scholarly journals Recurrent ectopic pregnancy on tubal remnant treated by laparoscopic resection: loop and stitch

2021 ◽  
Vol 13 (2) ◽  
pp. 183-186
Author(s):  
S. Restaino ◽  
A. Vidiri ◽  
L. Anchora Pedone ◽  
A. Finelli ◽  
M. Distefano ◽  
...  

Ectopic pregnancies occur in about 1-2 % of all pregnancies, with a high rate of maternal mortality due to bleeding caused by the rupture of the ectopic pregnancy. Ipsilateral ectopic pregnancy on a tubal remnant after salpingectomy is rare and it is associated with a higher mortality rate when compared to other ectopic pregnancies. Diagnosis and treatment of these pregnancies can be difficult, requiring a multidisciplinary management to plan the best treatment for the patient. The objective of this video is to show the laparoscopic removal of a tubal pregnancy on the stump of a previous salpingectomy with the application of three laparoscopic rings/endoloops® to isolate the tubal portion from the uterus.

Author(s):  
Neelotparna Saikia ◽  
Sukalyan Halder ◽  
Punam Jain

Cornual ectopic pregnancy accounts for 2-4% of all the ectopic pregnancies with a mortality rate 6-7 times higher than that of the ectopics in general. It is a diagnostic and therapeutic challenge to the clinician with a significant risk of rupturing and bleeding. As of yet, the incidence of recurrent cornual ectopic pregnancies is unknown. This report described the case of a patient who developed two cornual ectopic pregnancies within a span of 3 years with an intervening full term normal vaginal delivery. The 1st cornual ectopic was successfully managed by laparoscopic resection, which was followed by an uneventful postoperative course. The following contralateral cornual ectopic was managed by laparotomy since the patient presented with large hemoperitoneum.


2018 ◽  
Vol 46 ◽  
pp. 5
Author(s):  
Jia-San Zheng ◽  
Zheng Wang ◽  
Jia-Ren Zhang ◽  
Shuang Qiu ◽  
Ren-Yue Wei ◽  
...  

Background: Ectopic pregnancy mainly refers to tubal pregnancy and abdominal pregnancy. Tubal pregnancy presents as an implanted embryo that develops in the fallopian tubes, and is relatively common in humans. In animals, tubal pregnancy occurs primarily in primates, for example monkeys. The probability of a tubal pregnancy in non-primate animals is extremely low. Abdominal pregnancy is a type of ectopic pregnancy that occurs outside of the uterus, fallopian tube, ovary, and ligament(broad ligament, ovarian ligament, suspensory ligament).This paper describes two cases of ectopic pregnancy in cats.Cases: Cat 1. The presenting sign was a significant increase in abdominal circumference. The age and immune and sterilization status of the cat were unknown. On palpation, a 4 cm, rough, oval-shaped, hard mass was found in the posterior abdomen. Radiographic examination showed three high-density images in the posterior abdomen. The fetus was significantlycalcified and some feces was evident in the colon. The condition was preliminarily diagnosed as ectopic pregnancy. Cat 2. The owner of a 2-year-old British shorthair cat visited us because of a hard lump in the cat’s abdomen. The cat had a normal diet and was drinking normally. Routine immunization and insect repulsion had been implemented. The cat had naturally delivered five healthy kittens two months previous. Radiographs showed an oval-shaped mass with a clear edge in the middle abdominal cavity. Other examinations were normal. The case was preliminarily diagnosed as ectopic pregnancy, and the pregnancy was surgically terminated. The ectopic pregnancies were surgically terminated. During surgery, the structures of the uterus and ovary of cat 1 were found to be intact and the organs were in a normal physiological position.Cat 1 was diagnosed with primary abdominal pregnancy. In cat 2, the uterus left side was small and the fallopian tube on the same side was both enlarged and longer than normal. Immature fetuses were found in the gestational sac. Thus, cat 2 was diagnosed with tubal ectopic pregnancy based on the presenting pathology.Discussion: Cats with ectopic pregnancies generally show no obvious clinical symptoms. The ectopic fetus can remain within the body for several months or even years. Occasionally, necrotic ectopic tissues or mechanical stimulation of the ectopic fetus can lead to a systemic inflammatory response, loss of appetite, and apathy. The two cats in our reportshowed no significant clinical symptoms. To our knowledge, there have been no previous reports of the development of an ectopic fetus to maturity, within the abdominal cavity of felines, because the placenta of cats cannot support the growth and development of the fetus outside of the uterus. Secondary abdominal ectopic pregnancy, lacking any signs of uterine rupture is likely associated with the strong regenerative ability of uterine muscles. A damaged uterus or fallopian tube can quickly recover and rarely leaves scar tissue. In the present report, cat 1 showed no apparent scar tissue, nor signs of a ruptured ovary or fallopian tubes. It was diagnosed with primary ectopic abdominal pregnancy, which could arise from the descent of the fertilized egg from the fallopian tube into the abdominal cavity. There was an abnormal protrusion in left of the fallopian tubes in cat 2, to which the gestational sac was directly connected. Based on pathological examination of the uterus, fallopian tubes, and gestational sac, the cat was diagnosed with a tubal pregnancy. Placental tissues and signs of fetal calcification were observed in both the fallopian tube and gestational sac.Keywords: tubal pregnancy, abdominal pregnancy, feline, ectopic fetus, fallopian tube, gestational sac.


