A Ruptured Spontaneous Heterotopic Tubal Pregnancy With a Viable Intrauterine Pregnancy (original) (raw)
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Review of ectopic pregnancy at tertiary care center: 2 years analysis
International journal of reproduction, contraception, obstetrics and gynecology, 2020
An ectopic, or extra-uterine pregnancy is defined as a pregnancy implanted outside of the uterine cavity with over 98% implanting in the fallopian tube. The most common site of ectopic pregnancy is fallopian tube followed by ovary and abdomen. Some ectopic pregnancies resolve spontaneously, but others continue to grow and lead to rupture of the tube. It accounts for 2% of first trimester pregnancies of them 98% are in various part of the fallopian tube and out of these, 70% are in the ampullary region, 12% isthmic, 11.1% fimbrial, 3.2% ovarian, 2.4% interstitial, and 1.3% in the abdominal cavity. It is a catastrophic and life threatening condition and one of the commonest acute abdominal emergencies.
AORN Journal, 1991
ctopic pregnancy is an implantation of a fertilized egg or blastocyst outside the E uterine cavity. This occurs most commonly in the fallopian tubes. Since first described in the tenth century, ectopic pregnancy has been treated with starvation, ergot, and eventually surgical intervention. Recently, ectopic pregnancy has been treated nonoperatively and experimentally with methotrexate, an anticancer agent effective against trophoblastic and placental tissue. History perative therapy was pioneered by an English surgeon, Lawson Tait, MD, in 0 1883.' Consequently, the maternal mortality rate of ectopic pregnancy fell to the current level of less than 1%. Despite the availability of modem surgical intervention and blood transfusion, ectopic pregnancy is still a leading cause of maternal mortality.2 Physician misdiagnosis and delay by patients in seeking treatment cause many women to die of internal hemorrhage. The worldwide incidence of ectopic gestation varies significantly, ranging from 1 in 20 to 1 in 250 deliveries.' During the past several decades, the incidence in the United States has tripled." Researchers believe this marked rise results from tuba1 damage from salpingitis, the incidence of which also has increased. Despite this increased incidence of ectopic gestation,
Ruptured Heterotopic Pregnancy: Case Report
Journal of Surgery and Medicine
Ectopic pregnancy is defined as a condition in which the gestational sac is located outside the uterine cavity. And also Heterotopic pregnancy is the addition of at least one extra-uterine pregnancy to normal pregnancy. This is more common in patients with assisted reproductive techniques and ovulation induction. Today, with the increasing use of assisted reproductive techniques, the importance of primary care services has become increasingly important and must be kept in mind. We report a case of intrauterine normal pregnancy was accompanied by ruptured tubal pregnancy.
A rare case of spontaneous heterotopic pregnancy presented as ruptured ectopic pregnancy
International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2016
Heterotopic gestation, although common with assisted reproductive techniques, is very rare in natural conception. A high index of suspicion can help in timely diagnosis and appropriate intervention. We report a case of 30 year old patient who was treated for a heterotopic pregnancy. She had taken treatment for genital tuberculosis in the past. The patient presented acutely with a ruptured tubal pregnancy in shock and this was managed by emergency laparotomy. 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.
2014
Spontaneous heterotopic pregnancy causing tubal rupture in a patient with intrauterine device in-situ spontaneous heterotopic pregnancy (HP) is a rare but life threatening condition. A case of 27 years old patient who admitted to our emergency gynecology clinic for acute abdominal pain is presented. The transvaginal ultrasound revealed two embryos with cardiac activity; one intrauterine (8 week and 3 day) , and the other one in the left adnexa (7 week and 3 day) and an intrauterine device (IUD) in situ. The patient had left salpingectomy with laparotomy and after the fifth hour of operation she had spontaneous abortion of intrauterine pregnancy. We reported a case of heterotopic pregnancy and relation with IUD and a brief review of the literature.
Ectopic pregnancy in uncommon implantation sites
The Egyptian Journal of Radiology and Nuclear Medicine, 2013
The majority of ectopic pregnancies are located within the fallopian tube. Nevertheless, pregnancies have been reported to implant in the cervix, ovary, interstitial tubal segment, and at various intra-abdominal sites. The diagnosis and treatment of these unusual implantation sites presents a challenge for clinical as well as radiological diagnosis and there is a tendency to overlook its possibility. In this study, we attempt to summarize the current data regarding diagnosis and optimal treatment of these unusual ectopic pregnancies from our experience with six unusual types of ectopic pregnancies from the Women Hospital, Doha, Qatar.
