1
|
Dabreteau T, Puchar A, Nyangoh Timoh K, Fauconnier A, Legendre G, Touboul C, Lavoué V, Thubert T, Lecarpentier E, Haddad B, Dabi Y. Interstitial pregnancy management: A multicentric analysis of 98 patients from the FRANCOGENT group comparing surgery and medical treatment. Int J Gynaecol Obstet 2024; 165:125-130. [PMID: 37937363 DOI: 10.1002/ijgo.15239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 08/29/2023] [Accepted: 10/24/2023] [Indexed: 11/09/2023]
Abstract
OBJECTIVE To evaluate the outcomes associated with each therapeutic option for patients diagnosed with interstitial pregnancy (IP). METHODS We conducted a multicentric retrospective cohort study within the departments of Gynecology and Obstetrics involved in the Francogent research group. Women treated for an interstitial pregnancy between January 2008 to December 2019 were included. Three therapeutic options were evaluated: surgical treatment (ST); in situ methotrexate combined with systemic methotrexate (IS-MTX); and systemic methotrexate (IM-MTX). Success of first-line treatment was defined by hCG negativation (<5I U/L). Secondary outcomes included the need for secondary surgical procedure, secondary medical treatment, emergency surgery, postoperative complications, duration of hospitalization, and delay before hCG negativation. RESULTS A total of 98 patients were managed for IP: 42 (42.9%) patients had IM-MTX; 34 (34.7%) had IS-MTX; and 22 (22.4%) had ST. First-line treatment was successful in all patients of the ST group (22/22, 100%), in 31% of patients within the IM-MTX group (13/42) and 70.6% (24/34) in the IS-MTX group. The sole parameter associated with the risk of treatment failure was the mode of methotrexate administration. The size of the gestational sac or the presence of fetal heartbeat was not associated with decreased medical treatment (IS or IM-MTX) efficiency. CONCLUSION Either ST or IS-MTX are good options for IP treatment associated with high success rates. A single-dose regimen of IM-MTX is less efficient than IS-MTX or ST. Symptomatic patients with severity criteria should always undergo emergency surgery. IP remains a high-risk condition that should be managed, whenever possible, in referral centers to potentialize the chances of favorable outcomes.
Collapse
Affiliation(s)
- Thomas Dabreteau
- Department of Obstetrics and Gynecology, CHI Creteil, Creteil, France
| | - Anne Puchar
- Department of Obstetrics and Gynecology, Tenon Hospital, AP-HP, Sorbonne University, Paris, France
| | | | - Arnaud Fauconnier
- Department of Obstetrics and Gynecology, Intercommunal Hospital of Poissy/Saint-Germain-en-Laye, Poissy, France
| | - Guillaume Legendre
- Department of Obstetrics and Gynecology, Angers University Hospital, Angers, France
| | - Cyril Touboul
- Department of Obstetrics and Gynecology, Tenon Hospital, AP-HP, Sorbonne University, Paris, France
| | - Vincent Lavoué
- Department of Obstetrics and Gynecology, Rennes University Hospital, Rennes, France
| | - Thibault Thubert
- Department of Obstetrics and Gynecology, Nantes University Hospital, Nantes, France
| | | | - Bassam Haddad
- Department of Obstetrics and Gynecology, CHI Creteil, Creteil, France
| | - Yohann Dabi
- Department of Obstetrics and Gynecology, Tenon Hospital, AP-HP, Sorbonne University, Paris, France
| |
Collapse
|
2
|
McDougall AA, Rouabhi S, Magama Z, Odejinmi F. Laparoscopic myomectomy to facilitate laparoscopic resection of a bleeding interstitial ectopic pregnancy. BMJ Case Rep 2022; 15:e250584. [PMID: 36137642 PMCID: PMC9511600 DOI: 10.1136/bcr-2022-250584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Interstitial pregnancies present a diagnostic and management challenge and are associated with significant bleeding risk. We present a case of an interstitial ectopic pregnancy where there was a diagnostic delay due to the presence of uterine fibroids and where a laparoscopic myomectomy was required in order to perform laparoscopic resection of the ruptured interstitial pregnancy.This case demonstrates the possibilities at laparoscopy for ectopic pregnancy, highlights the benefit of a structured 'buddy' system between gynaecology surgeons and brings attention to the paucity of literature on the unique management challenges of ectopic pregnancy in the presence of leiomyoma.
Collapse
Affiliation(s)
| | - Schahrazed Rouabhi
- Obstetrics and Gynaecology, North Middlesex University Hospital NHS Trust, London, UK
| | - Zwelihe Magama
- Obstetrics and Gynaecology, Whipps Cross University Hospital NHS Trust, London, UK
| | - Funlayo Odejinmi
- Obstetrics and Gynaecology, Whipps Cross University Hospital NHS Trust, London, UK
| |
Collapse
|
3
|
Loh WN, Adno AM, Reid S. A 10‐year retrospective cohort study of non‐tubal ectopic pregnancy management outcomes in an Australian tertiary centre. Australas J Ultrasound Med 2022; 25:166-175. [PMID: 36405797 PMCID: PMC9644438 DOI: 10.1002/ajum.12312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Introduction Non-tubal ectopic pregnancy (NTEP) is a rare but significant early pregnancy complication which can result in maternal morbidity and mortality. There is however a lack of evidence-based guidelines for the management of NTEP. Purpose To evaluate the success rates of expectant, medical and surgical management in the treatment of NTEP at our tertiary centre. Methods Retrospective cohort study from 2010 to 2020. All NTEP were classified by ectopic sites. Primary management was classified by expectant, medical [systemic methotrexate (Sys-MTX) and/or local ultrasound-guided injection of MTX and/or KCl intra-sac (L-MTX, L-MTX/KCl)] or surgical. Primary management was considered successful if no change in intervention was required. Treatment complications were compared. Results Twenty-four NTEP were identified, which included 14 interstitial pregnancies (IP), 9 caesarean scar pregnancies (CSP) and 1 ovarian pregnancy (OP), which gave NTEP an incidence of 7.12% among all EP (4.15% for IP, 2.67% for CSP and 0.30% for OP). The success of primary surgical management was 100% (7/7), primary medical management was 76.9% (10/13) and primary expectant management was 33.3% (1/3). Primary medical management had a non-statistically significant greater mean time to serum ß-human Chorionic Gonadotrophin <5 IU/L, mean length of hospitalisation, mean number of follow-up visits and hospital re-presentation/readmissions compared to primary surgical management. There was no other difference in complication rates between the treatment management groups. Conclusion Surgery remains the most effective way to manage NTEP. However, medical management can be a safe and effective alternative option in carefully selected cases.
