101
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Madu AE, Canty S. Negative betaHCG tubal ectopic pregnancy. J OBSTET GYNAECOL 2006; 26:181-2. [PMID: 16483995 DOI: 10.1080/01443610500475768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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102
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Naki MM, Tekcan C, Uysal A, Güzin K, Yücel N. Heterotopic pregnancy following ovulation induction by clomiphene citrate and timed intercourse: a case report. Arch Gynecol Obstet 2006; 274:181-3. [PMID: 16463167 DOI: 10.1007/s00404-006-0121-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2005] [Accepted: 12/28/2005] [Indexed: 11/25/2022]
Abstract
We report a combined intra-uterine and unruptured tubal pregnancy following ovulation induction by clomiphene citrate (CC) and timed intercourse. The diagnosis of heterotopic pregnancy (HP) is the major problem until occurrence of tubal rupture. Because HP is a life-threatening condition, the diagnosis should be made as soon as possible. In a spontaneous conception, HP is a rare event. The risk of HP significantly increases after ovulation induction. Clomiphene itself could be associated with a high HP rate. We present a case with normally developing intra-uterine singleton pregnancy successfully managed by salpingectomy of synchronous tubal pregnancy following ovulation induction by CC and a review of the literature.
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103
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Attia M, Karuppaswamy J, Griffith H. Management of interstitial (cornual) pregnancy at 17 weeks' gestation: conservation of a ruptured uterus. J OBSTET GYNAECOL 2006; 25:722-3. [PMID: 16263557 DOI: 10.1080/01443610500307391] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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104
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Korkontzelos I, Tsirkas P, Antoniou N, Akrivis C, Tsirka A, Hadjopoulos G. Mild ovarian hyperstimulation syndrome coexisting with ectopic pregnancy after in vitro fertilization. CLIN EXP OBSTET GYN 2006; 33:148-50. [PMID: 17089577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Ovarian hyperstimulation syndrome (OHSS) is an entity arising in women undergoing assisted reproductive techniques (ART). The simultaneous presence of two different clinical complications such as OHSS and ectopic pregnancy (EP) is not frequent. The diagnosis of an extrauterine pregnancy can be obscured by the stimulated ovaries and ascites, and actually be missed, especially in women with increased body mass index. We report a case of a woman who presented with mild OHSS after in vitro fertilization (IVF), (intracytoplasmatic sperm injection (ICSI) and embryo transfer). The ectopic pregnancy was ascertained soon after by transvaginal ultrasound (TVS) and right salpingectomy was performed.
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105
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Ali CR, Fitzgerald C. Omental and peritoneal secondary trophoblastic implantation – an unusual complication after IVF. Reprod Biomed Online 2006; 12:776-8. [PMID: 16792857 DOI: 10.1016/s1472-6483(10)61090-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Omental pregnancy is an uncommon form of abdominal pregnancy; it has never been previously reported after IVF. A 35-year-old patient underwent IVF for tubal factor infertility. The treatment cycle was uneventful, but 3 weeks following embryo transfer the patient was diagnosed with a right tubal ectopic pregnancy on ultrasound. A laparoscopic salpingectomy was performed and the patient was discharged home. Two weeks later, the patient presented with abdominal pain and rising serum beta-human chorionic gonadotrophin (beta-HCG). A repeat laparoscopy showed omental and peritoneal trophoblastic implants. These were excised laparoscopically and confirmed on histology to be trophoblastic tissue. The HCG returned to < 3 IU/l, 1 week post-operatively. This case emphasizes the importance of intra-operative care during laparoscopic surgery for ectopic pregnancy and the need for post-operative surveillance of serum beta-HCG. An abdominal pregnancy, though rare, has a seven times higher mortality rate than non-abdominal pregnancies. Early diagnosis and treatment can prevent intra-abdominal haemorrhage, as haemorrhagic shock is the commonest cause of mortality from omental pregnancy.
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106
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Traore Y, Teguete I, Thera AT, Mulbah JK, Kane F, Mounkoro N, Diarra I, Diabate FS, Traore M, Dolo A. [Association of extrauterine and intrauterine pregnancy: 3 cases]. LE MALI MEDICAL 2006; 21:35-38. [PMID: 19437844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Extra uterine pregnancy (GEU) constitutes, by its frequency a problem of public health, by its gravity an obstetric emergency and a problem of fertility for the woman. It represents the chief reason of maternal death during the first quarter of pregnancy. The association of extra-uterine and intra-uterine pregnancy is a particular case of twin pregnancy said ditopic. It is rare, but non exceptional. The authors bring three cases to remind us of its existence.
