Ectopic Pregnancy

The aim of the study was to describe the delivery after a history of obstetric anal sphincter injury (OASIS) and to identify the risk factors for recurrent third-fourth degree perineal tears. Methods: Between January 1st, 2005 and December 31st, 2014, we included patients with an OASIS who delivered subsequently (vaginal delivery or caesarean) at the Besancon University Medical Centre. Outcome measures were: mode of delivery, type of perineal tears, recurrent third or fourth perineal tears, parity, fetal weight, fetal presentation, any shoulder dystocia or an episiotomy. Results: The prevalence of OASIS was 0.44%. Among the 104 patients included, 80.7% were primiparas. Median fetal weight was 3.380 g for third degree perineal tears against 3640.6 g for fourth degree perineal tears. Instrumental deliveries represented 55.8% of the births. Shoulder dystocia occurred in almost half the cases (46.6%). Forty two patients delivered subsequently (40.3%) including 29 vaginal deliveries (27.8%): 9 instrumentally assisted (IAD) and 20 normal deliveries (ND), 13 patients had an elective caesarean section. Obstetrical tears were: 34.5% of first degree tears, 24.1% of 2nd degree tears, 27.6% of intact perineum. We observed 10.3% of recurrent OASIS (11.1% after IAD and 10% after ND) and only one episiotomy (3.4%). Conclusion: Mode of delivery for the next pregnancy should be discussed with the patient but a vaginal delivery remains possible (OASIS recurrence of 10%).

Laparoscopy has many advantages over open surgery including less post-operative pain, earlier return of normal bowel function, shorter hospital stay, and earlier recovery. Bowel injury is a serious complication of gynecological laparoscopy. The most common site of bowel injury is the small bowel, followed by the large bowel and stomach. This is in agreement with a recent systematic review which has shown that the incidence of bowel injury in gynecologic laparoscopy is 1 in 769.3. Air saline test performed to check bowel integrity by inserting the rectal probe and filling the cavity with normal saline. After performing total laparoscopic hysterectomy with bilateral salphingoopherectomy with retroperitoneal lymphnode dissection done initially after pushing air from rectal probe into the bowel, no bubble was noted but after pushing sigmoid into the pool of saline, escape of air was seen. After suction, a 2×2 cm incidental sigmoidal injury was detected. Bowel injury is a serious complic...

Female genital schistosomiasis is a significant risk factor for ectopic pregnancy and infertility in schistosomiasis-endemic areas. A case of one previous ectopic pregnancy and subsequent obstruction of the contralateral tube in a secondary subfertility patient with chronic genital schistosomiasis is presented, emphasizing the need for a detailed history and parasitic evaluation of patients presenting with ectopic pregnancy or subfertility in areas where the disease is endemic.

Purpose: This study aimed to highlight the clinical features, diagnosis, and different modalities of the treatment of cesarean scar pregnancy (CSP). Methods: This study was done in the tertiary referral hospital of India for one year. A total of 11 cases were enrolled prospectively. In each case, the diagnostic ultrasonography and measurement of baseline betahuman chorionic gonadotropin (β-HCG) levels were done. The treatment was given based on the hemodynamic status of the patient and desire for future fertility. Various treatment modalities used were medical, surgical, or interventional digital subtraction angiography to control hemorrhage. Also, in some cases, ultrasound-guided methotrexate was injected into the scar ectopic. Medically treated cases were followed up until their β-HCG levels became normal. Results: Out of 11 patients, six had a history of two cesarean sections in the past, four patients had a history of one cesarean section and one patient with a previous three low segments cesarean section (LSCS). Seven out of 11 patients underwent medical management with either methotrexate with potassium chloride (KCl) or methotrexate alone. The success of the medical management was monitored by serial β-HCG values. The mean time for the resolution of these 10 patients was 86.7 ± 53.6 days. Three patients underwent emergency uterine artery embolization due to uncontrolled bleeding and one patient required laparotomy. Conclusion: CSP is a life-threatening condition that can be diagnosed with the help of transvaginal ultrasonography. The treatment, however, depends on the hemodynamic status of the patient and desire for future fertility. Well-defined diagnostic criteria coupled with structured management and follow-up protocol can help in treating this challenging form of ectopic pregnancy.

Objective: This study aimed to address the socio-demographic characteristics, therapeutic aspects, and prognosis of externalized uterine prolapse occurring for the first time during pregnancy. Patients and Methods: This was a prospective study over a period of 12 months (January 1 to December 31, 2021) focusing on patients treated for gravidarum prolapse. Results: Seven cases were recorded during the study period. The frequency of gravidarum prolapse was 2 cases/1000 deliveries in the department. The patients were young (28-31 years old), multiparous with an average age of 28.57 years and an average parity of four children. They were very young when they first gave birth (16-20 years old). Most of the risk factors described in the literature, namely: Age less than 20 years at first childbirth (6 cases, 85.71%), multiparity (7 cases, 85.71%), history of unassisted birth at home (6 cases, 85.71%), housekeeping and farming profession (100%), undernutrition (5 cases, 71.42%), cough (1 case, 14.28) and constipation (2 cases, 28.57%) were found in the patients. Premature rupture of membranes (2 cases, 28.57%), chorioamnionitis (1 case, 14.28%), premature delivery (1 case, 14.28%), postpartum hemorrhage (1 case, 14.28%) and anemia (1 case,

