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Laganà AS, Etrusco A, Haydamous J, Semaan S, Agrifoglio V, Chiantera V, Vitagliano A, Riemma G, D'Amato A, Montagna E. Efficacy of letrozole for the treatment of tubal ectopic pregnancy: A meta-analysis. Eur J Obstet Gynecol Reprod Biol 2024; 299:322-328. [PMID: 38968783 DOI: 10.1016/j.ejogrb.2024.06.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 06/25/2024] [Accepted: 06/30/2024] [Indexed: 07/07/2024]
Abstract
BACKGROUND Tubal ectopic pregnancy (EP) is a life-threatening condition, especially if undiagnosed or misdiagnosed, tipically in low income countries and/or where women have limited access to health care. The current management protocol of tubal EP consists of either surgical management, or medical management with methotrexate. Recent studies, while few, have suggested that letrozole, an aromatase inhibitor, may play a role in the medical treatment of tubal EP. OBJECTIVES To evaluate the effectiveness of letrozole alone in the medical treatment of tubal EP. SEARCH STRATEGY Electronic databases were searched until 31 December 2023. SELECTION CRITERIA Retrospective or prospective studies reporting the treatment of tubal EP with letrozole alone were considered eligible for inclusion. DATA COLLECTION AND ANALYSIS Pooled results were expressed as OR with 95 %CI. Heterogeneity was assessed using Higgins I2. Subgroup analysis was performed to compare outcomes according to time after intervention. Subgroup differences were checked through χ2 test. RESULTS A total of 152 patients were included. Seventy-nine patients (51.97 %) were treated with letrozole, 39 patients (16.54 %) with methotrexate, and 34 patients (31.49 %) underwent surgical treatment. Pooled data analysis supports the consistency of the effect of letrozole in reducing β-hCG over time at a comparable rate among studies, and that treatment with letrozole is superior to surgery and has the same efficacy as methotrexate. However, all the included studies were judged at high risk of bias in terms of study design, sample representativeness, and sampling technique. Furthermore, short and long term side effects were not reported in any of the included studies. CONCLUSIONS Letrozole is a promising alternative to methotrexate and surgical therapy in the treatment of tubal EP. Although this meta-analysis suggests efficacy and low hazard of the drug and encourages its application, the data available today remain extremely sparse, which weakens any claims that can be made, and is not sufficient to assert that letrozole is safe and effective in the treatment of EPs. There is an absolute need for randomized studies with accurate patient selection, fixed doses, large sample sizes, and reporting of short- and long-term side effects to refute or confirm this assumption.
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Affiliation(s)
- Antonio Simone Laganà
- Unit of Obstetrics and Gynecology, "Paolo Giaccone" Hospital, 90127 Palermo, Italy; Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90133 Palermo, Italy
| | - Andrea Etrusco
- Unit of Obstetrics and Gynecology, "Paolo Giaccone" Hospital, 90127 Palermo, Italy; Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90133 Palermo, Italy
| | - Joe Haydamous
- Department of Obstetrics Gynecology and Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center at Houston (UT Health), 77030 Houston, United States
| | - Samar Semaan
- Department of Obstetrics Gynecology and Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center at Houston (UT Health), 77030 Houston, United States
| | - Vittorio Agrifoglio
- Unit of Obstetrics and Gynecology, "Paolo Giaccone" Hospital, 90127 Palermo, Italy; Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90133 Palermo, Italy
| | - Vito Chiantera
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90133 Palermo, Italy; Unit of Gynecologic Oncology, National Cancer Institute - IRCCS - Fondazione "G. Pascale", 80131 Naples, Italy
| | - Amerigo Vitagliano
- Department of Interdisciplinary Medicine (DIM), Unit of Obstetrics and Gynecology, University of Bari "Aldo Moro", Policlinico of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Gaetano Riemma
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Van-vitelli", 80138 Naples, Italy
| | - Antonio D'Amato
- Department of Interdisciplinary Medicine (DIM), Unit of Obstetrics and Gynecology, University of Bari "Aldo Moro", Policlinico of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy.
| | - Erik Montagna
- Postgraduation Program in Health Sciences, Faculdade de Medicina do ABC/Centro Universitário FMABC, 09060-870 Santo André, Brazil
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Agbal T, Erturk Aksakal S, Pay RE, Erkaya S. Comparison of the success rates of a single dose and an additional dose of methotrexate on the 4th day in patients whose β-hCG values do not fall after a single dose of methotrexate (Day 0-4). J Gynecol Obstet Hum Reprod 2024; 53:102811. [PMID: 38844087 DOI: 10.1016/j.jogoh.2024.102811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Revised: 06/03/2024] [Accepted: 06/04/2024] [Indexed: 06/11/2024]
Abstract
INTRODUCTION This study's aim is to investigate whether the rise in β-hCG levels between days 0 and 4 in patients with tubal ectopic pregnancy who have received a single dose of methotrexate has prognostic value in treatment success, and to investigate whether administering a second dose on day 4 enhances treatment success. MATERIAL AND METHODS Patients diagnosed with ectopic pregnancy and experiencing an increase in β- hCG levels on day 4 after initiation of methotrexate treatment were included in our study. Patients treated with a single dose Methotrexate (MTX) protocol until December 2019 were retrospectively screened from January 2018 to December 2019. Patients receiving a second dose on day 4 until September 2021 were prospectively enrolled from January 2020 to September 2021. A decrease of over 15 % in the β-hCG value after the 4th dose was considered as treatment success. RESULTS Treatment success rates were compared between these two groups. 115 patients with ectopic pregnancy were included in the study. A single dose methotrexate protocol was applied in 67 of the patients (Group 1), while an additional dose methotrexate was applied in 48 (Group 2). The treatment was successful in 40 patients (59.7 %) in Group 1 and in 39 patients (81.3 %) in Group 2. The success rate of the treatment was significantly higher in patients who received an additional dose methotrexate protocol (p = 0.014). DISCUSSION This study shows that; it is possible to increase success rates by applying an additional MTX dose on the 4th day in cases with an increase in β-hCG on the 4th day.
