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Mansouri Z, Tarafdari A, Azizi S, Mehdikhani B, Shababi A, Vaghef Davari F. A case report of heterochronic presentation of a bilateral tubal pregnancy. Clin Case Rep 2023; 11:e8072. [PMID: 37900710 PMCID: PMC10600360 DOI: 10.1002/ccr3.8072] [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: 07/07/2023] [Revised: 09/15/2023] [Accepted: 10/08/2023] [Indexed: 10/31/2023] Open
Abstract
Key Clinical Message This paper highlights that diagnosis and treatment of one ectopic pregnancy does not rule out the happening of a second ectopic pregnancy in the same patient concurrently, especially if the patient has rising β-hCG and persistent symptoms. Abstract Bilateral tubal pregnancy (BTP) is the most uncommon form of tubal ectopic pregnancy. Complications can lead to maternal morbidity and mortality. We reported a case of left tubal pregnancy and the patient underwent laparoscopic salpingostomy. During the follow-up, the contralateral ectopic pregnancy was discovered and treated with MTX.
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Affiliation(s)
- Zeinab Mansouri
- Department of Obstetrics & Gynecology, Imam Khomeini Hospital complexTehran University of Medical sciencesTehranIran
| | - Azam Tarafdari
- Department of Obstetrics & Gynecology, Imam Khomeini Hospital complexTehran University of Medical sciencesTehranIran
| | - Sepideh Azizi
- Shahid Akbarabadi Clinical Research Development Unit (ShACRDU)Iran University of Medical Sciences (IUMS)TehranIran
| | | | - Amirali Shababi
- School of MedicineIran University of Medical SciencesTehranIran
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Trindade VD, Burmann L, Viégas D, Hentschke MR, Azambuja R, Okada L, Petracco RG, Petracco A, Badalotti M, Michelon JDR. Ectopic pregnancy in left ovary and contralateral uterine tube diagnosed one week apart in In Vitro Fertilization with donor eggs: Case report. JBRA Assist Reprod 2019; 23:439-441. [PMID: 31294952 PMCID: PMC6798600 DOI: 10.5935/1518-0557.20190030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Bilateral ectopic pregnancy is a rare clinical condition with an estimated prevalence of 1/200 000 in spontaneous pregnancies. Studies have found that In Vitro Fertilization (IVF) is related to ectopic pregnancy independently, but the incidence of tubal disease in the donor egg recipient population is thought to be significantly lower than in the standard IVF population. We report the case of a patient participating in the egg-sharing program, who was diagnosed with ovarian ectopic pregnancy, treated with surgery. After one week, she was diagnosed with tubal ectopic pregnancy in the contralateral tube. The clinician should be aware that the treatment of one ectopic pregnancy does not preclude the occurrence of a second ectopic pregnancy in the same patient and should pay attention to the intra-operatory inspection of both side fallopian tubes in any ectopic pregnancy case. Routine ultrasound after ectopic pregnancy treatment may be reasonable, especially in high risk patients.
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Affiliation(s)
- Vanessa Devens Trindade
- Fertilitat - Centro de Medicina Reprodutiva, Porto Alegre, Rio Grande do Sul, Brasil.,Pontifícia Universidade Católica do Rio Grande do Sul. Porto Alegre, Rio Grande do Sul, Brasil
| | - Lauren Burmann
- Pontifícia Universidade Católica do Rio Grande do Sul. Porto Alegre, Rio Grande do Sul, Brasil
| | - Dieny Viégas
- Fertilitat - Centro de Medicina Reprodutiva, Porto Alegre, Rio Grande do Sul, Brasil
| | - Marta Ribeiro Hentschke
- Fertilitat - Centro de Medicina Reprodutiva, Porto Alegre, Rio Grande do Sul, Brasil.,Pontifícia Universidade Católica do Rio Grande do Sul. Porto Alegre, Rio Grande do Sul, Brasil
| | - Ricardo Azambuja
- Fertilitat - Centro de Medicina Reprodutiva, Porto Alegre, Rio Grande do Sul, Brasil
| | - Lilian Okada
- Fertilitat - Centro de Medicina Reprodutiva, Porto Alegre, Rio Grande do Sul, Brasil
| | - Rafaella Gehm Petracco
- Fertilitat - Centro de Medicina Reprodutiva, Porto Alegre, Rio Grande do Sul, Brasil.,Pontifícia Universidade Católica do Rio Grande do Sul. Porto Alegre, Rio Grande do Sul, Brasil
| | - Alvaro Petracco
