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Peng S, Deng C, Chen J, Liu Z, Cui J, Liu S, Hu B, Chen G. TU-LESS procedure for acute abdomen in late pregnancy: a retrospective study. Arch Gynecol Obstet 2024; 310:713-718. [PMID: 38871965 DOI: 10.1007/s00404-024-07573-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 05/27/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND Acute abdominal conditions during pregnancy are significant risks to maternal and fetal health, necessitating timely diagnosis and intervention. The choice of surgical approach is a major concern for obstetricians. OBJECTIVE To evaluate the safety and efficacy of the TU-LESS procedure for acute abdomen in late pregnancy. METHODS We retrospectively analyzed 12 patients who underwent TU-LESS for acute abdominal conditions in the third trimester from 2020 to 2023. We reviewed medical records for clinical characteristics, surgical interventions, postoperative complications, and pregnancy outcomes. RESULTS The study included patients with a median age of 27 (range 20-35) and a BMI of 24.33 kg/m2 (range 21.34-31.96). The median gestational age at surgery was 30 weeks (range, 28 + 3-32 + 4 weeks), with surgeries lasting an average of 60 min (range, 30-163 min). Blood loss was 2-20 mL, and the median hospital stay post-surgery was 6 days (range, 2-16 days). There were no significant complications. The median time to delivery after TU-LESS was 56 days (range, 26-66 days), resulting in 8 full-term deliveries, 2 preterm cesareans, and 2 preterm vaginal deliveries. All newborns were healthy, with no fetal losses or neonatal deaths. CONCLUSION TU-LESS, performed by experienced obstetricians and gynecologists with proper preoperative preparation, is safe and effective for managing acute abdomen in late pregnancy, without the need to delay surgery due to gestational age.
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Affiliation(s)
- Shumin Peng
- Department of Obstetrics, Women and Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Chao Deng
- Department of Obstetrics and Gynecology, Junlian County People's Hospital, Sichuan, China
| | - Jun Chen
- Department of Obstetrics, Women and Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Zhaoming Liu
- Department of Obstetrics, Women and Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Jingen Cui
- Department of Obstetrics, Women and Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Shikai Liu
- Department of Obstetrics, Cangzhou Central Hospital, Hebei, China.
| | - Bin Hu
- Department of Gynecology, The Second Affiliated Hospital of Zhengzhou University, Henan, China.
| | - Gongli Chen
- Department of Obstetrics, Women and Children's Hospital of Chongqing Medical University, Chongqing, China.
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Didar H, Najafiarab H, Keyvanfar A, Hajikhani B, Ghotbi E, Kazemi SN. Adnexal torsion in pregnancy: A systematic review of case reports and case series. Am J Emerg Med 2023; 65:43-52. [PMID: 36584539 DOI: 10.1016/j.ajem.2022.12.026] [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: 11/08/2022] [Revised: 12/16/2022] [Accepted: 12/18/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES This study aimed to investigate clinical presentations, surgical procedures and findings, complications, and predisposing factors of adnexal torsion in pregnant women. METHODS We searched PubMed/Medline, Embase, and Web of Science from January 2000 to March 2022. All case reports and case series with full-text English language reporting adnexal torsion in pregnant women were included. Medical history, clinical presentations, surgical procedures and findings, complications related to adnexal torsion, and predisposing factors were independently extracted by two investigators. RESULTS A total of 182 articles reporting 662 pregnant women with adnexal torsion were included. Most of the adnexal torsions occurred during the first trimester (54.63%), while others occurred during the second (26.36%) and third (19.00%) trimesters. The most common symptom of adnexal torsion was sudden-onset pain (80.60%). Enlargement of the adnexa was the most prevalent ultrasound finding in a twisted adnexa (95.20%). Additionally, about half of the patients had decreased blood flow in Doppler ultrasound (53.80%). Laparoscopic surgery was the favorite option (56.88%), while cystectomy and detorsion were the most commonly performed procedure (29.06%). Expectant management was reported in only 2.99% of the patients. In addition, the most common complications were preterm labor (27.58%) and emergent cesarean sections (25.28%). CONCLUSIONS Clinicians should think of adnexal torsion when pregnant women complain of sudden-onset pain. Then, using ultrasound, adnexal enlargement or masses should be explored seriously. They should take invasive and urgent therapy to preserve ovaries and prevent complications.