Collapse
Affiliation(s)
- Wei‐Guo Nicholas Loh
- Department of Obstetrics and Gynaecology Liverpool Hospital Sydney New South Wales Australia
- South Western Sydney Clinical School University of New South Wales Sydney New South Wales Australia
| | - Alan Maurice Adno
- Department of Feto‐Maternal Unit Liverpool Hospital Sydney New South Wales Australia
| | - Shannon Reid
- Department of Obstetrics and Gynaecology Liverpool Hospital Sydney New South Wales Australia
- Faculty of Medicine Western Sydney University Sydney New South Wales Australia
| |
Collapse
|
4
|
Using MRI to differentiate upper-lateral intracavitary pregnancy and interstitial pregnancy for the patients with pregnancies in the uterotubal junction during the first trimester. Eur Radiol 2022; 32:6619-6627. [PMID: 35441841 PMCID: PMC9474412 DOI: 10.1007/s00330-022-08786-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 03/24/2022] [Accepted: 03/31/2022] [Indexed: 11/04/2022]
Abstract
Objectives To retrospectively evaluate the diagnostic value of MRI for the uterotubal junctional pregnancies during the first trimester. Methods This retrospective study involved 59 patients (January 2016 to July 2021) with a preoperative imaging diagnosis of uterotubal junctional pregnancy. Using operative and pathological reports as the reference standard, we identified 22 patients with upper-lateral intracavitary (angular) pregnancy and 37 patients with interstitial pregnancy. Two senior radiologists, blinded to the patients’ information, reviewed the MRI images and determined each MRI feature based on the original interpretation criteria. Any disagreement was resolved by discussion to achieve a consensus. The sensitivity and specificity of each MRI feature were calculated according to the reference standard. Results The endometrial thickness in the upper-lateral intracavitary pregnancy group was larger than in the interstitial group (p = 0.001). The cutoff value of the endometrial thickness was 11.5 mm with a sensitivity, specificity, and area under the curve that were 77.3%, 64.9%, and 0.743, respectively. Two key features to diagnose upper-lateral intracavitary pregnancy were “medial free edge” and “medial free edge plus above-cutoff endometrial thickness.” The sensitivity and specificity of the medial free edge were 100% and 94.9%, respectively. The sensitivity and specificity of the medial free edge plus above-cutoff endometrial thickness were 77.3% and 100%, respectively. The key feature to diagnose interstitial pregnancy was an “intact lateral junctional zone,” of which the sensitivity and specificity were 94.6% and 100%, respectively. Conclusions MRI can be used to differentiate the upper-lateral intracavitary pregnancy and interstitial pregnancy during the first trimester. Key Points • We demonstrated MRI diagnostic criteria for the interstitial pregnancy and upper-lateral intracavitary pregnancy. • MRI might be used to identify the complex interstitial pregnancies, those with a gestational sac protruding into the uterine cavity.
Collapse
|
5
|
Huang Y, Huang Q, Liu J, Guo M, Liu Y, Lai D. Concurrent Ovarian and Tubal Ectopic Pregnancy After IVF-ET: Case Report and Literature Review. Front Physiol 2022; 13:850180. [PMID: 35444560 PMCID: PMC9013932 DOI: 10.3389/fphys.2022.850180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 03/08/2022] [Indexed: 11/13/2022] Open
Abstract
Ovarian pregnancy (OP) coupled with tubal ectopic pregnancy is rare. We present a case of coexistent ovarian and tubal ectopic pregnancies in the same adnexa resulting from in vitro fertilization and embryo transfer (IVF-ET) for tubal occlusion. The patient presented with mild vaginal bleeding without abdominal pain. OP was diagnosed via sonographic findings of an ectopic gestational sac (GS) and yolk sac that seemed to be inside her left ovary. Laparoscopic exploration confirmed this diagnosis, and ipsilateral tubal ectopic pregnancy was suspected during surgery. The patient underwent left salpingectomy and resection of the ovarian lesion. A subsequent histopathological examination verified the diagnosis of coexistent ovarian and tubal ectopic pregnancy. Though the mechanism underlying concurrent OP and tubal ectopic pregnancy is still unclear, clinicians should be cautious of potential combined ectopic pregnancy when dealing with patients who have received more than one embryo transfer.