2013 ◽  
Vol 2013 ◽  
pp. 1-3 ◽  
Author(s):  
Mara Clapp ◽  
Jaou-Chen Huang

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.


Author(s):  
Archana Mehta ◽  
Shehla Jamal ◽  
Neerja Goel ◽  
Mayuri Ahuja

Background: Ectopic pregnancy is a global problem and is the most common life-threatening emergency in early pregnancy leading to significant morbidity and fetal loss. It occurs in variable presentations. The rate of ectopic pregnancies has increased from 0.5% in 1970 to 2% today. The aim of this study was to determine the incidence, clinical presentation, risk factors, treatment, and morbidity and mortality associated with ectopic pregnancy.Methods: The present retrospective study was conducted over a period of three years in the department of obstetrics and gynecology at SMS and R, Greater Noida, UP from Feb 2014 to Jan 2017.A total of 80 patients with ectopic pregnancy were analyzed regarding clinical presentation, risk factors, operative findings and treatment modality.Results: Total number of 80 cases of ectopic pregnancies were admitted during this period against 2645 deliveries representing frequency of 3%. Majority of cases (43.75%) were in the age group of 25-29 years and 41.25% were gravida 4 and above. Risk factors were identifiable in 66.25% of cases. Previous abortion was the most common risk factor (31.25%). The classical triad of amenorrhea, pain abdomen and vaginal bleeding was present in 71.25% of cases. More than half of case (55%) had ruptured tubal pregnancy on admission. Unruptured tubal pregnancy was seen in 10% case. Interestingly we found one rare case of bilateral ectopic pregnancy. Salpingectomy by open method was the mainstay of treatment (86.25%).Conclusions: Ectopic pregnancy is still a major challenge in gynecological practice. In our country most of the cases present late after tubal rupture requiring radical surgical treatment. Early diagnosis and timely intervention in the form of medical treatment or conservative surgery not only reduces maternal morbidity but also preserves future fertility.


Author(s):  
Ulrich Honemeyer ◽  
Sanja Kupesic-Plavsic ◽  
Afshin Pour-Mirza

ABSTRACT Implantation of the zygote outside the uterine cavity occurs in 2% of all pregnancies. The rate of ectopic pregnancies has increased from 0.5% in 1970 to 2% today. The prevalence of ectopic pregnancy in all women presenting to an emergency department with first-trimester bleeding, lower abdominal pain or a combination of the two is between 6 and 16%. When diagnosis is made early, the product of conception can be removed safely by laparoscopic surgery and be submitted for histological examination. Tubal rupture is a complication of late diagnosed tubal pregnancy which is more difficult to treat conservatively and often indicates tubectomy or segmental resection. In 5 to 15% of treated ectopic pregnancy cases, remnant conception product parts are diagnosed and may require a final methotrexate (MTX) injection. Rare sites of ectopic pregnancy include interstitial, cervical, abdominal and cesarean scar pregnancies. Our manuscript reviews and illustrates the use of novel sonographic methods such as three-dimensional ultrasound, multiplanar view, in combination with color and power Doppler ultrasound, for early detection of ectopic tubal pregnancy and of other, rare locations of ectopic pregnancy. How to cite this article Honemeyer U, Alkatout I, Plavsic SK, Pour-Mirza A, Kurjak A. The Value of Color and Power Doppler in the Diagnosis of Ectopic Pregnancy. Donald School J Ultrasound Obstet Gynecol 2013;7(4):429-439.


1970 ◽  
Vol 39 (3) ◽  
Author(s):  
S Chowdhury ◽  
T Chowdhury

Heterotopic pregnancy is coexistence of intrauterine and extrauterine pregnancies that is ectopic pregnancies. It is said to be rare. Here we report a case of 27 years old woman with heterotopic pregnancy. Patient had a typical presentation of severe lower abdominal pain following amenorrhoea for 2½ months. On clinical examination, there was suspicion of ectopic pregnancy but ultrasonography revealed early intrauterine pregnancy along with right tubal pregnancy with huge collection in abdomen . Immediate laparotomy was done and diagnosis was confirmed as a case of heterotopic pregnancy.DOI: http://dx.doi.org/10.3329/bmj.v39i3.9950 BMJ 2010; 39(3)


2020 ◽  
Vol 1 (1) ◽  
pp. 23-26
Author(s):  
Sadık Kükrer ◽  
Ayfer Pepekal Kukrer ◽  
Eren Haytoğlu ◽  
Erdal Yılmaz

Despite advancements in management and diagnosis, ruptured ectopic pregnancy is still a major reason for pregnancy-related mortality and morbidity. 2% of all pregnancies are ectopic pregnancy and interstitial ectopic pregnancy rate is 2-4% among all ectopic pregnancies. We should consider about it as an essential characteristic in each female of reproductive age that presents with the triad of amenorrhoea, unusual vaginal bleeding and abdominal irritation. It ruptures at a more sophisticated stage of gestation when compared with tubal ectopic pregnancy. Bleeding in interstitial ectopic pregnancy rupture is above that other ectopic pregnancies, also its life-threatening. Interstitial ectopic pregnancy rupture is two to five times greater compared to maternal mortality rate than tubal ectopic pregnancy rupture. Developing gestational sac causes uterine disruption and following hemorrhagic shock, resulting in morbidity and mortality. Clinics that aim to reduce maternal mortality should be much more concerned about convenient disclosure of this abnormal pregnancy condition.