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Affiliation(s)
- Hamidreza Didar
- Preventative Gynecology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hanieh Najafiarab
- Preventative Gynecology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amirreza Keyvanfar
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Bahareh Hajikhani
- Department of Microbiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Elena Ghotbi
- Department of Obstetrics and Gynecology, School of Medicine, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyyedeh Neda Kazemi
- Clinical Research Development Center, Imam Hossein Educational Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Obstetrics and Gynecology and Female Infertility Unit, Tehran University of Medical Sciences, Tehran, Iran.
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Chen S, Zhang G, Hua K, Ding J. Single-port laparoscopy versus conventional laparoscopy of benign adnexal masses during pregnancy: a retrospective case-control study. J Int Med Res 2022; 50:3000605221128153. [PMID: 36314266 PMCID: PMC9623375 DOI: 10.1177/03000605221128153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE To compare operative outcomes between single-port laparoscopy (SPL) and conventional laparoscopy (CL) to remove adnexal masses during pregnancy. METHODS This retrospective case-control study included all patients who had undergone laparoscopic removal of benign adnexal masses during pregnancy between October 2010 and January 2020. Multiple clinical characteristics and operative outcomes were retrospectively analysed and compared between patients who had undergone SPL versus CL, including cosmetic satisfaction with the scar, measured on a 10-point scale (10 indicating very satisfied). RESULTS A total of 64 patients were included (SPL, n = 22; and CL, n = 42). Overall scar satisfaction scores significantly favoured SPL versus CL (9.1 ± 1.7 versus 8.1 ± 1.3, respectively), however, surgery duration was significantly longer for SPL than CL (69.2 ± 21.0 min versus 54.7 ± 20.7 min). No incisional hernia was detected in the study. Operative blood loss, decrease in estimated haemoglobin level, length of hospital stay, and hospitalization expenses were comparable between the two groups. Pregnancy and fetal outcomes were not remarkably different. CONCLUSION For removal of benign adnexal masses during pregnancy, SPL may offer superior cosmetic satisfaction versus CL, and was not associated with additional perioperative danger, economic burden, or adverse pregnancy and neonatal outcomes.
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Affiliation(s)
- Sishi Chen
- Department of Gynaecology, the Obstetrics and Gynaecology Hospital of Fudan
University, Shanghai, China,Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases,
Shanghai, China
| | - Ganrong Zhang
- Department of Gynaecology, the Obstetrics and Gynaecology Hospital of Fudan
University, Shanghai, China,Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases,
Shanghai, China
| | - Keqin Hua
- Department of Gynaecology, the Obstetrics and Gynaecology Hospital of Fudan
University, Shanghai, China,Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases,
Shanghai, China,Ke-Qin Hua, Department of Gynaecology, the Obstetrics
and Gynaecology Hospital of Fudan University, 128 Shenyang Road, Shanghai 200090, China.
| | - Jingxin Ding
- Department of Gynaecology, the Obstetrics and Gynaecology Hospital of Fudan
University, Shanghai, China,Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases,
Shanghai, China,Jing-Xin Ding, Department of Gynaecology, the
Obstetrics and Gynaecology Hospital of Fudan University, 128 Shenyang Road, Shanghai 200090,
China.