Collapse
Affiliation(s)
- Yating Huang
- School of Medicine, The International Peace Maternity and Child Health Hospital, Shanghai Jiaotong University, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Disease, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Qin Huang
- School of Medicine, The International Peace Maternity and Child Health Hospital, Shanghai Jiaotong University, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Disease, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Jinglan Liu
- School of Medicine, The International Peace Maternity and Child Health Hospital, Shanghai Jiaotong University, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Disease, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Mengxi Guo
- School of Medicine, The International Peace Maternity and Child Health Hospital, Shanghai Jiaotong University, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Disease, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Yuan Liu
- School of Medicine, The International Peace Maternity and Child Health Hospital, Shanghai Jiaotong University, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Disease, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Dongmei Lai
- School of Medicine, The International Peace Maternity and Child Health Hospital, Shanghai Jiaotong University, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Disease, School of Medicine, Shanghai Jiaotong University, Shanghai, China
- *Correspondence: Dongmei Lai,
| |
Collapse
|
6
|
Cillard L, Dabi Y, Fernandez H, Lavoué V, Timoh KN, Thubert T, Bouet PE, Legendre G. Management of non-tubal ectopic pregnancies in France: Results of a practice survey. J Gynecol Obstet Hum Reprod 2022; 51:102330. [DOI: 10.1016/j.jogoh.2022.102330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 01/30/2022] [Accepted: 01/31/2022] [Indexed: 11/26/2022]
|
7
|
Gestación ectópica ovárica con diagnóstico en segundo trimestre de embarazo en paciente portadora de DIU. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2022. [DOI: 10.1016/j.gine.2021.100707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
8
|
Tsviban A, Maymon R, Pekar-Zlotin M, Smorgick N, Gat I, Melcer Y. Similar but different: A comparison of rare site ectopic pregnancies. Am J Emerg Med 2021; 52:50-53. [PMID: 34864290 DOI: 10.1016/j.ajem.2021.11.025] [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: 10/10/2021] [Revised: 11/03/2021] [Accepted: 11/15/2021] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVES A comparative examination of the clinical, laboratory, ultrasound findings, and operative characteristics of rare site located ectopic pregnancies. METHODS Retrospective analysis of all department cases of rare site located ectopic pregnancies diagnosed and treated from December 2006 to December 2019. RESULTS Thirty rare ectopic pregnancies were identified. Of these, 11 were ovarian, 10 were interstitial and 9 were tubal stump. The patients treated for ovarian pregnancy had significantly lower human chorionic gonadotropin (hCG) levels than patients treated for interstitial or stump pregnancies (2025 ± 1105 mIU/ml, 18,424 ± 2579 mIU/ml and 11,204 ± 9221 mIU/ml, respectively, p = 0.003). The main presenting symptom in patients with an ovarian pregnancy was abdominal pain (90.9%, 60.0% and 44.4%, respectively, p = 0.031). Signs of abdominal peritoneal irritation (i.e., rebound tenderness and guarding) were more frequent upon physical examination in patients with an ovarian pregnancy (72.2%, 30.0% and 22.2%, respectively, p = 0.044) who also exhibited the highest rates of syncope and hypovolemic shock upon admission compared to patients with an interstitial or stump pregnancy (54.5%, 10.0% and 11.1%, respectively, p = 0.031). Ovarian pregnancies were associated with the lowest sonographic detection rates (9.1%, 80.0% and 100%, respectively, p = 0.0001) and with free fluid in the pouch of Douglas (72.7%, 20.0% and 22.2%, respectively, p = 0.02). Ovarian pregnancies experienced the highest rupture rate during surgery compared to interstitial or stump pregnancies (66.9%, 16.7% and 44.4%, respectively, p = 0.028), had a significantly higher estimated blood loss (1081 ± 647 ml, 760 ± 597 ml and 343 ± 318 ml, respectively, p = 0.003) and required blood transfusions in the perioperative period (63.6%, 20.0% and 11.1%, respectively, p = 0.025) significantly more often. CONCLUSIONS Ovarian pregnancy remains the most challenging diagnosis compared to interstitial and tubal stump ectopic's. Health care providers should recognize these rare site ectopic pregnancies and to handle these gynecological emergencies promptly.
Collapse
Affiliation(s)
- Anna Tsviban
- Department of Obstetrics and Gynecology, The Yitzhak Shamir Medical Center (formerly Assaf Harofeh Medical Center), affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ron Maymon
- Department of Obstetrics and Gynecology, The Yitzhak Shamir Medical Center (formerly Assaf Harofeh Medical Center), affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Marina Pekar-Zlotin
- Department of Obstetrics and Gynecology, The Yitzhak Shamir Medical Center (formerly Assaf Harofeh Medical Center), affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Noam Smorgick
- Department of Obstetrics and Gynecology, The Yitzhak Shamir Medical Center (formerly Assaf Harofeh Medical Center), affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Itai Gat
- Department of Obstetrics and Gynecology, The Yitzhak Shamir Medical Center (formerly Assaf Harofeh Medical Center), affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yaakov Melcer
- Department of Obstetrics and Gynecology, The Yitzhak Shamir Medical Center (formerly Assaf Harofeh Medical Center), affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| |
Collapse
|
9
|
Ectopic pregnancy: a resident's guide to imaging findings and diagnostic pitfalls. Emerg Radiol 2021; 29:161-172. [PMID: 34618256 DOI: 10.1007/s10140-021-01974-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 07/20/2021] [Indexed: 10/20/2022]
Abstract
Ectopic pregnancy (EP) is a term used to describe any pregnancy which does not implant into the uterine cavity. There are several types of EPs: tubal, interstitial, ovarian, abdominal, heterotopic, cervical, and cesarean scar. Ectopic pregnancies can acutely rupture and are the number one cause of maternal death in the first trimester of pregnancy. Therefore, prompt recognition and accurate localization have significant clinical implications on patient outcome. Unfortunately, EPs have many mimickers, which can make the diagnosis challenging in certain cases. In this review, we aim to describe and illustrate sonographic findings of each type of EP, as well as present mimickers and various imaging pitfalls. We will clarify how to avoid potential misdiagnoses that could adversely affect patient outcomes. Lastly, we will briefly address management of each type of EP and discuss potential complications.
Collapse
|
10
|
Herondelle C, Spiers A, Nyangoh-Timoh K, Thubert T, Fauconnier A, Moquet PY, Bouet PE, Legendre G. Efficacy of In Situ Methotrexate Injection in the Treatment of Nontubal Ectopic Pregnancies: A Retrospective Multicenter Study. J Minim Invasive Gynecol 2021; 29:243-249. [PMID: 34400353 DOI: 10.1016/j.jmig.2021.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 08/03/2021] [Accepted: 08/09/2021] [Indexed: 11/18/2022]
Abstract
STUDY OBJECTIVE Evaluation of the efficacy of different injection sites of methotrexate in the treatment of nontubal ectopic pregnancies. DESIGN Retrospective multicenter study. SETTING Multicenter, including 3 teaching hospitals, an intercommunal hospital, and a clinic. PATIENTS A total of 106 patients with nontubal ectopic pregnancies, including 59 interstitial, 39 cesarean scar, and 8 cervical or isthmic. INTERVENTIONS Overall, 58 patients received methotrexate via intramuscular injection (IM group), 35 received methotrexate via in situ injection (IS group), and 13 received a combination of both in situ and intramuscular injections of methotrexate (IS + IM group). MEASUREMENTS AND MAIN RESULTS The main end point of this study was measured via the primary success rate (defined as a negative β-human chorionic gonadotropin level without recourse to any additional treatment) of treatment with methotrexate according to injection site. The primary success rate was 46.55% in the IM group, 60% in the IS group, and 61.54% in the IS + IM group, respectively. In the multivariate analysis, the primary success rate of treatment was significantly correlated to the in situ injection of methotrexate, either solely or in conjunction with an intramuscular injection of methotrexate administered the following day, (odds ratio = 2.7; 95% confidence interval, 1.03-7.14). CONCLUSION Solely an intramuscular injection of methotrexate is a less efficient first-line treatment strategy for the conservative management of nontubular ectopic pregnancy. The use of an in situ injection of methotrexate should therefore be preferred.
