ĐẶC ĐIỂM LÂM SÀNG VÀ HÌNH ẢNH SIÊU ÂM  QUA ĐƯỜNG ÂM ĐẠO CHỬA NGOÀI TỬ CUNG

Nguyễn Văn Sang; Doãn Văn Ngọc; Vũ Sỹ Quân; Trần Phan Ninh

doi:10.51298/vmj.v509i2.1780

ĐẶC ĐIỂM LÂM SÀNG VÀ HÌNH ẢNH SIÊU ÂM QUA ĐƯỜNG ÂM ĐẠO CHỬA NGOÀI TỬ CUNG

Tạp chí Y học Việt Nam ◽

10.51298/vmj.v509i2.1780 ◽

2022 ◽

Vol 509 (2) ◽

Author(s):

Nguyễn Văn Sang ◽

Doãn Văn Ngọc ◽

Vũ Sỹ Quân ◽

Trần Phan Ninh

Keyword(s):

Β Hcg

Nghiên cứu 61 bệnh nhân CNTC được siêu âm đầu dò âm đạo trước mổ, được phẫu thuật tại khoa Phụ sản Bệnh viện E trong thời gian từ tháng 7 năm 2019 đến tháng 10 năm 2020. Kết quả: Tuổi hay gặp từ 30 đến 39, trung bình 34 ± 7,14. 55,7% có tiền sử nạo hút thai, 24,6% có tiền sử đã từng CNTC. Khi vào viện 11,5% bệnh nhân có choáng, đau bụng 96,7%, chậm kinh 77,0% và ra máu âm đạo 60,6%. Khám lâm sàng 63,9% bệnh nhân di động tử cung đau, cùng đồ khám đau 50,8%, phần phụ có khối nề 41,0%, phản ứng thành bụng 31,1% và tử cung to hơn bình thường chiếm 14,7%. Nồng độ β hCG trung bình 2.235 ± 4.767mIU/mL; thấp nhất: 44,9 mIU/mL; cao nhất: 35.176 mIU/mL. Hình ảnh túi thai không điển hình chiếm 78,7%; điển hình 9,8%. Kích thước khối chửa từ 20-40mm chiếm tỷ lệ cao nhất (39,3%). Hình ảnh dịch Douglas chiếm cao nhất 73,8% phù hợp với kết quả phẫu thuật thấy máu trong ổ bụng chiếm 74,2%, dịch buồng tử cung chiếm 22,9%, dịch ổ bụng chiếm 60,6%. Độ dày niêm mạc tử cung trung bình 8,93 ± 4,35mm (5-25 mm) dày trên 8mm chiếm 55,7%. Giá trị chẩn đoán đúng của dấu hiệu trực tiếp, gián tiếp đều đạt 100%. Kết luận: Siêu âm đầu dò âm đạo có giá trị cao, giúp lâm sàng phát hiện sớm và xử lý kịp thời CNTC.

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Role of Serum β-HCG doubling in Diagnosis of Early Pregnancy and its Management Strategy

Current Women s Health Reviews ◽

10.2174/1573404816999200905140919 ◽

2020 ◽

Vol 16 ◽

Author(s):

Divya Mirji ◽

Shubha Rao ◽

Akhila Vasudeva ◽

Roopa P.S

Keyword(s):

