A Case of Rupture Ectopic Pregnancy Diagnosed 10 Days After Hospital Stay In A 22-Year-Old Girl Presented With Symptoms of Anemia Without Abdominal Pain and Amenorrhea: Lessons Learned (original) (raw)
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Research Square (Research Square), 2023
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.
Case-control study of ectopic pregnancies in Myanmar: infectious etiological factors
The Southeast Asian journal of tropical medicine and public health
We studied the role of infections in ectopic pregnancy and the different methods of detecting Chlamydia trachomatis infection using serology, cervical and tubal PCR assays, by using a hospital-based, case-control study conducted between November 2007 and September 2009. The sample size was 339 with 113 cases and 226 controls. The cases were women admitted for the management of ectopic pregnancy while the controls were women admitted for spontaneous miscarriage. Both cases and controls were tested for syphilis and chlamydial infection by serology. In addition, cervical samples from controls and both cervical and tubal samples from cases were examined for the presence of chlamydia and gonococcal DNA. Sociodemographic data and past histories were collected using set Proforma. Independent variables for multivariate analysis included previous history of spontaneous abortion, ectopic pregnancy, symptoms of sexully transmitted infections (STI), and use of contraception. Women with a previous history of ectopic pregnancy (adjusted OR 28.3; 95% CI 5.8-138.8; p=0.01) and a past history of having had symptoms of STI (adjusted OR 11.06; 95% CI 5.45-22.44; p=0.0005) were significantly more likely to have an ectopic pregnancy than those without such a history. Syphilis serology was positive in 13.3% of ectopic pregnancy cases compared to only 3.5% of controls (crude OR 0.24; 95% CI -0.10-0.58; p=0.001). From cervical swabs, chlamydia DNA was detected significantly more frequently in cases than controls (8.0% vs 2.2%; crude OR 0.261; 95% CI -0.09-0.80, p=0.012) but gonorrhea DNA detection rates were not significantly different (3.5% vs 0.9%, crude OR 0.24; 95% CI -0.04-1.35; p=0.1). Chlamydia was positive in cases only as diagnosed tubal samples for PCR in 17 (15.0%), cervical samples for PCR in 9 (8.0%) and IgM ELISA in 6 (5.3%). Among the three STI tested for in this study, C. trachomatis was the most frequently associated with ectopic pregnancy and was more frequently diagnosed by PCR on tubal samples than PCR on cervical samples or chlamydia IgM serology.
A profile of ectopic pregnancy at nepal medical college teaching hospital
2007
was carried out to determine incidence, demographic features, clinical presentation, duration at presentation and treatment, and the management protocol. A total of 36 cases of ectopic pregnancy were treated giving the incidence of ectopic pregnancy of 10.2/1000 deliveries and 7.3 /1000 pregnancies. The mean age is 30.1 years (range 23-45 years) and the mean parity is 1.2 with nulliparous at 49%. The mean gestational age is 6.9 weeks (range 5-11 weeks). Among the ethnicity, Mongolians constituted at 54.6%. The commonest risk factors present were infertility (33.3%), previous ectopic pregnancy (16.7%), pelvic inflammatory disease (13.9%) and tubal surgery (13.9%). The commonest symptoms at presentation are abdominal pain (94.4%), amenorrhea (72.2%) and abnormal vaginal bleeding (58.3%); and commonest signs were abdominal tenderness (91.7%), adnexal tenderness (72.2%) and cervical excitation (50.0%). The mean time from symptom to treatment was 176.58 hours and mean time from admission to treatment was 12.88 hours. Ectopic pregnancy was correctly diagnosed clinically in 85.0% patients including 42.5% (12/36) of ruptured ectopic pregnancy. Abdominal ultrasound and urinary β-hCG tests (ELISA test) were additional diagnostic tools. Sixty one percent (22/36) presented in subacute condition. Two cases (5.6%) were presented late causing diagnostic problem and more morbidity like anaemia, blood transfusion, adhesion needing major operations. Salpingectomy is the mainstay of treatment. Only one case has conservative surgery. Late presentation and ruptured ectopic pregnancy is associated with increased morbidity and mortality. High index of suspicion and early recourse to laparotomy save the life from this obstetric disaster.