- Fertilitat - Centro de Medicina Reprodutiva, Porto Alegre, Rio Grande do Sul, Brasil
| | - Mariangela Badalotti
- Fertilitat - Centro de Medicina Reprodutiva, Porto Alegre, Rio Grande do Sul, Brasil
| | - João da Rosa Michelon
- Fertilitat - Centro de Medicina Reprodutiva, Porto Alegre, Rio Grande do Sul, Brasil.,Pontifícia Universidade Católica do Rio Grande do Sul. Porto Alegre, Rio Grande do Sul, Brasil
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Gasparri ML, Mueller MD, Taghavi K, Papadia A. Conventional versus Single Port Laparoscopy for the Surgical Treatment of Ectopic Pregnancy: A Meta-Analysis. Gynecol Obstet Invest 2018; 83:329-337. [PMID: 29669329 DOI: 10.1159/000487944] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 02/22/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND/AIMS A new minimally invasive laparoscopic approach for ectopic pregnancy, the laparo-endoscopic single site surgery (LESS), has recently been introduced. The aim of this study is to compare the surgical outcome of this approach with conventional laparoscopy for ectopic pregnancy. METHOD A review following the Preferred Reporting Items for Systematic reviews and Meta-Analyses statement was performed. Electronic databases PubMed, MEDLINE, and Scopus were searched in December 2017 by searching the terms "single port laparoscopy" or "laparoendoscopic single site-surgery" or "single site laparoscopy" or "single-incision laparoscopic surgery" and "ectopic pregnancy." Studies comparing the 2 techniques and reporting surgical outcome were selected. Endpoints included comparison of length of operative time (OT), hemoglobin drop, length of hospitalization, number of patients requiring packed red blood cells (PRBC) transfusion, intra- and post-operative complication rates between patients undergoing conventional laparoscopy and those undergoing LESS. RESULTS A total of 56 studies were retrieved of which 5 studies including 460 patients met selection criteria. No differences were found between conventional laparoscopy and LESS with regards to length of OT time (even after stratification for presence of hemoperitoneum and/or adhesions), length of hospitalization, mean hemoglobin drop, number of patients requiring transfusions of PRBC, and intra- and post-operative complications. CONCLUSION The management of ectopic pregnancies with LESS does not seem to be superior to conventional laparoscopy.
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Affiliation(s)
- Maria Luisa Gasparri
- Department of Obstetrics and Gynecology, University Hospital of Berne and University of Berne, Berne, Switzerland.,Department of Gynecology Obstetrics and Urology, Sapienza Univeristy of Rome, Rome, Italy.,Surgical and Medical Department of Translational Medicine, Sapienza University of Rome, Rome, Italy
| | - Michael D Mueller
- Department of Obstetrics and Gynecology, University Hospital of Berne and University of Berne, Berne, Switzerland
| | - Katayoun Taghavi
- Department of Obstetrics and Gynecology, University Hospital of Berne and University of Berne, Berne, Switzerland
| | - Andrea Papadia
- Department of Obstetrics and Gynecology, University Hospital of Berne and University of Berne, Berne, Switzerland
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Chemotherapy in the Emergency Department? There Is a Role for That: Methotrexate for Ectopic Pregnancy. Adv Emerg Nurs J 2017; 39:18-25. [PMID: 28141607 DOI: 10.1097/tme.0000000000000137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Approximately 1.6% of all emergency department (ED) visits in the United States are for vaginal bleeding in early pregnancy, translating to around 500,000 ED visits per year. A potentially life-threatening condition, ectopic pregnancy occurs in 1.5%-2% of pregnancies. Many patients will require either surgical or pharmacological intervention following a positive diagnosis. With regard to pharmacological options, methotrexate, largely known for its use in the oncology arena, has emerged as the most effective nonsurgical option and the pharmacological agent of choice. However, this therapy is not without its own unique adverse event profile and patients should be adequately educated on the monitoring parameters of this pharmacotherapy.