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Affiliation(s)
- Tugba Agbal
- Department of Gynaecology, University of Health Sciences, Etlik Zubeyde Hanım Women's Health Training and Research Hospital, Ankara, Turkey.
| | - Sezin Erturk Aksakal
- Department of Gynaecology, University of Health Sciences, Etlik Zubeyde Hanım Women's Health Training and Research Hospital, Ankara, Turkey
| | - Ramazan Erda Pay
- Department of Gynaecology, University of Health Sciences, Etlik Zubeyde Hanım Women's Health Training and Research Hospital, Ankara, Turkey
| | - Salim Erkaya
- Department of Perinatology, University of Health Sciences, Etlik Zubeyde Hanım Women's Health Training and Research Hospital, Ankara, Turkey
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Ungureanu CO, Stanculea FC, Iordache N, Georgescu TF, Ginghina O, Mihailov R, Vacaroiu IA, Georgescu DE. Ruptured Recurrent Interstitial Ectopic Pregnancy Successfully Managed by Laparoscopy. Diagnostics (Basel) 2024; 14:506. [PMID: 38472978 DOI: 10.3390/diagnostics14050506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 02/13/2024] [Accepted: 02/16/2024] [Indexed: 03/14/2024] Open
Abstract
Ectopic pregnancies are a frequently encountered cause of first-trimester metrorrhagia. They occur when an embryo is implanted and grows outside the normal uterine space. Uncommonly, the embryo can be implanted in the intramural portion of the uterine tube, a condition referred to as interstitial localization. This specific type of ectopic pregnancy may have an unpredictable course, potentially leading to severe uterine rupture and catastrophic bleeding if not promptly diagnosed and managed. We present a rare case of a multiparous 36-year-old female patient who underwent pelvic ultrasonography in the emergency department for intense pelvic pain associated with hypotension and moderate anemia. A history of right salpingectomy for a ruptured tubal ectopic pregnancy 10 years previously was noted. High beta-HCG levels were also detected. A pelvic ultrasound allowed us to suspect a ruptured ectopic interstitial pregnancy at 8 weeks of amenorrhea. An association with hemoperitoneum was suspected, and an emergency laparoscopy was performed. The condition was confirmed intraoperatively, and the patient underwent a right corneal wedge resection with suture of the uterine myometrium. The postoperative course was uneventful, and the patient was discharged on the fourth day postoperatively. Interstitial ectopic pregnancy is a rare yet extremely perilous situation. Timely ultrasound-based diagnosis is crucial as it can enable conservative management with Methotrexate. Delayed diagnosis can lead to uterine rupture with consecutive surgery based on a transection of the pregnancy and cornual uterine resection.
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Affiliation(s)
- Claudiu Octavian Ungureanu
- Department of Surgery, "Carol Davila" University of Medicine and Pharmacy, 37, Dionisie Lupu Street, 020021 Bucharest, Romania
- General Surgery Department, "Sf. Ioan" Clinical Emergency Hospital, 13 Vitan-Bârzeşti Road, 042122 Bucharest, Romania
| | - Floris Cristian Stanculea
- Department of Surgery, "Carol Davila" University of Medicine and Pharmacy, 37, Dionisie Lupu Street, 020021 Bucharest, Romania
- General Surgery Department, "Sf. Ioan" Clinical Emergency Hospital, 13 Vitan-Bârzeşti Road, 042122 Bucharest, Romania
| | - Niculae Iordache
- Department of Surgery, "Carol Davila" University of Medicine and Pharmacy, 37, Dionisie Lupu Street, 020021 Bucharest, Romania
- General Surgery Department, "Sf. Ioan" Clinical Emergency Hospital, 13 Vitan-Bârzeşti Road, 042122 Bucharest, Romania
| | - Teodor Florin Georgescu
- Department of Surgery, "Carol Davila" University of Medicine and Pharmacy, 37, Dionisie Lupu Street, 020021 Bucharest, Romania
- General Surgery Department, Clinical Emergency Hospital Bucharest, SplaiulIndependentei nr 168, Sect 5, 050098 Bucharest, Romania
| | - Octav Ginghina
- Department of Surgery, "Carol Davila" University of Medicine and Pharmacy, 37, Dionisie Lupu Street, 020021 Bucharest, Romania
- General Surgery Department, "Prof. Dr. Alexandru Trestioreanu" Oncological Institute, 022328 Bucharest, Romania
| | - Raul Mihailov
- General Surgery Department, "Sf. Andrei" Clinical Emergency Hospital, 177 Braila Street, 800578 Galati, Romania
| | - Ileana Adela Vacaroiu
- Department of Surgery, "Carol Davila" University of Medicine and Pharmacy, 37, Dionisie Lupu Street, 020021 Bucharest, Romania
- Nephrology and Dialysis Clinic, "Sf. Ioan" Emergency Clinical Hospital, Sos. Vitan-Barzesti nr 12, 042122 Bucharest, Romania
| | - Dragos Eugen Georgescu
- Department of Surgery, "Carol Davila" University of Medicine and Pharmacy, 37, Dionisie Lupu Street, 020021 Bucharest, Romania
- General Surgery Department, "Dr. I. Cantacuzino" Clinical Hospital, 5-7 I. Movila Street, 022904 Bucharest, Romania