Bangladesh demonstrates a higher susceptibility to maternal mortality, particularly concerning the incidence of adverse events that occur during pregnancy. Ectopic pregnancy is also a pregnancy-related condition which accounts for 10% of pregnancy-related deaths during the rst trimester. Therefore, in our study, we investigated the factors including genital TB associated with ectopic pregnancy in Bangladesh. All eligible women who are admitted to the indoor department of Obstetrics and Gynecology with diagnosed cases of rupture ectopic pregnancy and who give written informed consent are enrolled consecutively. Data are collected using a pre-tested semi-structured questionnaire, face-to-face interview, clinical examination, and recording of the investigation reports. We collected a total of 226 samples using a purposive sampling procedure from Dhaka Medical College, Bangladesh. Frequency table, factor analysis and clustering methods are used to describe the characteristics that are common to ectopic pregnant patients. Only 3.54% of women had a previous history of ectopic pregnancy and nearly 5% of women tested positive for TB when using Endometrial sampling for TBPCR. Over half of the women are from lower-income families (61.06%) with secondary schooling (69.03%). Around 7.08% and 11.5% of patients were previously affected by TB and contact with TB patients, respectively. 19.47% of women had a previous history of MR, among them 16.74% had spontaneous abortions, 11.06% used the D &C method, and 9.73% utilized induced abortion methods. The mean of white blood cell count, lymphocyte size, and Erythrocyte Sedimentation Rate is 10637.17, 17%, and 25.20, respectively. Age of respondents, occupation, Education, Contraceptive history, Previous history of MR, induced abortion, duration of marital life, type of delivery system, age of last child, and menstrual hygiene showed signi cant association with clusters of ectopic pregnant patients. The healthcare providers' ability to both diagnose and counsel patients at risk for recurrent ectopic pregnancy can be optimized by awareness of the clinical features of this condition It is important to motivate women to seek care from a formal government or private institution and not from home, and women should seek care from a professional provider, and practice modern family planning to reduce the risk of ectopic pregnancy. The ndings from this study can contribute to government collaboration to lead and scaling up the research for the greater impact on reproductive health and can give insight to policymakers to focus on reducing ectopic pregnancy as well as maternal mortality.

We prospectively investigated the maternal serum level of beta- human chorionic gonadotropin (beta-hCG) progesterone (P), estradiol (E2), human placental lactogen (HPL), alfa-fetoprotein (AFP) and cancer antigen 125 (CA 125) during the first trimester of normal and abnormal pregnancies. Serum samples were obtained from 20 women with normal intra-uterine pregnancy (IUPs). Fifteen whose pregnancies were complicated with spontaneous abortion and 31 with surgically and pathologically confirmed ectopic pregnancies (EPs). The mean serum levels of beta-hCG, E2 and P in patients with Eps (9490.55 +/- 3071.2 mIU/ml, 100.1 +/- 22.09 pg/ml, 4.18 +/- 1.19 ng/ml, respectively) were significantly lower than those measured in normal IUPs (73796.8 +/- 15554.7 mIU/ml, 500.15 +/- 98.84 pg/ml, 19.2 +/- 2.8 ng/ml respectively (p < 0.001) and significantly lower than in patients with spontaneous abortion (22524 +/- 6213 mIU/ml, p < 0.05, 339.8 +/- 112.16 pg/ml, p < 0.01, 10.59 +/- 3.03 ng/ml, p...

Chlamydia trachomatiscontrol efforts that enhance detection and treatment of infected women may paradoxically increase susceptibility of the population to infection. Conversely, these surveillance programs lower incidences of adverse sequelae elicited by genital tract infection (e.g., pelvic inflammatory disease and ectopic pregnancy), suggesting enhanced identification and eradication ofC. trachomatissimultaneously reduces pathogen-induced upper genital tract damage and abrogates formation of protective immune responses. In this paper, we detail findings fromC. trachomatisinfection control programs that increase our understanding of chlamydial immunoepidemiology and discuss their implications for prophylactic vaccine design.

Endovaginal sonography has greatly improved the diagnostic evaluation of suspected ectopic pregnan• cy. Some authors ~,•ggest imaging solely by endovaginal technique for diagnosis. We perform both a transabdominal scan for a global view of the pelvic and abdominal contents and an endovaginal sonographic examination for a higher resolution and focused view of the gynecologic structures. We report three patients with negative endovaginal A prompt and correct diagnosis of an ectopic pregnancy is an important clinical issue. Ectopic pregnancy is the leading cause of pregnancy-related death during the first trimester.• The prevalence of ectopic pregnancy has been rising steadily since 1970.1 Early diagnosis can reduce morbidity and mortality and facilitate less invasive therapies that may preserve fertility.

Background: Ectopic pregnancy is a common cause of maternal morbidity and mortality in the 1 st trimester of pregnancy; without timely diagnosis and intervention, ruptured ectopic pregnancy can become a life threatening condition. Objective: This study aims to give baseline indices on the incidence, clinical presentation, risk factors and the management of cases of ectopic pregnancy that presented in Alex Ekwueme Federal University Teaching Hospital, Abakaliki over a 5-year period. Materials and Method: This is a 5-year retrospective study of patients who were diagnosed with ectopic pregnancy between January 1 st 2012 and December 31 st 2016. The statistical analysis was done using SPSS version 22. Result: During the study period, there were 11,932 deliveries while 7725 Gynaecology patients were admitted. Over the same period there were 156 patients diagnosed and managed for ectopic pregnancy, accounting for 1.31% of all deliveries and 2.0% of all Gynaecological admissions. The modal age group was 26 -30 years 68 (43.6%), 122 (78.2%) were married, while 34 (21.7%) were single. Nulliparous were 41 (26.3%) and primiparous were 33 (21.2%). The commonest presenting complaints were lower abdominal pain and amenorrhea, and the commonest identified risk factor was previous pelvic inflammatory disease. Most of the cases were ruptured prior to presentation and partial salpingectomy was the management in all tubal pregnancy while two cases were unruptured and had salpingostomy and another case was abdominal pregnancy and had exploratory laparotomy only. Out of 156 women that presented with ectopic pregnancy, 8 (5.1%) died before surgery could be done due to late presentation. Fifty-seven women presented in a state of shock and 9 (5.8%) of the cases