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Sargin MA, Yassa M, Taymur BD, Çelik A, Aydin S, Orhan E, Tug N. A Clinical Experience of Ectopic Pregnancies with Initial Free Intraperitoneal Fluid. J Clin Diagn Res 2016; 10:QC22-6. [PMID: 27656512 DOI: 10.7860/jcdr/2016/20363.8376] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 06/06/2016] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Extra-uterine pregnancy or Ectopic Pregnancy (EP) is a major health problem for pregnant women, presenting as a potentially life-threatening emergency in the first trimester. There are three major options for the treatment of EP: expectant management, surgical treatment and medical management. The presence of free intraperitoneal fluid in EP-diagnosed patients is crucial for treatment planning and evaluation. AIM To compare the outcomes of both the expectant man-agement and medical treatment with methotrexate (MTX) in ectopic pregnancies with free intraperitoneal fluid. MATERIALS AND METHODS This retrospective cohort study inclu-ded a total of 91 ectopic pregnancies with or without rupture in which the women had initial free intraperitoneal fluid and were haemodynamically stable. Serial β-HCG measurements were used to assess the outcome of expectant management and medical treatment with MTX. For the statistical analysis, the SPSS statistical software package, version 22.0 (Chicago, IL, USA), was used. For the quantitative variables that were not distributed normally, the Kruskal-Wallis test and the Mann-Whitney U test were performed for the evaluation of differences between the groups. RESULTS It was observed that the success rate with expectant management was 81% (initial β HCG concentration 626±443 mIU/mL). With a single dose of MTX, it was 76% (initial β HCG concentration 2124±1647 mIU/mL) and with a total single or double dose of MTX, it was 88% (initial β HCG concentration 2252±78 mIU/mL) from among EP with or without rupture in women with initial free intraperitoneal fluid during diagnosis. There was no significant difference between the groups with regard to ultrasonography findings. CONCLUSION Expectant management or medical treatment with methotrexate should be the first line treatment for ectopic pregnancies with initial free intraperitoneal fluid, albeit with rupture, in patients who are haemodynamically stable, along with β-HCG follow-up.
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Affiliation(s)
- Mehmet Akif Sargin
- Lecturer, Department of Obstetrics and Gynecology, Fatih Sultan Mehmet Training and Research Hospital , İstanbul, Turkey
| | - Murat Yassa
- Lecturer, Department of Obstetrics and Gynecology, Fatih Sultan Mehmet Training and Research Hospital , İstanbul, Turkey
| | - Bilge Dogan Taymur
- Lecturer, Department of Obstetrics and Gynecology, Fatih Sultan Mehmet Training and Research Hospital , İstanbul, Turkey
| | - Ayhan Çelik
- Lecturer, Department of Obstetrics and Gynecology, Fatih Sultan Mehmet Training and Research Hospital , İstanbul, Turkey
| | - Sibel Aydin
- Lecturer, Department of Obstetrics and Gynecology, Umraniye Training and Research Hospital , İstanbul, Turkey
| | - Emrah Orhan
- Student, Department of Obstetrics and Gynecology, Fatih Sultan Mehmet Training and Research Hospital , İstanbul, Turkey
| | - Niyazi Tug
- Associate Professor, Department of Obstetrics and Gynecology, Fatih Sultan Mehmet Training and Research Hospital , İstanbul, Turkey
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Xiromeritis P, Margioula-Siarkou C, Miliaras D, Kalogiannidis I. Laparoscopic excision of coexisting left tubal and right pseudotubal pregnancy after conservative management of previous ectopic pregnancy with methotrexate: an unusual clinical entity. Case Rep Surg 2015; 2015:645826. [PMID: 25810942 PMCID: PMC4355117 DOI: 10.1155/2015/645826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 01/26/2015] [Indexed: 11/22/2022] Open
Abstract
Tubal pregnancy concerns 97% of all ectopic pregnancies. Treatment can be either surgical (salpingostomy or salpingectomy) or medical (methotrexate administration). We present a case of a pseudotubal pregnancy after methotrexate treatment of a previous ectopic pregnancy. A37-year-old woman was diagnosed with ectopic pregnancy in the left Fallopian tube. A year ago, she had an ectopic pregnancy in the right tube, which was successfully treated with intramuscular methotrexate. During laparoscopy, two tubal masses were revealed, one in each Fallopian tube, and bilateral salpingectomy was performed. Histological analysis confirmed tubal pregnancy in the left Fallopian tube and presence of endosalpingitis in the right tube with no signs of chorionic villi. The optimal management of such cases has not yet been clarified. However, evaluation of tubal patency after a medically treated ectopic pregnancy would permit proper counsel of the patient on her fertility options, in order to choose the appropriate method of conception to achieve and accomplish a future pregnancy.
