1
|
Ryu S, Lee CM, Kang BK, Kim M. Retroperitoneal Ectopic Pregnancy Detected by CT: A Case Report. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2024; 85:217-221. [PMID: 38362382 PMCID: PMC10864160 DOI: 10.3348/jksr.2023.0064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 07/31/2023] [Accepted: 08/26/2023] [Indexed: 02/17/2024]
Abstract
Retroperitoneal ectopic pregnancy is a rare form of ectopic pregnancy. Owing to its rarity and nonspecific symptoms, diagnosing retroperitoneal ectopic pregnancy at the initial presentation poses a significant challenge. Typically, the diagnosis relies on non-radiation imaging modalities, such as ultrasonography and MRI, whereas CT is infrequently used. Herein, we report a rare case of a retroperitoneal ectopic pregnancy, which was diagnosed using CT.
Collapse
|
2
|
Byamukama A, Bibangambah P, Rwebazibwa J, Acan M, Sebikali MJ. Advanced abdominal ectopic pregnancy and the role of antenatal ultrasound scan in its diagnosis and management. Radiol Case Rep 2023; 18:4409-4413. [PMID: 37840888 PMCID: PMC10570543 DOI: 10.1016/j.radcr.2023.09.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 09/12/2023] [Accepted: 09/14/2023] [Indexed: 10/17/2023] Open
Abstract
Abdominal pregnancy is a very rare form of ectopic gestation in which implantation occurs in the peritoneal cavity. It accounts for about 1% of all ectopic pregnancies and is associated with a higher risk of morbidity and mortality due to complications such as preeclampsia, placenta abruption, and oligohydromnios, which necessitate pregnancy termination before term, and the risk of massive hemorrhage associated with abnormal placentation. We present a case of advanced abdominal ectopic pregnancy, diagnosed in the second trimester and complicated by anhydramnios. An abdominal ultrasound scan showed a nongravid uterus and a single live extrauterine fetus within the abdominal cavity, with no surrounding liquor at 23 weeks and 3 days average gestational age. Mother was consented and an emergency laparatomy performed. A premature baby was delivered but died in Neonatal Intensive Care Unit (NICU) after 4 hours due to severe acute respiratory distress syndrome. Mother had good postoperative recovery. Advanced abdominal ectopic pregnancy though very rare, is associated with complications that lead to early termination. Ultrasound scan is a reliable tool for the diagnosis of abdominal pregnancy in settings with limited access to Magnetic Resonance Imaging (MRI). It should be recommended to all mothers at their earliest antenatal care (ANC) visit to help determine the site of pregnancy and guide further intervention.
Collapse
Affiliation(s)
- Anacret Byamukama
- Department of Radiology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Prossy Bibangambah
- Department of Radiology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Joseph Rwebazibwa
- Department of Obstetrics & Gynecology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Moses Acan
- Department of Radiology, Mbarara University of Science and Technology, Mbarara, Uganda
| | | |
Collapse
|
3
|
Traisrisilp K, Sethasathien S. Large unruptured tubal pregnancy mimicking abdominal pregnancy. BMJ Case Rep 2023; 16:e256090. [PMID: 37816580 PMCID: PMC10565280 DOI: 10.1136/bcr-2023-256090] [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: 10/12/2023] Open
Abstract
Ectopic pregnancy accounts for 1-2% of all pregnancies. Ultrasound is the primary diagnostic tool to locate pregnancy outside the uterus and identify complications such as haemoperitoneum. In inconclusive cases, MRI is an adjunctive imaging modality offering more precise tissue differentiation and helpful to location identification. Presented is an unusual case of tubal pregnancy. The patient in her 30s, who was 14 weeks into her first pregnancy, had a suspected abdominal pregnancy. Both transabdominal ultrasound and an MRI indicated an ectopic pregnancy, likely originating from the right fallopian tube. A successful laparotomy and right salpingectomy were performed without complications. Rarely, as in this case, large unruptured and advanced tubal pregnancies can mimic an abdominal pregnancy, underscoring the importance of disease recognition and familiarity with uncommon image findings. An accurate diagnosis of pregnancy location is crucial for effective case management.
