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Trefsgar JR, Padgett W. Bilateral Tubal Ectopic Pregnancy: A Case Report and Review. Cureus 2024; 16:e68742. [PMID: 39371849 PMCID: PMC11455586 DOI: 10.7759/cureus.68742] [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] [Accepted: 09/04/2024] [Indexed: 10/08/2024] Open
Abstract
A bilateral ectopic pregnancy is a rare condition, and even more so with spontaneous conception. The known risk factors and clinical presentation are shared by both unilateral and bilateral ectopic pregnancy. This poses a risk for misdiagnosis, treatment failure, and, ultimately, maternal mortality. The current standard for diagnostics is not discernible for a bilateral ectopic pregnancy, thus, medical management tends to be sub-therapeutic. In fact, it is fairly common for the correct diagnosis and efficient treatment to be achieved by surgical intervention. As there are no established diagnostic or treatment guidelines for this rare condition, the possibility of a bilateral ectopic pregnancy should not be ruled out lightly.
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Affiliation(s)
| | - William Padgett
- Obstetrics and Gynecology, Southern Illinois Healthcare Foundation (SIHF) Healthcare, Olney, USA
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2
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Zhang Y, Lu X, Wang X, Wu X, Jing X, Cui X. Rare Unilateral Twin Ectopic Pregnancy After Frozen Embryo Transfer: A Case Report and Literature Review. Int Med Case Rep J 2023; 16:731-737. [PMID: 38020575 PMCID: PMC10655727 DOI: 10.2147/imcrj.s409492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 11/04/2023] [Indexed: 12/01/2023] Open
Abstract
Background Unilateral twin ectopic pregnancy is extremely rare in natural pregnancy, with an incidence rate of only 1 in 200,000-2,500,000, represents a major health risk for reproductive-aged women, leading to even life-threatening complications. There is a lack of data on the prevalence of this rare disease after in-vitro fertilization-embryo transfer (IVF-ET) cycles. Case Report We present a case of a 51-year-old woman with rare unilateral twin ectopic pregnancy after frozen embryo transfer treated with bilateral salpingectomy, followed by a review of the literature. Conclusion Twin ectopic pregnancy is a very rare type of pregnancy that requires a high index of suspicion to diagnose and treat early to prevent complications and maternal death.
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Affiliation(s)
- Yuxia Zhang
- Reproductive Medicine Center, the Affiliated Children’s Hospital of Shanxi Medical University, Children’s Hospital of Shanxi, Shanxi Maternal and Child Health Hospital, Taiyuan, 030001, People’s Republic of China
| | - Xiaobing Lu
- Reproductive Medicine Center, the Affiliated Children’s Hospital of Shanxi Medical University, Children’s Hospital of Shanxi, Shanxi Maternal and Child Health Hospital, Taiyuan, 030001, People’s Republic of China
| | - Xianping Wang
- Reproductive Medicine Center, the Affiliated Children’s Hospital of Shanxi Medical University, Children’s Hospital of Shanxi, Shanxi Maternal and Child Health Hospital, Taiyuan, 030001, People’s Republic of China
| | - Xueqing Wu
- Reproductive Medicine Center, the Affiliated Children’s Hospital of Shanxi Medical University, Children’s Hospital of Shanxi, Shanxi Maternal and Child Health Hospital, Taiyuan, 030001, People’s Republic of China
| | - Xuan Jing
- Clinical Laboratory, Shanxi Provincial People’s Hospital (Fifth Hospital) of Shanxi Medical University, Taiyuan, 030001, People’s Republic of China
| | - Xiangrong Cui
- Reproductive Medicine Center, the Affiliated Children’s Hospital of Shanxi Medical University, Children’s Hospital of Shanxi, Shanxi Maternal and Child Health Hospital, Taiyuan, 030001, People’s Republic of China
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3
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Al-Nuaimy Y, John J, Alhomsi SM, Al-Baghdadi OO. Multiple Spontaneous Ectopic Pregnancies Following Bilateral Salpingectomy. Int Med Case Rep J 2023; 16:725-729. [PMID: 37954088 PMCID: PMC10638940 DOI: 10.2147/imcrj.s432437] [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: 08/03/2023] [Accepted: 10/21/2023] [Indexed: 11/14/2023] Open
Abstract
Introduction Ectopic pregnancy (EP) is a significant cause of gynaecological morbidity and mortality. Salpingectomy is the preferred management modality in recurrent ectopic pregnancies; although they do not eliminate the risk of reoccurrence. The aetiology of recurrent ectopic pregnancies remains unknown but there are identifiable risk factors associated with increased likelihood of occurrence. Case Presentation We present the case of a 30-year-old woman who attended the emergency unit with her second spontaneous ectopic pregnancy following a previous bilateral salpingectomy. She had prior multiple spontaneous ectopic pregnancies: laparoscopic salpingectomy for a left cornual EP in 2017 followed by laparotomic salpingectomy for a ruptured right EP after failed medical management in 2018. Lastly, she had laparoscopic removal of an EP sac in the scar of a previous left cornual EP in 2019. She presented with a history of missed periods, pelvic pain, and vaginal spotting. Her examination revealed left lower abdominal pain, soft, non-tender abdomen, and no cervical excitation. Pelvic ultrasound revealed a thin endometrium and no intrauterine pregnancy visualised. A suspicious complex mass near the left ovary with a ring-like structure was noted. Her β-HCG was (251 IU/L) which plateaued after 48 hrs (220 IU/L). She responded well to methotrexate with no need for surgical intervention this time. Conclusion This case is unique as it highlights the importance of keeping an open mind when managing recurrent ectopic pregnancies, especially when preventative surgical measures have been performed previously.