Author(s):  
Suvarna Jyothi Ganta ◽  
Sunanda R. Kulkarni ◽  
Vidya Muralidhar

Background: Ectopic pregnancy is still a diagnostic dilemma presenting with various complaints. The classic triad of amenorrhea, abdominal pain, vaginal bleeding and /or syncope is not always seen. Misdiagnosis can lead to delay in treatment, blood loss is found to be the major cause of death. Early and accurate diagnosis is critical in bringing down the maternal mortality and morbidity. Prompt and effective treatment of an ectopic pregnancy can help preserve the chances of future healthy pregnancies. Aim of present study was to investigate whether creatinine phosphokinase (cpk) can be used as an effective diagnostic tool in the early diagnosis of ectopic pregnancy which can help in decreasing the maternal mortality and morbidityMethods: This observational comparative three group clinical study was conducted at Chinmaya Mission Hospital, Bangalore, between May 2016 to January 2017.120 women in their early trimester were studied of which 40 were diagnosed cases of ectopic pregnancies, 40 women presented with intrauterine abortive pregnancies and 40 women had normal healthy pregnancies. Serum CPK, serum B-HCG, vaginal scans were done in all, along with routine investigations.Results: The mean CPK values in normal, abortive and ectopic pregnancies were 36.92±6.44, 43.95±11.96 and 91.55±30.43 respectively. It was found to be significantly higher in ectopic Pregnancies. Also, the mean CPK in ruptured and unruptured ectopic pregnancy were 97.26±25.97 and 63.82±34.92 respectively.Conclusions: Present study shows that maternal CPK levels are significantly higher in women with ectopic pregnancies. CPK can serve as the reliable biochemical marker to diagnose ectopic pregnancy particularly ruptured. CPK can be used to increase the diagnostic efficacy in ectopic pregnancy, which followed by rapid and appropriate treatment can reduce the mortality, morbidity and preserve future fertility.


Author(s):  
Peter Igbaudumhe Sede

AbstractThe slow reduction in maternal mortality rate in Sub-Saharan Africa is a serious cause for policy concern. This has not only retained the sub region in the web of leading region in high rate of reproductive health challenges but spells signals of poverty and low economic growth. The study therefore, examined the efficacy of health expenditure targeting and financial protection in reducing maternal mortality in 44 Sub-Saharan Africa countries. The study adopts fixed effect panel data modelling technique. Results show that financial protection is correctly signed but not statistically significant while relative health expenditure targeting is both correctly signed and statistically significant in reducing maternal mortality. Recommendation is that health expenditure should generally be increased so as to increase the slope of decrease in maternal mortality rate in Sub-Saharan Africa and health expenditure should be more targeted against GDP as common denominator.    


2018 ◽  
Vol 3 (1) ◽  
pp. 28-37
Author(s):  
Lismawati . ◽  
Ria Oktaviance

Ectopic pregnancies are impaired including high-risk pregnancies that can be marked by either spotting or moderate bleeding that can be life-threatening to the mother. Based on worldwide WHO research, there is a maternal mortality of 500,000 lives per year and infant mortality in particular 10 million neonates per year. More than 60% of ectopic pregnancies occur in women aged 20-30 with low socio-economic and live in areas with high prevalence ofgonorrhea and tuberculosis prevalence. In Indonesia the maternal mortality rate is 330/100,000 live births. Maternal mortality is estimated at about 16,500-17,500 per year. One-third of them are due to falling-out services.Goals : Performing a Craving Care in Pregnant Women Mrs.T Age 28 years old G3P1A1 with Disturbed Ectopic Pregnancy using a seven step Varney approachMethods:Using descriptive method with case study approach implemented by author through approach of midwifery management. The case observed by the author in this Final Report is Mrs. T Age 28 years G3P1A1 with Disturbed Ectopic Pregnancy at Saint Elizabeth Hospital Medan Year 2018.Results: Gain real experience on the implementation of Midwifery care in pregnant women with Disturbed Ectopic Pregnancy at Saint Elizabeth Hospital Medan. Implementation of midwifery care in pregnant women with Disturbed Ectopic Pregnancy at Saint Elizabeth Hospital Medan is in accordance with the existing theory and hope can be used as input by students so as to provide broad insight into the quality of midwifery services according to midwifery care.Conclution : Standards through the approach of midwifery care management in pregnant women with Disturbed Ectopic Pregnancy.


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