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Cagino K, Li X, Thomas C, Delgado D, Christos P, Acholonu U. Surgical Management of Adnexal Masses in Pregnancy: A Systematic Review and Meta-analysis. J Minim Invasive Gynecol 2021; 28:1171-1182.e2. [PMID: 33515746 DOI: 10.1016/j.jmig.2021.01.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 01/20/2021] [Accepted: 01/22/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The incidence of adnexal masses in pregnancy is 1% to 6%. Although surgery is often indicated, there are no definitive management guidelines. We aimed to investigate the optimal approach to surgical management of adnexal masses in pregnancy on the basis of a meta-analysis of previous studies. DATA SOURCES We performed a systematic review using MEDLINE, Embase, Cochrane Library, and Clinicaltrials.gov from inception to July 17, 2020. METHODS OF STUDY SELECTION There were no restrictions on study type, language, or publication date. Comparative and noncomparative retrospective studies that reviewed operative techniques used in surgery of adnexal masses in pregnancy were included. Meta-analyses were performed to assess outcomes. This study was registered in the International Prospective Register of Systematic Reviews (CRD42019129709). TABULATION, INTEGRATION, AND RESULTS Comparative studies were identified for laparoscopy vs laparotomy and elective vs emergent surgery (11 and 4, respectively). Elective surgery is defined as a scheduled antepartum procedure. For laparoscopy vs laparotomy, the mean maternal ages and gestational ages at time of surgery were similar (27.8 years vs 27.7 years, p = .85; 16.2 weeks in laparoscopy vs 15.4 weeks in laparotomy, p = .59). Mass size was larger in those undergoing laparotomy (mean 8.8 cm vs 7.8 cm, p = .03). The most common pathologic condition was dermoid cyst (36%), and the risk of discovering a malignant tumor was 1%. Laparoscopy was not associated with a statistically increased risk of spontaneous abortion (SAB) or preterm delivery (PTD) (odds ratio [OR] 1.53; 95% confidence interval [CI], 0.67-3.52; p = .31 and OR 0.95; 95% CI, 0.47-1.89; p = .88, respectively). The mean length of hospital stay was 2.5 days after laparoscopy vs 5.3 days after laparotomy (p <.001). The decrease in estimated blood loss in laparoscopy was not statistically significant (94.0 mL in laparotomy vs 54.0 mL in laparoscopy, p = .06). Operative times were similar in laparoscopy and laparotomy (80.0 minutes vs 72.5 minutes, p = .09). Elective surgery was associated with a decreased risk of PTD (OR 0.13; 95% CI, 0.04-0.48; p = .05). Noncomparative studies were identified for laparoscopy and laparotomy. Laparotomy had more SABs and PTDs than laparoscopy (pooled proportion = 0.02 vs 0.07 and pooled proportion = 0.02 vs 0.14, respectively). CONCLUSION Laparoscopy for the surgical management of adnexal masses in pregnancy is associated with shorter length of hospital stay and similar risk of SAB or PTD. Elective surgery is associated with a decreased risk of PTD.
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Affiliation(s)
- Kristen Cagino
- Department of Obstetrics and Gynecology (Drs. Cagino, Li, and Acholonu, Jr).
| | - Xuan Li
- Department of Obstetrics and Gynecology (Drs. Cagino, Li, and Acholonu, Jr)
| | - Charlene Thomas
- Department of Population Health Sciences (Dr. Christos and Ms. Thomas)
| | - Diana Delgado
- Samuel J. Wood Library and C.V. Starr Biomedical Information Center (Ms. Delgado), NewYork-Presbyterian Weill Cornell Medical Center, New York, New York
| | - Paul Christos
- Department of Population Health Sciences (Dr. Christos and Ms. Thomas)
| | - Uchenna Acholonu
- Department of Obstetrics and Gynecology (Drs. Cagino, Li, and Acholonu, Jr)
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Tantchev L, Kotzev A, Yordanov AA. Disturbed Interstitial Pregnancy: A First Case of Successful Treatment Using a Mini-Laparoscopic Approach. ACTA ACUST UNITED AC 2019; 55:medicina55050215. [PMID: 31137907 PMCID: PMC6571741 DOI: 10.3390/medicina55050215] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 04/08/2019] [Accepted: 05/21/2019] [Indexed: 12/17/2022]
Abstract
Interstitial ectopic pregnancy (EP) is a life-threatening condition due to the risk of massive hemorrhage in the event of its disturbance. We present the case of a 27-year-old patient who was admitted with massive hemoperitoneum, caused by the rupture of an interstitial pregnancy in the area of the fallopian tube stump, which had been removed after a previous ectopic pregnancy. The condition was overcome using a mini-laparoscopic approach (2.6 mm, 30° optics), with one 3 mm port for micro-laparoscopic instruments and one 10 mm port. Such an approach has not yet been reported in the available literature, among the casuistically reported cases of pregnancy in the tubal stump. We consider that the technique is safe, completely in the interest of the patient, applicable by an experienced team, and in agreement with modern trends regarding the minimization of operative access.