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Al Wattar BH, Solangon SA, de Braud LV, Rogozińska E, Jurkovic D. Effectiveness of treatment options for tubal ectopic pregnancy: A systematic review and network meta-analysis. BJOG 2024; 131:5-14. [PMID: 37443463 DOI: 10.1111/1471-0528.17594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 06/13/2023] [Accepted: 06/15/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND Tubal ectopic pregnancy (TEP) is a common gynaecological emergency. Several medical and surgical treatment options exist, but it is not clear which is the safest and most effective treatment. OBJECTIVES To compare the effectiveness of expectant, medical and surgical treatment options for TEP using a systematic review and network meta-analysis. SEARCH STRATEGY MEDLINE, EMBASE, and CENTRAL from inception till September 2022. SELECTION CRITERIA Randomised trials that evaluated any treatment option for woman with a TEP. DATA COLLECTION AND ANALYSIS We performed pairwise and network meta-analyses using a random effect model. We assessed the studies' risk of bias, heterogeneity and network inconsistency. We reported primarily on TEP resolution and treatment failure using relative risk (RR) and 95% confidence-intervals (CI). MAIN RESULTS We included 31 randomised trials evaluating ten treatments (n = 2938 women). Direct meta-analysis showed no significant benefit for using methotrexate compared to expectant management for TEP resolution. Network meta-analysis showed similar effect-size for most conservative treatment options compared to expectant management for TEP resolution (glucose intra-sac instillation vs. expectant RR 0.84, 95% CI 0.63-1.12; methotrexate intra-sac instillation vs. expectant RR 0.91, 95% CI 0.75-1.10; multi-dose methotrexate vs. expectant RR 1.00, 95% CI 0.88-1.15; prostaglandin intra-sac instillation vs. expectant RR 0.75, 95% CI 0.53-1.07; salpingotomy vs. expectant RR 0.99, 95% CI 0.84-1.16; single dose methotrexate vs. expectant RR 0.97, 95% CI 0.85-1.10; single dose methotrexate + mifepristone vs. expectant RR 1.09, 95% CI 0.89-1.33). All treatment options showed a higher risk of failure compared to salpingectomy. CONCLUSIONS There is insufficient evidence to support the use of any medical treatment option for TEP over expectant management.
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Affiliation(s)
- Bassel H Al Wattar
- Beginning Assisted Conception Unit, Epsom and St Helier University Hospitals, London, UK
- Comprehensive Clinical Trials Unit, Institute of Clinical Trials & Methodology, University College London, London, UK
| | - Sarah A Solangon
- Women's Health Department, University College London Hospitals, London, UK
- EGA Institute for Women's Health, Faculty of Population Health Sciences, University College London (UCL), London, UK
| | - Lucrezia V de Braud
- Women's Health Department, University College London Hospitals, London, UK
- EGA Institute for Women's Health, Faculty of Population Health Sciences, University College London (UCL), London, UK
| | - Ewelina Rogozińska
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, University College London, London, UK
| | - Davor Jurkovic
- Comprehensive Clinical Trials Unit, Institute of Clinical Trials & Methodology, University College London, London, UK
- EGA Institute for Women's Health, Faculty of Population Health Sciences, University College London (UCL), London, UK
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Saçıntı KG, Demirci G, Sönmezer M, Öztürk HS. What if the value of laboratory-acquired human chorionic gonadotropin (hCG) is misleading you? J OBSTET GYNAECOL 2023; 43:2171785. [PMID: 36708522 DOI: 10.1080/01443615.2023.2171785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- Koray Görkem Saçıntı
- Department of Obstetrics and Gynecology, Ankara University School of Medicine, Ankara, Turkey
| | - Gülşah Demirci
- Department of Medical Biochemistry, Ankara University School of Medicine, Ankara, Turkey
| | - Murat Sönmezer
- Department of Obstetrics and Gynecology, Ankara University School of Medicine, Ankara, Turkey
| | - Hasan Serdar Öztürk
- Department of Medical Biochemistry, Ankara University School of Medicine, Ankara, Turkey
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Alanwar A, Khalaf WM, Alfussaily E, Salem MA, Taema MI, Ali I. The impact of systemic methotrexate and surgical management on fertility preservation in tubal ectopic pregnancy among Saudi women. J Matern Fetal Neonatal Med 2023; 36:2241106. [PMID: 37500183 DOI: 10.1080/14767058.2023.2241106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 07/06/2023] [Accepted: 07/21/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND The impact of various management plans on subsequent fertility after tubal ectopic pregnancy (EP) is not well known. The objective of the present study was an evaluation of the subsequent fertility outcome among women with EP managed either surgical or medical with systemic methotrexate or medical management followed by surgical one. PATIENTS AND METHODS A retrospective cohort study was done by reviewing of medical records of all women diagnosed with EP at King Faisal Military Hospital, Southern Region, Saudi Arabia throughout the period from January 2015 to December 2016 provided that they were hemodynamic stable, with starting βhCG level less than 10000 IU/L, and adnexal mass less than 5 cm. These cases were followed for four years from January 2017 to December 2020. RESULTS The study included 85 women with EP. Their mean age was 31.3 ± 6.7 years. Medical management (systemic Methotrexate) was followed in 48.2% of cases whereas surgical management was applied for 43.5% of them while medical management followed by surgical one was seen in 8.2% of cases. Complete follow-up throughout 2017-2020 was available for 52 women. A history of recurrent EP was observed among 3 women (5.8%). Most of them (75%) had a viable pregnancy. There was no statistically significant association between the method of management of EP and subsequent fertility, although the rate of normal pregnancy (intrauterine viable pregnancy ≥ 24 weeks which is the age of viability at our hospital) was higher among those managed surgically or by medical followed by surgical management than those managed medical only (84.6% and 100% vs. 62.5%). CONCLUSION Although the normal pregnancy rate was higher among those managed surgically or by medical followed by surgical management than those managed medically only, this was not statistically significant.