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Nanotechnology in reproductive medicine: Emerging applications of nanomaterials. NANOMEDICINE-NANOTECHNOLOGY BIOLOGY AND MEDICINE 2014; 10:921-38. [DOI: 10.1016/j.nano.2014.01.001] [Citation(s) in RCA: 117] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Revised: 12/09/2013] [Accepted: 01/09/2014] [Indexed: 12/21/2022]
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Polat M, Boynukalın FK, Yaralı İ, Yaralı H. Bilateral ectopic pregnancy following ICSI. BMJ Case Rep 2014; 2014:bcr-2014-204814. [PMID: 24969072 DOI: 10.1136/bcr-2014-204814] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Bilateral tubal ectopic pregnancy is a rare clinical condition with an estimated prevalence of 1/200,000 spontaneous pregnancies. There is paucity of data on the prevalence of this rare condition following intracytoplasmic sperm injection and embryo transfer (ICSI-ET) cycles. We report two patients with bilateral tubal ectopic pregnancy following ICSI-ET. Both patients had normal, reassuring β-human chorionic gonadotropin dynamics during follow-up; the diagnosis was performed when no gestational sac was noted at the first planned antenatal visit. Of the two patients, one was treated medically and the other surgically with laparoscopic salpingotomy and salpingectomy for the right and left sides, respectively. Both patients thereafter conceived and delivered healthy infants following subsequent ICSI-ET attempts.
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Affiliation(s)
- Mehtap Polat
- IVF Unit, Anatolia IVF and Women Health Center, Ankara, Turkey
| | | | - İrem Yaralı
- IVF Unit, Anatolia IVF and Women Health Center, Ankara, Turkey
| | - Hakan Yaralı
- IVF Unit, Anatolia IVF and Women Health Center, Ankara, Turkey Department of Obstetrics and Gynecology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Trophoblastic infiltration in tubal pregnancy evaluated by immunohistochemistry and correlation with variation of Beta-human chorionic gonadotropin. PATHOLOGY RESEARCH INTERNATIONAL 2014; 2014:302634. [PMID: 24523985 PMCID: PMC3913197 DOI: 10.1155/2014/302634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Revised: 11/23/2013] [Accepted: 12/08/2013] [Indexed: 11/21/2022]
Abstract
Objective. To evaluate trophoblastic cell proliferation and angiogenesis in tubal pregnancy assessed by immunohistochemical study and their correlation with an average variation of β-hCG in an interval of 48 hours before surgery. Methods. A prospective study was conducted on 18 patients with a diagnosis of tubal pregnancy. The patients were divided into two groups of ectopic pregnancy of which 11 showed rise of β-hCG levels and 7 patients showed declining β-hCG levels in an interval of 48 hours prior to surgery. Trophoblastic cell proliferation and angiogenesis were assessed by Ki-67 and VEGF, respectively. Trophoblastic cell proliferation was assessed by Ki-67 and was classified into three groups (grade I: less than 1/3 of stained nuclei, grade II: 1/3 to 2/3 of the stained nuclei, and grade III: more than 2/3 of the nuclei stained). The cases analyzed for VEGF were divided into three groups (grade I: less than 1/3 of the stained cytoplasm; grade II: 1/3 to 2/3 of the stained cytoplasm; grade III: more than 2/3 of the stained cytoplasm). Statistical analysis was performed using the chi-square, ANOVA, and Kruskal-Wallis tests. Results. The mean variation in the serum β-hCG levels in 48 hours in tubal pregnancy patients correlated with trophoblastic cell proliferation assessed by Ki-67 and showed a decline of 13.46% in grade I, a rise of 45.99% in grade II, and ascension of 36.68% in grade III (P = 0.030). The average variation in the serum β-hCG in 48 hours, where angiogenesis was evaluated by VEGF, showed a decline of 18.35% in grade I, a rise of 32.95% in grade II, and ascension of 37.55% in grade III (P = 0.047). Conclusions. Our observations showed a direct correlation of increased levels of serum β-hCG in 48h period prior to surgery with higher trophoblastic cell proliferation assessed by Ki-67 and angiogenesis assessed by VEGF in tubal pregnancy.
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10
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Sun J, Sugiyama A, Inoue S, Takeuchi T, Furukawa S. Effect of methotrexate on neuroepithelium in the rat fetal brain. J Vet Med Sci 2013; 76:347-54. [PMID: 24200895 PMCID: PMC4013360 DOI: 10.1292/jvms.13-0457] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Pregnant rats were treated with 30 mg/kg of methotrexate (MTX) on gestation day
13, and fetal brains were examined histopathologically from 6 to 48 hr after the
treatment. In the telencephalon of the control group, there were few pyknotic
neuroepithelial cells throughout the experimental period. Six hr after MTX treatment,
several pyknotic neuroepithelial cells scattered throughout the telencephalic wall. At
12–36 hr, pyknotic neuroepithelial cells increased significantly and were diffusely
distributed throughout the telencephalic wall. Neuroepithelial cells were eliminated and
showed sparse cell density at 36 hr in the telencephalon. Almost all fetuses died at 48
hr. Most of the pyknotic neuroepithelial cells were positively stained by the TUNEL method
and positive for cleaved caspase-3. While mitotic and phospho-histone H3-positive
neuroepithelial cells were located along the ventricular layer of telencephalon in the
control group, they were rarely observed in the same region at 6–36 hr in the MTX-treated
group. MTX induced few pyknotic changes to neuroepithelial cells in the metencephalon,
compared to other parts of brain. The distribution of apoptotic neuroepithelial cells and
the time-course changes of the indices of apoptotic and mitotic neuroepithelial cells were
different from those of other DNA-damaging chemicals reported previously. The difference
may reflect the disparity in mechanisms of apoptosis and the inhibition of cell
proliferation in neuroepithelial cells induced by MTX. To our knowledge, this is the first
report demonstrating histopathological findings of fetal brain damage induced by MTX.