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Affiliation(s)
- Yusor Al-Nuaimy
- College of Medicine, Ajman University, Ajman, United Arab Emirates
| | - Jacqueline John
- Department of Obstetrics and Gynaecology, Tawam Hospital, Al-Ain City, Abu Dhabi, United Arab Emirates
| | - Sousan Mohamad Alhomsi
- Department of Obstetrics and Gynaecology, Tawam Hospital, Al-Ain City, Abu Dhabi, United Arab Emirates
| | - Omaema Omar Al-Baghdadi
- Department of Obstetrics and Gynaecology, Tawam Hospital, Al-Ain City, Abu Dhabi, United Arab Emirates
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4
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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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5
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Öztürk E, Aktürk H. Sonographically Positive Fetal Heartbeat in Unilateral Tubal Twin Pregnancy as a Rare Case With Literature Review. Cureus 2023; 15:e39697. [PMID: 37398746 PMCID: PMC10308801 DOI: 10.7759/cureus.39697] [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] [Accepted: 05/30/2023] [Indexed: 07/04/2023] Open
Abstract
Ectopic pregnancies occur when a fertilized egg implants outside the uterus, usually in the fallopian tube. Twin ectopic pregnancies are rare and pose significant diagnostic and management challenges. This case report presents the clinical details and management of a unilateral twin ectopic pregnancy in a 31-year-old female patient. The purpose of this report is to highlight the complexities associated with the diagnosis and management of this uncommon condition. In this case, we performed the left salpingectomy. We confirmed pathologically and histologically in pregnancy in the same tube.
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Affiliation(s)
- Emine Öztürk
- Obstetrics and Gynaecology, Bakırköy Sadikonuk Education and Research Hospital, Istanbul, TUR
| | - Hilal Aktürk
- Obstetrics and Gynaecology, Bakırköy Sadi Konuk Education and Research Hospital, Istanbul, TUR
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Masten M, Alston M. Spontaneous Bilateral Ectopic Pregnancy Treated With Combination of Methotrexate, Unilateral Salpingectomy, and Unilateral Expulsion of Pregnancy. Cureus 2022; 14:e29031. [PMID: 36237762 PMCID: PMC9552852 DOI: 10.7759/cureus.29031] [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] [Accepted: 09/08/2022] [Indexed: 11/23/2022] Open
Abstract
Spontaneous bilateral ectopic pregnancies are rare. In the majority of case reports, treatments prescribed were methotrexate, bilateral salpingectomy, or salpingectomy/salpingostomy. A 31-year-old gravida 3 para 0 at our institution underwent diagnostic laparoscopy due to ruptured ectopic pregnancy, and based on visual inspection, had a bilateral ectopic pregnancy. She underwent right salpingectomy for a ruptured ectopic pregnancy and had spontaneous expulsion of the left ectopic pregnancy with mobilization of the fallopian tube. She received methotrexate as per the two-dose protocol and was followed with a negative beta-human chorionic gonadotropin (b-hCG). Pathology confirmed bilateral tubal ectopic pregnancies. Spontaneous bilateral tubal ectopic pregnancy requires a high level of clinical suspicion. If a tubal pregnancy has expulsion of tissue intraoperatively, a two-dose protocol for methotrexate administration may be used for treatment, especially in the case of a bilateral ectopic pregnancy with fertility desires.
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Kyejo W, Rubagumya D, Fidaali Z, Jusabani A, Kaguta M, Jaiswal S. Bilateral tubal ectopic gestation: Complication in a patient with previous ectopic pregnancy, rare case report. Int J Surg Case Rep 2022; 97:107470. [PMID: 35926381 PMCID: PMC9403351 DOI: 10.1016/j.ijscr.2022.107470] [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: 07/07/2022] [Revised: 07/27/2022] [Accepted: 07/28/2022] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Ectopic pregnancy results of implantation of conceptus outside of endometrial cavity. It remains an important cause of maternal mortality. Spontaneous bilateral tubal pregnancies are the rare form of ectopic and are considered spontaneous when no fertility treatments are involved. CASE FINDINGS A 31-year-old nulliparous woman presented at the Family Medicine Clinic with complaints of non-specific mild lower abdominal pain for 3 days and amenorrhea for 5 weeks. Transvaginal Ultrasound showed bilateral unruptured adnexa pregnancies. The trial of medical therapy was done without success and later laparotomy salpingostomy was done. One year later patient was able to conceive and delivery well by cesareans section. DISCUSSION Bilateral ectopic pregnancy is a unique from of twin pregnancy frequently occurring with assisted reproductive technology rather than spontaneous pregnancy. Diagnosis of bilateral ectopic pregnancy is often challenging as the clinical symptoms and signs may not be indicative of bilateral involvement. Laboratory test with βhcg levels cannot suggestive if is unilateral or bilateral nature and sonographers may be falsely reassured if they are not careful and satisfied with visualization of ectopic gestation on one side. Laparoscopic salpingostomy or salpingectomy is the gold standard treatment modality for bilateral tubal ectopic pregnancy although laparotomy may be indicated in unstable patient. CONCLUSION AND RECOMMENDATION Therefore, any women in childbearing age presenting with clinical features of acute lower abdominal pain should be considered to have potential ectopic gestation.