A Clinical Study on Ectopic Pregnancy in Govt. General Hospital Kurnool
Background: Ectopic pregnancy remains one of the important cause of maternal morbidity and mortality, if not diagnosed in time it will result in rupture leading to emergency laparotomy or laparoscopy endangering the mother's life. Due to increased incidence of infertility, ART, STI, early diagnostic procedures like ultrasound, there is a rising trend of ectopic pregnancies. Aims and Objective: The aim is to study the incidence, clinical presentation risk factors, site of ectopic, management modalities at Govt. General Hospital Kurnool, Andhra Pradesh. It is a retrospective observational study. 710 antenatal mothers were admitted to the labour room with first trimester complaints and those with diagnosed ectopic pregnancy from outside were included in the study. After admission necessary investigations were done, planned for surgery/conservative management depending on the patient profile. Most cases were taken up for emergency laparotomy. Age, parity, risk factors, treatment, intraoperative findings were collected and the data has been analysed. Of 710 patients admitted, 27(3.8%) cases of ectopic pregnancies in which 18(66.6%) presented as ectopic rupture of which 9 (50%) presented as rupture in shock and 9 (33.33%) presented as early diagnosis, either with ultrasonographic or clinical findings. Results: Ectopic pregnancy constituted 1.12% of all gynaecological admissions, and its incidence was 1-2%. The commonest age group of the patients was 25-30 years. 18(66.6%) patients presented in emergency with rupture ectopic of which 9(50%) presented as rupture in shock. 9(33.33%) patients were admitted, on the basis of early diagnosis, with incidental ultrasonography finding, or due to any of the mentioned symptoms, and confirmed on ultrasound. The commonest (85%) clinical presentation was abdominal pain, and the commonest (34%) identified risk factor was a previous history of sexually transmitted diseases confirmed as pelvic inflammatory condition or others. No death due to ectopic pregnancy was found during the study period. Conclusion: Ruptured ectopic pregnancy is of profound threat to the well being of the women, and if undiagnosed early, is the major cause of maternal morbidity and mortality, and has remained a reproductive health challenge in developing countries.
Ruptured Ovarian Ectopic Pregnancy in Tuberculosis Patient: A Case Report
Journal of Evolution of medical and Dental Sciences, 2014
BACKGROUND: Ovarian pregnancy is seen rarely. Diagnosis is based on criteria established in 1878 by Spiegelberg. It is often done during surgery and requires histological consideration. The condition has not been reported locally and its diagnosis is easily missed. CASE: A 26 Years old women, primigravida with history of pulmonary tuberculosis in past presented with acute abdomen and clinical picture suggestive of ectopic pregnancy. Ultrasound showed a complex right adnexal mass. On exploration, was found to be ruptured ovarian pregnancy. Right partial oophorectomy was done. Histopathology report confirmed the diagnosis of ovarian ectopic. CONCLUSION: Ovarian ectopic is rarest of the rare condition which present late and is hazardous for the reproductive status of a women. INTRODUCTION: Primary ectopic ovarian pregnancy is seen rarely. The incidence of such pregnancies varies from 0.001% to 0.013% of normal pregnancies and from 0.17% to 1% of ectopic pregnancies. 1 A rare case of pr...
BMC research notes, 2017
Female genital tuberculosis (FGTB) is a Mycobacterium infection in the reproductive organs which often leads to infertility. FGTB is either asymptomatic or causes uncharacteristic clinical presentations, making an early diagnosis is challenging. Our aims were to evaluate the clinical presentations, the process to confirm the diagnosis and followed-up the patients who had undergone laparoscopy at our center. FGTB has been reported from many countries, but has never been reported from Indonesia. Here we present case studies to document the presence of FGTB in Indonesia. There were three patients admitted to our center; two patients were admitted with irregular menstrual cycle as their chief complaint, while one patient came due to infertility. The results from laparoscopy were suggestive of FGTB; including the presence of caseating granulomas surrounded by epithelioid cells, lymphocytes, plasma cells, and Langhans giant cells. Additionally, PCR testing confirmed presence of MTB. Subse...
Ectopic pregnancy in a tertiary care centre of Jharkhand, India
International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2019
Ectopic pregnancy is divided into extrauterine and uterine types. Among extrauterine are: tubal (most common, 97%), ovarian (0.5%) and abdominal (1%). Uterine ABSTRACT 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.