AMH of 13.39 pmol/l. Patients with breast cancer had significantly lower serum AMH than control group (p¼0.04). Lymphoma patients had serum AMH that appeared lower but was not significantly different from the volunteers (p¼0.67). Baseline characteristics including family history of early menopause, smoking status, BMI and contraception use were not significantly different in both groups. The ovarian reserve, assessed using serum AMH, is significantly lower in newly diagnosed breast cancer patients compared to healthy volunteers pior to chemotherapy. In our precition model, a cancer patient had serum AMH levels of an 6 year older volunteer. CONCLUSION: Reproductive age women with malignancy appear to have lower ovarian reserve than healthy volunteers even before any gonadotoxic treatment is commenced. In view of those findings routine measurement of AMH level before discussing and commencing fertility preservation treatment would be highly recommended even in young women.

Our objective was to determine the expression of the elements of the Lin28/Let-7 system, and related microRNAs (miRNAs), in early stages of human placentation and ectopic pregnancy, as a means to assess the potential role of this molecular hub in the pathogenesis of ectopic gestation. Seventeen patients suffering from tubal ectopic pregnancy (cases) and forty-three women with normal on-going gestation that desired voluntary termination of pregnancy (VTOP; controls) were recruited for the study. Embryonic tissues were subjected to RNA extraction and quantitative PCR analyses for LIN28B, Let-7a, miR-132, miR-145 and mir-323-3p were performed. Our results demonstrate that the expression of LIN28B mRNA was barely detectable in embryonic tissue from early stages of gestation and sharply increased thereafter to plateau between gestational weeks 7-9. In contrast, expression levels of Let-7, mir-132 and mir-145 were high in embryonic tissue from early gestations (#6-weeks) and abruptly declined thereafter, especially for Let-7. Opposite trends were detected for mir-323-3p. Embryonic expression of LIN28B mRNA was higher in early stages (#6-weeks) of ectopic pregnancy than in normal gestation. In contrast, Let-7a expression was significantly lower in early ectopic pregnancies, while miR-132 and miR-145 levels were not altered. Expression of mir-323-3p was also suppressed in ectopic embryonic tissue. We are the first to document reciprocal changes in the expression profiles of the gene encoding the RNA-binding protein, LIN28B, and the related miRNAs, Let-7a, mir-132 and mir-145, in early stages of human placentation. This finding suggests the potential involvement of LIN28B/Let-7 (de)regulated pathways in the pathophysiology of ectopic pregnancy in humans.

AMH of 13.39 pmol/l. Patients with breast cancer had significantly lower serum AMH than control group (p¼0.04). Lymphoma patients had serum AMH that appeared lower but was not significantly different from the volunteers (p¼0.67). Baseline characteristics including family history of early menopause, smoking status, BMI and contraception use were not significantly different in both groups. The ovarian reserve, assessed using serum AMH, is significantly lower in newly diagnosed breast cancer patients compared to healthy volunteers pior to chemotherapy. In our precition model, a cancer patient had serum AMH levels of an 6 year older volunteer. CONCLUSION: Reproductive age women with malignancy appear to have lower ovarian reserve than healthy volunteers even before any gonadotoxic treatment is commenced. In view of those findings routine measurement of AMH level before discussing and commencing fertility preservation treatment would be highly recommended even in young women.

Endoscopic surgery of ectopic pregnancy is actually the gold standard for the management of fallopian tubal diseases. A survey was conducted to evaluate fertility in patients who underwent endoscopic management for ectopic pregnancy. A retrospective study was conducted at the department of general and endoscopic surgery of the Point "G" teaching hospital, in Bamako, Mali, from January 1st 2007 to December 31, 2016. Forty-eight (48) patients who underwent endoscopic management of tubal ectopic pregnancy and who have been followed up for fertility were included in this study. Statistical tests used were X2 or Fisher test and their confident interval, p <1 % has been considered as statistically significant. The therapeutic score of Pouly was less than 4 in 25.0% (n = 12). The return to fertility was observed among 48.0% of patients (n = 23). The chance of conception was less than 80.0% after the fourth postoperative year (p=0.001). The outcome of pregnancies has been seven...

Ovarian pregnancy is a rare form of ectopic pregnancy. Its incidence is 0.5-1% of all ectopic gestations or 1 in 7000 to 40000 live births. The diagnosis is intricate and based on surgical and histopathological observations. In our institute in last 10 years, we have seen a single confirmed case out of 189 ectopic pregnancies. It was a spontaneous pregnancy with no history of contraception failure and diagnosed as tubal ectopic by ultrasound imaging. Laparotomy findings and histopathology confirmed it to be an Ovarian Pregnancy.

Omental pregnancy is a very rare form of ectopic pregnancy. Here we presented a case of primary omental pregnancy diagnosed at surgical exploration. A 28 year old woman submitted with severe abdominal pain, without any delay of menstruation. History of the patient revealed no use of contraceptive method. There was no gestational sac in the endometrial cavity and no tubal ring in the adnexa, but free peritoneal fluid in the pouch of Douglas was detected at ultrasonography. Laparotomy was done according to pre-operative diagnosis of ruptured tubal pregnancy. Bilateral tubes and ovaries were intact; omental pregnancy was detected and partial omentectomy was performed. Although 16 cases of omental pregnancy (mostly secondary) were reported in the literature, herein we describe a primary omental pregnancy without adnexial involvement.