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Affiliation(s)
- Willbroad Kyejo
- Department of Family Medicine, Aga Khan University, P.O. Box 38129, Dar Es Salaam, Tanzania,Corresponding author.
| | - Davis Rubagumya
- Department of Family Medicine, Aga Khan University, P.O. Box 38129, Dar Es Salaam, Tanzania,Department of Family Medicine, Premier Care Clinic Masaki, PO Box 220, Dar Es Salaam, Tanzania
| | - Zainab Fidaali
- Department of Radiology, Aga Khan Hospital, P.O. Box 2289, Dar Es Salaam, Tanzania
| | - Ahmed Jusabani
- Department of Radiology, Aga Khan Hospital, P.O. Box 2289, Dar Es Salaam, Tanzania
| | - Munawar Kaguta
- Department of Obstetrics and Gynecology, Aga Khan Hospital, P.O. Box 2289, Dar Es Salaam, Tanzania
| | - Shweta Jaiswal
- Department of Obstetrics and Gynecology, Aga Khan Hospital, P.O. Box 2289, Dar Es Salaam, Tanzania
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Wang ZZ, Xu LW, Zhao L, Chen YJ, Liu HC, Yu EK. Simultaneous bilateral fallopian tubal pregnancy of a laparoscopic definite spontaneous unilateral ovulation: a case report. BMC Pregnancy Childbirth 2022; 22:110. [PMID: 35144595 PMCID: PMC8832656 DOI: 10.1186/s12884-022-04453-0] [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: 07/26/2021] [Accepted: 02/02/2022] [Indexed: 11/25/2022] Open
Abstract
Background Bilateral simultaneous fallopian tubal pregnancy is one of the rarest forms of ectopic pregnancy. Due to the lack of unique features and clinical presentation to distinguish bilateral from unilateral ectopic pregnancy, challenges the diagnosis. Case report A 27-year-old Asian woman presented with pelvic pain and vaginal bleeding. Pelvic transvaginal ultrasound showed fluid in Douglas Pouch and posterior fornix puncture revealed unclotted blood. Laparoscopic examination unveiled bilateral ectopic pregnancy with two corpus luteum visible in the right ovary, suggesting a double spontaneous unilateral ovulation. Bilateral fallopian tube fenestration and embryo extraction were performed to preserve fertility. Conclusion Diagnosis of bilateral tubal pregnancy is difficult during preoperative ultrasound examination and careful examination during laparoscopic inspection of the whole pelvic cavity to avoid missed diagnosis.
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Affiliation(s)
- Zhen-Zhen Wang
- Department of Gynaecology, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China
| | - Lian-Wei Xu
- Department of Gynaecology, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China
| | - Li Zhao
- Department of Gynaecology, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China
| | - Yi-Jia Chen
- Department of Gynaecology, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China
| | - Hui-Cong Liu
- Department of Gynaecology, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China
| | - Er-Kai Yu
- Department of Gynaecology, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China.
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Imaging of complications following treatment with assisted reproductive technology: keep on your radar at each step. Abdom Radiol (NY) 2022; 47:328-340. [PMID: 34535828 DOI: 10.1007/s00261-021-03245-y] [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: 05/26/2021] [Revised: 08/07/2021] [Accepted: 08/07/2021] [Indexed: 10/20/2022]
Abstract
Since the advent of assisted reproductive technology (ART), the utilization of ART procedures has become increasingly popular among women seeking to establish pregnancy. Radiologists are therefore likely to encounter the various complications of ART therapy. The most common is ovarian hyperstimulation syndrome; others are multiple, ectopic, and heterotopic pregnancies. Ultrasonography is considered the initial modality to investigate ART complications, However, nonspecific symptoms might need the use of an additional imaging modality, such as computed tomography or magnetic resonance imaging, as a problem-solving tool. This article briefly discusses the steps involved in assisted reproduction. Its aim is to help radiologists become familiarized with the multimodality imaging features of the spectrum of ART-related complications. Their key imaging features and differential considerations are emphasized. This will facilitate the provision of precise and timely diagnoses, and aid the avoidance of fatal consequences.
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10
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Matuzak AR. Sonographic Diagnosis of Bilateral Tubal Pregnancies. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2021. [DOI: 10.1177/8756479321992351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Bilateral tubal pregnancy (BTP) is a very rare form of ectopic twin gestation. Many times, they occur after the use of assisted reproductive therapy. Most cases of BTP are diagnosed during laparoscopy. This case report demonstrates a rare preoperative, sonography diagnosis of a spontaneous BTP which occurred after a tubal ligation. The sonogram revealed two corpus luteal cysts, both located on the right ovary, which suggests that the left tubal pregnancy most likely occurred as a result of ovum transmigration. This case demonstrates the important role that sonography plays in the early diagnosis of ectopic pregnancies as well as the importance of thoroughly examining the entire pelvis during a pelvic sonogram.
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Affiliation(s)
- Amber R. Matuzak
- Division of Ultrasound, University of Colorado Hospital, Aurora, CO, USA
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11
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Spontaneous Bilateral Ectopic Pregnancy in a Patient With Endometriosis. J Emerg Med 2021; 61:424-426. [PMID: 34148774 DOI: 10.1016/j.jemermed.2021.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/09/2021] [Accepted: 04/26/2021] [Indexed: 11/23/2022]
Abstract
Background Bilateral ectopic pregnancies (EPs) occur in 1 of 200,000 pregnancies. Evidence suggests that endometriosis is an independent risk factor for unilateral EPs. However, the link between endometriosis and bilateral EPs has not been established. Case Report We report a case of a bilateral EP in a patient with endometriosis. The patient was initially misdiagnosed with the unilateral EP. Why Should an Emergency Physician Be Aware of This? Although rare, bilateral EP should be on a differential diagnosis in a pregnant patient presenting with abdominal pain or vaginal bleeding. This includes patients presenting with worsening symptoms after the recent surgery for the unilateral EP. Endometriosis as a risk factor for bilateral EP cannot be established based on a single report, but such a report should raise awareness of the issue.
