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Ungureanu CO, Stanculea FC, Iordache N, Georgescu TF, Ginghina O, Mihailov R, Vacaroiu IA, Georgescu DE. Ruptured Recurrent Interstitial Ectopic Pregnancy Successfully Managed by Laparoscopy. Diagnostics (Basel) 2024; 14:506. [PMID: 38472978 DOI: 10.3390/diagnostics14050506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 02/13/2024] [Accepted: 02/16/2024] [Indexed: 03/14/2024] Open
Abstract
Ectopic pregnancies are a frequently encountered cause of first-trimester metrorrhagia. They occur when an embryo is implanted and grows outside the normal uterine space. Uncommonly, the embryo can be implanted in the intramural portion of the uterine tube, a condition referred to as interstitial localization. This specific type of ectopic pregnancy may have an unpredictable course, potentially leading to severe uterine rupture and catastrophic bleeding if not promptly diagnosed and managed. We present a rare case of a multiparous 36-year-old female patient who underwent pelvic ultrasonography in the emergency department for intense pelvic pain associated with hypotension and moderate anemia. A history of right salpingectomy for a ruptured tubal ectopic pregnancy 10 years previously was noted. High beta-HCG levels were also detected. A pelvic ultrasound allowed us to suspect a ruptured ectopic interstitial pregnancy at 8 weeks of amenorrhea. An association with hemoperitoneum was suspected, and an emergency laparoscopy was performed. The condition was confirmed intraoperatively, and the patient underwent a right corneal wedge resection with suture of the uterine myometrium. The postoperative course was uneventful, and the patient was discharged on the fourth day postoperatively. Interstitial ectopic pregnancy is a rare yet extremely perilous situation. Timely ultrasound-based diagnosis is crucial as it can enable conservative management with Methotrexate. Delayed diagnosis can lead to uterine rupture with consecutive surgery based on a transection of the pregnancy and cornual uterine resection.
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Affiliation(s)
- Claudiu Octavian Ungureanu
- Department of Surgery, "Carol Davila" University of Medicine and Pharmacy, 37, Dionisie Lupu Street, 020021 Bucharest, Romania
- General Surgery Department, "Sf. Ioan" Clinical Emergency Hospital, 13 Vitan-Bârzeşti Road, 042122 Bucharest, Romania
| | - Floris Cristian Stanculea
- Department of Surgery, "Carol Davila" University of Medicine and Pharmacy, 37, Dionisie Lupu Street, 020021 Bucharest, Romania
- General Surgery Department, "Sf. Ioan" Clinical Emergency Hospital, 13 Vitan-Bârzeşti Road, 042122 Bucharest, Romania
| | - Niculae Iordache
- Department of Surgery, "Carol Davila" University of Medicine and Pharmacy, 37, Dionisie Lupu Street, 020021 Bucharest, Romania
- General Surgery Department, "Sf. Ioan" Clinical Emergency Hospital, 13 Vitan-Bârzeşti Road, 042122 Bucharest, Romania
| | - Teodor Florin Georgescu
- Department of Surgery, "Carol Davila" University of Medicine and Pharmacy, 37, Dionisie Lupu Street, 020021 Bucharest, Romania
- General Surgery Department, Clinical Emergency Hospital Bucharest, SplaiulIndependentei nr 168, Sect 5, 050098 Bucharest, Romania
| | - Octav Ginghina
- Department of Surgery, "Carol Davila" University of Medicine and Pharmacy, 37, Dionisie Lupu Street, 020021 Bucharest, Romania
- General Surgery Department, "Prof. Dr. Alexandru Trestioreanu" Oncological Institute, 022328 Bucharest, Romania
| | - Raul Mihailov
- General Surgery Department, "Sf. Andrei" Clinical Emergency Hospital, 177 Braila Street, 800578 Galati, Romania
| | - Ileana Adela Vacaroiu
- Department of Surgery, "Carol Davila" University of Medicine and Pharmacy, 37, Dionisie Lupu Street, 020021 Bucharest, Romania
- Nephrology and Dialysis Clinic, "Sf. Ioan" Emergency Clinical Hospital, Sos. Vitan-Barzesti nr 12, 042122 Bucharest, Romania
| | - Dragos Eugen Georgescu
- Department of Surgery, "Carol Davila" University of Medicine and Pharmacy, 37, Dionisie Lupu Street, 020021 Bucharest, Romania
- General Surgery Department, "Dr. I. Cantacuzino" Clinical Hospital, 5-7 I. Movila Street, 022904 Bucharest, Romania
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Zhang X, Wang C. Predictive value of PAPP-A for ectopic pregnancy and analysis of related factors. Exp Ther Med 2021; 22:801. [PMID: 34093757 PMCID: PMC8170667 DOI: 10.3892/etm.2021.10233] [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: 03/10/2020] [Accepted: 12/14/2020] [Indexed: 11/06/2022] Open
Abstract
The present study was designed to analyze the expression of pregnancy-associated plasma protein-A (PAPP-A) in the serum of patients with ectopic pregnancy (EP) and related factors inducing this condition. Seventy-five patients with EP admitted to the Affiliated Hospital of Jining Medical University from January 2018 to February 2019 were selected as the research group, and another 59 healthy pregnant women of the corresponding age, gravidity and gestational week were enrolled in the control group. ELISA was employed to detect the serum expression levels of PAPP-A and inflammatory factors such as interleukin-8 (IL-8) and tumor necrosis factor-α (TNF-α). ROC was adopted to evaluate the diagnostic value of serum PAPP-A in patients with EP, and Pearson correlation coefficient was applied to analyze the correlation of PAPP-A with inflammatory factors IL-8 and TNF-α. Serum PAPP-A expression was significantly lower in EP patients than those in the control group. The area under the curve (AUC) of serum PAPP-A in diagnosing EP patients was 0.812, and the PAPP-A value in the control group was significantly higher than that of the research group at 7-8 weeks and ≥9 weeks. With regard to the expression of inflammatory factors, the research group presented markedly higher IL-8 and TNF-α levels than the control group. PAPP-A was negatively related to inflammatory factors IL-8 and TNF-α in the research group. In addition, it was revealed that patients with a history of genital surgery, salpingotomy, pelvic infection, EP or low PAPP-A expression were at high risk of EP. In conclusion, PAPP-A was revealed to be lowly expressed in the serum of EP patients, and to negatively be correlated with inflammatory factors IL-8 and TNF-α, which may serve as a useful marker for the diagnosis and prognosis of EP.
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Affiliation(s)
- Xiaoyun Zhang
- Department of Obstetrics, Affiliated Hospital of Jining Medical University, Jining, Shandong 272000, P.R. China
| | - Chunxia Wang
- Department of Obstetrics, Affiliated Hospital of Jining Medical University, Jining, Shandong 272000, P.R. China
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