Caesarean scar pregnancy is one of the rarest forms of ectopic pregnancy. Transvaginal ultrasound and color flow Doppler provides a high diagnostic accuracy. A delay in diagnosis and treatment can lead to uterine rupture, major hemorrhage, hysterectomy and serious maternal morbidity and mortality. Early diagnosis can offer treatment options of avoiding uterine rupture and hemorrhage, thus preserving the uterus and future fertility. Primary health care provider should know about this rare entity, because if diagnosed timely, and referral to specialized centre is done without delay will definitely save maternal morbidity and mortality. Management plan should be individualized. Termination of pregnancy is the treatment of choice in the first trimester. Expectant treatment has a poor prognosis because of risk of rupture. In this case report we aim to discuss the associated diagnostic dilemma, most appropriate methods of diagnosis and management, with their implications in clinical pract...

Ovarian pregnancy is one of the rarest varieties of ectopic gestation. Intrauterine devices have evolved as probable risk factor. It is often difficult to distinguish it from tubal ectopic clinically. Diagnosis is generally retrospective during surgery with confirmation by histopathological examination. Hereby we are presenting a case of primary ovarian pregnancy in a multiparous female of reproductive age group using cu-t as contraception presented with acute abdomen managed by conservative surgery and diagnosis confirmed by histopathological examination.

Primary ovarian pregnancy is a rare type of ectopic pregnancy, particularly following in vitro fertilization. Although there have been a few reported cases of primary ovarian pregnancy following in vitro fertilization embryo transfer, we believe this is the first report involving donor embryo transfer. A high index of clinical suspicion, abnormal human chorionic gonadotropin levels, and early ultrasound evaluation may aid timely diagnosis and appropriate management. This report provides a reminder to practitioners to advise patients undergoing embryo transfer of the primary ovarian pregnancy risk. Information is provided herein regarding the diagnosis and management of primary ovarian pregnancy in women treated with in vitro fertilization. We review the criteria for early diagnosis and treatment options.

We heartily agree with the authors of "Unusual Ectopic Pregnancies: Sonographic Findings and Implications for Management" 1 for their recognition of the important and consequential clinical distinction between "cornual" and "interstitial" ectopic pregnancies, even if they are so often used interchangeably. In fact, that also follows a prior underscoring of this distinction by Fylstra. 2 However, we wish to add yet another important (and easily missed) type of unusual ectopic pregnancy: namely, an intramural ectopic pregnancy (found within the myometrial wall), which we recently described. Clearly, sonography will often find such occurrences of these clinical entities that cannot otherwise be diagnosed.

Intramural pregnancy is a rare form of ectopic pregnancy, and little is known about its etiology, prevalence and natural history. There is no consensus regarding the ultrasound criteria necessary for the diagnosis of intramural pregnancy, and management strategies vary depending on the severity of clinical presentation, exact location of the pregnancy, viability and gestational age at diagnosis. We present four cases of intramural pregnancy diagnosed in a single institution that illustrate variability in their clinical presentation and difficulty in reaching the correct diagnosis. We also propose a set of ultrasound criteria to facilitate differential diagnosis between intramural and other types of uterine ectopic pregnancy.

Background: Surveillance of ectopic pregnancy (EP) using electronic databases is important. To our knowledge, no published study has assessed the validity of EP case ascertainment using electronic health records. We aimed to assess the validity of an enhanced version of a previously validated algorithm, which used a combination of encounters with EP-related diagnostic/procedure codes and methotrexate injections. Methods: Medical records of 500 women aged 15-44 years with membership at Kaiser Permanente Southern and Northern California between 2009 and 2018 and a potential EP were randomly selected for chart review, and true cases were identified. The enhanced algorithm included diagnostic/procedure codes from the International Classification of Diseases, Tenth Revision, used telephone appointment visits, and excluded cases with only abdominal EP diagnosis codes. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall performance (Youden index and F-score) of the algorithm were evaluated and compared to the validated algorithm. Results: There were 334 true positive and 166 true negative EP cases with available records. True positive and true negative EP cases did not differ significantly according to maternal age, race/ethnicity, and smoking status. EP cases with only one encounter and non-tubal EPs were more likely to be misclassified. The sensitivity, specificity, PPV, and NPV of the enhanced algorithm for EP were 97.6%, 84.9%, 92.9%, and 94.6%, respectively. The Youden index and F-score were 82.5% and 95.2%, respectively. The sensitivity and NPV were lower for the previously published algorithm at 94.3% and 88.1%, respectively. The sensitivity of surgical procedure codes from electronic chart abstraction to correctly identify surgical management was 91.9%. The overall accuracy, defined as the percentage of EP cases with correct management (surgical, medical, and unclassified) identified by electronic chart abstraction, was 92.3%. The performance of the enhanced algorithm for EP case ascertainment in integrated health care databases is adequate to allow for use in future epidemiological studies. Use of this algorithm will likely result in better capture of true EP cases than the previously validated algorithm.

A molaterhesség a terhességi trophoblastbetegségek közé sorolt, rendkívül ritka kórkép. A kórkép patogenezise egyedülálló, hiszen az anyai daganat eredete maga a terhességi szövet. Előfordulását tekintve főleg a reproduktív korú nőket érinti. Esetbemutatásunkban egy 53 éves nőbeteg postmenopausalis vérzési rendellenességet okozó panaszainak hátterében igazolódott molaterhesség. A molaterhesség fokozott kockázattal járó veszélyállapot, mely esetén a mihamarabbi befejezés alapját a megfelelő diagnosztika adja. Kezdeti tünetei megtévesztőek lehetnek, ectopiás terhességet vagy inkomplett abortuszt, anovulációs vérzési rendellenességet utánozhatnak. Esetismertetésünk célja, hogy felhívja a figyelmet a molaterhesség atipikus megjelenésére; postmenopausalis nőbetegünk kapcsán áttekintjük a molaterhesség kezelésének alapelveit, és bemutatjuk egy sikeresen kezelt eset diagnosztikus és terápiás lépéseit.