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Affiliation(s)
- Ahmed Alanwar
- Department of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
- Mouwasat Hospital, Saudi Arabia
| | - Waleed M Khalaf
- Department of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
- Mouwasat Hospital, Saudi Arabia
| | - Eman Alfussaily
- King Faisal Military hospital (Armed forces Hospitals), Saudi Arabia
| | - Marwa A Salem
- King Faisal Military hospital, Imam Abdulrahman Al Faisal hospital, NGH, Dammam, Saudi Arabia
| | - Mohamed I Taema
- Department of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ibrahim Ali
- Department of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
- King Faisal Military hospital (Armed forces Hospitals), Saudi Arabia
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Flanagan HC, Duncan WC, Lin CJ, Spears N, Horne AW. Recent advances in the understanding of tubal ectopic pregnancy. Fac Rev 2023; 12:26. [PMID: 37920274 PMCID: PMC10619208 DOI: 10.12703/r/12-26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023] Open
Abstract
Ectopic pregnancy (EP) is described as the implantation of an embryo outside the normal uterine cavity. It most commonly occurs in the fallopian tube, hence termed a tubal ectopic pregnancy (tEP). It is a gynaecological emergency and remains the leading cause of direct maternal mortality related to the first trimester of pregnancy worldwide. This article explores the emergence of additional risk factors for tEP, showing new evidence for identifying patient risk factors and highlighting potential areas of research. Additionally, we discuss the up-to-date patient-centred approach for the diagnosis, management and counselling of patients with tEP and ongoing clinical trials for the improvement of medical management.
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Affiliation(s)
- Heather C Flanagan
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, Scotland
- Biomedical Sciences, University of Edinburgh, Edinburgh, Scotland
| | - W Colin Duncan
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, Scotland
| | - Chih-Jen Lin
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, Scotland
| | - Norah Spears
- Biomedical Sciences, University of Edinburgh, Edinburgh, Scotland
| | - Andrew W Horne
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, Scotland
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Aiob A, Shqara RA, Mikhail SM, Sharon A, Odeh M, Lowenstein L. Alternative beta-hCG follow-up protocols after single-dose methotrexate therapy for ectopic pregnancy: A retrospective cohort study. Eur J Obstet Gynecol Reprod Biol 2023; 284:120-124. [PMID: 36989686 DOI: 10.1016/j.ejogrb.2023.03.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/05/2023] [Accepted: 03/20/2023] [Indexed: 03/29/2023]
Abstract
OBJECTIVE This study assessed the relevance of reductions in beta-hCG levels between days 0 and 4 and between days 0 and 7 after single-dose methotrexate therapy, and the success of the therapy. STUDY DESIGN A retrospective cohort study of 276 women diagnosed with ectopic pregnancy who received methotrexate as first-line treatment. Demographics, sonographic findings and beta-hCG levels and indexes were compared between women with successful and failed treatment outcomes. RESULTS The median beta-hCG levels were lower in the success than the failure group on days 0, 4 and 7: 385 (26-9134) vs. 1381 (28-6475), 329 (5-6909) vs. 1680 (32-6496) and 232 (1-4876) vs. 1563 (33-6368), respectively, P < 0.001 for all. The best cut-off for the change in beta-hCG level from day 0 to 4 was a 19% decrease; the sensitivity was 77.0% and specificity 60.0%, positive predictive value (PPV) was 85% CI 95 [78.7.1%-89.9%]. The best cut-off for the change in beta-hCG level from day 0 to 7 was a 10% decrease; the sensitivity was 80.1% and specificity 70.8%, PPV was 90.5% CI 95 [85.1%-94.5%]. CONCLUSIONS A decrease of 10% in beta-hCG between days 0 and 7 and 19% between days 0 and 4 can be used as a predictor of treatment success in specific cases.
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El-Kharoubi AF. Tubal Pathologies and Fertility Outcomes: A Review. Cureus 2023; 15:e38881. [PMID: 37197301 PMCID: PMC10184952 DOI: 10.7759/cureus.38881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2023] [Indexed: 05/19/2023] Open
Abstract
Anomalies of the fallopian tubes represent one of the most significant elements that might contribute to reproductive issues. They can be inherited or acquired; they are among the most important problems of the profession. Although there is much discussion regarding which therapies for each tubal disease are the most effective and result in the best long-term reproductive outcomes. During the evaluation of an infertile couple, certain anomalies of the fallopian tubes are frequently discovered. These abnormalities were thought, for a long time, to not have an influence on fertility; however, in recent years, researchers have discovered that they seem to play a crucial role in fertility problems. Couples in industrialized countries are postponing childbearing, which raises the risk of women developing tubal diseases before they are ready to become pregnant. These disorders may have a negative impact on a woman's ability to get pregnant. The goals of this study are to conduct research to gain a deeper understanding of the recent advancements that have been made in the field of tubal diseases and to carry out an evaluation of the medical conducts that have the best fertility outcomes. We searched both Medline and PubMed, paying special attention to the most relevant articles that have been added to either database over the course of the last six years.