Collapse
Affiliation(s)
- Charlyne Herondelle
- Department of Obstetrics and Gynecology, Angers University Hospital (Drs. Herondelle, Bouet, and Legendre and Mr. Spiers), Angers; Department of Obstetrics and Gynecology, Nantes University Hospital (Drs. Herondelle and Thubert), Nantes
| | - Andrew Spiers
- Department of Obstetrics and Gynecology, Angers University Hospital (Drs. Herondelle, Bouet, and Legendre and Mr. Spiers), Angers
| | - Krystel Nyangoh-Timoh
- Department of Obstetrics and Gynecology, Rennes University Hospital (Dr. Nyangoh-Timoh)
| | - Thibault Thubert
- Department of Obstetrics and Gynecology, Nantes University Hospital (Drs. Herondelle and Thubert), Nantes
| | - Arnaud Fauconnier
- Department of Obstetrics and Gynecology, Intercommunal Hospital of Poissy/Saint-Germain-en-Laye (Dr. Fauconnier), Poissy
| | - Pierre-Yves Moquet
- Department of Obstetrics and Gynecology, La Sagesse Clinic (Dr. Moquet), Rennes
| | - Pierre-Emmanuel Bouet
- Department of Obstetrics and Gynecology, Angers University Hospital (Drs. Herondelle, Bouet, and Legendre and Mr. Spiers), Angers
| | - Guillaume Legendre
- Department of Obstetrics and Gynecology, Angers University Hospital (Drs. Herondelle, Bouet, and Legendre and Mr. Spiers), Angers; CESP UMR Inserm 1018 - Center for Research in Epidemiology and Public Health (Dr. Legendre), Villejuif, France.
| |
Collapse
|
11
|
An updated guide to the diagnosis and management of cesarean scar pregnancies. Curr Opin Obstet Gynecol 2021; 32:255-262. [PMID: 32618745 DOI: 10.1097/gco.0000000000000644] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE OF REVIEW To review the current literature on the diagnosis and management of cesarean scar pregnancies RECENT FINDINGS: The incidence of cesarean scar pregnancies (CSPs) is increasing as a result of the increasing cesarean section rate, improved diagnostic capabilities, and a growing awareness. CSPs are associated with significant morbidity and early diagnosis is key. Diagnosis is best achieved with transvaginal ultrasound. Sonographic diagnostic criteria have been developed over decades and recently endorsed by the Society for Maternal-Fetal Medicine and other professional societies. The current categorization system differentiates CSPs that are endogenic or 'on the scar' from those that are exogenic or 'in the niche'. Following diagnosis, the challenge remains in determining the optimal management as multiple modalities can be considered. Studies have demonstrated the favorable outcomes with combined local and systemic methotrexate, surgical excision through multiple routes, and adjunctive therapies, such as uterine artery embolization or uterine balloons. The current evidence is insufficient to identify a single best treatment course and a combined approach to treatment is often required. SUMMARY Successful outcomes while minimizing complications can be achieved with a multidisciplinary, collaborative effort. Guidelines for cesarean scar pregnancies will continue to evolve as the published reports grow.
Collapse
|
12
|
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.
Collapse
|
13
|
Ortiz G, Kameyama N, Sulaiman JP, Lopez-Bayghen E. Successful management of cervical ectopic pregnancy with embryo reduction: report of three cases. J Surg Case Rep 2021; 2021:rjab216. [PMID: 34055299 PMCID: PMC8159264 DOI: 10.1093/jscr/rjab216] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 04/30/2021] [Accepted: 05/10/2021] [Indexed: 11/18/2022] Open
Abstract
If methotrexate (MTX) fails to resolve cervical ectopic pregnancies (CEP), the remaining surgical options result in the potential loss of the patient’s fertility. Therefore, we examined if the embryo reduction technique can resolve the CEP without any complications while conserving the patient’s fertility. We report three cases in which CEP didn’t respond to MTX but was successfully solved by embryo reduction. Each patient underwent a standard in vitro fertilization (IVF) protocol. Once CEP was confirmed, the pregnancy’s location, the fetus’s size and gestational sac and heartbeat were determined. Afterward, embryo reduction was performed under general anesthesia (operative time: ~30 min). All patients had successful procedures without any postoperative complications. Since the procedure, one woman was pregnant and delivered, the second has registered a positive β-human chorionic gonadotropin test and the last is waiting for IVF preparation. In summary, embryo reduction is a feasible approach in the management of CEP with favorable fertility outcomes.