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107
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Pereira PP, Cabar FR, Raiza LCP, Roncaglia MT, Zugaib M. Emergency contraception and ectopic pregnancy: report of 2 cases. Clinics (Sao Paulo) 2005; 60:497-500. [PMID: 16358141 DOI: 10.1590/s1807-59322005000600012] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
MESH Headings
- Adult
- Chorionic Gonadotropin, beta Subunit, Human/blood
- Chorionic Gonadotropin, beta Subunit, Human/urine
- Contraception, Postcoital/adverse effects
- Contraceptives, Oral, Synthetic/administration & dosage
- Contraceptives, Oral, Synthetic/adverse effects
- Female
- Humans
- Levonorgestrel/administration & dosage
- Levonorgestrel/adverse effects
- Pregnancy
- Pregnancy, Tubal/chemically induced
- Pregnancy, Tubal/diagnosis
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108
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Zuzarte R, Khong CC. Recurrent ectopic pregnancy following ipsilateral partial salpingectomy. Singapore Med J 2005; 46:476-8. [PMID: 16123833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
An unusual case of a second ipsilateral ectopic pregnancy following a partial (proximal) salpingectomy for ectopic gestation is presented in a 32-year-old woman with a history of secondary infertility. This occurred in the distal remnant of the left fallopian tube. It is postulated that the pregnancy was conceived following migration of spermatozoa or the fertilised egg from the endometrial cavity to the distal remnant of the left fallopian tube or by passage of spermatozoa through the intact right fallopian tube and the pouch of Douglas. Consequent to the maintenance of a high index of suspicion of ectopic pregnancy, there was early diagnosis and expedient surgical intervention on both occasions.
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109
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110
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Stiefelhagen P. [In one of 100 pregnant women is the uterus empty]. MMW Fortschr Med 2005; 147:14-5. [PMID: 16180565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
MESH Headings
- Adult
- Chorionic Gonadotropin, beta Subunit, Human/blood
- Cohort Studies
- Diagnosis, Differential
- Female
- Humans
- Methotrexate/administration & dosage
- Methotrexate/therapeutic use
- Pregnancy
- Pregnancy, Abdominal/epidemiology
- Pregnancy, Ectopic/diagnosis
- Pregnancy, Ectopic/drug therapy
- Pregnancy, Ectopic/epidemiology
- Pregnancy, Ectopic/mortality
- Pregnancy, Ectopic/surgery
- Pregnancy, Tubal/diagnosis
- Pregnancy, Tubal/drug therapy
- Pregnancy, Tubal/epidemiology
- Pregnancy, Tubal/surgery
- Risk Factors
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111
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Rackow BW, Quiñones JN, Barnhart K. Second-trimester tubal pregnancy: a case report. THE JOURNAL OF REPRODUCTIVE MEDICINE 2005; 50:719-22. [PMID: 16363762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
BACKGROUND Second-trimester tubal pregnancy is an infrequent diagnosis, as these pregnancies often present with symptoms during the first trimester. CASE A previously asymptomatic woman presented with pelvic pain and vaginal bleeding at 4 months' gestation and was found to have a live, 14-week, tubal pregnancy. CONCLUSION Second-trimester symptoms, including nausea, vomiting, pelvic or abdominal pain, and vaginal bleeding, necessitate ultrasound to determine the pregnancy location, maintaining suspicion for a tubal or abdominal pregnancy.
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112
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Maag HC, Fink D. [Gynaecological emergencies]. PRAXIS 2005; 94:1339-43. [PMID: 16171005 DOI: 10.1024/0369-8394.94.35.1339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Any primary care doctor should be prepared to encounter and to handle gynaecological emergencies in patients, even those in critically ill states. We want to present a concentrated review on some of the "hard" gynaecological emergencies like extrauterine pregnancy, abortion, and malignancy associated hemorrhage. Moreover, there is another group of patients with "soft" gynaecological emergencies, as for instance the distressing symptoms caused by a vulvovaginal infection. Despite most advanced strategies for early detection, emergency situations caused by ectopic pregnancies still happen. Ectopic pregnancies are most frequently located in the fallopian tubes. Tubal abortion and tubal rupture are very demanding situations in the course of a tubal pregnancy that need immediate assessment and treatment, and maybe emergency life support. Of all the different types of abortion, incomplete abortion is most likely to provoke life-threatening situations. Incomplete expulsion of the products of conception may lead to severe bleeding from the uterus. Immediate uterine curettage is required in this case. Advanced stages of cervical cancer may cause life-threatening hemorrhages as a result of vascular arrosion. Ovarian torsion is a gynaecological emergency characterised by acute abdominal pain.