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Hao HJ, Feng L, Dong LF, Zhang W, Zhao XL. Reproductive outcomes of ectopic pregnancy with conservative and surgical treatment: A systematic review and meta-analysis. Medicine (Baltimore) 2023; 102:e33621. [PMID: 37115078 PMCID: PMC10145868 DOI: 10.1097/md.0000000000033621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 04/01/2023] [Accepted: 04/04/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Ectopic pregnancy (EP), one of the most common gynecological emergencies, is the major cause of maternal death in the first trimester and increases the incidence of infertility and repeat ectopic pregnancy (REP). The aim of this study was to compare the effects of different treatment methods for tubal EP on natural pregnancy outcomes. METHODS We systematically searched PubMed, Embase, Cochrane Library, Web of Science, and Clinical Trials for observational studies on EP (published until October 30,2022 in English) comparing methotrexate (MTX) versus surgery, MTX versus salpingostomy, MTX versus salpingectomy, salpingostomy versus salpingectomy, and MTX versus expectant treatment. Our main endpoints included subsequent natural intrauterine pregnancy (IUP) and REP. We assessed the pooled data using Review Manager software (version 5.3) with a random effects model. RESULTS Of 1274 identified articles, 20 were eligible and 3530 participants were included in our analysis. There was a significant difference in the odds of subsequent IUP in tubal EP patients who underwent MTX compared with those who were treated with surgery [odds ratios (OR) = 1.52, 95% confidence interval (CI):1.20-1.92]. No significant difference was found in the odds of REP between the 2 groups (OR = 1.12, 95% confidence interval [CI]: 0.84-1.51). There was no significant difference in the odds of subsequent IUP and REP in patients after MTX compared to those after salpingostomy (OR = 1.04,95% CI: 0.79-1.38; OR = 1.10, 95% CI: 0.64-1.90). There was a significant difference in the odds of subsequent IUP in patients after MTX compared with those after salpingectomy (OR = 2.11, 95% CI: 1.52-2.93). No significant difference was found in the odds of REP between the 2 groups (OR = 0.98, 95% CI: 0.57-1.71). There was a significant difference in the odds of subsequent IUP between patients who underwent salpingostomy and those who underwent salpingectomy (OR = 1.61, 95% CI: 1.29-2.01). No significant difference was found in the odds of REP between the 2 groups (OR = 1.21, 95% CI: 0.62-2.37). There was no significant difference in the odds of subsequent IUP and REP in patients after MTX compared with those after expectant treatment (OR = 1.25, 95% CI: 0.64-2.45; OR = 0.69, 95% CI: 0.09-5.55). CONCLUSION For hemodynamically stable tubal EP patients, MTX has advantages over surgery, particularly salpingectomy, in improving natural pregnancy outcomes. However, MTX is not inferior to salpingostomy and expectant treatment.
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Affiliation(s)
- Hong-Juan Hao
- Department of Gynecology, The Fourth Hospital of Shijiazhuang, Shijiazhuang, Hebei, China
| | - Li Feng
- Department of Gynecology, The Fourth Hospital of Shijiazhuang, Shijiazhuang, Hebei, China
| | - Li-Fei Dong
- Department of Gynecology, The Fourth Hospital of Shijiazhuang, Shijiazhuang, Hebei, China
| | - Wei Zhang
- Department of Gynecology, The Fourth Hospital of Shijiazhuang, Shijiazhuang, Hebei, China
| | - Xiao-Li Zhao
- Department of Gynecology, The Fourth Hospital of Shijiazhuang, Shijiazhuang, Hebei, China
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Török P, Naem A, Csehely S, Chiantera V, Sleiman Z, Laganà AS. Reproductive outcomes after expectant and surgical management for tubal pregnancy: a retrospective study. MINIM INVASIV THER 2023:1-9. [PMID: 36815764 DOI: 10.1080/13645706.2023.2181091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
Background: The management of ectopic pregnancy is widely debated. Salpingectomy, salpingostomy, and expectant management are widely performed, but the best approach in terms of keeping good future spontaneous fertility chances is yet to be determined. Material and methods: We performed a retrospective analysis (Clinical Trial ID: NCT05479786) of the medical records of patients with an ultrasonographic or surgical diagnosis of tubal ectopic pregnancy that were admitted to the University of Debrecen Clinical Centre between 2012 and 2020. Results: A total of 312 patients were included in the analysis. Patients managed expectantly and patients treated with salpingostomy had significantly higher rates of clinical pregnancy than patients treated with salpingectomy. Pregnancy outcomes and recurrence rates were comparable between the study groups. Salpingectomy was found to decrease the likelihood of conceiving spontaneously by 65%. A stratified analysis based on serum β-HCG levels demonstrated that all treatment modalities carry the same reproductive opportunities for patients presenting with β-HCG levels ≤ 1745 IU/L. Conclusion: Salpingectomy was found to decrease the patient's chance of achieving a natural conception. Conservative approaches should be considered with caution only when the patient's clinical condition permits, and the patient is appropriately counseled.
