Evaluation of the recurrence and fertility rate following salpingostomy in patients with tubal ectopic pregnancy

Background Ectopic pregnancy is one of the leading causes of pregnancy-related mortality; the treatment strategies associated with this condition entail complications, such as recurrence of ectopic pregnancy or infertility. The objective of this study was to evaluate the recurrence and fertility rate after salpingostomy in patients with tubal ectopic pregnancy. Methods This cross-sectional retrospective study was conducted at four referral centers of Obstetrics and Gynecology, under the supervision of Shiraz University of Medical Sciences (Iran). The medical records of 125 patients with tubal pregnancy were reviewed. These patients underwent laparoscopic salpingostomy from April 2009 to March 2016.Data on maternal age, BMI, history of previous EP, genital tract infection, IUD insertion, history of previous surgery, and infertility were further obtained. The patients were followed up for approximately 1 to 7 years. The recurrence of EP and subsequent pregnancy rate were assessed during the follow-up period. Results There was no statistically significant relationship between post-salpingostomy recurrence and maternal age, previous abdominopelvic surgery, and history of infertility(P = .425); however, the post-salpingostomy recurrence of EP was correlated with BMI (P = 0.001), previous history of EP (P = 0.001), genital tract infection (P = 0.001), and IUD insertion (P = 003). Among 95 women who had no contraception, pregnancy occurred in 51 cases (53.6%) and recurrence of EP was observed in 16 patients (12.8%). Conclusions Our results suggest that salpingostomy is a safe method with a low risk of recurrence and good fertility outcomes for women who consider future pregnancy.

Spontaneous heterotopic pregnancy: a case report

Heterotopic pregnancy is defined as multiple gestation in which intrauterine and extrauterine gestational sacs co-exist. The extra uterine gestational sac is most commonly tubal ectopic pregnancy. We presented case of a 26 years old multigravida who presented to emergency with complaints of pain abdomen and giddiness for 2-3 days. She was at period of gestation (POG) 7 weeks and on clinical examination patient was anxious with mild pallor, mildly tachycardiac and blood pressure (BP) was 90/60 mm of Hg. After thorough clinical examination and sonography diagnosis of heterotopic pregnancy with ruptured tubal ectopic was made. She was taken up for Emergency laparotomy after investigations and consent. Left salpingectomy was done and she was discharged with a single intrauterine live pregnancy on 6th post op day. For early detection of cases of heterotopic pregnancy careful evaluation of adnexa is mandatory in early gestation scan.

Dual extrauterine ectopic pregnancy: double management

A 30-year-old nulliparous woman was referred with suspected left ovarian ectopic pregnancy. She had undergone laparoscopic left salpingectomy for ruptured tubal ectopic pregnancy 3 weeks earlier, following treatment with medications for ovulation induction. Sonological examination revealed a left ovarian ectopic pregnancy corresponding to 8 0/7 weeks with cardiac activity. She underwent ultrasound-guided intrasac therapy with intrasac instillation of 3 mEq of potassium chloride followed by 50 mg of methotrexate. She was followed with weekly measurements of serum beta human Chorionic Gonadotropin (hCG) which returned to baseline after 65 days of the intrasac therapy. This case not only highlights the need for continued follow-up of the serum beta hCG after definitive management of an ectopic pregnancy in cases with multiple ovulations, but also the option of medical management in cases of advanced ovarian ectopic pregnancy. It also accentuates the necessity for adequate counselling to avoid conception in a multiple ovulation cycle.