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113
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Intapibool S. Unruptured left cornual pregnancy: case report. JOURNAL OF THE MEDICAL ASSOCIATION OF THAILAND = CHOTMAIHET THANGPHAET 2005; 88:1137-9. [PMID: 16404846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Cornual pregnancy is a rare condition. The morbidity and mortality are directly related to the length of time for diagnosis. The present paper reports a case of unruptured left cornual pregnancy which was diagnosed by the patient's symptom, physical examination and positive urine pregnancy test. Ultrasonography confirmed the diagnosis. Left cornual resection was carried out in the present case without immediate or long-term complication.
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114
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Abstract
A case of advanced tubal pregnancy at 30 weeks is described. The placenta was implanted on the salpinx. Most tubal pregnancies become symptomatic within the first 12 weeks. A small number of tubal pregnancies have progressed beyond this. We present this unusual case of a 30-week tubal pregnancy situated in the proximal half of the tube that created a diagnostic dilemma.
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115
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Lyden SD, Nojadera L. Images in clinical medicine. Ruptured ectopic pregnancy. N Engl J Med 2005; 353:74. [PMID: 16000357 DOI: 10.1056/nejmicm050182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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116
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Sebire NJ, Lindsay I, Fisher RA, Savage P, Seckl MJ. Overdiagnosis of Complete and Partial Hydatidiform Mole in Tubal Ectopic Pregnancies. Int J Gynecol Pathol 2005; 24:260-4. [PMID: 15968202 DOI: 10.1097/01.pgp.0000164597.19346.b5] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Partial or complete hydatidiform mole (HM) affects approximately 1 in 500 to 1,000 pregnancies. Previous small series suggest that histopathologic diagnosis of HM may be difficult in tubal ectopic pregnancies. The histopathology database of a regional Trophoblastic Disease Unit was searched to identify cases with a referral diagnosis of tubal HM, and the histopathologic findings were reviewed. During the study period (1986-2004 inclusive), there were 132 cases. After central review by specialist histopathologists, the final diagnosis was ectopic partial mole in two, ectopic complete mole in five, and ectopic hydatidiform mole (not otherwise specified) in one. The final diagnosis of definite hydatidiform mole was made in eight (6%) cases, significantly less than in referred uterine curettage specimens, in which approximately 90% have a confirmatory diagnosis of HM (Z = 12.9; p < 0.0001). No cases in this series developed persistent gestational trophoblastic disease, the human chorionic gonadotropin concentration spontaneously returning to normal. Ectopic pregnancies, where managed surgically, should be submitted for histopathologic examination; however, the pathologist should be aware that the degree of extravillus trophoblastic proliferation may appear more florid compared with evacuated uterine products of conception. Molar pregnancy should only be diagnosed when strict criteria regarding morphologic abnormalities previously described in uterine evacuation material are applied.
