal
Keyword(s):  
Ectopic Pregnancy ◽  
Failure Rate ◽  
Tertiary Care ◽  
Care Hospital ◽  
Age Group ◽  
Female Sterilization ◽  
Intrauterine Pregnancy ◽  
Open Method ◽  
Laparoscopic Sterilization ◽  
Permanent Method

Background: The most common permanent method of family planning accepted in India is female tubal sterilization as it has a very low failure rate of 0.1- 0.8% in the first year and over all pregnancy chances of 1 in 200. It can be done by open method but laparoscopic method has now gained wide popularity.Methods: Ours was a retrospective study of post female sterilization failure cases admitted to the Department of Obstetrics and Gynecology, Government Kilpauk Medical College Hospital within a 10 year time period between April 2007 and March 2017.Results: Over a decade we had 134 post sterilization failures. 71 patients presented with intrauterine pregnancy whereas 63 presented as ectopic pregnancy following sterilization. Majority of patients belonged to 26-30 year age group and the median age was 28 years. 40.3% ectopic presented at 5-6 weeks gestational age. Over 90% of sterilization failures were done by open method and around 35.8% were done during caesarean section. Around 65.0 % sterilization failures were seen within 5 years of sterilization but 2 patients presented as late as 17 years post sterilization. In four cases (3%) failure was due to improper surgical procedure.Conclusions: Female sterilization may result in failure even after years of sterilization. In the present study, pregnancy after sterilization is higher in the youngest age group (15-30) years than for the age group (31-35) years and stabilized in the oldest age group (36-49) years. Open sterilization had a higher failure rate than laparoscopic sterilization. The most common mode of sterilization failure was intrauterine pregnancy than the ectopic pregnancy and it was almost equal to each other. Therefore, patients undergoing sterilization must be counselled about chances of failure; even though it is a permanent method, and to consult immediately if missed period else at a later stage they may go in for rupture ectopic leading to high maternal morbidity and mortality.

scholarly journals Ruptured Tubal Ectopic Pregnancy at Fifteen Weeks Gestational Age

2019 ◽  
Vol 3 (1) ◽  
pp. 62-64 ◽  
Author(s):  
Justine Stremick ◽  
Kyle Couperus ◽  
Simeon Ashworth
Keyword(s):  
Abdominal Pain ◽  
Ectopic Pregnancy ◽  
Gestational Age ◽  
Vaginal Bleeding ◽  
First Trimester ◽  
Second Trimester ◽  
Intrauterine Pregnancy ◽  
Tubal Ectopic Pregnancy ◽  
Ectopic Pregnancies ◽  
First Trimester Ultrasound

Tubal ectopic pregnancies are commonly diagnosed during the first trimester. Here we present a second-trimester tubal ectopic pregnancy that was previously misdiagnosed as an intrauterine pregnancy on a first-trimester ultrasound. A 39-year-old gravida 1 para 0 woman at 15 weeks gestation presented with 10 days of progressive, severe abdominal pain, along with vaginal bleeding and intermittent vomiting for two months. She was ultimately found to have a ruptured left tubal ectopic pregnancy. Second-trimester ectopic pregnancies carry a significant maternal mortality risk. Even with the use of ultrasound, they are difficult to diagnose and present unique diagnostic challenges.

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 Pregnancy of unknown location: outcome in a tertiary care teaching hospital

2017 ◽  
Vol 6 (7) ◽  
pp. 2787
Author(s):  
A. Shanti Sri ◽  
P. Kalpana
Keyword(s):  
Ectopic Pregnancy ◽  
Early Pregnancy ◽  
Tertiary Care ◽  
Expectant Management ◽  
Transvaginal Sonography ◽  
Intrauterine Pregnancy ◽  
Care Teaching ◽  
Asymptomatic Patients ◽  
Pain Outcome ◽  
Pregnancy Of Unknown Location

Background: A pregnancy of unknown location (PUL) is a descriptive term used to classify a woman when she has a positive pregnancy test but no intra- or extra-uterine pregnancy is visualized on transvaginal sonography. The objective of present study was to find out the outcome of women with pregnancy of unknown location presenting to a tertiary care teaching hospital.Methods: The prospective study was conducted from from 1st October 2015 to 31st September 2016, to antenatal out-patient department, at Princess Esra Hospital, Deccan College of medical sciences, Hyderabad. Data was collected for women with early pregnancy or with history of amenorrhea, bleeding or pain. These women were investigated with serum beta-human chorionic gonadotrophin levels at interval of 48 hrs and transvaginal ultrasonography. Expectant management was done for failing pregnancy of unknown location while medical or surgical management was considered for persistent pregnancy of unknown location and ectopic pregnancy.Results: During study period, 9210 patients were admitted, and, of them, 960 (10.42%) were patients with early pregnancy. Meeting the inclusion criteria were 112 (11.6%) patients who formed the study sample. There were 104 (92.85%) patients presenting with amenorrhea, 98 (87.5%) had bleeding and 78 (69.64%) presented with pain. Outcome of 42 (48.83%) patients was failing pregnancy, 31 (36.04%) had intrauterine pregnancy, 8 (9.3%) converted to ectopic pregnancy, while 5 (5.81%) had persistent pregnancy of unknown location. All patients with persistent pregnancy of unknown location and 3 patients with ectopic pregnancy were medically treated. Three patients having an ectopic pregnancy were managed surgically.Conclusions: Management of choice for asymptomatic patients having pregnancy of unknown location is expectant management. Most of the patients suspected to have PUL resolved either into F-PUL or IUP with expectant management.

scholarly journals Levonorgestrel intrauterine system embedded within tubal ectopic pregnancy: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Dorothy Makena ◽  
Ingrid Gichere ◽  
Khadija Warfa
Keyword(s):  
Case Report ◽  
Ectopic Pregnancy ◽  
Fallopian Tube ◽  
Intrauterine Device ◽  
African Woman ◽  
Rare Occurrence ◽  
Intrauterine Pregnancy ◽  
Case Presentation ◽  
Tubal Ectopic Pregnancy ◽  
Left Fallopian Tube

Abstract Background The presence of the levonorgestrel-releasing intrauterine system embedded within an ectopic pregnancy is a rare occurrence. Tubal migration of an intrauterine device is not well understood and has not been extensively studied in literature. Case presentation A 34-year-old African woman, para 1, gravida 2, presented with symptoms of ruptured ectopic pregnancy. She underwent a laparoscopy where a ruptured left ectopic pregnancy was found with a levonorgestrel-releasing intrauterine system inserted 2 years prior embedded within the tube. A left salpingectomy was performed with removal of the levonorgestrel-releasing intrauterine system. The patient recovered well and proceeded to have an intrauterine pregnancy 3 months later. Conclusion Migration of the levonorgestrel-releasing intrauterine system into the fallopian tube is a rare occurrence that is not well understood. In the case presented, levonorgestrel-releasing intrauterine system was found embedded within the fimbrial end of the left fallopian tube, which had a ruptured ectopic pregnancy. Surgical treatment with laparoscopy is recommended for intraabdominal intrauterine device to prevent complications.

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