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Affiliation(s)
- Jing Sun
- Courses of Veterinary Laboratory Medicine, School of Veterinary Medicine, Faculty of Agriculture, Tottori University, 4-101 Koyama-cho Minami, Tottori, Tottori 680-8553, Japan
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Lawani OL, Anozie OB, Ezeonu PO. Ectopic pregnancy: a life-threatening gynecological emergency. Int J Womens Health 2013; 5:515-21. [PMID: 23983494 PMCID: PMC3751381 DOI: 10.2147/ijwh.s49672] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Ectopic pregnancy is a life-threatening gynecological emergency, and a significant cause of maternal morbidity and mortality in Nigeria. Objective The aim of this work was to determine and evaluate the incidence, clinical presentation, risk factors, and management outcomes of ectopic pregnancies at Ebonyi State University Teaching Hospital (EBSUTH) in Abakaliki. Methods This was a retrospective, descriptive study of ectopic pregnancies managed in EBSUTH during the study period (June 1, 2002 to May 31, 2012). The medical records of the patients managed for ectopic pregnancy as well as the total birth record and gynecological admission records during the period under review were retrieved, and data were collected with the aid of data-entry forms designed for this purpose. There were 4,610 gynecological admissions and 9,828 deliveries, with 215 cases of ectopic pregnancies. A total of 205 cases were suitable for analysis after excluding cases with incomplete records. The relevant data collected were analyzed with SPSS version 15.0 for Windows. Results Ectopic pregnancy constituted 4.5% of all gynecological admissions, and its incidence was 2.1%. The mean age of the patients was 27 ± 2 years, 196 of 205 (95.6%) had ruptured ectopic pregnancies, and the remaining nine (4.4%) were unruptured. The commonest (166 of 205, 80.0%) clinical presentation was abdominal pain, and the commonest (105 of 205, 51.2%) identified risk factor was a previous history of induced abortion. Three deaths were recorded, giving a case-fatality rate of 1.4% (three of 205). Conclusion Ectopic pregnancy is a recognized cause of maternal morbidity and mortality and has remained a reproductive health challenge to Nigerian women, as well as a threat to efforts in achieving the UN’s Millennium Development Goal 5 in sub-Saharan Africa.
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Affiliation(s)
- Osaheni L Lawani
- Department of Obstetrics and Gynecology, Federal Teaching Hospital, Abakaliki, Nigeria
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Ustunyurt E, Duran M, Coskun E, Ustunyurt ÖB, Simşek H. Role of initial and day 4 human chorionic gonadotropin levels in predicting the outcome of single-dose methotrexate treatment in women with tubal ectopic pregnancy. Arch Gynecol Obstet 2013; 288:1149-52. [PMID: 23666603 DOI: 10.1007/s00404-013-2879-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Accepted: 05/02/2013] [Indexed: 11/27/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the initial and day 4 beta-human chorionic gonadotropin (β-hCG) levels as a predictor of methotrexate (MTX) therapy success for ectopic pregnancy. METHODS Retrospective study of 87 patients with tubal ectopic pregnancy treated with a single dose of 50 mg/m(2) MTX at Bursa Şevket Yılmaz Research and Education Hospital between January 2011 and July 2012 was performed. RESULTS The overall success rate is measured as 72.4 %. The two groups of patients, successfully treated patients (n = 63) and unsuccessfully treated patients (n = 24), were compared. The mean initial β-hCG level was significantly lower in the treatment success group than in the treatment failure group (1,417 mIU/mL versus 5,995 mIU/mL, p < 0.001). The number of cases with decreasing β-hCG level on day 4 was significantly more in the success group compared to the failure group (61.9 and 37.5 %, respectively, p = 0.04). The success rate was 90 % when β-hCG levels were <1,000 mIU/mL, 85.7 % when the levels were between 1,000 and 1,999 mIU/mL, and 76.5 % when the levels were between 2,000 and 2,999 mIU/mL, 54.5 % when the levels were between 3,000 and 3,999 mIU/mL. CONCLUSION Single-dose MTX therapy is a safe and effective treatment modality for tubal ectopic pregnancies with the β-hCG serum concentration below 3,000 mIU/mL, and β-hCG level changes between days 0 and 4 after MTX therapy are important in predicting the outcome of treatment.