Collapse
Affiliation(s)
- Ginna Ortiz
- Investigación Clínica, Instituto de Infertilidad y Genética México SC, Ingenes, México City, México
| | - Nicolas Kameyama
- Investigación Clínica, Instituto de Infertilidad y Genética México SC, Ingenes, México City, México
| | - Jean Paul Sulaiman
- Investigación Clínica, Instituto de Infertilidad y Genética México SC, Ingenes, México City, México
| | - Esther Lopez-Bayghen
- Departamento de Toxicología, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional (CINVESTAV-IPN), México City, México
| |
Collapse
|
14
|
Cagino K, Pereira N, Fields JC, Fenster TB. Laparoscopic management of a primary posterior cul-de-sac abdominal ectopic pregnancy. Fertil Steril 2021; 116:605-607. [PMID: 33892956 DOI: 10.1016/j.fertnstert.2021.03.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 03/21/2021] [Accepted: 03/25/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To report a case of laparoscopic management of a primary posterior cul-de-sac abdominal ectopic pregnancy (AEP). DESIGN Video article. SETTING Academic medical center. PATIENT(S) A 40-year-old G5P3013 woman at approximately 7 weeks of pregnancy was referred to our emergency department because of abnormally rising β-human chorionic gonadotropin levels. Transvaginal ultrasonography revealed a cystic structure measuring 2.8 × 1.6 ×1.9 cm in the posterior cul-de-sac distinct from the cervix. The mass was noted to have peripheral hypervascularity and a thickened wall. A moderate amount of complex free fluid was noted adjacent to the mass. The patient's baseline β-human chorionic gonadotropin level and hematocrit were 6,810.7 mIU/mL and 42.4%, respectively. INTERVENTION(S) Laparoscopy for suspected AEP. MAIN OUTCOME MEASURE(S) Laparoscopic excision of a primary AEP. RESULT(S) Diagnostic laparoscopy revealed a normal uterus, normal right ovary, normal left ovary with a corpus luteal cyst, and normal bilateral fallopian tubes without dilatation or hemorrhage. The AEP was noted in the right posterior cul-de-sac and was excised from the underlying peritoneum. The left lateral aspect of the AEP extended into the posterior vaginal wall. The patient was admitted for overnight observation, and her postoperative hematocrit was 35.1%. CONCLUSION(S) AEPs are extremely rare and account for 1% of all ectopic pregnancies. Approximately 90% of AEPs require surgical management. Historically, AEPs were treated with laparotomy because of the high risk of hemorrhage and hemodynamic instability. However, as exemplified by the current case, laparoscopy is a safe and feasible option for surgical management of AEPs.
Collapse
Affiliation(s)
- Kristen Cagino
- Department of Obstetrics and Gynecology, New York Presbyterian Hospital-Weill Cornell Medicine, New York, New York
| | - Nigel Pereira
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, New York, New York
| | - Jessica C Fields
- Department of Obstetrics and Gynecology, New York Presbyterian Hospital-Weill Cornell Medicine, New York, New York
| | - Tamatha B Fenster
- Department of Obstetrics and Gynecology, New York Presbyterian Hospital-Weill Cornell Medicine, New York, New York.
| |
Collapse
|
15
|
Controversies in family planning: Management of cesarean-scar ectopic pregnancy. Contraception 2020; 103:208-212. [PMID: 33359510 DOI: 10.1016/j.contraception.2020.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 12/14/2020] [Accepted: 12/17/2020] [Indexed: 11/23/2022]
|
16
|
Stabile G, Zinicola G, Romano F, Buonomo F, Mangino FP, Ricci G. Management of Non-Tubal Ectopic Pregnancies: A Single Center Experience. Diagnostics (Basel) 2020; 10:E652. [PMID: 32878097 PMCID: PMC7555978 DOI: 10.3390/diagnostics10090652] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 08/27/2020] [Accepted: 08/29/2020] [Indexed: 01/13/2023] Open
Abstract
Non-tubal ectopic pregnancies (NT-EPs) are rare but potentially life-threatening conditions. The incidence ranges are between 5-8.3% of all ectopic pregnancies. For this retrospective observational study, 16 patients with NT-EP and treated from January 2014 to May 2020 were recruited. Demographic details, symptoms, Beta human chorionic gonadotrophin (β-hCG) levels, ultrasound findings, management and treatment outcomes were presented. In hemodynamically stable patients, diagnosis was made using ultrasounds and β-hCG levels. Laparoscopy was essential to identify and remove the ectopic pregnancy in clinical unstable patients. A radical laparoscopic approach was chosen in one case of cervical pregnancy diagnosed late in the first trimester. Medical treatment and minimally invasive procedure, alone or combined, resulted in effective strategies in asymptomatic women with an early diagnosis of NT-EP. We report cases of cervical pregnancies successfully treated by hysteroscopy alone or combined with medical treatment, the first case of scar pregnancy treated by mini-reseptoscope and curettage and the fifth case of interstitial pregnancy treated with Methotrexate and Mifepristone. In this manuscript we report a single center experience in the management of NT-EPs with the aim of outlining the importance of the early diagnosis for a minimally invasive treatment in order to reduce maternal morbidity and mortality and preserve future fertility.
Collapse
Affiliation(s)
- Guglielmo Stabile
- Institute for Maternal and Child Health IRCCS “Burlo Garofolo”, 34137 Trieste, Italy; (F.R.); (F.B.); (F.P.M.); (G.R.)
| | - Giulia Zinicola
- Department of Medicine, Surgery and Health Sciences, University of Trieste, 34127 Trieste, Italy;
| | - Federico Romano
- Institute for Maternal and Child Health IRCCS “Burlo Garofolo”, 34137 Trieste, Italy; (F.R.); (F.B.); (F.P.M.); (G.R.)
| | - Francesca Buonomo
- Institute for Maternal and Child Health IRCCS “Burlo Garofolo”, 34137 Trieste, Italy; (F.R.); (F.B.); (F.P.M.); (G.R.)
| | - Francesco Paolo Mangino
- Institute for Maternal and Child Health IRCCS “Burlo Garofolo”, 34137 Trieste, Italy; (F.R.); (F.B.); (F.P.M.); (G.R.)
| | - Giuseppe Ricci
- Institute for Maternal and Child Health IRCCS “Burlo Garofolo”, 34137 Trieste, Italy; (F.R.); (F.B.); (F.P.M.); (G.R.)