Ectopic Pregnancy ◽

Early Pregnancy ◽

Management Strategy ◽

Transvaginal Ultrasound ◽

Expectant Management ◽

First Trimester ◽

Intrauterine Pregnancy ◽

Β Hcg ◽

Pregnancy Of Unknown Location

Background: Pregnancy of unknown location (PUL) is defined as the absence of intrauterine or extrauterine sac and Beta Human Chorionic Gonadotropin levels (β-HCG) above the discriminatory zone of 1500 mIU/ml. It should be noted that PUL is not always an ectopic; however, by measuring the trends of serum β-HCG, we can determine the outcome of a PUL. Objective: This study aims to identify the various trends β-HCG levels in early pregnancy and evaluate the role of β-HCG in the management strategy. Methods: We conducted a prospective observational study of pregnant women suspected with early pregnancy. Cases were classified as having a pregnancy of unknown location (PUL) by transvaginal ultrasound and ß-HCG greater than 1000 mIU/ml. Expectant management was done until there was a definite outcome. All the collected data were analyzed by employing the chi-square test using SPSS version 20. Results: Among 1200 women who had early first trimester scans, 70 women who fulfilled our criteria of PUL and ß-HCG > 1000 mIU/ml were recruited in this study. In our study, the mean age of the participants was 30±5.6yrs, and the overall mean serum ß-HCG was 3030±522 mIU/ml. The most common outcome observed was an ectopic pregnancy, 47% in our study. We also found the rate of failing pregnancy was 27%, and that of intrauterine pregnancy (IUP) was 25%. Overall, in PUL patients diagnosed with ectopic pregnancy, 9% behaved like IUP, and 4% had an atypical trend in their ß-HCG. Those who had an IUP, 11% had a suboptimal increase in ß-HCG. Conclusion: PUL rate in our unit was 6%. Majority of the outcome of PUL was ectopic in our study. Every case of PUL should be managed based on the initial ß-HCG values, clinical assessments and upon the consent of the patient.

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Ectopic pregnancy in a tertiary care centre of Jharkhand, India

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20193505 ◽

2019 ◽

Vol 8 (8) ◽

pp. 2969

Author(s):

Meetali Parashar ◽

Meena Mehta

Keyword(s):

Ectopic Pregnancy ◽

Clinical Presentation ◽

Previous History ◽

First Trimester ◽

Near Miss ◽

Obstetrics And Gynaecology ◽

Maternal Morbidity And Mortality ◽

History Of ◽

Β Hcg ◽

A Prospective Study

Background: Ectopic pregnancy is one in which the fertilized ovum is implanted and develops outside the endometrial cavity. It is an important cause of maternal morbidity and mortality in first trimester. The present study was conducted to study the risk factors, clinical presentation and management of ectopic pregnancy in RIMS, Ranchi, Jharkhand, India.Methods: This was a prospective study conducted in the department of obstetrics and gynaecology, RIMS, Ranchi, Jharkhand during May 2017 to September 2018. A total of 90 cases were included in the study.Results: 80% of the patients presented with amenorrhoea, 98% had abdominal pain and 69% had vaginal bleeding. Ultrasonography revealed hemoperitoneum in about 93% patients. 16 (18%) patients had history of infertility whereas 10 patients (11%) had taken treatment of infertility.6 (7%) patients had history of STD or PID.14 (16%) had undergone bilateral tubectomy.2 (2%) had history of IUCD insertion and 12 (13%) patients had undergone previously lscs. 54 patients (60%) had undergone D and C and 6 patients (7%) had a previous history of ectopic pregnancy. 68 (76%) underwent only salpingectomy.12 (13%) had salpingo-oophorectomy and 10 (11%) had salpingectomy with contralateral tubectomy.Conclusions:Diagnosis of ectopic pregnancy requires clinical suspicion and supportive investigations like UPT, ultrasonography, β HCG and laparoscopy. It is an important cause of admission to RIMS as maternal near miss cases.Background: Ectopic pregnancy is one in which the fertilized ovum is implanted and develops outside the endometrial cavity. It is an important cause of maternal morbidity and mortality in first trimester. The present study was conducted to study the risk factors, clinical presentation and management of ectopic pregnancy in RIMS, Ranchi, Jharkhand, India.Methods: This was a prospective study conducted in the department of obstetrics and gynaecology, RIMS, Ranchi, Jharkhand during May 2017 to September 2018. A total of 90 cases were included in the study.Results: 80% of the patients presented with amenorrhoea, 98% had abdominal pain and 69% had vaginal bleeding. Ultrasonography revealed hemoperitoneum in about 93% patients. 16 (18%) patients had history of infertility whereas 10 patients (11%) had taken treatment of infertility.6 (7%) patients had history of STD or PID.14 (16%) had undergone bilateral tubectomy.2 (2%) had history of IUCD insertion and 12 (13%) patients had undergone previously lscs. 54 patients (60%) had undergone D and C and 6 patients (7%) had a previous history of ectopic pregnancy. 68 (76%) underwent only salpingectomy.12 (13%) had salpingo-oophorectomy and 10 (11%) had salpingectomy with contralateral tubectomy.Conclusions: Diagnosis of ectopic pregnancy requires clinical suspicion and supportive investigations like UPT, ultrasonography, β HCG and laparoscopy. It is an important cause of admission to RIMS as maternal near miss cases.