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Affiliation(s)
- Emın Ustunyurt
- The Department of Obstetrics and Gynecology, Bursa Şevket Yılmaz Research and Education Hospital, Bursa, Turkey,
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13
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Rubal L, Chung K. Do you need to definitively diagnose the location of a pregnancy of unknown location? The case for "yes". Fertil Steril 2013; 98:1078-84. [PMID: 23084009 DOI: 10.1016/j.fertnstert.2012.09.033] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Revised: 09/17/2012] [Accepted: 09/20/2012] [Indexed: 12/27/2022]
Abstract
Pregnancy of unknown location (PUL) is a common diagnostic challenge. The primary diagnostic goal is to ensure that the PUL is nonviable prior to proceeding with any invasive procedures. In nonviable PUL, there are several diagnostic and treatment strategies, which are generally quite safe. However, the management option that provides the most definite diagnosis is uterine curettage. We advocate use of uterine curettage in all cases of nonviable PUL because it limits exposure to a chemotherapeutic agent to only those who need it and it allows for the most accurate information for counseling the patient on prognosis of future pregnancies.
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Affiliation(s)
- Lauren Rubal
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, University of Southern California Keck School of Medicine, Los Angeles, California, USA
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Talwar P, Sandeep K, Naredi N, Duggal BS, Jose T. Systemic methotrexate: An effective alternative to surgery for management of unruptured ectopic pregnancy. Med J Armed Forces India 2012; 69:130-3. [PMID: 24600085 DOI: 10.1016/j.mjafi.2012.08.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2010] [Accepted: 08/25/2012] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Medical management of an unruptured ectopic pregnancy with intramuscular methotrexate is a common and cost-effective alternative to surgery. Early diagnosis and timely institution of methotrexate has resulted in a dramatic decline in the morbidity, mortality and financial burden associated with ectopic pregnancy. The objective of our study was to evaluate the efficacy of medical management in a series of patients with unruptured ectopic pregnancy meeting the strict inclusion criteria. METHODS Multiple dose methotrexate regimen was utilized for the management of the cases. Parenteral methotrexate 1 mg/kg was administered on Day 1, Day 3, Day 5 and Day 7 whereas rescue dose of injection leucovorin 0.1 mg/kg was given on Day 2, Day 4, Day 6 and Day 8. Monitoring for the resolution of the ectopic was carried out with β-hCG, done on Day 1, Day 3, Day 5, and Day 7. Any value showing a decline of >15% of the baseline value led to the termination of treatment and only surveillance was carried out. If the decrease was <15%, treatment was continued. RESULTS Total 43 patients with ectopic pregnancy were diagnosed over a period of 1 year, conceived during infertility evaluation and treatment. 11 cases went directly for surgery whereas 32 were subjected to medical treatment. 75% of the patients got successfully treated and rest 25% required surgery following failed medical management. CONCLUSIONS Methotrexate therapy is a safe and effective alternative for the management of unruptured ectopic pregnancies with minimal or no side-effects and associated advantage of avoiding invasive surgery.
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Affiliation(s)
- Pankaj Talwar
- Senior Advisor (Obstetrics & Gynaecology), INHS Asvini, Colaba, Mumbai, India
| | - K Sandeep
- Classified Specialist (Obstetrics & Gynaecology), ART Centre, Army Hospital (R&R), New Delhi 10, India
| | - Nikita Naredi
- Graded Specialist (Obstetrics & Gynaecology), ART Centre, Army Hospital (R&R), New Delhi 10, India
| | - B S Duggal
- Consultant (Gynaec) & Endoscopic Surgeon, Ruby Hospital, Pune, Maharashtra, India
| | - Tony Jose
- Classified Specialist (Obstetrics & Gynaecology), Army Hospital (R&R), New Delhi 10, India
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15
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Wu MP, Lee CL. The trends of minimally invasive surgery for benign gynecologic lesions, 1997-2007 in Taiwan. Gynecol Minim Invasive Ther 2012. [DOI: 10.1016/j.gmit.2012.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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He GB, Luo W, Zhou XD, Liu LW, Yu M, Ma XD. A preliminary clinical study on high-intensity focused ultrasound therapy for tubal pregnancy. Scott Med J 2012; 56:214-9. [PMID: 22089043 DOI: 10.1258/smj.2011.011161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Our aim was to explore the clinical application value of high-intensity focused ultrasound (HIFU) therapy for tubal pregnancy. Forty hospitalized patients with tubal pregnancies (28 cases of non-ruptured tubal pregnancy and 12 cases of ruptured tubal pregnancy) were selected to receive HIFU therapy. Serum human chorionic gonadotropin (β-HCG) concentrations were compared before and after treatment. Serum β-HCG was measured weekly and patients received observation only if the concentration decreased by 15% or more, compared with the previous value. Patients were given supplement HIFU therapy if the decrease in the serum β-HCG was <15% within two weeks. Ultrasound was used to detect the volume changes in the ectopic lesions before and after treatment, and changes in vital signs and complications were recorded. Contrast-enhanced ultrasonography was used to assess fallopian tube patency after treatment. HIFU treatment was successful in 33 of the 40 patients (82%). Seven patients failed HIFU treatment and received surgical therapy (18%). Before and after treatment, serum β-HCG concentrations and lesion volume were significantly different (P < 0.05, P < 0.01, respectively). Post-treatment tubal contrast-enhanced ultrasonography showed tubal patency on the affected side in 21 cases (64%) at six months and in 27 cases (82%) at 12 months. In conclusion, HIFU is safe and effective, and can be a treatment option for tubal pregnancy.