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Case Report of Spontaneous Bilateral Ovarian Pregnancy in a Nulliparous Lady. Case Rep Obstet Gynecol 2021; 2021:6670763. [PMID: 34055434 PMCID: PMC8143897 DOI: 10.1155/2021/6670763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 05/02/2021] [Indexed: 11/23/2022] Open
Abstract
Nontubal ectopic pregnancies, especially ovarian ones, are rare. Here, we report a case of spontaneous bilateral ovarian pregnancy in a 23-year-old nulliparous lady who presented with a three-day history of abdominal pain localized to the right iliac fossa. Laboratory investigations and pelvic US and transvaginal US findings were suggestive of a right ovarian ectopic pregnancy and left ovarian cyst. Following the patient's consent, the gynaecologist laparoscopically removed the right ovarian ectopic pregnancy and performed a left ovarian cystectomy. Histopathology revealed findings of trophoblastic tissue and chorionic villi with products of conception in both ovaries leading to the diagnosis of bilateral spontaneous ectopic pregnancy. Physicians must be mindful in cases that have a similar clinical presentation because an early diagnosis leads to a reduction in the morbidity and mortality of this specific patient population and helps to improve their overall prognosis.
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Zeng X, Luo L, Ou-Yang YW. A spontaneous bilateral fallopian tube pregnancy with didelphic uterus: A case report. Medicine (Baltimore) 2021; 100:e24291. [PMID: 33466216 PMCID: PMC7808534 DOI: 10.1097/md.0000000000024291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 12/23/2020] [Indexed: 01/05/2023] Open
Abstract
RATIONALE In this article, we report interesting clinical manifestation of spontaneous bilateral fallopian tube pregnancies in a patient with a didelphic uterus. PATIENT CONCERNS A 26-year-old female patient, gravida 2, para 0 + 1, suffered from progressive abdominal pain and vaginal bleeding. A laboratory exam revealed a human chorionic gonadotropin level of 1091 IU/L. Transvaginal ultrasound detected no embryo sacs in the uterus but revealed a didelphic uterus, and a mass measuring 39 mm x 32 mm in the left adnexa region with another mass measuring 42 x 28 mm in the right adnexa region. DIAGNOSES An ectopic pregnancy in the left adnexa region and a corpus hemorrhagicum in the right adnexa region were suspected. INTERVENTIONS Laparoscopic exploration operation confirmed a didelphic uterus, and pathological biopsy revealed bilateral fallopian tube pregnancies. OUTCOMES The patient made a good recovery and the human chorionic gonadotropin became normal within the following 2 months. LESSONS To the best of our knowledge, clinical manifestation of spontaneous bilateral fallopian tube pregnancies in a patient with a didelphic uterus has never been reported before. Based on the experience with this case, we suggest that if a gestational sac is found in 1 fallopian tube, the contralateral fallopian tube needs to be examined for an ectopic pregnancy during surgery.
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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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15
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Seak CJ, Goh ZNL, Wong AC, Seak JCY, Seak CK. Unilateral live twin tubal ectopic pregnancy presenting at 12 weeks of gestation: A case report. Medicine (Baltimore) 2019; 98:e17229. [PMID: 31567985 PMCID: PMC6756681 DOI: 10.1097/md.0000000000017229] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
RATIONALE Abdominal pain in pregnancy represents a demanding diagnostic challenge in the emergency department (ED) due to the extensive list of differential diagnoses to be considered, coupled with the possibility of each disease having nonclassical, atypical signs and symptoms, resultant from the patient's pregnant state. Additionally, emergency physicians (EPs) face limitations on investigative imaging modalities because of the need to minimize fetal radiation exposure. EPs have to tackle this diagnostic challenge while performing a balancing act to maximize both maternal and fetal outcomes in a time-sensitive manner, becauser any delays in decision-making at the ED may threaten the safety of mother and child. Two common causes of abdominal pain in pregnancy presenting to the ED are acute appendicitis and ectopic pregnancy. The latter is almost always diagnosed by 10 weeks of gestation. Here, we report an extremely rare case of unilateral live spontaneous twin tubal ectopic pregnancy presenting past 12 weeks of gestation, diagnosed after magnetic resonance imaging (MRI) of the abdomen. PATIENT CONCERNS A 37-year-old gravida 2 para 1 at 12 weeks and 6 days of gestation presented to our ED with a 2-day history of right iliac fossa pain, not associated with vaginal bleeding, fever, diarrhea, and vomiting. On examination, she was tachycardic (pulse rate 124 beats/min) and hypertensive (blood pressure 142/88 mm Hg). There was marked tenderness and guarding at the lower abdomen. DIAGNOSES Blood investigations were unremarkable, while abdominal ultrasonography found a live twin gestation with foetal heartbeats of 185 and 180 beats/min. MRI of the abdomen revealed an empty uterine cavity; 2 amniotic sacs and fetuses of diameter 10 cm, and a single placenta were noted in the right uterine adnexa. The patient was diagnosed with right live monochorionic diamniotic twin tubal pregnancy. INTERVENTION Our patient underwent emergency laparoscopic right salpingectomy. OUTCOMES The operation was successful and her postoperative care remained uneventful up to discharge. LESSONS Ectopic pregnancy cannot be ruled out based on prior normal antenatal examinations and gestational age of >10 weeks. EPs should not hesitate to order MRI scans for further evaluation if ultrasonography and laboratory findings are equivocal.