- Department of Medicine, Surgery and Health Sciences, University of Trieste, 34127 Trieste, Italy;
| |
Collapse
|
17
|
Delplanque S, Le Lous M, Flévin M, Bauville E, Moquet PY, Dion L, Fauconnier A, Guérin S, Leveque J, Lavoué V, Nyangoh Timoh K. Effectiveness of conservative medical treatment for non-tubal ectopic pregnancies: a multicenter study. J Gynecol Obstet Hum Reprod 2020; 49:101762. [PMID: 32325266 DOI: 10.1016/j.jogoh.2020.101762] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 04/04/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To assess the effectiveness of conservative treatment for the management of non-tubal ectopic pregnancies (NTEP) METHODS: Retrospective cohort study in three centers (two referral centers) of patients managed for NTEP diagnosed by 2D or 3D ultrasonograhy. Patients underwent one of the following: expectant management, systemic methotrexate (MTX) injection, local MTX injection, combined MTX injection (local and systemic), local injection of hyperosmolar glucose, or misoprostol administration. The primary endpoint was final success defined by resolution of hCG level without need for emergency surgical treatment. Sixty-four patients diagnosed with NTEP were included: 37 (57%) had an interstitial pregnancy, 23 (35.9%) a cesarean scar pregnancy, two (3.1%) a cervical pregnancy and two (3.1%) an ovarian pregnancy. RESULTS Six patients (9.4%) underwent expectant management, 24 (37.5%) a systemic MTX injection, 28 (43.8%) a local injection of MTX, three (4.7%) a combined MTX injection, one (1.6%) a local injection of hyperosmolar glucose (1.6%), and two (3.1%) were administered misoprostol. The median age was 32 years (22-45) and mean follow-up was 41 months. The final success rate overall was 92.2%: 100% for expectant management, 87.5% for systemic MTX, 96.4% for local MTX, 100% for combined injection of MTX, 100% for local injection of hyperosmolar glucose, and 50% for misoprostol. No patient required a hysterectomy. Nine (14.1%) patients required surgery, including five (7.8% (5/64)) following a rupture of the NTEP. CONCLUSIONS Our results suggest that conservative medical management of NTEP is effective and safe and should be the first-line treatment for pauci-symptomatic patients with an NTEP.
Collapse
Affiliation(s)
- Sophie Delplanque
- Department of Obstetrics and Gynecology, CHU Rennes Hospital, 35000 Rennes, France; Université de Rennes 1 : 2 avenue de Professeur Léon Bernard, 35000, Rennes, France
| | - Maela Le Lous
- Department of Obstetrics and Gynecology, CHU Rennes Hospital, 35000 Rennes, France; Université de Rennes 1 : 2 avenue de Professeur Léon Bernard, 35000, Rennes, France; SAFE CIC 1414 Thematic Team, University Hospital Rennes, Rennes, France; INSERM, UMR 1099, Rennes, F-35000, France; Université de Rennes 1, LTSI, Rennes, F-35000, France
| | - Marie Flévin
- Department of Obstetrics and Gynecology, CHU Rennes Hospital, 35000 Rennes, France
| | - Estelle Bauville
- Department of Obstetrics and Gynecology, CHU Rennes Hospital, 35000 Rennes, France; Department of Gynecology and Obstetrics, CHI Poissy-St-Germain, 78300 Poissy, France; SAFE CIC 1414 Thematic Team, University Hospital Rennes, Rennes, France
| | - Pierre Yves Moquet
- Department of Gynecology and Obstetrics, Clinique mutualiste La sagesse, 35 000 Rennes, France
| | - Ludivine Dion
- Department of Obstetrics and Gynecology, CHU Rennes Hospital, 35000 Rennes, France; Université de Rennes 1 : 2 avenue de Professeur Léon Bernard, 35000, Rennes, France; SAFE CIC 1414 Thematic Team, University Hospital Rennes, Rennes, France
| | - Arnaud Fauconnier
- Department of Gynecology and Obstetrics, Clinique mutualiste La sagesse, 35 000 Rennes, France
| | - Sonia Guérin
- Department of Obstetrics and Gynecology, CHU Rennes Hospital, 35000 Rennes, France; Université de Rennes 1 : 2 avenue de Professeur Léon Bernard, 35000, Rennes, France
| | - Jean Leveque
- Department of Obstetrics and Gynecology, CHU Rennes Hospital, 35000 Rennes, France; Université de Rennes 1 : 2 avenue de Professeur Léon Bernard, 35000, Rennes, France; SAFE CIC 1414 Thematic Team, University Hospital Rennes, Rennes, France
| | - Vincent Lavoué
- Department of Obstetrics and Gynecology, CHU Rennes Hospital, 35000 Rennes, France; Université de Rennes 1 : 2 avenue de Professeur Léon Bernard, 35000, Rennes, France; SAFE CIC 1414 Thematic Team, University Hospital Rennes, Rennes, France
| | - Krystel Nyangoh Timoh
- Department of Obstetrics and Gynecology, CHU Rennes Hospital, 35000 Rennes, France; Université de Rennes 1 : 2 avenue de Professeur Léon Bernard, 35000, Rennes, France; SAFE CIC 1414 Thematic Team, University Hospital Rennes, Rennes, France; INSERM, UMR 1099, Rennes, F-35000, France; Université de Rennes 1, LTSI, Rennes, F-35000, France
| |
Collapse
|
18
|
|
19
|
Italiano S, Tong S, Readman E, Tassone M, Hastie R, Pritchard N. Combination methotrexate and gefitinib: A potential medical treatment for inoperable nontubal ectopic pregnancy. J Obstet Gynaecol Res 2019; 46:531-535. [PMID: 31814216 DOI: 10.1111/jog.14169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 11/14/2019] [Indexed: 11/29/2022]
Abstract
Nontubal ectopic pregnancies present as a therapeutic challenge. A 35-year-old primigravida at 7 weeks gestation had a live interstitial ectopic pregnancy and contraindications to surgery. The patient was treated with a multidose methotrexate regimen combined with oral gefitinib (250 mg daily for 7 days). The peak human chorionic gonadotropin (hCG) of the patient was recorded at 19 510 IU/L and began declining from day 4 of combination therapy (day 6 of initial treatment). Successful resolution of the ectopic was demonstrated by cessation of the fetal heart by day 15 and hCG falling to 23 IU/L by day 42. A 10-year review of all nontubal ectopic pregnancies treated with methotrexate identified 46 cases, which had a comparable time to resolution to combination therapy. However, for cases where cardiac activity was present, the median time to resolution following methotrexate treatment was 64 days (47-87 days), 22 days longer than combination therapy. Combination therapy may provide a safe medical treatment for inoperable nontubal ectopic pregnancy.