Management of Undisturbed Ectopic Pregnancy: A comprehensive Review
2021
Ectopic pregnancy occurs when a fertilized ovum implants outside of the uterine cavity. In the United States, the estimated prevalence of ectopic pregnancy is 1% to 2%, and ruptured ectopic pregnancy accounts for 2.7% of pregnancy-related deaths. Risk factors include a history of pelvic inflammatory disease, cigarette smoking, fallopian tube surgery, previous ectopic pregnancy, and infertility. Ectopic pregnancy should be considered in any patient presenting early in pregnancy with vaginal bleeding or lower abdominal pain in whom intrauterine pregnancy has not yet been established. The definitive diagnosis of ectopic pregnancy can be made with ultrasound visualization of a yolk sac and/or embryo in the adnexa. However, most ectopic pregnancies do not reach this stage. More often, patient symptoms combined with serial ultrasonography and trends in beta human chorionic gonadotropin levels are used to make the diagnosis. Pregnancy of unknown location refers to a transient state in whic...
Ectopic pregnancies with unusual location and an angular pregnancy: Report of eight cases
Wiener klinische Wochenschrift, 2012
Studie: Durch die vermehrte Anwendung von assistierter Reproduktionstechnologie kommt es auch zu einer Zunahme von ektopen Schwangerschaften mit untypischen Lokalisationen und der damit vergesellschafteten erhöhten mütterlichen Morbidität und Mortalität. Sieben Fallberichte von ektopen Schwangerschaften mit seltenen Lokalisationen und eine anguläre Schwangerschaft werden vorgestellt, die diagnostischen und therapeutischen Optionen diskutiert sowie eine kurze Literaturübersicht inklusive genauer Nomenklatur wird präsentiert. Untersuchungen und Methoden: Fallberichtserie von sieben ektopen Schwangerschaften in untypischer Lokalisation, nach künstlicher Befruchtung oder spontan entstanden (Sectionarbenschwangerschaft, Bauchhöhlenschwangerschaft im Mesoappendix) sowie eine anguläre Schwangerschaft. Alle Patienten wurden in den letzen acht Jahren an unserer Klinik behandelt. Eine retrospektive Analyse. Ergebnisse: Interstitielle Schwangerschaft, cornuale Schwangerschaft, Sectionarbenschwangerschaft, Bauchhöhlenschwangerschaft im Omentum majus, heterotopezervikale Schwangerschaft, Bauchhöhlenschwangerschaft im Mesoappendix, anguläre Schwangerschaft. Alle Patienten wurden operativ therapiert. Schlussfolgerung: Die Diagnose von ektopen Schwangerschaften, besonders derer in unüblichen Lokalisationen, ist schwierig und wird verkompliziert durch die embryonale Einnistung in unmittelbarer Nähe des Ostium uterinum tubae. Hier besonders hinsichtlich der genauen Beurteilung einer intra-oder extrauterinen Lokalisation. Hohe Komplikationsraten und verschiedene Behandlungsmöglichkeiten erschweren die Situation. Summary. Objective: Th e increased use of assisted reproduction techniques has been accompanied by an increase in ectopic pregnancies with unusual location being associated with signifi cant maternal morbidity and mortality. Th is article reports on seven cases of ectopic pregnancies with unusual location and an angular pregnancy. Diagnostic and therapeutic strategies are discussed and a brief review of literature is presented. Study design: Case series of seven cases with ectopic pregnancy in unusual location, following assisted reproductive technique or conceived spontaneously (cesarean scar pregnancy and early abdominal pregnancy in mesoappendix) and an angular pregnancy, having presented at our hospital during the last eight years. Retrospective analyses. Results: Interstitial pregnancy, cornual pregnancy, cesarean scar pregnancy, early abdominal pregnancy in omentum majus, heterotopic (cervical) pregnancy, early abdominal pregnancy in mesoappendix, angular pregnancy. All patients were surgically treated. Conclusion: Diagnosis of ectopic pregnancy with unusual location may be diffi cult, and diff erentiation of intact intrauterine or extrauterine pregnancy with adequate consideration of the area of uterine ostium of the fallopian tube may be delicate. Moreover, varying treatment strategies and high rates of complications aggravate the situation.
Management of Ectopic Pregnancy In Unusual Location: Five-Year Experience In A Single Center
Journal of Clinical and Experimental Investigations
The aim of this study is to evaluate the diagnostic and therapeutic strategies in patients with unusual ectopic pregnancy and present a brief review of the literature. Patients and methods: Twenty-seven cases with ectopic pregnancy in unusual locations were classified in five groups; two cesarean scars, six cervical, six cornual, two ovarian, and eleven heterotopic pregnancies. All of data were retrospectively analyzed according to the patient's gestational week, gestational sac location, obstetric history, treatment modality and treatment success. Results: Eleven patients with heterotopic pregnancy treated by surgery. Five of remaining sixteen patients were treated medically and two of them required major surgical procedure (hysterectomy and bilateral internal iliac artery ligation). Minimal invasive procedures and follow-up were done each remaining patient. Conclusion: The suspicion of the ectopic pregnancy and evaluation the whole pelvic cavity through ultrasonography are crucial for diagnosis of ectopic pregnancy. Three-dimensional ultrasonography can be helpful tool for accurate diagnosis. Early diagnosis of ectopic pregnancy provides patients to utilize fertility preservation as well as choice several treatment modalities.