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Affiliation(s)
- Chen-June Seak
- Department of Emergency Medicine, Lin-Kou Medical Center, Chang Gung Memorial Hospital
- College of Medicine, Chang Gung University, Taoyuan, Taiwan, Republic of China
| | | | | | | | - Chen-Ken Seak
- Sarawak General Hospital, Kuching, Sarawak, Malaysia
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16
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Tsakiridis I, Chatzikalogiannis I, Dagklis T, Athanasiadis A, Mamopoulos A. Spontaneous unilateral twin tubal pregnancy: a rare case report with conservative management. J OBSTET GYNAECOL 2019; 39:1030-1031. [DOI: 10.1080/01443615.2019.1586859] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Ioannis Tsakiridis
- Third Department of Obstetrics and Gynaecology, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Chatzikalogiannis
- Third Department of Obstetrics and Gynaecology, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Themistoklis Dagklis
- Third Department of Obstetrics and Gynaecology, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Apostolos Athanasiadis
- Third Department of Obstetrics and Gynaecology, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Apostolos Mamopoulos
- Third Department of Obstetrics and Gynaecology, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Abstract
RATIONALE Ectopic pregnancy (EP) is a condition in which a fertilized oocyte implants outside the uterine. Spontaneous bilateral tubal pregnancies are the rarest form of ectopic and are considered spontaneous when no fertility treatments are involved. There are few prior cases. Here I report a case of spontaneous bilateral tubal pregnancy. PATIENT CONCERNS A 24-year-old female with long lasting vaginal bleeding of 29 days duration. DIAGNOSES Transvaginal ultrasound observed small complex masses on both adnexal sides without intrauterine gestational sac, and the hCG level was 21438 IU/L. But diagnosing based only on imaging findings and blood test result was difficult. INTERVENTIONS Operative laparoscopy with salpingectomy bilaterally. OUTCOMES Villi were clearly shown in both resected tubes. A spontaneous bilateral tubal pregnancy was confirmed finally and the patient recovered uneventfully. LESSONS Women of reproductive age with irregular menstruation should get access to diagnosis and appropriate treatment without delay. Salpingotomy should also be considered if the patient had a strong wish for future pregnancy. Developments of diagnosis and management of such condition are strongly called for.
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Management of Bilateral Ectopic Pregnancies after Ovulation Induction Using Unilateral Salpingectomy and Methotrexate for the Remaining Ectopic with Subsequent Intrauterine Pregnancy. Case Rep Obstet Gynecol 2018; 2018:7539713. [PMID: 30069421 PMCID: PMC6057319 DOI: 10.1155/2018/7539713] [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: 03/25/2018] [Accepted: 06/12/2018] [Indexed: 11/30/2022] Open
Abstract
Bilateral ectopic pregnancy is a rare phenomenon which is found with increased frequency when using assisted reproductive technology (ART). This diagnosis is most often made incidentally and intraoperatively, as ultrasound and serial β-hCG trends have shown poor efficacy for accurate diagnosis. Management of bilateral ectopic pregnancies is most commonly reported using bilateral surgical removal of the ectopic pregnancy (salpingostomy and/or salpingectomy). We present a case of an ART patient with incidentally found bilateral tubal ectopic pregnancies, where multiple management strategies including medical and surgical techniques were used concurrently which resulted in a subsequent spontaneous intrauterine pregnancy. While the standard of care is difficult to establish, we recommend individualizing management decisions based on the patient's reproductive goals and overall risk profile.
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Eom JM, Choi JS, Bae J, Lee WM, Lee E, Lee J, Keum JH. Coexisting ovarian and tubal pregnancies on opposite sides after intrauterine insemination: a case report. BMC Pregnancy Childbirth 2018; 18:259. [PMID: 29940883 PMCID: PMC6019221 DOI: 10.1186/s12884-018-1801-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 04/30/2018] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Ovarian pregnancy is very rare, and contralateral tubal pregnancy coexisting with ovarian pregnancy must be even rarer. CASE PRESENTATION A 33-year-old Korean nulliparous woman was referred to our hospital because she suffered lower abdominal pain and had missed her periods after controlled ovarian hyperstimulation and intrauterine insemination. We could not identify any normal gestational sac in the endometrium, or specific ectopic pregnancies, on an initial ultrasound scan. However, there was a large hematoma in the cul-de-sac and free fluid in the right paracolic gutter. We decided to perform emergent laparoscopic surgery. We found contralateral tubal and ovarian ectopic pregnancies. CONCLUSION To the best of our knowledge, this is the first report of a case in which a patient underwent laparoscopic right salpingectomy and left ovarian ectopic mass excision due to contralateral tubal and ovarian ectopic pregnancies after assisted reproductive technology.
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Affiliation(s)
- Jeong Min Eom
- Division of Gynecologic Oncology and Gynecologic Minimally Invasive Surgery, Full time faculty of the Department of Obstetrics and Gynecology, Hanyang University College of Medicine, 222-1 Wangsimni-ro Seongdong-gu, Seoul, 04763, Republic of Korea
| | - Joong Sub Choi
- Division of Gynecologic Oncology and Gynecologic Minimally Invasive Surgery, Full time faculty of the Department of Obstetrics and Gynecology, Hanyang University College of Medicine, 222-1 Wangsimni-ro Seongdong-gu, Seoul, 04763, Republic of Korea.