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Affiliation(s)
- Latchesar Tantchev
- Obstetrics and Gynecology Clinic, Acibadem City Clinic Hospital "Tokuda", PC 1000 Sofia City, Bulgaria.
| | - Andrey Kotzev
- Clinic of Gastroenterology, University Hospital for Active Treatment "Alexandrovska", PC 1000 Sofia City, Bulgaria.
| | - And Angel Yordanov
- Clinic of Oncological Gynecology, University General Hospital for Active Treatment "Dr. G. Stranski", PC 5800 Pleven City, Bulgaria.
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Ye P, Zhao N, Shu J, Shen H, Wang Y, Chen L, Yan X. Laparoscopy versus open surgery for adnexal masses in pregnancy: a meta-analytic review. Arch Gynecol Obstet 2019; 299:625-634. [PMID: 30706184 PMCID: PMC6394438 DOI: 10.1007/s00404-018-05039-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 12/22/2018] [Indexed: 11/22/2022]
Abstract
PURPOSE The objective of this meta-analysis is to investigate and compare the pregnancy outcomes of laparoscopy and open surgery in the treatment of ovarian tumors during pregnancy. METHODS Search was conducted using MEDLINE, EMBASE, and Cochrane Databases from January 1990 to November 2018. A broad search strategy was used to identify studies comparing laparoscopy and open surgery in pregnancy. Inclusion criteria included comparative studies with the quantitative outcome data on gravida. Two authors independently reviewed and assessed for the quality of included studies according to the Newcastle-Ottawa Scale. Data were extracted for fetal loss, preterm delivery, duration of surgery, blood loss and length of hospital stay. RESULTS Nine retrospective trials were identified involving 985 patients. No statistical significance was found in fetal loss between laparoscopy and open surgery (P value = 0.334). The pooled estimate for preterm labor statistically significantly decreased for laparoscopy group (P value = 0.014). Reduced operative blood loss was found in laparoscopy group by 83.81 ml (P value = 0.015). Duration of operation may be longer in the laparoscopy group, but without statistical significance (P value = 0.346). Length of hospital stay was shorter in the laparoscopy group with reduction of 1.95 days (P value < 0.001). CONCLUSIONS The available low-grade evidence suggests that laparoscopic surgery might be a feasible alternative for pregnant women with adnexal masses.
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Affiliation(s)
- Piaopiao Ye
- Department of Gynecology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Na Zhao
- Department of Gynecology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Jing Shu
- Department of Gynecology, Zhejiang Provincial People's Hospital, Hangzhou, 310014, China
| | - Heping Shen
- Department of Gynecology, Zhejiang Provincial People's Hospital, Hangzhou, 310014, China
| | - Yanpeng Wang
- Department of Gynecology, Zhejiang Provincial People's Hospital, Hangzhou, 310014, China
| | - Lifeng Chen
- Department of Gynecology, Zhejiang Provincial People's Hospital, Hangzhou, 310014, China
| | - Xiaojian Yan
- Department of Gynecology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China.