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Affiliation(s)
- G-B He
- Department of Ultrasonography, Xijing Hospital, The Fourth Military Medical University, Xi'an 710032, Shaanxi Province, China
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Marcelli M, Lamourdedieu C, Lazard A, Cravello L, Gamerre M, Agostini A. Salpingectomy for ectopic pregnancy by transumbilical single-site laparoscopy with the SILS® system. Eur J Obstet Gynecol Reprod Biol 2012; 162:67-70. [DOI: 10.1016/j.ejogrb.2012.01.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2011] [Revised: 12/17/2011] [Accepted: 01/10/2012] [Indexed: 12/01/2022]
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Abstract
Nurses are in an ideal position to perform pelvic ultrasound evaluations, and appropriately trained nurses can perform limited ultrasound evaluations as part of the assessment and treatment of infertility. In this article, the author provides detailed descriptions and accompanying ultrasonic images illustrating the use of ultrasound in providing vital clinical information in reproductive medicine and in the assessment of the first trimester of pregnancy.
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Affiliation(s)
- Susan C Carr
- Reproductive Associates of Delaware, 4735 Ogletown-Stanton Rd., Newark, DE 19713, USA.
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The Value of Hysterosalpingography following Medical Treatment with Methotrexate for Ectopic Pregnancy. Obstet Gynecol Int 2011; 2011:547946. [PMID: 21961008 PMCID: PMC3180780 DOI: 10.1155/2011/547946] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Revised: 07/21/2011] [Accepted: 07/26/2011] [Indexed: 11/18/2022] Open
Abstract
After an ectopic pregnancy (EP) fertility decreases, mostly due to tubal factor. Hysterosalpingography (HSG) is the most cost-effective tool for tubal patency assessment. Objective. To evaluate the usefulness of a HSG after a medical treatment for an EP, in order to counsel women on the most appropriate way to conceive future pregnancies. Methods. Between 1998 and 2008, 144 patients were submitted to medical treatment for an EP and performed HSG 3 months after the event. Results. 72.2% of normal HSG, 18.8% with unilateral obstruction, 6.3% tubal patency with defect, and 2.8% bilateral obstruction. Conclusion. Routine HSG following medical treatment for an EP does not seem necessary, as it does not change the initial management in 97.2% of the cases, but might be considered in selected risk cases, permitting timely referral of patients to in vitro fertilization.