Collapse
Affiliation(s)
| | - Stephen Tong
- Translational Obstetrics Group, Department of Obstetrics and Gynaecology, University of Melbourne, Heidelberg, Victoria, Australia.,Mercy Perinatal, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Emma Readman
- Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | | | - Roxanne Hastie
- Translational Obstetrics Group, Department of Obstetrics and Gynaecology, University of Melbourne, Heidelberg, Victoria, Australia.,Mercy Perinatal, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Natasha Pritchard
- Translational Obstetrics Group, Department of Obstetrics and Gynaecology, University of Melbourne, Heidelberg, Victoria, Australia.,Mercy Perinatal, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| |
Collapse
|
20
|
Shah JS, Nasab S, Papanna R, Chen HY, Promecene P, Berens P, Johnson A, Bhalwal A. Management and reproductive counseling in cervical, caesarean scar and interstitial ectopic pregnancies over 11 years: identifying the need for a modern management algorithm. Hum Reprod Open 2019; 2019:hoz028. [PMID: 31777762 PMCID: PMC6870555 DOI: 10.1093/hropen/hoz028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 08/11/2019] [Indexed: 12/12/2022] Open
Abstract
STUDY QUESTION Do management strategies (treatment type and order), including provision of reproductive counseling, differ in patients with non-tubal pregnancies? SUMMARY ANSWER Medical and surgical treatment strategies varied widely for each type of non-tubal pregnancy and reproductive counseling in this patient population is lacking. WHAT IS KNOWN ALREADY Owing to the rarity of non-tubal pregnancies, there is no consensus regarding treatment strategies or protocol. Furthermore, there is limited data on how patients with a non-tubal pregnancy are counseled about future fertility. STUDY DESIGN SIZE DURATION This is a descriptive retrospective study. Data were collected from January 2006 to December 2017. A total of 50 patients were included in the study. PARTICIPANTS/MATERIALS SETTING METHODS Patients with an ultrasound diagnosis of a non-tubal ectopic pregnancy (e.g. cervical ectopic pregnancy [CEP], Caesarean scar pregnancy [CSP] or interstitial ectopic pregnancy [IEP]) were included. This study was performed at a university-based institution tertiary referral center. Demographic and clinical characteristics, treatment type and order, reproductive counseling and outcomes were collected. Descriptive statistics were used for analyses. MAIN RESULTS AND THE ROLE OF CHANCE Of the 50 patients identified, 13 were CEP (26%), 8 were CSP (16%) and 29 were IEP (58%). Patients with a CSP had a higher parity (median = 3, P = 0.02) and number of prior Caesarean deliveries (mean = 2.1, P < 0.001). A total of 66% (23/35) of patients expressed a desire for future fertility prior to treatment and only 56% (28/50) of patients received reproductive counseling according to the electronic medical records. Among all non-tubal pregnancies, there were variations in the type and the order of treatments that patients received. LIMITATIONS REASONS FOR CAUTION This study was performed in a tertiary referral center therefore the management strategy could have been influenced by the prior interventions and patient response. The descriptive retrospective design precluded any assumption of causation. WIDER IMPLICATIONS OF THE FINDINGS The management for non-tubal pregnancies has wide variations. Reproductive counseling in this patient population is lacking. The findings highlight the need for the development of a treatment algorithm and a reproductive counseling protocol for each non-tubal pregnancy to better standardize treatment strategy. STUDY FUNDING/COMPETING INTERESTS There was no funding for this study. The authors have no conflict of interest to report.
Collapse
Affiliation(s)
- Jaimin S Shah
- Department of Obstetrics & Gynecology, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Susan Nasab
- Department of Obstetrics & Gynecology, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Ramesha Papanna
- Department of Fetal Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Han-Yang Chen
- Department of Obstetrics & Gynecology, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Pamela Promecene
- Department of Obstetrics & Gynecology, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Pamela Berens
- Department of Obstetrics & Gynecology, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Anthony Johnson
- Department of Fetal Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Asha Bhalwal
- Department of Obstetrics & Gynecology, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, USA
| |
Collapse
|
21
|
Abstract
Ultrasound is the imaging study of choice for detection and full characterization of early pregnancies based on its accuracy, low cost, safety profile, and abundant availability. This article reviews the goals and utility of first-trimester ultrasound in gestation localization, viability determination, and abnormal pregnancies, including ectopic implantation, retained products, and molar pregnancy.
Collapse
Affiliation(s)
- Peter S Wang
- Department of Radiology, Einstein Medical Center, 5501 Old York Road, Philadelphia, PA 19141, USA.