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7
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Bassi A, Czuzoj-Shulman N, Abenhaim HA. Effect of Pregnancy on the Management and Outcomes of Ovarian Torsion: A Population-Based Matched Cohort Study. J Minim Invasive Gynecol 2018; 25:1260-1265. [DOI: 10.1016/j.jmig.2018.03.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 03/21/2018] [Accepted: 03/24/2018] [Indexed: 10/17/2022]
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8
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Rezai S, Giovane RA, Minton H, Bardawil E, Zhang Y, Patil NM, Henderson CE, Guan X. Laparoendoscopic Single-Site Surgery for Management of Heterotopic Pregnancy: A Case Report and Review of Literature. Case Rep Obstet Gynecol 2018; 2018:7232637. [PMID: 30069420 PMCID: PMC6057289 DOI: 10.1155/2018/7232637] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Revised: 04/15/2018] [Accepted: 04/26/2018] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Heterotopic pregnancy occurs when two pregnancies occur simultaneously in the uterus and an ectopic location. Treatment includes removal of the ectopic pregnancy with preservation of the intrauterine pregnancy. Treatment is done laparoscopically with either a Laparoendoscopic Single-Site Surgery (LESS) or a multiport laparoscopic surgery. CASE We present a case of a first trimester heterotopic pregnancy in a 42-year-old gravida 5, para 0-1-3-1 female with previous history of left salpingectomy, who underwent laparoscopic right salpingectomy and lysis of adhesions (LOA) via Single-Incision Laparoscopic Surgery (SILS). CONCLUSION Although LESS for benign OB/GYN cases is feasible, safe, and equally effective compared to the conventional laparoscopic techniques, studies have suggested no clinically relevant advantages in the frequency of perioperative complications between LESS and conventional methods. No data on the cost effectiveness of LESS versus conventional methods are available. LESS utilizes only one surgical incision which may lead to decreased pain and better cosmetic outcome when compared to multiport procedure. One significant undesirable aspect of LESS is the crowding of the surgical area as only one incision is made. Therefore, all instruments go through one port, which can lead to obstruction of the surgeon's vision and in some cases higher rate of procedure failure resulting in conversion to multiport procedure.
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Affiliation(s)
- Shadi Rezai
- Department of Obstetrics and Gynecology, Southern California Kaiser Permanente, Kern County, 1200 Discovery Drive, Bakersfield, CA 93309, USA
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Baylor College of Medicine, 6651 Main Street, 10 Floor, Houston, TX 77030, USA
| | - Richard A. Giovane
- University of Alabama, Department of Family Medicine, 801 Campus Drive, Tuscaloosa, AL 35487, USA
| | - Heather Minton
- University of Birmingham, School of Medicine, 1720 2 Avenue, Birmingham, AL 35294, USA
| | - Elise Bardawil
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Baylor College of Medicine, 6651 Main Street, 10 Floor, Houston, TX 77030, USA
| | - Yiming Zhang
- Division of Reproductive Medicine, Jinan Central Hospital Group, 105 Jiefang Road, Jinan City, Shandong Province 250013, China
| | - Ninad M. Patil
- Department of Pathology & Immunology, Baylor College of Medicine, 6651 Main Street, 4 Floor, Houston, TX 77030, USA
| | - Cassandra E. Henderson
- Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, Lincoln Medical and Mental Health Center, 234 East 149 Street, Bronx, NY 10451, USA
| | - Xiaoming Guan
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Baylor College of Medicine, 6651 Main Street, 10 Floor, Houston, TX 77030, USA
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Pearl JP, Price RR, Tonkin AE, Richardson WS, Stefanidis D. SAGES guidelines for the use of laparoscopy during pregnancy. Surg Endosc 2017. [DOI: 10.1007/s00464-017-5637-3] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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10
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El abdomen agudo en el embarazo aumenta el riesgo de complicaciones obstétricas sin influir en el pronóstico materno-fetal. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2017. [DOI: 10.1016/j.gine.2015.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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11
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Ding DC, Chang YH. Laparoendoscopic single-site surgical cystectomy of a twisted ovarian dermoid cyst during early pregnancy: A case report and literature review. Gynecol Minim Invasive Ther 2016. [DOI: 10.1016/j.gmit.2015.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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12
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Kahramanoglu I, Eroglu V, Turan H, Kaval G, Sal V, Tokgozoglu N. Isolated adnexal torsion in a 20-week spontaneous twin pregnancy. Int J Surg Case Rep 2016; 23:138-40. [PMID: 27129134 PMCID: PMC4855745 DOI: 10.1016/j.ijscr.2016.04.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 04/09/2016] [Accepted: 04/18/2016] [Indexed: 12/12/2022] Open
Abstract
Diagnosis of adnexal torsion can be difficult during pregnancy. Delay in diagnosis can lead to necrosis and loss of the affected ovary. Laparoscopy is an effective approach in diagnosis and treatment of adnexal torsion even in advanced pregnancies.