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117
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Ghi T, Banfi A, Marconi R, Iaco PDE, Pilu G, Aloysio DDE, Pelusi G. Three-dimensional sonographic diagnosis of ovarian pregnancy. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2005; 26:102-4. [PMID: 15971283 DOI: 10.1002/uog.1933] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
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118
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119
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Nishijima K, Shukunami KI, Tsuyoshi H, Hattori Y, Yoshida Y, Kotsuji F. Ruptured interstitial pregnancy caused by inactive chorionic villi presenting with negative serum beta-hCG. Am J Emerg Med 2005; 23:89. [PMID: 15672345 DOI: 10.1016/j.ajem.2004.01.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
MESH Headings
- Adult
- Chorionic Gonadotropin, beta Subunit, Human/blood
- Chorionic Villi/pathology
- Emergency Medicine/methods
- Female
- Humans
- Necrosis/complications
- Pregnancy
- Pregnancy Trimester, First
- Pregnancy, Tubal/blood
- Pregnancy, Tubal/diagnosis
- Pregnancy, Tubal/etiology
- Pregnancy, Tubal/surgery
- Rupture, Spontaneous/blood
- Rupture, Spontaneous/diagnosis
- Rupture, Spontaneous/etiology
- Rupture, Spontaneous/surgery
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120
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Strauss A, Kuemper C. Ectopic tubal pregnancy without fallopian tubes--an (im)possible diagnosis? Eur J Obstet Gynecol Reprod Biol 2005; 118:109-10. [PMID: 15596283 DOI: 10.1016/j.ejogrb.2004.03.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2004] [Indexed: 11/27/2022]
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121
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Stoĭkov S, Emin A, Nikolova M. [Gynecological laparoscopy and treatment of ectopic pregnancy]. AKUSHERSTVO I GINEKOLOGIIA 2005; 44:23-5. [PMID: 15853023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
The aim of the present study is to show the advantages of the gynecologic laparoscopy for the diagnosis and treatment of the intact tubal pregnancy. For the fulfillment of this aim was made a prospective study for 5 years' period of the patients with diagnosis "Ectopic pregnancy", treated in Gynecological clinic of UMBAL-Pleven. The objects of observation were 33 women with diagnosis: "Intact ectopic pregnancy". Methotrexate was used by plan for 6 patients, in 7 patients was made laparotomy, and in 20 patients--gynecological laparoscopy. From the performed 20 gynecological laparoscopy, 16 women were recovered laparoscopically, in 14 of which was made partial salpingectomy, and in 2--milking. In one of the last two patients was injected Methotrexate in the bed of the gestational bag. In 4 women was necessary laparotomy, because of impossibility of performing of laparoscopic surgery. The authors emphasized the advantages of the gynecological laparoscopy for precise diagnosis and contemporary treatment of the intact ectopic pregnancy.
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122
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Cheng PJ, Chueh HY, Qiu JT. Heterotopic Pregnancy in a Natural Conception Cycle Presenting as Hematometra. Obstet Gynecol 2004; 104:1195-8. [PMID: 15516450 DOI: 10.1097/01.aog.0000142698.17433.cd] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Heterotopic pregnancy is a rare event in natural conception cycles. Diagnosis of heterotopic pregnancy requires a high index of suspicion. Described herein is a reported case of a heterotopic pregnancy presenting as hematometra. CASE A young, multiparous woman, with her last menstrual period 6 weeks before presentation, complained of a dark reddish-brown vaginal discharge and progressive left lower-quadrant discomfort during early pregnancy following a natural conception cycle. An intrauterine mass was observed, and subsequently a heterotopic pregnancy complicated by hematometra was diagnosed with the help of transvaginal ultrasonography and 3-dimensional power Doppler ultrasound angiography. CONCLUSION Women with intrauterine fluid accumulation during pregnancy may be at risk for coexistent ectopic pregnancy. High resolution transvaginal color Doppler sonography may be useful to identify a heterotopic pregnancy preoperatively.
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123
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Strelec M, Dmitrovic R, Simunic V. Heterotopic triplet pregnancy with laparoscopic resection of the ruptured tube at 10 weeks of gestation. Eur J Obstet Gynecol Reprod Biol 2004; 117:117-8. [PMID: 15474258 DOI: 10.1016/j.ejogrb.2004.02.040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2004] [Indexed: 11/25/2022]
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124
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Dokić MD, Perisić DV. [Conservative treatment of ectopic pregnancies: comparison of velocity of decrease of beta-HCG between spontaneous and methotrexate induced resorptions]. SRP ARK CELOK LEK 2004; 132:163-6. [PMID: 15493587 DOI: 10.2298/sarh0406163d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The evolution of the process can take two different directions. If an Intact pregnancy continues to grow, there is a tubal abortion or a rupture of the Fallopian tube. In the oppsote case, there is spontaneous resorption of the tubal pregnancy. In certain cases with the application of methotrexate, the ectopic pregnancy growth can be interrupted and spontaneous resorption can be induced. Nowadays, the international standards of treating patients with early ectopic gravidities and no peritoneal effusions, with beta-HCG values below 6000 UI/l, gestational sac diameter below 3 cm, and without any visible heart action, imply methotrexate treatment. The objective of this study is to prove the efficiency of methotrexate use in patients who meet the above criteria. The first group did not manifest satisfying decrease of [beta-HCG after two measurements, so methotrexate was used, while the second group showed satisfying decrease of beta-HCG, measured on the third day. Comparing the velocity of decrease of beta-HCG level among both groups of patients, it was proved that iatrogenically induced decrease, that is to say the achieved resorption, was equal to the spontaneous resorption, which justified the use of methotrexate in ectopic pregnancy treatment.