A 23-year-old woman, gravida 2 para 0, presented at 8 weeks gestation with a spontaneously conceived triplet cornual ectopic pregnancy. She was at high risk of ectopic pregnancy as she had been previously treated for pelvic inflammatory disease and had also undergone laparoscopic salpingostomy for right-sided ectopic pregnancy. She was clinically stable and her abdomen was soft and non-tender. The diagnosis was made on transvaginal ultrasound scan and this was confirmed on the three-dimensional scan. She was counselled about her treatment options and subsequently underwent laparoscopic cornual resection using the modified endoloop method. The estimated blood loss was 20 ml intraoperatively and the patient recovered well. She subsequently conceived spontaneously with an intrauterine pregnancy and underwent lower segment caesarean section at 37 weeks in view of previous laparoscopic cornual resection. Intraoperatively, the right cornua appeared normal and there was no sign of thinning.

Introduction: Ovarian reserve is a major prognosic factor for Medical Assisted Procreation. Tubal surgery, realised close to mesosalpinx and ovarian vascularization, could impare ovarian function. However, salpingectomy is currently used to treat ectopic pregnancies or hydrosalpinx before IVF attempt. Disponible studies on this subject are unclear. The aim of this study is to evaluate the impact of salpingectomy for ectopic pregnancy on the ovarian response during IVF attempt. Material and methods: It was a single center comparative study. Included patients were the one receiving oocyte puncture for IVF attempt, with a history of unilateral tubal surgery: salpingectomy for ectopic pregnancy. We conducted a case-control study, comparing the sonographic parameters of the surgery ovary (case) to those of the safe ovary (control) during the first IVF attempt after salpingectomy. The ovarian sonographic response was evaluated according to the follicular antral count on day 3 and the sonographic follicular count on trigger day. Results: 55 patients were included. There was no significant difference in the number of recruited follicles on the operated side versus control side (p = 0.85 for >14 mm follicles, p = 0,46 for 10 to 14 mm, p = 0,52 for total amount of recruited follicles). There was no significant difference for the follicular antral count neither (p = 0.79). Discussion: In our population, there was no significant difference in the sonographic ovarian response to IVF stimulation between the ovary on the operated side and the control ovary among patients treated by unilateral salpingectomy for ectopic pregnancy.

Cervical ectopic pregnancy (CEP) is a rare form of ectopic pregnancy. Cases diagnosed early in pregnancy can be managed medically, but more advanced pregnancies often require hysterectomy. Uterine artery embolization (UAE) is a novel approach to CEP for those who wish to preserve fertility. Here we present the case of a 44-year-old female with a 2-week history of vaginal bleeding and abdominal pain who was diagnosed with CEP and successfully treated with bilateral UAE (BUAE) in combination with methotrexate. A 44-year-old female presented to the emergency department with a 2-week history of vaginal bleeding. Serum beta-hCG was 71,964 mIU/ml. The transvaginal ultrasound confirmed CEP. The patient was referred to obstetrics and interventional radiology and ultimately treated with BUAE and methotrexate. Symptoms resolved quickly and she was discharged after 3 days.

Cases of ectopic pregnancy (EP) and associated fetal mumification in bitches have been rarely reported. In this case report, it was aimed to present a case of secondary abdominal EP diagnosed in a 3‐year‐old bitch. Abdominal EP was incidentally diagnosed by radiographic examination of the bitch, which had a traffic accident, for likely possible fractures in the body. This case, which can be classified as secondary abdominal EP, was found to be compatible with the literature. The ectopic fetuses were removed from the body by surgical method, and the bitch was fully recovered.

Background:  Primary abdominal pregnancies are potentially life‐threatening, particularly without an accurate preoperative diagnosis.Case:  A 41‐year‐old woman presented to the emergency room with 2 days‐lasting left upper quadrant abdominal pain, irradiated to the left shoulder. An urine β‐human chorionic gonadotropin test was positive. Transvaginal sonography raised a suspicion of ectopic pregnancy. The patient was then submitted to abdominal laparoscopy that revealed no sign of active bleeding or ectopic pregnancy. Because of worsening of abdominal pain and progressive anaemia, the patient underwent abdominal ultrasound and multislice computerized tomography scan (TC) that showed the presence of a mass at the superior splenic pole with haemoperitoneum. The patient was taken to the operating room and submitted to a laparoscopic total splenectomy. The post‐operative course was uneventful, and the patient was discharged 8 days after intervention.Conclusion:  Abdominal pregnancy shou...

We report a case of a woman presenting in a state of shock with classic symptoms of ruptured ectopic pregnancy. She had a history of tubal ligation done three years back. Exploratory laparotomy was done, and a diagnosis of ruptured ectopic ovarian pregnancy was made.