| | - Jaeman Bae
- Division of Gynecologic Oncology and Gynecologic Minimally Invasive Surgery, Full time faculty of the Department of Obstetrics and Gynecology, Hanyang University College of Medicine, 222-1 Wangsimni-ro Seongdong-gu, Seoul, 04763, Republic of Korea
| | - Won Moo Lee
- Division of Gynecologic Oncology and Gynecologic Minimally Invasive Surgery, Full time faculty of the Department of Obstetrics and Gynecology, Hanyang University College of Medicine, 222-1 Wangsimni-ro Seongdong-gu, Seoul, 04763, Republic of Korea
| | - Eunhyun Lee
- Division of Gynecologic Oncology and Gynecologic Minimally Invasive Surgery, Full time faculty of the Department of Obstetrics and Gynecology, Hanyang University College of Medicine, 222-1 Wangsimni-ro Seongdong-gu, Seoul, 04763, Republic of Korea
| | - Jongwon Lee
- Division of Gynecologic Oncology and Gynecologic Minimally Invasive Surgery, Full time faculty of the Department of Obstetrics and Gynecology, Hanyang University College of Medicine, 222-1 Wangsimni-ro Seongdong-gu, Seoul, 04763, Republic of Korea
| | - Ji Hyun Keum
- Division of Gynecologic Oncology and Gynecologic Minimally Invasive Surgery, Full time faculty of the Department of Obstetrics and Gynecology, Hanyang University College of Medicine, 222-1 Wangsimni-ro Seongdong-gu, Seoul, 04763, Republic of Korea
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20
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A rare case of spontaneous live unilateral twin tubal pregnancy with both fetuses presenting with heart activities and a literature review. Obstet Gynecol Sci 2018; 61:274-277. [PMID: 29564320 PMCID: PMC5854909 DOI: 10.5468/ogs.2018.61.2.274] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 07/10/2017] [Accepted: 07/21/2017] [Indexed: 12/04/2022] Open
Abstract
Ectopic pregnancy is an extrauterine pregnancy, and 98% of which occur in the fallopian tube. The incidence of twin tubal pregnancy is rare but is increasing due to assisted reproductive technology. Spontaneous unilateral twin tubal pregnancy is extremely rare, and only a small number of case reports have been made. We herein report a rare case of spontaneous unilateral twin tubal pregnancy with both fetuses presenting with heart activities and a literature review. Right salpingectomy was performed in this case. Pathologic and histologic assessment confirmed the 2 distinct pregnancies in the same tube. The twins were dichorionic and diamniotic.
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21
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Bilateral Tubal Pregnancy without Known Risk Factor. Case Rep Obstet Gynecol 2017; 2017:4356036. [PMID: 29181210 PMCID: PMC5664235 DOI: 10.1155/2017/4356036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 09/13/2017] [Indexed: 11/17/2022] Open
Abstract
Spontaneous bilateral ectopic gestation is very rare. The authors report a case diagnosed and taken care of at Yalgado Ouedraogo Teaching Hospital, Ouagadougou. It was a 30-year-old patient with no known pathological history. She had presented at the obstetric emergencies with a state of hypovolemic shock by haemoperitoneum with digestive disorders, pelvic pain, vaginal bleeding, and a mention of delayed menstruation. The ultrasound coupled with the urinary immunological pregnancy test confirmed the diagnosis of ruptured ectopic pregnancy and a bilateral form was suspected. A laparotomy in emergency confirmed the diagnosis of bilateral ectopic gestation with a right ampullary unruptured pregnancy and a left isthmic ruptured gestation. A bilateral salpingectomy was performed and counseling was made for the use of medical help of procreation in case of future need of pregnancy.
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Sampson V, Mogekwu O, Ahmed A, Bano F. Unilateral Atraumatic Expulsion of an Ectopic Pregnancy in a Case of Bilateral Ectopic Pregnancy. Case Rep Obstet Gynecol 2017; 2017:6391849. [PMID: 29090103 PMCID: PMC5635280 DOI: 10.1155/2017/6391849] [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: 04/21/2017] [Revised: 08/07/2017] [Accepted: 08/23/2017] [Indexed: 11/17/2022] Open
Abstract
Ectopic pregnancy occurs in 1-2% of pregnancies. The fallopian tube is the most common site; however, bilateral tubal ectopic pregnancy is an extremely rare phenomenon, seen in approximately 1/200,000 pregnancies. It is usually the result of assisted reproductive techniques (ART). Ultrasound (USS) and serial beta-hCG levels have shown poor efficacy for accurate diagnosis. Laparoscopy is the diagnostic gold standard. The majority of cases are managed surgically with bilateral salpingectomy. A 26-year-old female presented to our early pregnancy unit with pain and vaginal bleeding at 5-week gestation after IVF. USS was inconclusive and her b-hCG levels rose with worsening pain; therefore, a decision was made for diagnostic laparoscopy. Although there was a clear right sided ectopic pregnancy, the left tube was swollen and therefore a methylene blue dye test was carried out to confirm blockage. Atraumatic milking, to expose the dye, expelled necrotic tissue which histology confirmed to be a second ectopic pregnancy. She made a good recovery with falling beta-hCG levels and left tubal preservation. As the use of ART increases, bilateral ectopic pregnancies will become more common. Novel and established techniques should be used to help confirm the diagnosis and assist in tubal preservation.
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Affiliation(s)
- Victoria Sampson
- Department of Obstetrics and Gynaecology, Queen's Hospital, Romford, UK
| | - Oluremi Mogekwu
- Department of Obstetrics and Gynaecology, Queen's Hospital, Romford, UK
| | - Ammar Ahmed
- Department of Obstetrics and Gynaecology, Queen's Hospital, Romford, UK
| | - Farida Bano
- Department of Obstetrics and Gynaecology, Queen's Hospital, Romford, UK
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23
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A case of bilateral tubal pregnancy. Gynecol Minim Invasive Ther 2017; 6:191-192. [PMID: 30254912 PMCID: PMC6135196 DOI: 10.1016/j.gmit.2017.05.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Revised: 04/10/2017] [Accepted: 05/12/2017] [Indexed: 11/21/2022] Open
Abstract
Bilateral tubal pregnancy is very rare and occurs in only 1 out of every 200,000 spontaneous pregnancies. In this case, a 29-year-old woman with a history of primary infertility underwent treatment with human menopausal gonadotropin (hMG)-human chorionic gonadotropin (hCG), and became pregnant. A gestational sac (GS) was not detected in the uterus and transvaginal ultrasonography (USG) revealed GS with fetal heartbeat in the left adnexa at 7 weeks and 6 days of gestation. The patient underwent laparoscopic surgery and ultimately, bilateral tubal pregnancy was diagnosed. Consequently, bilateral fallopian tube resection was performed. Afterwards, she conceived by assisted reproductive technology (ART) and delivered vaginally. This case suggests that even if a GS is found in one fallopian tube by USG, it is important to evaluate the other fallopian tube carefully. Abbreviations: TV-USG, transvaginal ultrasound; hCG, human chorionic gonadotropin; DD, dichorionic-diamniotic.