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125
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Blaauwgeers JLG, Omtzigt AWJ. [Diagnostic image (210). A young woman suffering from abdominal pain]. NEDERLANDS TIJDSCHRIFT VOOR GENEESKUNDE 2004; 148:2020. [PMID: 15553998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
A 33-year-old pregnant woman presenting with low abdominal pain was diagnosed with left-sided tubal extra-uterine pregnancy, which was surgically removed.
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126
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Gálvez CR, Fernández VC, de Los Reyes JMR, Jaén MMM, Teruel RG. Primary tubal choriocarcinoma. Int J Gynecol Cancer 2004; 14:1040-4. [PMID: 15361223 DOI: 10.1111/j.1048-891x.2004.014550.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Choriocarcinoma is one of the most serious forms of gestational trophoblastic tumor. It is a malignant tumor from the epithelium of the chorionic villi. The most frequent location site is the uterus. Associated with ectopic pregnancy, it is extremely rare and in general, very aggressive. In 75% of the cases, it items from distant metastasis; therefore, a histological examination of the tubes must be performed in all ectopic pregnancies. Our patient was a 33-year-old woman who was admitted to emergency room (ER) with an intense pain in the right, iliac cavity, and limited genital bleeding. During the exploration, there was abdominal pain, with doubtful signs of peritoneal irritation. The vaginal ultrasound offered an image that was compatible with an extra uterine pregnancy in the left appendages. At emergency, right salpingectomy was performed via laparotomy. The patient was treated with polychemotherapy and contraceptives for a year, with no recurrence of the disease. Control follow-up was performed using beta-human chorionic gonadotropin (HCG) testing on a weekly basis during the first month and then bi-monthly during the first year of follow-up.
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127
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Sethi R, Lauszus FF. [Heterotopic pregnancy after ovarian stimulation]. Ugeskr Laeger 2004; 166:3107. [PMID: 15387314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
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128
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129
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Ghosh PS, Orife SU, Esen U, Obafunwa J. Beware: failed medical termination of pregnancy. J OBSTET GYNAECOL 2004; 24:325-6. [PMID: 15203649 DOI: 10.1080/01443610410001661075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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130
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Filhastre M, Dechaud H, Lesnik A, Taourel P. Interstitial pregnancy: role of MRI. Eur Radiol 2004; 15:93-5. [PMID: 15647954 DOI: 10.1007/s00330-004-2306-4] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2003] [Revised: 01/19/2004] [Accepted: 03/02/2004] [Indexed: 10/26/2022]
Abstract
We report the MRI features of two cases of interstitial pregnancy. In both cases, MRI was able to localize the ectopic pregnancy by showing a gestational structure surrounded by a thick wall in the upper part of the uterine wall separated from the endometrium by an uninterrupted junctional zone. Because US may confuse angular and interstitial pregnancies and because interstitial pregnancy has a particular evolutive course, MR imaging may play a key role in the diagnosis and management of women with interstitial pregnancy.
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131
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Kabukoba JJ, de Courcy-Wheeler RH. Hysteroscopy in the diagnosis of suspected interstitial pregnancy. Int J Gynaecol Obstet 2004; 37:121-6. [PMID: 1348700 DOI: 10.1016/0020-7292(92)90493-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Three cases are reported in which interstitial pregnancy was suspected on ultrasound scan. The first was managed by scans and laparoscopy, but resulted in rupture of the uterus and hysterectomy at 20 weeks. In the following cases hysteroscopy was used to refute the diagnosis in one patient and confirm it in another within the first trimester. A case is made for the use of hysteroscopy in the assessment of patients with suspected interstitial pregnancy.