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Gnisci A, Rua S, Courbiere B, Cravello L, Gamerre M, Agostini A. Plasma creatine phosphokinase level may predict successful treatment after a single injection of methotrexate for ectopic pregnancy. Fertil Steril 2011; 95:2131-3. [DOI: 10.1016/j.fertnstert.2010.12.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2010] [Revised: 11/04/2010] [Accepted: 12/13/2010] [Indexed: 11/16/2022]
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21
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Kawamura K, Kawamura N, Kumazawa Y, Kumagai J, Fujimoto T, Tanaka T. Brain-derived neurotrophic factor/tyrosine kinase B signaling regulates human trophoblast growth in an in vivo animal model of ectopic pregnancy. Endocrinology 2011; 152:1090-100. [PMID: 21239439 DOI: 10.1210/en.2010-1124] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Although medical treatment of unruptured ectopic pregnancy using methotrexate has been established, development of more potent and safer medical treatment is needed due to limited indications and side effects of methotrexate. Brain-derived neurotrophic factor (BDNF) signals through its receptor tyrosine kinase B (TrkB) to regulate the growth of malignant trophoblastic, choriocarcinoma cell. We investigated possible involvement of this signaling system in nonmalignant human trophoblast growth in both ectopic and intrauterine pregnancy. Here, we demonstrated the expression of BDNF in syncytiotrophoblasts and extravillous trophoblasts (EVTs) together with TrkB in cytotrophoblasts and EVTs in human placental villi during both normal and ectopic pregnancies. Treatment of cultured villous explants with soluble TrkB ectodomain or a Trk receptor inhibitor K252a suppressed cytotrophoblast differentiation by inhibiting EVT outgrowth reflected by decreased levels of an EVT marker, human leukocyte antigen-G. These inhibitors also decreased cytotrophoblast proliferation and cellular viability based on histopathological analyses and monitoring glucose metabolism, together with increased apoptosis in cytotrophoblasts based on in situ terminal deoxynucleotidyl transferase-mediated 2'-deoxyuridine 5'-triphosphate nick end-labeling and caspase-3/7 assays. After xenotransplantation of human placental villi into SCID mice as an in vivo model of ectopic pregnancy, treatment with K252a suppressed transplanted villi growth as reflected by decreased cytotrophoblast differentiation and proliferation, reduced tissue levels of chorionic gonadotropin-β, and increased apoptosis and caspase-3/7 activities. Thus, paracrine signaling by the BDNF/TrkB system is important for human cytotrophoblast differentiation, proliferation, and survival, and inhibition of BDNF/TrkB signaling in cytotrophoblasts could provide a novel medical treatment for ectopic pregnancy.
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Affiliation(s)
- Kazuhiro Kawamura
- Department of Obstetrics and Gynecology, Akita University School of Medicine, 1-1-1 Hondo, Akita 010-8543, Japan.
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Butts SF, Gibson E, Sammel MD, Shaunik A, Rudick B, Barnhart K. Race, socioeconomic status, and response to methotrexate treatment of ectopic pregnancy in an urban population. Fertil Steril 2010; 94:2789-92. [PMID: 20674907 PMCID: PMC2992583 DOI: 10.1016/j.fertnstert.2010.06.062] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2010] [Revised: 06/14/2010] [Accepted: 06/16/2010] [Indexed: 10/19/2022]
Abstract
On the basis of the documented racial disparities in ectopic pregnancy incidence and mortality we hypothesized that African-American women with ectopic pregnancy would be more likely than white women to have treatment failure with methotrexate. In this retrospective cohort study, a racial disparity in methotrexate effectiveness was not found, but a significant relationship between low socioeconomic status and methotrexate failure was demonstrated.
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Affiliation(s)
- Samantha F Butts
- Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.
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Okorie CO. Retroperitoneal ectopic pregnancy: Is there any place for non-surgical treatment with methotrexate? J Obstet Gynaecol Res 2010; 36:1133-6. [DOI: 10.1111/j.1447-0756.2010.01270.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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24
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Ambler DR, Derian E, Bieber EJ. A Ruptured Ectopic Pregnancy Without Sustained Bleeding After Administration of Methotrexate. J Gynecol Surg 2009. [DOI: 10.1089/gyn.2009.0020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Dana R. Ambler
- Division of Reproductive Endocrinology and Infertility, Geisinger Medical Center, Danville, PA
| | - Edie Derian
- Division of Gynecology, Department of Obstetrics and Gynecology, Geisinger Medical Center, Danville, PA
| | - Eric J. Bieber
- Division of Reproductive Endocrinology and Infertility, Geisinger Medical Center, Danville, PA
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25
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Panda S, Darlong LM, Singh S, Borah T. Case report of a primary ovarian pregnancy in a primigravida. J Hum Reprod Sci 2009; 2:90-2. [PMID: 19881157 PMCID: PMC2800936 DOI: 10.4103/0974-1208.57231] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2009] [Revised: 04/30/2009] [Accepted: 05/09/2009] [Indexed: 11/04/2022] Open
Abstract
Primary ovarian pregnancy occurs quite rarely and that too usually in young highly fertile multiparous women using intra uterine device. We present a case where a young primigravida presented with abdominal pain and was diagnosed as ectopic pregnancy and was confirmed intra-operatively and histopathologically as primary ovarian pregnancy, managed with partial ovariectomy.
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Affiliation(s)
- Subrat Panda
- Departments of Obstetrics and Gynecology, North East Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India
| | - Laleng M Darlong
- Departments of Surgery, North East Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India
| | - Santa Singh
- Departments of Obstetrics and Gynecology, North East Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India
| | - Tulon Borah
- Departments of Obstetrics and Gynecology, North East Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India
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