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24
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Baghdadi T, Salle B, Bordes A, Lamblin G. Simultaneous bilateral tubal ectopic pregnancy after intracytoplasmic sperm injection and embryo transfer, in a patient with Stage 3 endometriosis. Gynecol Minim Invasive Ther 2017; 6:199-201. [PMID: 30254915 PMCID: PMC6135200 DOI: 10.1016/j.gmit.2017.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2016] [Revised: 02/27/2017] [Accepted: 03/07/2017] [Indexed: 11/26/2022] Open
Abstract
Introduction The incidence of extrauterine pregnancy increases to 2-12% following in vitro fertilization -embryo transfer. Several pathogenic theories have been suggested, including abnormal hormonal secretion or exogenous hormones administered in assisted reproductive technology (ART). Case report A 32-year-oId nulliparous woman with primary infertility and Stage 3 endometriosis was treated by ART with intracytoplasmic sperm injection and embryo transfer. The patient showed simultaneous bilateral extrauterine pregnancy, managed by laparoscopic salpingectomy. Discussion The various possible pathophysiological mechanisms are described, with a review of the literature on simultaneous bilateral extrauterine pregnancy following ART. In pregnancies following ART, ectopic pregnancy should always be screened for by serum β-human chorionic gonadotropin monitoring and transvaginal ultrasound until the implantation site can be confirmed as the incidence is higher than in spontaneous pregnancy. Even if serum β-human chorionic gonadotropin concentration increases normally, possible bilateral ectopic pregnancy should always be investigated if no intrauterine gestational sac can be seen.
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Affiliation(s)
- Tariq Baghdadi
- Department of Obstetrics and Gynecology, Femme-Mère-Enfant University Hospital, Bron, France.,Department of Reproductive Medicine, Femme-Mère-Enfant University Hospital, Bron, France
| | - Bruno Salle
- Department of Reproductive Medicine, Femme-Mère-Enfant University Hospital, Bron, France
| | - Agnès Bordes
- Department of Obstetrics and Gynecology, Femme-Mère-Enfant University Hospital, Bron, France.,Department of Reproductive Medicine, Femme-Mère-Enfant University Hospital, Bron, France
| | - Gery Lamblin
- Department of Obstetrics and Gynecology, Femme-Mère-Enfant University Hospital, Bron, France
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25
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Abstract
The estimated prevalence of ectopic pregnancy (EP) is 1-2% worldwide. Bilateral tubal pregnancies represent the rarest form of heterotopic pregnancy, and spontaneously conceived are extremely unusual, as many cases are derived from assisted reproductive techniques. We describe a case of bilateral tubal pregnancy after clomiphene therapy and sexual intercourse in which the second EP was not contemporarily revealed.
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Affiliation(s)
- Sandro Gerli
- a Department of Obstetrics and Gynecology , University of Perugia , Perugia , Italy
| | - Claudia Giordano
- a Department of Obstetrics and Gynecology , University of Perugia , Perugia , Italy
| | - Gian Carlo Di Renzo
- a Department of Obstetrics and Gynecology , University of Perugia , Perugia , Italy
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26
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Bilateral ectopic tubal pregnancy, following in vitro fertilisation (IVF). Folia Histochem Cytobiol 2016; 47:S147-8. [PMID: 20067887 DOI: 10.2478/v10042-009-0093-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
This is a case report of a 33 year-old-woman who underwent in vitro fertilization, because of primary infertility caused by fallopian tube factor. The patient underwent three trials of frozen embryo transfers (ET-CRYO). On the 26th day after the third probe of ET-CRYO she suffered from pelvic pain and vaginal bleeding. Transvaginal ultrasonographic scan revealed bilateral tubal ectopic pregnancy without fluid in the Douglas pouch and no gestational sac in the uterus. Laparoscopic bilateral salpingectomy was performed on the next day after admission. The postoperative course was uneventful.
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27
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Zhu B, Xu GF, Liu YF, Qu F, Yao WM, Zhu YM, Gao HJ, Zhang D. Heterochronic bilateral ectopic pregnancy after ovulation induction. J Zhejiang Univ Sci B 2014; 15:750-5. [PMID: 25091994 DOI: 10.1631/jzus.b1400081] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Ectopic pregnancy is identified with the widely-applied assisted reproductive technology (ART). Bilateral ectopic pregnancy is a rare form of ectopic pregnancy which is difficult to be diagnosed at the pre-operation stage. In this paper, we presented an unusual case of heterochronic bilateral ectopic pregnancy after stimulated intrauterine insemination (IUI), where there has been a delay of 22 d between the diagnoses of the two ectopic pregnancies. Literature was reviewed on the occurrence of bilateral ectopic pregnancy during the past four years in the MEDLINE database. We found 16 cases of bilateral ectopic pregnancy reported since 2008, and analyzed the characteristics of those cases of bilateral ectopic pregnancy. We emphasize that ovulation induction and other ARTs may increase the risk of bilateral ectopic pregnancy. Because of the difficulty in identification of bilateral ectopic pregnancy by ultrasonography, 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-operation inspection of both side fallopian tubes in any ectopic pregnancy case.