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132
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da Costa Soares R, Elito J, Han KK, Camano L. Endometrial thickness as an orienting factor for the medical treatment of unruptured tubal pregnancy. Acta Obstet Gynecol Scand 2004; 83:289-92. [PMID: 14995926 DOI: 10.1111/j.0001-6349.2004.0387.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To evaluate the efficacy of the endometrial thickness measurement through transvaginal ultrasound as an orienting factor for the medical treatment of unruptured tubal pregnancy with a single dose of methotrexate in order to select the best cases for the medical treatment. METHODS A prospective study, in which the largest measurement of endometrial thickness in millimeters was evaluated, along the longitudinal uterine axis, by means of transvaginal ultrasound. A total of 38 patients meeting the inclusion criteria for single-dose methotrexate treatment [50 mg/m2 intramuscularly (i.m.)] were included in the study. We observed whether there was any difference in mean value of endometrial thickness and initial beta-human choriongonadotropin levels, between the cases that evolved successfully with the treatment, and those that failed. RESULTS The mean value of endometrial thickness and initial beta-human choriongonadotropin (beta-hCG) levels, for patients evolving successfully with medical treatment (28 cases), were 6.39 mm and 1936.2 mUI/ml, respectively, while the mean values for failures were 11.70 mm and 6831.3 mUI/ml. We carried out statistical analysis using the 'Student's t-test', with p < 0.05. CONCLUSIONS The mean value of endometrial thickness, along the longitudinal uterine axis through transvaginal ultrasound, reflects hormonal action and has been demonstrated to be another important parameter in indicating the medical treatment of an unruptured tubal pregnancy.
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133
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Somers MP, Spears M, Maynard AS, Syverud SA. Ruptured heterotopic pregnancy presenting with relative bradycardia in a woman not receiving reproductive assistance. Ann Emerg Med 2004; 43:382-5. [PMID: 14985667 DOI: 10.1016/j.annemergmed.2003.08.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
We report a case of heterotopic pregnancy in a woman who had not undergone in vitro fertilization or any other reproductive assistance. The patient failed to mount a tachycardic response to hemorrhagic shock. Bradycardia is a well-established phenomenon in the setting of hemoperitoneum and particularly with ruptured ectopic pregnancy. This is a case of heterotopic pregnancy with relative bradycardia in a woman without predisposing factors for heterotopic pregnancy. We make suggestions on avoiding common pitfalls in the emergency department diagnosis of heterotopic pregnancy. We also address the similar clinical presentations of heterotopic pregnancy and intrauterine pregnancy with ruptured corpus luteum cyst.
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134
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Perkins JD, Mitchell MR. Heterotopic pregnancy in a large inner-city hospital: a report of two cases. J Natl Med Assoc 2004; 96:363-6. [PMID: 15040518 PMCID: PMC2594869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
While ectopic pregnancy is a common occurrence, especially in the nonwhite female patient population, heterotopic pregnancy has traditionally been regarded as a rare clinical event until recently, especially with the advent of assisted reproductive procedures. We reported two cases, one in which an intrauterine pregnancy was discovered after a diagnosis of tubal abortion, another in which a patient underwent laparotomy for a tubal ectopic pregnancy with a concomitant previously diagnosed intrauterine pregnancy. The first patient subsequently delivered at term, while the second was lost to follow-up. In both cases, there was a delay in detecting the ectopic pregnancy component. These cases suggest that the clinician maintain a reasonable index of suspicion while evaluating a patient presenting with pelvic pain in the face of a documented intrauterine pregnancy. They also demonstrate the need for prompt and immediate action at the first sign indicating ectopic pregnancy to avoid missing this potentially life-threatening condition.
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135
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Pasic R, Scobee J, Tolar B. Ectopic Pregnancy Months after Laparoscopic Supracervical Hysterectomy. ACTA ACUST UNITED AC 2004; 11:94-5. [PMID: 15104842 DOI: 10.1016/s1074-3804(05)60021-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Although it is an easy diagnosis to eliminate, pregnancy is rarely considered in a woman with acute abdominopelvic pain and history of hysterectomy. A 37-year-old woman was seen because of acute onset of pelvic pain. Her history was significant for laparoscopic supracervical hysterectomy performed 4 months previously. A urine pregnancy test was positive. At diagnostic laparoscopy, an area in the right tube was consistent with ectopic pregnancy. Bilateral salpingectomy was performed, and pathology confirmed an ectopic pregnancy in the right tube. A diagnosis of ectopic pregnancy should be entertained in any woman with pain and intact ovaries.
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136
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Garba M, Almoustapha T, Garba A, Nouhou H. [Extra uterine pregnancy associated with a tubal schistosomiasis due to Schistosoma haematobium. A case report from Niger]. BULLETIN DE LA SOCIETE DE PATHOLOGIE EXOTIQUE (1990) 2004; 97:41-2. [PMID: 15104157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
We are reporting the case of a 21-year-old woman hospitalized for pelvic pains in a context of secondary amenorrhoea, whose examinations revealed a tubal pregnancy After surgical operation, the examination of the operative part showed a schistosomal tubal obstruction. Schistosomal tubal obstructions are the cause of ectopic pregnancies and infertility not to be forgotten in endemic areas. The implementation of a control programme based on chemotherapy by praziquantel will enable the reduction of their frequency.