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Lung neoplasm mimicking as ectopic pregnancy due to paraneoplastic secretion of human chorionic gonadotropin: a case report and literature review

Archives of Gynecology and Obstetrics ◽

10.1007/s00404-020-05927-2 ◽

2021 ◽

Author(s):

Jin Peng ◽

Shangge lv ◽

Lin Liu ◽

Shuai Feng ◽

Naidong Xing

Keyword(s):

Systematic Review ◽

Ectopic Pregnancy ◽

Chorionic Gonadotropin ◽

Human Chorionic Gonadotropin ◽

Lung Neoplasm ◽

High Serum ◽

Pregnancy Test ◽

Positive Pregnancy Test ◽

Β Hcg ◽

Present Systematic Review

Abstract Purpose The present systematic review aimed to examine the relationship between lung neoplasm and human chorionic gonadotropin (HCG). Especially, women with lung neoplasm mimicking as ectopic pregnancy were explored. Methods A rare case of lung neoplasm with high serum β-HCG, which was initially thought to be ectopic pregnancy, was reported. A literature search was performed of the US National Library of Medicine (MEDLINE), EMBASE, PubMed, and the Cochrane Database of Systematic Reviews using appropriate keywords and subject headings to February 2020. Results Studies assessed lung neoplasm patients with positive HCG were included. Twenty studies, including 24 patients, were included. These cases illustrate the importance of considering the possibility of paraneoplastic secretion of β-HCG in patients who have a positive pregnancy test. This may prevent a delay in the diagnosis and treatment of malignancy in young women. Of the 24 cases, only 7 (29.17%) were managed surgically; others were managed conservatively or with chemotherapy or radiation. Conclusion The present systematic review shows the need to re-awaken awareness and high index of suspicion to lung neoplasm diagnosis in patients with positive pregnancy test.

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Rare heterotopic pregnancy after frozen embryo transfer: a case report and literature review

BMC Pregnancy and Childbirth ◽

10.1186/s12884-020-03214-1 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Xianping Wang ◽

Ding Ma ◽

Yangang Zhang ◽

Yanhua Chen ◽

Yuxia Zhang ◽

...

Keyword(s):

Embryo Transfer ◽

Left Kidney ◽

Frozen Embryo Transfer ◽

Heterotopic Pregnancy ◽

Psoas Major Muscle ◽

History Of ◽

Gestational Sac ◽

Β Hcg ◽

Ectopic Pregnancies ◽

Psoas Major

Abstract Background Heterotopic pregnancy occurred after frozen embryo transfer with two D3 embryos, and the case had a history of bilateral salpingectomy due to salpingocyesis. An ectopic heterotopic pregnancy was implanted in the left psoas major muscle, which has not been previously reported. Case presentation A 33-year-old woman presented with left back pain after curettage due to foetal arrest in the uterus without vaginal bleeding and spotting, and painkillers relieved the pain initially. When the painkillers ceased to work, the patient returned to the hospital. The β-human chorionic gonadotropin (β-hCG) level remained increased compared with the time of curettage, and a diagnosis of retroperitoneal abdominal pregnancy was suggested by ultrasonography and computerized tomography (CT) with the gestational sac implanted in the left psoas major muscle at the left hilum level. Laparotomy was performed to remove the ectopic pregnancy. During the operation, we carefully separated the adipose tissue between the space of the left kidney door and left psoas major muscle, peeled away the gestational sac that was approximately 50 mm × 40 mm with a 25-mm-long foetal bud, and gave a local injection of 10 mg of methotrexate in the psoas major muscle. Fifty days later, β-hCG decreased to normal levels. Conclusion It is necessary to pay more attention to the main complaints to exclude rare types of ectopic pregnancies of the pelvis and abdomen after embryo transfer.

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