Background Adnexal torsion can be a life-threatning condition in pregnancy, while the risk of late diagnosis is increased, in second and third trimester in particular. Laparoscopy is an effective approach in diagnosis and treatment of adnexal torsion. However, entry to abdomen may be challenging in more advanced pregnancies. Case report Herein, we report a case of adnexal torsion during 20th week of twin pregnancy, which was detorsioned laparoscopically. The woman delivered healthy infants at her 36th week of pregnancy. Discussion Adnexal torsion as a cause of acute abdomen may be kept in mind in pregnants, even if there is no predisposing factor. Laparoscopy may be performed safely in 2nd trimester for acute abdomen.
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Affiliation(s)
- Ilker Kahramanoglu
- Department of Obstetrics and Gynecology, Cerrahpasa Medical School, Istanbul University, Turkey.
| | - Vasfiye Eroglu
- Department of Obstetrics and Gynecology, Cerrahpasa Medical School, Istanbul University, Turkey
| | - Hasan Turan
- Department of Obstetrics and Gynecology, Cerrahpasa Medical School, Istanbul University, Turkey
| | - Gizem Kaval
- Department of Obstetrics and Gynecology, Cerrahpasa Medical School, Istanbul University, Turkey
| | - Veysel Sal
- Department of Obstetrics and Gynecology, Cerrahpasa Medical School, Istanbul University, Turkey
| | - Nedim Tokgozoglu
- Department of Obstetrics and Gynecology, Cerrahpasa Medical School, Istanbul University, Turkey
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Nishida M, Miyamoto Y, Kawano Y, Takebayashi K, Narahara H. A case of successful laparoscopic surgery for tubal stump pregnancy after tubectomy. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2015; 8:1-4. [PMID: 25674027 PMCID: PMC4294634 DOI: 10.4137/ccrep.s20907] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 11/05/2014] [Accepted: 11/07/2014] [Indexed: 11/25/2022]
Abstract
The incidence of ectopic pregnancy is approximately 1.3–2% of all pregnancies, and more than 90% of ectopic pregnancies are detected in the ampulla of the fallopian tube. Ectopic pregnancy occurring in tubal stump after tubectomy is extremely rare, and the frequency of tubal stump pregnancy is approximately 0.4% of all pregnancies. We report one of these rare cases of ectopic pregnancy in a 26-year-old Japanese woman, gravida 4, parity 1. She had undergone laparoscopic tubectomy because of a tubal pregnancy two years ago. She was presented to our hospital with a positive pregnancy test, but no gestational sac was detected in the uterus by echography, even though the level of human chorionic gonadotropin (hCG) in the blood was elevated to 8,900 mIU/mL. Laparoscopic surgery for ectopic pregnancy was performed. During surgery, the position of the pregnancy was found to be in the tubal stump, where tubectomy had already been performed, and the gestational sac was successfully removed. After the surgery, the condition of the patient uneventfully improved and she was discharged from the hospital three days after the surgery. The diagnosis of tubal stump pregnancy is more difficult than that of the more common positions of an ectopic pregnancy in the fallopian tube, and so it is more important to carefully examine the patients with suspected ectopic pregnancy. Laparoscopic surgery is one of the options for tubal stump pregnancy if diagnosed early and if the condition of the patient is stable.
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Affiliation(s)
- Masakazu Nishida
- Department of Obstetrics and Gynecology, Faculty of Medicine, Oita University, Yufu, Oita, Japan
| | - Yuko Miyamoto
- Department of Obstetrics and Gynecology, Faculty of Medicine, Oita University, Yufu, Oita, Japan
| | - Yasushi Kawano
- Department of Obstetrics and Gynecology, Faculty of Medicine, Oita University, Yufu, Oita, Japan
| | - Kanetoshi Takebayashi
- Department of Obstetrics and Gynecology, Faculty of Medicine, Oita University, Yufu, Oita, Japan
| | - Hisashi Narahara
- Department of Obstetrics and Gynecology, Faculty of Medicine, Oita University, Yufu, Oita, Japan
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14
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Gasless laparoendoscopic single-site surgery for management of adnexal masses during pregnancy. Eur J Obstet Gynecol Reprod Biol 2014; 180:28-34. [DOI: 10.1016/j.ejogrb.2014.06.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 06/14/2014] [Accepted: 06/19/2014] [Indexed: 11/17/2022]
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