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137
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Rodríguez Cardoso J. [Tubal pregnancy treated with oral methotrexate. Report of one case]. GINECOLOGIA Y OBSTETRICIA DE MEXICO 2004; 72:45-6. [PMID: 15239564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
Report of a case of ectopic pregnancy, treated with oral methotrexate qd. as medical management of tubal pregnancy. We report a succesfully case.
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138
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Rizos A, Eyong E, Yassin A. Recurrent ectopic pregnancy at the ipsilateral fallopian tube following laparoscopic partial salpingectomy with endo-loop ligation. J OBSTET GYNAECOL 2003; 23:678-9. [PMID: 14617485 DOI: 10.1080/01443610310001609524] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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139
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Fauconnier A, Mabrouk A, Heitz D, Ville Y. [Ectopic pregnancy: interest and value of clinical examination in management policy]. JOURNAL DE GYNECOLOGIE, OBSTETRIQUE ET BIOLOGIE DE LA REPRODUCTION 2003; 32:S18-27. [PMID: 14699316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
Clinical examination (history and physical examination) is not considered to be a useful tool in the diagnosis of ectopic pregnancy (EP). In this systematic review we aimed to evaluate its value when ancillary tests are not readily available or when they are equivocal. Suspicion of EP is based on the presence of one or more of the following signs: vaginal bleeding, acute pelvic pain, or any risk factors for EP occurring in a pregnant woman. Detection of early pregnancy by urinary or serum hCG testing must be systematic because neither medical history nor physical examination can rule out early pregnancy with a high level of confidence. No isolated sign has sufficient diagnostic accuracy to rule out EP. In presence of vaginal bleeding without pain and if abdominal and pelvic examination are normal the risk of EP is very low. The presence of spontaneous pain moderate to severe, peritoneal signs, or definite pain during digital cervical mobilization increase the probability of EP. Absence of these signs does not rule out EP but tend to eliminate tubal rupture. In the presence of these signs one may consider an emergency transfer in a specialized center. In their absence, suspicion of EP may have outpatient diagnosis procedures.
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140
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Campo S, Campo V, Gambadauro P. Bilateral tubal pregnancy following in vitro fertilization and embryo transfer. Eur J Obstet Gynecol Reprod Biol 2003; 110:237-9. [PMID: 12969592 DOI: 10.1016/s0301-2115(03)00103-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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141
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Phupong V, Manipalviratn S. Simultaneous tubal pregnancy and twisted ovarian cyst. Arch Gynecol Obstet 2003; 268:211-3. [PMID: 12819988 DOI: 10.1007/s00404-003-0516-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2003] [Accepted: 04/16/2003] [Indexed: 11/25/2022]
Abstract
BACKGROUND Simultaneous or concomitant bilateral adnexal pathology is rare. But simultaneous tubal pregnancy and twisted ovarian cyst is even rarer. CASE A 25-year-old woman, gravida 2, parity 0, presented with acute abdomen after 12 weeks of amenorrhea. Simultaneous right tubal pregnancy and twisted left ovarian cyst were intraoperatively diagnosed. Right salpingostomy and left salpingo-oophorectomy were performed. The follow-up serum beta-hCG was negative at the nineteenth postoperative day. She was well at discharge and throughout the 4-week follow-up period. CONCLUSION Although simultaneous or concomitant bilateral adnexal pathology is uncommon, a careful assessment of both adnexa is mandatory especially in the cases with inconsistent site of symptom and pathology in order to avoid undiagnosed simultaneous pathologies that may be missed.
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142
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143
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Radaelli T, Bulfamante G, Cetin I, Marconi AM, Pardi G. Advanced tubal pregnancy associated with severe fetal growth restriction: a case report. J Matern Fetal Neonatal Med 2003; 13:422-5. [PMID: 12962269 DOI: 10.1080/jmf.13.6.422.425] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
A case is described of advanced tubal pregnancy associated with severe fetal growth restriction delivered at 27 weeks. The placenta was implanted on the salpinx and on the uterotubal angle. Progressing tubal pregnancy and its placental histological characteristics could be a model of placental dysfunction typically associated with intrauterine growth restriction.