| | - Shuchi K Rodgers
- Department of Radiology, Einstein Medical Center, 5501 Old York Road, Philadelphia, PA 19141, USA
| | - Mindy M Horrow
- Department of Radiology, Einstein Medical Center, 5501 Old York Road, Philadelphia, PA 19141, USA
| |
Collapse
|
22
|
Suzuki S, Takahashi T, Ota K, Nishimura K, Fukase M, Watanabe N, Matsukawa J, Matsuo K, Kawagoe J, Mizunuma H, Nagase S. Successful laparoscopic treatment of an abdominal pregnancy implanted in the utero-ovarian ligament: a case report of a rare form of ectopic pregnancy. J OBSTET GYNAECOL 2019; 39:579-580. [PMID: 30795700 DOI: 10.1080/01443615.2018.1534816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Satoko Suzuki
- a Department of Obstetrics and Gynecology , Yamagata University Faculty of Medicine , Yamagata , Japan
| | - Toshifumi Takahashi
- b Fukushima Medical Center for Children and Women, Fukushima Medical University , Fukushima , Japan
| | - Kuniaki Ota
- b Fukushima Medical Center for Children and Women, Fukushima Medical University , Fukushima , Japan
| | - Kyoko Nishimura
- a Department of Obstetrics and Gynecology , Yamagata University Faculty of Medicine , Yamagata , Japan
| | - Mika Fukase
- a Department of Obstetrics and Gynecology , Yamagata University Faculty of Medicine , Yamagata , Japan
| | - Norikazu Watanabe
- a Department of Obstetrics and Gynecology , Yamagata University Faculty of Medicine , Yamagata , Japan
| | - Jun Matsukawa
- a Department of Obstetrics and Gynecology , Yamagata University Faculty of Medicine , Yamagata , Japan
| | - Koki Matsuo
- a Department of Obstetrics and Gynecology , Yamagata University Faculty of Medicine , Yamagata , Japan
| | - Jun Kawagoe
- a Department of Obstetrics and Gynecology , Yamagata University Faculty of Medicine , Yamagata , Japan
| | - Hideki Mizunuma
- b Fukushima Medical Center for Children and Women, Fukushima Medical University , Fukushima , Japan
| | - Satoru Nagase
- a Department of Obstetrics and Gynecology , Yamagata University Faculty of Medicine , Yamagata , Japan
| |
Collapse
|
23
|
Bajis R, Paterson D, McElhinney B. Primary omental ectopic pregnancy: a case report. J OBSTET GYNAECOL 2018; 39:560-561. [PMID: 30207509 DOI: 10.1080/01443615.2018.1473351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Rawan Bajis
- a Obstetrics and Gynaecology Department , King Edward Memorial Hospital , Perth , Australia
| | - Danii Paterson
- a Obstetrics and Gynaecology Department , King Edward Memorial Hospital , Perth , Australia
| | - Bernadette McElhinney
- a Obstetrics and Gynaecology Department , King Edward Memorial Hospital , Perth , Australia
| |
Collapse
|
24
|
Ajong AB, Kenfack B, Agbor VN, Njotang PN. Ruptured caesarean scar ectopic pregnancy: a diagnostic dilemma in a resource-limited setting. BMC Res Notes 2018; 11:292. [PMID: 29751813 PMCID: PMC5948667 DOI: 10.1186/s13104-018-3389-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 05/02/2018] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Caesarean scar pregnancy (CSP) remains a very rare form of ectopic pregnancy associated with serious life threatening obstetric complications and even death in case of late diagnosis and treatment. CASE PRESENTATION We report a case of a ruptured caesarean scar pregnancy in a 29 year-old gravida 5, para 3 with a past obstetric history of two consecutive caesarean sections done 9 and 5 years ago respectively. The patient presented with intermittent lower abdominal pains on a 20 weeks gestation associated with mild epigastralgia and 2 previous episodes of mild pervaginal bleeding (2 and 1 months ago respectively before consultation) managed with injectable progesterone. Her evolution 4 h later was marked by an increase in the intensity of the abdominal pain, an unmeasurable blood pressure and a feeble pulse. Immediate paracentesis revealed 10 cc of fresh non coagulating blood. The diagnosis of ruptured ectopic pregnancy with abundant hemoperitoneum was considered and an emergency laparotomy with fluid and blood resuscitation was carried out. A midline laparotomy revealed a ruptured caesarean scar ectopic pregnancy with an abundant hemoperitoneum. Careful resection of the placenta and repair of the ruptured isthmic region of the uterus was carried out. Recovery after surgery was without complications and the patient was discharged on the 6th day following surgery. CONCLUSION Caesarean scar pregnancy remains a very rare obstetric condition. Late diagnosis of this condition can be associated with serious life threatening obstetric complications. The rarity of the condition warrants a high index of suspicion among clinicians.
Collapse
Affiliation(s)
| | - Bruno Kenfack
- Department of Biomedical Sciences, University of Dschang, Dschang, Cameroon
| | | | - Philip Nana Njotang
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
- Obstetrics and Gynaecology Unit, Yaoundé Central Hospital, Yaoundé, Cameroon
| |
Collapse
|
25
|
To evaluate the feasibility of magnetic resonance imaging in predicting unusual site ectopic pregnancy: a retrospective cohort study. Eur Radiol 2018; 28:2444-2454. [PMID: 29349699 DOI: 10.1007/s00330-017-5237-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Revised: 11/07/2017] [Accepted: 12/04/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To evaluate the accuracy of pelvic MRI in the diagnosis of unusual ectopic pregnancy (EP), when ultrasound (US) examination is inconclusive. METHODS We retrospectively reviewed the medical records of 150 patients with suspected EP. Clinical, US and MRI features of 15 unusual EPs were analysed. Two radiologists independently reviewed each case resolving by consensus any diagnostic discrepancy. Interobserver agreement was assessed using the Cohen κ test. RESULTS MRI displayed a gestational sac-like structure surrounded by a thick wall in all cases. The thick wall displayed hyperintensity in 41 %, isointensity in 35 % and hypointensity in 24 % of cases on T1-weighted images. Diffusion- and fat saturation T1-weighted images were the most accurate sequences, as they enabled identification of 15/15 and 14/15 patients, respectively. Although US was false negative in detecting cervical and uterine infiltration underlying the caesarean scar, MRI was able to identify the invasion. Interobserver agreement was very good for all sequences (κ=0.892-1.0). CONCLUSIONS MRI plays an important role in the early diagnosis of unusual EP. It should be considered after negative US findings, providing accurate evaluation of the site and the possible infiltration of these lesions, which help in the management of these patients. KEY POINTS • MRI is being increasingly used as a problem-solving modality in ectopic pregnancy. • MRI plays an important role in early diagnosis of unusual ectopic pregnancy. • Knowledge of MRI features in EP is essential to determinate appropriate management.
Collapse
|
26
|
Odejinmi F, Mallick R, Oliver R. Re: Comparison of management regimens following ultrasound diagnosis of non-tubal ectopic pregnancies: a retrospective cohort study. BJOG 2017; 125:626-627. [PMID: 28891225 DOI: 10.1111/1471-0528.14847] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Funlayo Odejinmi
- Department of Gynaecology, Barts Health NHS Trust, Whipps Cross University Hospital, London, UK
| | - Rebecca Mallick
- Department of Gynaecology, Barts Health NHS Trust, Whipps Cross University Hospital, London, UK
| | - Reeba Oliver
- Department of Gynaecology, Barts Health NHS Trust, Whipps Cross University Hospital, London, UK
| |
Collapse
|