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Affiliation(s)
- Péter Török
- University of Debrecen, Faculty of Medicine, Department of Obstetrics and Gynecology, Debrecen, Hungary
| | - Antoine Naem
- Faculty of Mathematics and Computer Science, University of Bremen, Bremen, Germany.,Department of Obstetrics, Gynecology, Gynecologic Oncology, and Senology, Bethesda Hospital Duisburg, Duisburg, Germany
| | - Szilvia Csehely
- University of Debrecen, Faculty of Medicine, Department of Obstetrics and Gynecology, Debrecen, Hungary
| | - Vito Chiantera
- Unit of Gynecologic Oncology, ARNAS "Civico - Di Cristina - Benfratelli", Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Zaki Sleiman
- Lebanese American University Medical Center - Rizk Hospital, Beirut, Lebanon
| | - Antonio Simone Laganà
- Unit of Gynecologic Oncology, ARNAS "Civico - Di Cristina - Benfratelli", Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
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Shen YT, Yang YY, Zhang PG, He LM, Che RH, Li Z, Lu W. Tubal ectopic pregnancy: a retrospective cohort study on clinical characteristics, treatment options and reproductive outcomes within 5 years. Arch Gynecol Obstet 2022; 306:2055-2062. [PMID: 36036288 DOI: 10.1007/s00404-022-06690-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 06/19/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE To investigate the association between different treatments of tubal ectopic pregnancy (EP) -expectant management, methotrexate (MTX), selected or recommended laparoscopic surgery-and the subsequent reproductive outcomes. METHODS We conducted a retrospective cohort study including 228 EPs. The patients were divided into four treatment groups: 28 (12.3%) with expectant management successfully, 60 (26.3%) with MTX successfully, 140 patients with laparoscopic salpingectomy, of which 47 (20.6%) were assigned to selected surgery group because they opted for surgical treatment versus MTX, 93 (40.8%) were assigned to recommended surgery group as recommended by the attending physician. RESULTS The recommended surgery group had the lowest rate of intrauterine pregnancy (IUP) (77.42%) and live birth (LB) (72.04%), while the incidence of recurrent EP (REP) (20.43%) was the highest, but the statistical differences were not significant. We did not observe significant differences of the EP-IUP time interval, rates of LB and miscarriage (MIS) between the four groups. Compared to the MTX group, recommended surgery was negatively associated with IUP (adjusted OR, 95%CI: 0.34, 0.11-1.03) and LB (0.35, 0.14-0.92), while it had higher risk for REP (3.48, 1.03-11.74) in the subsequent pregnancy. Further, compared to selective surgery group, recommended surgery was negatively associated with IUP (0.15, 0.03-0.68) and LB (0.23, 0.07-0.74), while it had higher risk for REP (6.83, 1.43-32.67) in the subsequent pregnancy. Expectant treatment was negatively associated with assisted reproductive technology (ART) (0.08, 0.02-0.40) compared with MTX. Of the185 patients who had LBs, all adverse outcomes were not statistically different between the four groups. CONCLUSION Patients with recommended laparoscopic salpingectomy had worse reproductive outcomes than the other treatment groups. The disease status of EP may play an important role in the association rather than the surgery alone.
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Affiliation(s)
- Yu-Ting Shen
- Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, People's Republic of China
| | - Ying-Ying Yang
- Clinical Research Center, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, People's Republic of China
| | - Ping-Gui Zhang
- Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, People's Republic of China
| | - La-Man He
- Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, People's Republic of China
| | - Rong-Hua Che
- Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, People's Republic of China
| | - Zhen Li
- Clinical Research Center, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, People's Republic of China.
| | - Wen Lu
- Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, People's Republic of China.
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Khalil A, Saber A, Aljohani K, Khan M. The Efficacy and Success Rate of Methotrexate in the Management of Ectopic Pregnancy. Cureus 2022; 14:e26737. [PMID: 35967136 PMCID: PMC9363683 DOI: 10.7759/cureus.26737] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2022] [Indexed: 11/20/2022] Open
Abstract
Background Ectopic pregnancy is a life-threatening medical condition wherein pregnancy occurs outside the uterus. This study primarily aimed to evaluate the efficacy of methotrexate (MTX) in treating patients diagnosed with early ectopic pregnancy between 2016 and 2021. Second, it aimed to investigate the clinical outcomes of subsequent pregnancies following ectopic pregnancy treatment. Methods A retrospective cohort study was carried out at a tertiary care centre in Jeddah, Saudi Arabia. The sample for this study comprised 59 patients who were diagnosed with ectopic pregnancy and treated with MTX at King Abdulaziz Medical City, Jeddah, between 2016 and 2021. The data were stored in the Microsoft Office Excel format and analyzed using the SPSS software. Results There were 10 reported cases of ruptured ectopic pregnancy; seven of these underwent surgery, while three were successfully treated conservatively using MTX. Success rates of 55.9% and 93.8% were recorded after administering the first and second dose of MTX, respectively, based on beta-human chorionic gonadotrophin (β-hCG) drop between day 4 and day 7. Among those treated with MTX, 37.3% of the patients reported a successful subsequent pregnancy, of which 54.5% delivered a live, healthy infant and 13.6% had a second ectopic pregnancy. Conclusion MTX proved effective in treating ectopic pregnancy, with a β-hCG drop of more than 15%. Patients who received a second dose of MTX showed a higher drop in β-hCG level, indicating greater success as a cumulative effect. The clinical outcome after MTX treatment of ectopic pregnancy was shown to be significant with a p-value <0.05.