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144
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Stefanetti M, Comerci G, Bulletti C. Heterotopic pregnancy. THE JOURNAL OF THE AMERICAN ASSOCIATION OF GYNECOLOGIC LAPAROSCOPISTS 2003; 10:140. [PMID: 12732761 DOI: 10.1016/s1074-3804(05)60288-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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145
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Basama FMS. Preoperative diagnosis of unilateral tubal twin ectopic pregnancy with one live twin. J OBSTET GYNAECOL 2003; 23:313-4. [PMID: 12918472 DOI: 10.1080/01443610310000105948a] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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146
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Sachdev PS, Memon RA, Jatoi N, Sachdev CS. Ectopic ovarian pregnancy. J Coll Physicians Surg Pak 2003; 13:229-30. [PMID: 12718782 DOI: 04.2003/jcpsp.229230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2002] [Accepted: 03/20/2003] [Indexed: 11/04/2022]
Abstract
A case of ectopic ovarian pregnancy is presented occurring in a 24 years old woman after natural conception. The clinical diagnosis was ruptured tubal pregnancy. Gross findings were suggestive of ruptured corpus luteum cyst on exploration. The histopathological examination of specimen brought forward the diagnosis of ovarian pregnancy.
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147
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Sheffer-Mimouni G, Pauzner D, Maslovitch S, Lessing JB, Gamzu R. Ectopic pregnancies following emergency levonorgestrel contraception. Contraception 2003; 67:267-9. [PMID: 12684145 DOI: 10.1016/s0010-7824(02)00539-5] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
There are little or no data on the risk of ectopic pregnancy following levonorgestrel treatment as an emergency contraception. We encountered three cases of ectopic pregnancy following the use of levonorgestrel administered peri- or postovulation. Here we report these cases and discuss the clinical and epidemiologic implications of this association. Health providers should be alert to the possibility of an ectopic pregnancy in women who become pregnant or complain of lower abdominal pain after taking levonorgestrel.
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148
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Callister LC. Miscarriage after infertility. MCN Am J Matern Child Nurs 2003; 28:125. [PMID: 12675042 DOI: 10.1097/00005721-200303000-00021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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149
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Varras M, Akrivis C, Hadjopoulos G, Antoniou N. Heterotopic pregnancy in a natural conception cycle presenting with tubal rupture: a case report and review of the literature. Eur J Obstet Gynecol Reprod Biol 2003; 106:79-82. [PMID: 12475588 DOI: 10.1016/s0301-2115(02)00154-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Heterotopic pregnancy is a potentially fatal condition, rarely occurring in natural conception cycles. CASE We report such a case in a 28-year old para 0, gravida 1 woman with no known risk factors. The ectopic pregnancy was diagnosed after rupturing at 11 weeks, 4 weeks after diagnosis of the intrauterine pregnancy, and resected via laparotomy. A healthy baby was delivered without complications at 40 weeks gestation. CONCLUSION Heterotopic pregnancy is possible with natural conception and the survival of the intrauterine fetus is feasible.
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Abstract
The authors described two cases of the ruptured unrecognized interstitial pregnancy. 32-year-old woman, was admitted for abdominal colics in 17th week of uncontrolled pregnancy. Obstetric finding on admission was normal, while ultrasonography pointed to 17th week of gestation. During the first night of hospitalization, severe abdominal pain, with collapse, tachycardia and hypotension developed. Laparotomy was performed in general endotracheal anesthesia with resuscitation measures, and revealed hematoperitoneum and ruptured right-sided interstitial pregnancy with a dead fetus among the bowels. Abdominal hysterectomy without adnexa was performed. S. J., a 35-year-old tertigravida, six years before, left-sided adnexectomy was performed for perforated tubal pregnancy. 5 weeks before artificial abortion now, ultrasonography revealed a vital fetus biometrically corresponding to the 11th week of gestation. The condition was recognized as an unsuccessful artificial abortion and intact pregnancy. During preoperative preparation the patient lost consciousness and required immediate resuscitation. The abdominal cavity was opened by Pfannenstiel's relaparotomy, and revealed hematoperitoneum with numerous adhesions between the small intestine, sigma, uterus and urinary bladder, and ruptured left-sided interstitial pregnancy. Adhesiolysis was completed, a lesion in the sigma was sutured, and hysterectomy was performed. Exploration of the abdominal cavity revealed a dead fetus among small intestine loops, and an indurated, sharply delineated neoplasia of the head of the pancreas.
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