Ectopic Pregnancy -Modern Diagnosis and Management 46 2. Methods Medline searches (up to March 2011) were performed using various combinations of terms: ectopic pregnancy, heterotopic pregnancy, In Vitro Fertilization, Intrauterine Insemination, pelvic inflammatory disease, Chlamydia trachomatis, heterotopic pregnancy, cervical pregnancy, cost-effectiveness. The search was complemented with perusal of the bibliographies of retrieved papers and review articles. We included studies that evaluated the presence of an ectopic pregnancy after IVF in case reports, although in other chapters information was obtained from studies in the general population. Number of tested samples was not an exclusion criterion. Only studies including human subjects were included. For each study, information was obtained on authors, journal, year of publication, country and years of study enrollment, study design and study target, number of tested samples, tissue and disease tested, searched molecules and pathways involved, clinical outcome and whether biopsy was performed with the site. Data extraction was performed independently by two investigators, and conflicts were resolved after discussion. Frequencies of all important parameters were performed. Statistical analyses were performed in using the Statistical Package for Social Sciences (SPSS) version 12.0 (SPSS, Chicago, IL, USA). No sponsor was involved in the study design, report writing, or paper submission. A total of 42 abstracts were retrieved and further screened. Only studies that performed basic investigations were included in this part. Out of 20 included studies, 3 were performed in USA (15%), 2 in Germany (10%), Israel, Sweden and UK, and from one (5%) in Brazil,

PURPOSE Worldwide, more than 80% of people diagnosed with cancer will require surgery during their disease course, but only 5% to 20% of low- and middle-income countries have access to safe, affordable, and timely surgery. Developing surgical oncology skills requires significant time and mentoring. Virtual reality (VR) simulators can reduce the time required to master surgical procedures but are prohibitively expensive. We sought to determine whether a VR simulator using low-cost computer gaming equipment could train novice surgeons in Africa to perform a virtual radical abdominal (open) hysterectomy (RAH). METHODS Our RAH VR simulator used the Oculus Rift (Oculus VR, Menlo Park, CA), a VR headset with hand controllers that costs less than $1,500. Surgical novices learned to perform five key steps of a virtual RAH. We measured and identified predictors of movement and time efficiency for the simulation. RESULTS Ten novice surgeons in Lusaka, Zambia, enrolled in the study. Movement a...

Ectopic pregnancy is a common problem and there is a potential threat for maternal morbidity and mortality. Ipsilateral ectopic pregnancy after partial or total salpingectomy is a rare occurrence with less than a dozen cases reported in the literature in the last 20 years. We are presenting the case of a 20 year old Para 0+1 young female who presented with colicky pain abdomen, sever pallor, hypotension, and tachycardia. She had a previous right sided ruptured ectopic pregnancy and right salpingectomy done six month back. On laparotomy, there was right sided ruptured ectopic pregnancy from previous salpingectomy site. This case emphasizes that total salpingectomy too carries the potential for the recurrence of ectopic pregnancy on the same side hence the need for clinician awareness and vigilance.

Spontaneous heterotopic pregnancy is a rare clinical condition in which intrauterine and extra uterine pregnancies occur at the same time. It can be a life threatening condition and can be easily missed with the diagnosis being overlooked. We are presenting the case of a 24 year old Para 2+1 young female who presented with pain abdomen and vomiting after an induced abortion. Ultrasonography revealed intrauterine embryo of 7-8 weeks without cardiac activity suggesting missed abortion and, with right adenexal mass about (7 x 6) cm adhered to the uterus with free fluid in pouch of Douglas. The patient presented acutely with a ruptured tubal pregnancy and this was managed by laparotomy. The ectopic pregnancy was not suspected at her initial presentation. A high index of suspicion is needed in women with risk factors for an ectopic pregnancy and in low risk women who have free fluid with or without an adnexal mass with an intrauterine gestation.

La grossesse abdominale (GA) se définit comme la nidation et le développement de l'oeuf fécondé dans la cavité péritonéale. Elle reste une variété rare de grossesse ectopique, dont la découverte peut être fortuite simulant une urgence chirurgicale. Nous rapportons un cas rare d'une occlusion intestinale aiguë fébrile révélant une grossesse abdominale chez une patiente âgée de 27ans sans antécédents pathologiques particuliers, reçue pour la prise en charge d'un syndrome occlusif évoluant depuis une semaine. L'examen physique retrouvait un abdomen distendu luisant, sensible dans son ensemble et météorisé. Le bilan biologique montrait des globules blancs à 20300, le taux d'hémoglobine à 7,2g/dL. L'exploration chirurgicale avait objectivé un hémopéritoine de 2000ml, une masse retro-utérine encapsulée, adhérent fortement au méso-sigmoïde et au sigmoïde responsable d'une sténose du colon descendant. Il a été réalisé une exérèse monobloc dont l'effraction montrait un placenta accolé au méso-sigmoïde relié au foetus, une annexectomie droite, une colostomie.

Ectopic pregnancies (EPs) are pregnancies that occur outside of the endometrial cavity; 97% occur in the fallopian tube. These cases are characterized by a variety of clinical presentations, which may include dark or mixed red bleeding, abdominal pain, and nonspecific gastrointestinal symptoms, which, when combined with a positive hCG, is classic of a suspected EP. If left untreated, this can eventually lead to serious maternal complications. The abdominal mesentery, a rare implantation site, poses a unique challenge for clinicians as the clinical presentation and management can differ considerably from other fallopian tube or extratubal sites. This is a report of a rare case of abdominal ectopic pregnancy (AEP), which also serves as a platform for future discussion, as management of such cases is not part of the usual clinical conversations. This case report increases the surgical and medical review teams' awareness of rare abdominal ectopic pregnancy cases and their need to be recognized early and managed.

Intramural ectopic pregnancy: a case report A rare condition of ectopic pregnancy, with potential severe consequences if not diagnosed and treated early, is the intramural one. Here, we report the case of a woman with intramural pregnancy. The first suspicion of the presence of such a condition emerged while doing a transvaginal sonography, after which it was decided to excise the mass in order to confirm its nature histologically. The gestational sac was then excised via laparotomy and the following histological examination proved our hypothesis of having come across an intramural pregnancy.