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Mohr-Sasson A, Tamir M, Mugilevsky D, Meyer R, Mashiach R. Should expectant management of heterotopic pregnancy be considered? Arch Gynecol Obstet 2022; 306:1127-1133. [PMID: 35648227 DOI: 10.1007/s00404-022-06628-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 05/12/2022] [Indexed: 11/27/2022]
Abstract
KEY MESSAGE Both expectant and interventional managements are acceptable in selected cases, when heterotopic pregnancy is diagnosed, with high ongoing intra-uterine pregnancy rate and term deliveries. PURPOSE Heterotopic pregnancy, though relatively rare, is potentially a life-threatening condition. The aim of the study is to compare expectant versus interventional management of heterotopic pregnancies. METHODS This is a retrospective cohort study including all women diagnosed with heterotopic pregnancy on ultrasound from March 2011 to December 2020 in a single medical center. Expectant and interventional management outcomes were compared. Primary outcome was defined as live birth. RESULTS Forty-one women were diagnosed with heterotopic pregnancy during the study period. Management was expectant in 10 (24.4%) and interventional in 31 (75.6%) of the women. Expectant management was considered when the patient was stable, and the attending physician decided that the ectopic pregnancy did not continue to develop. Interventions included laparoscopic salpingectomy (n = 26), laparoscopic cornual resection (n = 2), laparotomic cornual resection (n = 1) and gestational sac aspiration (n = 2). The intra-uterine pregnancy continued to develop in 6 (60.0%) and 22 (81.5%) of the women in the expectant and interventional groups, respectively (p = 0.52). All women managed expectantly reached term delivery, as opposed to 17/22 (77.3%) in the intervention management group (p = 0.60). Multivariate analysis found serum β-hCG level as the only independent parameter associated with ongoing pregnancy rate (B = 0.001, p = 0.04). CONCLUSIONS Both expectant and interventional management were found to be acceptable when heterotopic pregnancy was diagnosed, with high ongoing intra-uterine pregnancy rate and term deliveries.
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Affiliation(s)
- Aya Mohr-Sasson
- Department of Obstetrics and Gynecology, Sheba Medical Center, 52621, Tel-Hashomer, Israel.
- Sackler School of Medicine, Tel Aviv University, 69978, Tel Aviv, Israel.
| | - Mordechai Tamir
- Department of Obstetrics and Gynecology, Sheba Medical Center, 52621, Tel-Hashomer, Israel
| | - Dimitry Mugilevsky
- Department of Obstetrics and Gynecology, Sheba Medical Center, 52621, Tel-Hashomer, Israel
- Sackler School of Medicine, Tel Aviv University, 69978, Tel Aviv, Israel
| | - Raanan Meyer
- Department of Obstetrics and Gynecology, Sheba Medical Center, 52621, Tel-Hashomer, Israel
- Sackler School of Medicine, Tel Aviv University, 69978, Tel Aviv, Israel
| | - Roy Mashiach
- Department of Obstetrics and Gynecology, Sheba Medical Center, 52621, Tel-Hashomer, Israel
- Sackler School of Medicine, Tel Aviv University, 69978, Tel Aviv, Israel
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Method of Hormonal Contraception and Protective Effects Against Ectopic Pregnancy. Obstet Gynecol 2022; 139:764-770. [PMID: 35576335 PMCID: PMC9015020 DOI: 10.1097/aog.0000000000004726] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 12/16/2021] [Indexed: 11/26/2022]
Abstract
The risk of ectopic pregnancy was higher in women using low-dose hormonal intrauterine devices (13.5 mg levonorgestrel) than in women using other types of hormonal contraception OBJECTIVE: METHOD: RESULTS: CONCLUSION:
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Üreyen Özdemir E, Yalçın Bahat P, Topbaş Selçuki NF, Çakmak K, Çakmak F, Neşelioğlu S, Erel Ö. Evaluation of Oxidative Stress in Ectopic Pregnancies. ACTA BIO-MEDICA : ATENEI PARMENSIS 2022; 93:e2022025. [PMID: 35315421 PMCID: PMC8972882 DOI: 10.23750/abm.v93i1.11097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 01/31/2021] [Indexed: 11/21/2022]
Abstract
PURPOSE The aim of the study is to show the relationship between oxidative stress and ectopic pregnancy. MATERIALS AND METHODS A total of 62 patients, 31 in the ectopic pregnancy group (study group) and 31 in the first-trimester pregnancy (control group) were included in the study. Patients between 18-45 years of age who had tubal ectopic pregnancy diagnosed by transvaginal ultrasonography and serum β-HCG values were included in the study group. Serum thiol- disulfide hemostasis were measured from venous blood. RESULTS Between the control group and the ectopic pregnant group; there was no statistically significant difference in terms of age, total thiol, albumin, disulfide, index 1 (disulfide / total thiol), index 2 (disulfide / native thiol), and index 3 levels (p> 0.05). The area under the ROC curve for native thiol measurements was statistically significant in distinguishing the control group and the ectopic pregnant group [AUC = 0.657, 95% CI: 0.521-0.793, p = 0.034] Conclusion: This study shows that ectopic pregnancies may be associated with the presence of high oxidative stress. Especially in early stage suspected patients, demonstrating the presence of oxidative stress together with serial β-HCG follow-up may be helpful in diagnosis.