Comparison of Successful Outcome in Medical Versus Expectant Management in Patients with Unruptured T. P. having Β-Hcg 1000-3000 Iu/L

Objective: To compare the successful outcome in medical versus expectant management in patients with unruptured tubal pregnancy having β-hcg 1000-3000 IU/L. Materials & Methods: In this randomized controlled trial, total 90 patients of ectopic pregnancy having age 18-40 years and having size of ectopic mass< 4cm were selected from the Department of Obstetrics & Gynecology Combined Military Hospital, Bahawalpur from March 20 to September 20. Group A included patients in which expectant management was done while Group B included the patients in which medical management (single intramuscular injection of methotrexate in a dose of 50mg/m2) was done. After one week, successful outcome was compared between the both groups. Results: Total 90 women with tubal ectopic pregnancy were selected for this study. Comparison of successful outcome between the bot study groups was done. Mean age of the patients was 31.66 ± 6.44 years, mean gestational age was 7.83 ± 2.33 weeks and mean β-hcg levels 1565.45 ± 517.89 IU/L. In study group A, outcome was found successful in 40 (88.89%) patients and 31 (68.89%) patients of group B was found with successful outcome. After applying chi-square test, difference of successful outcome between the both groups was found statistically significant with p value 0.037. Conclusion: This study concluded that expectant management is associated with better outcome (β-hcg levels negligible i.e. <10 IU/L and complete resolution on ultrasonography (absence of adnexal mass, pelvic free fluid, gestational sac) within one week) as compared to medical management in women with tubal ectopic pregnancy having β-hcg between 1000-3000 IU/L Keywords: Ectopic pregnancy, methotrexate, expectant, resolution

MRI findings in ruptured ovarian ectopic pregnancy: an unexplored avenue

Ovarian ectopic pregnancy (OEP) is a rare form of ectopic pregnancy (EP) and constitutes approximately 0.5-3% of all ectopic cases. Its presentation mimics the symptoms of tubal ectopic pregnancy, hemorrhagic ovarian cyst/follicle, tubo-ovarian abscess, urinary tract calculi, appendicitis or ovarian torsion. Occasionally determining the anatomic location of an extra-tubal ectopic pregnancy based on ultrasound imaging and presentation alone can be challenging, particularly when it is adherent to the fallopian tube. Although transvaginal ultrasound (TVS) is the primary modality used in the diagnosis, various forms of OEP and its complications may be incidentally detected and further evaluated on computed tomography (CT) or magnetic resonance imaging (MRI) when an alternative diagnosis is suspected. We reported a case of a second gravid para zero, 25 years old lady, who came with pain in the left lower abdomen. Her urine pregnancy test was positive. TVS showed empty uterine cavity, an extremely tender, heterogenous hyperechoic right adnexal mass, but no obvious gestation sac (GS). A large hematoma was detected adjacent to it in the pouch of Douglas (POD). Keeping a high suspicion of ectopic pregnancy, MRI was performed to evaluate the lesion better which revealed a natural, non-assisted, ruptured right ovarian ectopic pregnancy and was subsequently confirmed at laparotomy and proven on histopathology. Patient underwent left oophorectomy and discharged on 4th day with uneventful follow up.

Case Report of an Undisturbed Ectopic Pregnancy with Very High Human Chorionic Gonadotrophin (β-hCG)

This is a case report of a patient with an undisturbed ectopic pregnancy and very high levels of human chorionic gonadotrophin (β-HCG). The patient presented to the emergency room at 9+1 weeks of gestation with mild abdominal pain and vaginal bleeding. She had an obstetric history of two previous cesarean section deliveries. On presentation, her human chorionic gonadotropin (β-HCG) was measured to be 26,530 mIU/ml, and after 18 hours, the β-HCG level was 25,660 mIU/ml. An ultrasound scan revealed no evidence of intrauterine pregnancy, a left ovarian cyst measuring 2.86 cm x 2.17 cm, and the presence of a mixed mass near the ovary measuring 3.92 cm x3.62 cm. The patient was diagnosed with a left tubal ectopic pregnancy and was taken for an immediate laparoscopy. Intraoperatively, the left tubal ectopic pregnancy was undisturbed and measured about 4-5 cm involving more than half of the fallopian tube. The mixed mass, along with the left fallopian tube, was removed as a whole. Keywords: Abdominal pain, Cesarean Section, Ectopic-pregnancy, Laparoscopy, Tubal pregnancy, Ultrasonography