A pilot study was designed to examine whether the outcome of embryo transfer in women with a hydrosalpinx might be improved by surgical drainage of the hydrosalpinx at the time of oocyte collection for in-vitro fertilization treatment. A comparative, controlled but retrospective analysis of the results was performed of all women with infective tubal damage aged <40 years old, who had ovulatory cycles, a normal uterus and a partner with normal spermatozoa. A standardized treatment regimen was used. A maximum of three embryos were transferred. Hydrosalpinx was defined by prior hysterosalpingography and/or laparoscopy with transcervical dye injection. A total of 237 embryo transfer cycles in women with hydrosalpinges (tubal distension not visible in 151, visible but not drained in 30 and drained in 56) were compared with 705 embryo transfer cycles in women with tubal disease but no hydrosalpinx. Results were analysed in the first three cycles but also separately in the first cycle to check for bias. Success rates were higher in the first cycle, but did not significantly influence overall differences. Implantation rates were significantly reduced overall in the hydrosalpinx group (8.0 versus 13.2% for controls; P < 0.001), being 8.3% (P < 0.01) in the subgroup without evident tubal distension and 7.5% (not significant) in the drained hydrosalpinx group. This study shows that tubal damage with distal occlusion is associated with a marked reduction in embryo implantation, even in the absence of obvious fluid distension. Surgical drainage of distended hydrosalpinges appears to offer no benefit.

Ectopic pregnancy is the localization of the embryo outside of the uterus, most often it occurs in the fallopian tube. The ovarian form of ectopic pregnancy is a rare form of pregnancy and its frequency is 0.3-3%. Diagnosis of ovarian pregnancy is quite difficult and can be diagnosed only by morphological examination after surgery. At present, methotrexate is considered as an alternative method of surgical treatment of ectopic pregnancy, although most of the treatment methods are surgical (laparotomy, laparoscopic). In our case we present a 35-year-old woman who underwent surgical treatment at TSMU First University Clinic. Before the surgical intervention, inpatient studies and diagnostic methods established the probable diagnosis: pregnancy of the left fallopian tube with the type of abortion, hemoperitoneum, after which due to the instability of hemodynamic parameters, laparotomy with salpingectomy and ovarian resection have been done. The diagnosis of ovarian pregnancy was made only as a result of the morphological study of the preparation, which once again indicates the implementation of the perfection of diagnostic methods in the case of the mentioned pathology.

Background: Ectopic pregnancy, defined as the implantation of a fertilized ovum outside the uterine cavity, is a potentially life-threatening condition and a leading cause of first-trimester maternal mortality. The clinical spectrum is wide, ranging from asymptomatic cases to severe hemodynamic compromise, and remains underexplored in local settings. This study was designed to systematically assess the frequency of common signs and symptoms of ectopic pregnancy in a selected population, aiming to enhance early detection and improve outcomes.

Objective: To evaluate the frequency of common clinical signs and symptoms of ectopic pregnancy and their demographic correlations in a population presenting to a tertiary care hospital.

Methods: This descriptive cross-sectional study was conducted at the Department of Obstetrics and Gynecology, Prime Teaching Hospital, Peshawar, from 1st April 2022 to 30th September 2022. Women aged 15–45 years diagnosed with ectopic pregnancy were included, while cases of miscarriage, molar pregnancy, and other pelvic pathologies were excluded. Ectopic pregnancy was confirmed via serum beta-human chorionic gonadotropin (>10 IU/mL) and transvaginal ultrasound. Data on demographics, clinical symptoms (amenorrhea, abdominal pain, vaginal bleeding), and clinical signs (abdominal tenderness, cervical excitation pain, mass in the Pouch of Douglas) were collected and analyzed using SPSS version 23. Frequencies and percentages were reported for qualitative variables, and means ± standard deviations for quantitative variables.

Results: The study included 80 participants with a mean age of 30.01 ± 5.518 years. Most patients (52.5%) were aged ≤30 years, with 57.5% residing in rural areas. The mean BMI was 23.988 ± 2.602 kg/m², and the mean parity was 3.15 ± 1.662. The most frequently reported symptom was amenorrhea (87.5%), followed by abdominal pain (81.3%) and vaginal bleeding (68.8%). Among clinical signs, abdominal tenderness was observed in 77.5%, cervical excitation pain in 62.5%, and a mass in the Pouch of Douglas in 31.3%.

Conclusion: This study demonstrated that ectopic pregnancy most commonly presents with amenorrhea and abdominal pain, while abdominal tenderness and cervical excitation pain are the most prevalent clinical signs. Early recognition of these features is essential for timely diagnosis and management, particularly in resource-limited settings.

Background: Ectopic tubal pregnancy (ETP) is a dreadful situation for both the patient and the doctor. Prevalence of ETP is increasing because of availability of convenient and modern modalities for the diagnosis of ectopic pregnancy. Patients are aware of the condition and many lives can be saved when diagnosed and managed at an early stage; still almost 10% of maternal deaths are due to ETP. The etiology of ETP remains unknown in almost half of the cases and hence the risk of recurrence remains high. The present study has been conducted to screen patients with history of tubal ectopic pregnancyand to determine the role of tubercular infestation of the eutopicendometrium as an important etiological factor in ‘unexplained’ ectopic. Results: This retrospective analysis was conducted at Calcutta Fertility Mission in Kolkata, India, from January 2010 to December 2018. Of 282 patients with history of ETP,who were selected, 109 were in Group A, 72 of them in Group B and 101 in Group C. T...