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Affiliation(s)
- Bo Zhu
- Women's Hospital, School of Medicine, Zhejiang University, Hangzhou 310006, China; Key Laboratory of Reproductive Genetics, Ministry of Education, Zhejiang University, Hangzhou 310006, China
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28
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Bayyarapu VB, Bettaiah R, Saraogi R. Incidental Laparoscopic Diagnosis of a Concurrent Contralateral Ectopic Pregnancy in a Donor Egg Recipient with Left Tubal Gestation. J Gynecol Surg 2014. [DOI: 10.1089/gyn.2013.0090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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29
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Seol HJ, Tong SY. Spontaneous bilateral tubal pregnancy following hysterosalpingography. Arch Gynecol Obstet 2013; 289:923-4. [PMID: 24220846 DOI: 10.1007/s00404-013-3089-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Accepted: 10/30/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Hyun-Joo Seol
- Department of Obstetrics and Gynecology, School of Medicine, Kyung Hee University, Seoul, South Korea
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30
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Baron KT, Babagbemi KT, Arleo EK, Asrani AV, Troiano RN. Emergent complications of assisted reproduction: expecting the unexpected. Radiographics 2013; 33:229-44. [PMID: 23322839 DOI: 10.1148/rg.331125011] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
With the increasing popularity of assisted reproductive technology (ART), radiologists are more likely to encounter associated complications, especially in an emergency setting. These complications include ovarian hyperstimulation syndrome (OHSS), ovarian torsion, and ectopic and heterotopic pregnancy. OHSS occurs following ovulation induction or ovarian stimulation and manifests with bilateral ovarian enlargement by multiple cysts, third-spacing of fluids, and clinical findings ranging from gastrointestinal discomfort to life-threatening renal failure and coagulopathy. Enlarged hyperstimulated ovaries are at risk for torsion. Clinical symptoms are often nonspecific, and ovarian torsion should be suspected and excluded in any female patient undergoing infertility treatment who presents with severe abdominal pain. The most consistent imaging finding is asymmetric enlargement of the twisted ovary. There is also an increased risk for ectopic pregnancy following ART, with a relative increased risk for rarer and more lethal forms, including interstitial and cervical ectopic pregnancies. Heterotopic pregnancy refers to simultaneous intrauterine and ectopic pregnancies and has an incidence of 1%-3% in ART patients. Careful evaluation of the adnexa is critical in this patient population, even when an intrauterine pregnancy has been confirmed. Ultrasonography is the first-line imaging modality for the evaluation of complications of ART, although nonspecific symptoms may sometimes lead to cross-sectional imaging being performed. Familiarity with the multimodality imaging appearance of these entities will allow accurate and timely diagnosis and help avert potentially fatal consequences.
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Affiliation(s)
- Keren Tuvia Baron
- Department of Radiology, New York Presbyterian Hospital-Weill Cornell Medical Center, New York, NY, USA.
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31
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Svirsky R, Maymon R, Vaknin Z, Mendlovic S, Weissman A, Halperin R, Herman A, Pansky M. Twin tubal pregnancy: a rising complication? Fertil Steril 2010; 94:1910.e13-6. [PMID: 20416870 DOI: 10.1016/j.fertnstert.2010.03.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2009] [Revised: 02/25/2010] [Accepted: 03/08/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To present four cases of twin tubal pregnancies and discuss possible etiologies. Twin tubal pregnancies are a rare event, with incidence rates estimated as 1 out of 725-1,580 of tubal pregnancies. DESIGN Case series. SETTING Department of obstetrics and gynecology at a tertiary health care facility. PATIENT(S) All women with twin tubal pregnancy diagnosed and treated in the department during the years 2007-2009, according to electronic files and histologic reports. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Artificial reproductive technique preceding twin tubal pregnancies RESULT(S) We diagnosed four twin pregnancies of 163 tubal pregnancies, an incidence of 2.4%. Of the four cases, two conceived after gonadotropin stimulation and intrauterine insemination. The third conceived following in vitro fertilization and intracytoplasmic sperm injection. The fourth was a spontaneous conception diagnosed as monochorial monoamniotic twin tubal pregnancy. CONCLUSION(S) Twin tubal pregnancies may not be as rare as previously thought. Three of the four cases identified during a 2-year period followed artificial reproductive technique. We hope that this report will promote the study of the epidemiology of this event, improve diagnosis, and encourage the development of treatment modalities.
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Affiliation(s)
- Ran Svirsky
- Department of Obstetrics and Gynecology, Assaf Harofe Medical Center, Zerifin, Israel
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32
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SENTILHES L, BOUET PE, JALLE T, BOUSSION F, LEFEBVRE-LACOEUILLE CÃ, DESCAMPS P. Ultrasound diagnosis of spontaneous bilateral tubal pregnancy. Aust N Z J Obstet Gynaecol 2009; 49:695-6. [DOI: 10.1111/j.1479-828x.2009.01081.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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33
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Abstract
Spontaneous bilateral ectopic pregnancy is the rarest form of ectopic pregnancy. A 31-year-old patient with spontaneous bilateral tubal pregnancy was admitted after light vaginal bleeding, 42 days after her last menstruation. Ultrasonography showed a bilateral tubal ectopic pregnancy. A bilateral laparoscopic salpingectomy was performed without complication and the pathology report confirmed the diagnosis. This is an unusual case of early diagnosis.
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34
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Plotti F, Nelaj E, Sansone M, Boni T, Panici PB. Bilateral Tubal Pregnancy with Live Embryos After Intracytoplasmatic Sperm Injection. J Gynecol Surg 2009. [DOI: 10.1089/gyn.2009.0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Francesco Plotti
- Department of Obstetrics and Gynecology, “La Sapienza” University of Rome, Rome, Italy
| | - Ermal Nelaj
- Department of Obstetrics and Gynecology, “La Sapienza” University of Rome, Rome, Italy
| | - Milena Sansone
- Department of Obstetrics and Gynecology, “La Sapienza” University of Rome, Rome, Italy
| | - Terenzio Boni
- Department of Obstetrics and Gynecology, “La Sapienza” University of Rome, Rome, Italy
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