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Affiliation(s)
- Eda Üreyen Özdemir
- Çubuk Halil Şıvgın Hospital, Department of Obstetrics and Gynecology Ankara, Turkey
| | - Pınar Yalçın Bahat
- Health Sciences University, Istanbul Kanuni Sultan Suleyman Training and Research Hospital, Department of Obstetrics and Gynecology, Istanbul, Turkey
| | - Nura Fitnat Topbaş Selçuki
- Health Sciences University, Istanbul Sisli Hamidiye Etfal Training and Research Hospital, Department of Obstetrics and Gynecology, Istanbul, Turkey
| | - Kübra Çakmak
- Esenler Maternity and Children’s Hospital, Department of Obstetrics and Gynecology, Istanbul, Turkey
| | | | - Salim Neşelioğlu
- Yildirim Beyazit University, Department of Biochemistry, Ankara, Turkey
| | - Özcan Erel
- Yildirim Beyazit University, Department of Biochemistry, Ankara, Turkey
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Kang OJ, Koh JH, Yoo JE, Park SY, Park JI, Yang S, Lee SH, Lee SJ, Ahn JW, Roh HJ, Kim JS. Ruptured Hemorrhagic Ectopic Pregnancy Implanted in the Diaphragm: A Rare Case Report and Brief Literature Review. Diagnostics (Basel) 2021; 11:diagnostics11122342. [PMID: 34943579 PMCID: PMC8699918 DOI: 10.3390/diagnostics11122342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 12/06/2021] [Accepted: 12/09/2021] [Indexed: 11/16/2022] Open
Abstract
The mortality and morbidity rates of non-tubal ectopic pregnancies with abdominal hemorrhaging are 7-8 times higher than those of tubal pregnancies. Diaphragmatic pregnancy is a rare non-tubal ectopic form, causing acute abdominal hemoperitoneum. Here, we present a case of a primary diaphragmatic ectopic pregnancy with hemorrhage that was immediately diagnosed and successfully managed with laparoscopic surgery. Rapid and accurate diagnosis using appropriate imaging modalities is critical for improving the prognosis of a child-bearing woman with an abdominal pregnancy.
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Affiliation(s)
- Ok Ju Kang
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea;
| | - Ji Hye Koh
- Department of Obstetrics and Gynecology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan 44033, Korea; (J.H.K.); (J.E.Y.); (S.Y.P.); (S.-H.L.); (S.-J.L.); (J.-W.A.); (H.-J.R.)
| | - Ji Eun Yoo
- Department of Obstetrics and Gynecology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan 44033, Korea; (J.H.K.); (J.E.Y.); (S.Y.P.); (S.-H.L.); (S.-J.L.); (J.-W.A.); (H.-J.R.)
| | - So Yeon Park
- Department of Obstetrics and Gynecology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan 44033, Korea; (J.H.K.); (J.E.Y.); (S.Y.P.); (S.-H.L.); (S.-J.L.); (J.-W.A.); (H.-J.R.)
| | - Jeong-Ik Park
- Department of Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan 44033, Korea; (J.-I.P.); (S.Y.)
| | - Songsoo Yang
- Department of Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan 44033, Korea; (J.-I.P.); (S.Y.)
| | - Sang-Hun Lee
- Department of Obstetrics and Gynecology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan 44033, Korea; (J.H.K.); (J.E.Y.); (S.Y.P.); (S.-H.L.); (S.-J.L.); (J.-W.A.); (H.-J.R.)
| | - Soo-Jeong Lee
- Department of Obstetrics and Gynecology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan 44033, Korea; (J.H.K.); (J.E.Y.); (S.Y.P.); (S.-H.L.); (S.-J.L.); (J.-W.A.); (H.-J.R.)
| | - Jun-Woo Ahn
- Department of Obstetrics and Gynecology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan 44033, Korea; (J.H.K.); (J.E.Y.); (S.Y.P.); (S.-H.L.); (S.-J.L.); (J.-W.A.); (H.-J.R.)
| | - Hyun-Jin Roh
- Department of Obstetrics and Gynecology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan 44033, Korea; (J.H.K.); (J.E.Y.); (S.Y.P.); (S.-H.L.); (S.-J.L.); (J.-W.A.); (H.-J.R.)
| | - Jeong Sook Kim
- Department of Obstetrics and Gynecology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan 44033, Korea; (J.H.K.); (J.E.Y.); (S.Y.P.); (S.-H.L.); (S.-J.L.); (J.-W.A.); (H.-J.R.)
- Correspondence:
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Dhanawat J, Pape J, Stuhlmann‐Laeisz C, Maass N, Freytag D, Gitas G, Alkatout I. Ectopic pregnancy in noncommunicating horn of unicornuate uterus: 3D-ultrasound and primary laparoscopic management. Clin Case Rep 2021; 9:e04261. [PMID: 34084520 PMCID: PMC8142796 DOI: 10.1002/ccr3.4261] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 01/23/2021] [Indexed: 11/12/2022] Open
Abstract
Unicornuate uterus with pregnancy in the noncommunicating rudimentary horn is extremely rare. Diagnosis requires awareness, high suspicion index, 3D ultrasound, and MRI. If missed, it can be catastrophic. Treatment varies across literature. We present a case where detection was done by 3D ultrasound and primary laparoscopic surgery done for treatment.
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Affiliation(s)
- Juhi Dhanawat
- Department of Gynecology and ObstetricsUniversity Hospitals Schleswig‐HolsteinKielGermany
| | - Julian Pape
- Department of Gynecology and ObstetricsUniversity Hospitals Schleswig‐HolsteinKielGermany
| | | | - Nicolai Maass
- Department of Gynecology and ObstetricsUniversity Hospitals Schleswig‐HolsteinKielGermany
| | - Damaris Freytag
- Department of Gynecology and ObstetricsUniversity Hospitals Schleswig‐HolsteinKielGermany
| | - Georgios Gitas
- Department of Gynaecology and ObstetricsUniversity Hospitals Schleswing‐HolsteinLeubeckGermany
| | - Ibrahim Alkatout
- Department of Gynecology and ObstetricsUniversity Hospitals Schleswig‐HolsteinKielGermany
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