The following report describes the case of an ectopic pregnancy with contralateral corpus luteum after spontaneous conception. The patient was a 33-yearold female (gravida 3, segmentary C sections 3), with positive pregnancy test, and an Intrauterine Device (IUD). The patient was asymptomatic. At vaginal ultrasound, we observed an anteverted uterus of normal shape and size, a 20 x 12 mm intramural myoma and an irregular endometrial thickness of 16.5 mm, with no intrauterine sac. An ectopic pregnancy in the left Fallopian tube and a contralateral corpus luteum were detected, possibly as consequence of ovum pick up through the opposite tube (oocyte transmigration). Further laparoscopic and histopathologic studies confirmed our findings, and the ectopic pregnancy was successfully removed. In conclusion, oocyte transmigration is a common event and should be account when we wish to provide medical advice to patients with a single Fallopian tube trying to conceive. There are real chances for a patient to become pregnant even when only a single tube is present.

Caesarean scar ectopic pregnancy (CSEP) is considered an extremely rare entity, but life threatening, however, with the increase in C/S rates it is becoming a more common finding. To explore the possibility of utilizing ultrasound guided transvaginal aspiration and injection of 50 mg methotrexate followed by mechanical disruption as a promising primary treatment approach for CSEP. In a series of 11 cases at Tawam Hospital (UAE) diagnosed with CSEP, an ultrasound guided transvaginal aspiration of the amniotic fluid and gestational tissue, followed by injection of 50 mg Methotrexate into the remaining chorionic sac and then disruption of the sac with the needle. B-hCG level were measured on: day of procedure, day 1 or 2 after the procedure and then weekly. Final resolution was considered when B-hCG returned to &lt; 5mIU/mL. All cases presented and diagnosed in the 1st trimester, mean gestational age at diagnosis was 6.6 weeks (range 5-10). The presenting symptoms were mainly lower abd...

Introduction: Ectopic pregnancy is defined as the implantation of a fertilized ovum outside the endometrial cavity. The most common site is the fallopian tube. The incidence of ectopic pregnancy is 1-2% of all pregnancies. Methotrexate is the most commonly used drug for the medical management of ectopic pregnancy. It is a folic acid antagonist that prevents the growth of rapidly dividing cells including trophoblasts and fetal cells by interfering with DNA synthesis. Aim and objective: To study initial and day 4 β-hCG levels as predictors of outcome of single-dose methotrexate therapy in the medical management of ectopic pregnancy. Materials and methods: Thirty patients after confirmed diagnoses of tubal ectopic pregnancy were enrolled in the study. β-hCG was estimated using a sequential two-step immunoenzymatic (sandwich) assay. Results: Out of 30 women who received inj MTX on day 0, 19 (63.3%) women were treated successfully with a single dose of methotrexate (group I), 8 (26.6%) women required a second dose of methotrexate, and 3 (10%) women required surgery. Women who required a second dose or surgery were treatment failure (group II) (36.6%) with a single-dose methotrexate regimen. The mean initial β-hCG β-hCG level was 2294.92 ± 1162.93 mIU/mL in group I and 3831.18 ± 1066.83 mIU/mL in group II. The difference of mean was statistically significant between group I and group II on day 0, day 4, and day 7. Results in the present study favor therapeutic intervention with a second dose of methotrexate on day 4 against day 7 as in the current protocol in women with a rising trend of β-hCG between day 0 and day 4. However, due to the small sample size, further studies are needed to validate these findings.

Hemoperitoneum with an adnexal mass in reproductive age group women points to a life-threatening differential diagnosis of a ruptured ectopic pregnancy. Rarely isolated tubal pathology such tubal torsion with hematosalpinx may mimic such a picture and the diagnosis is difficult in hemodynamically compromised patients. This is a case report of isolated hematosalpinx without torsion in early pregnancy which was histologically confirmed following surgical management.

Recibido el 1 de diciembre de 2010; aceptado el 18 de enero de 2011 Accesible en lı ´nea el 14 de abril de 2011 Resumen Se presenta el caso de una gestante a la que se le detecto ´un embarazo ecto ´pico cervical en la sexta semana de gestacio ´n. La rapidez del diagno ´stico y el buen estado clı ´nico de la paciente permitieron la instauracio ´n de tratamiento conservador, siendo preciso el uso de dos dosis de metotrexato siste ´mico para que disminuyeran las cifras de la beta gonadotropina corio ´nica humana, y posteriormente el empleo de metotrexato intrasacular, debido a la persistencia de la imagen ecogra ´fica. El tratamiento me ´dico con metotrexato siste ´mico y/o intrasacular es una medida altamente eficaz para conseguir una escasa morbilidad, reservando otras te ´cnicas ma ´s agresivas para aquellos casos que no respondan a este tratamiento o si aparecen complicaciones.

The evidence base supporting the National Chlamydia Screening Programme, initiated in 2003, has been questioned repeatedly, with little consensus on modelling assumptions, parameter values or evidence sources to be used in cost-effectiveness analyses. The purpose of this project was to assemble all available evidence on the prevalence and incidence of Chlamydia trachomatis (CT) in the UK and its sequelae, pelvic inflammatory disease (PID), ectopic pregnancy (EP) and tubal factor infertility (TFI) to review the evidence base in its entirety, assess its consistency and, if possible, arrive at a coherent set of estimates consistent with all the evidence. Evidence was identified using &#39;high-yield&#39; strategies. Bayesian Multi-Parameter Evidence Synthesis models were constructed for separate subparts of the clinical and population epidemiology of CT. Where possible, different types of data sources were statistically combined to derive coherent estimates. Where evidence was inconsis...