Collapse
Affiliation(s)
- Kuntharee Traisrisilp
- Obstetric and Gynecology, Chiang Mai University, Faculty of Medicine, Chiang Mai, Thailand
| | - Sethawat Sethasathien
- Obstetric and Gynecology, Chiang Mai University, Faculty of Medicine, Chiang Mai, Thailand
| |
Collapse
|
4
|
Ishikawa Y, Nakanishi K, Tsumura A, Murakami K, Nishiwaki K. Early abdominal wall ectopic pregnancy treated with laparoscopic surgery: A case report and literature review. J Obstet Gynaecol Res 2023; 49:2544-2548. [PMID: 37424208 DOI: 10.1111/jog.15739] [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: 03/10/2023] [Accepted: 06/28/2023] [Indexed: 07/11/2023]
Abstract
The abdominal wall is a rare site of ectopic implantation. Laparoscopic surgery for early abdominal pregnancy, in contrast to its use for tubal ectopic pregnancy, remains controversial because of concerns regarding heavy bleeding at the implantation site. Treatment of early abdominal pregnancy must be individualized for each implantation site. Herein, we present a case of an early abdominal pregnancy implanted in the anterior abdominal wall that was successfully treated with laparoscopic surgery. A 28-year-old multiparous woman with a 6-week amenorrhea presented with acute abdominal pain. An ectopic pregnancy was suspected because of elevated serum human chorionic gonadotropin levels without a visible gestational sac on transvaginal ultrasonography. Diagnostic laparoscopy revealed a gestational sac hanging from the anterior abdominal wall near the previous cesarean section wound. Laparoscopic surgery was successfully performed, and the patient was discharged on postoperative day three. In the present case, laparoscopic surgery was beneficial.
Collapse
Affiliation(s)
- Yuta Ishikawa
- Department of Obstetrics and Gynecology, Wakkanai City Hospital, Wakkanai, Hokkaido, Japan
| | - Kentaro Nakanishi
- Department of Obstetrics and Gynecology, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Ai Tsumura
- Department of Obstetrics and Gynecology, Wakkanai City Hospital, Wakkanai, Hokkaido, Japan
| | - Koji Murakami
- Department of Obstetrics and Gynecology, Wakkanai City Hospital, Wakkanai, Hokkaido, Japan
| | - Kunihiko Nishiwaki
- Department of Obstetrics and Gynecology, Wakkanai City Hospital, Wakkanai, Hokkaido, Japan
| |
Collapse
|
5
|
Dunphy L, Boyle S, Cassim N, Swaminathan A. Abdominal ectopic pregnancy. BMJ Case Rep 2023; 16:e252960. [PMID: 37775278 PMCID: PMC10546113 DOI: 10.1136/bcr-2022-252960] [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: 10/01/2023] Open
Abstract
An ectopic pregnancy (EP) accounts for 1-2% of all pregnancies, of which 90% implant in the fallopian tube. An abdominal ectopic pregnancy (AEP) is defined as an ectopic pregnancy occurring when the gestational sac is implanted in the peritoneal cavity outside the uterine cavity or the fallopian tube. Implantation sites may include the omentum, peritoneum of the pelvic and abdominal cavity, the uterine surface and abdominal organs such as the spleen, intestine, liver and blood vessels. Primary abdominal pregnancy results from fertilisation of the ovum in the abdominal cavity and secondary occurs from an aborted or ruptured tubal pregnancy. It represents a very rare form of an EP, occurring in <1% of cases. At early gestations, it can be challenging to render the diagnosis, and it can be misdiagnosed as a tubal ectopic pregnancy. An AEP diagnosed >20 weeks' gestation, caused by the implantation of an abnormal placenta, is an important cause of maternal-fetal mortality due to the high risk of a major obstetric haemorrhage and coagulopathy following partial or total placental separation. Management options include surgical therapy (laparoscopy±laparotomy), medical therapy with intramuscular or intralesional methotrexate and/or intracardiac potassium chloride or a combination of medical and surgical management. The authors present the case of a multiparous woman in her early 30s presenting with heavy vaginal bleeding and abdominal pain at 8 weeks' gestation. Her beta-human chorionic gonadotropin (bHCG) was 5760 IU/L (range: 0-5), consistent with a viable pregnancy. Her transvaginal ultrasound scan suggested an ectopic pregnancy. Laparoscopy confirmed an AEP involving the pelvic lateral sidewall. Her postoperative 48-hour bHCG was 374 IU/L. Due to the rarity of this presentation, a high index of clinical suspicion correlated with the woman's symptoms; bHCG and ultrasound scan is required to establish the diagnosis to prevent morbidity and mortality.
Collapse
Affiliation(s)
- Louise Dunphy
- Department of Obstetrics and Gynaecology, Leighton Hospital, Crewe, UK
| | - Stephanie Boyle
- Department of Obstetrics and Gynaecology, Leighton Hospital, Crewe, UK
| | - Nadia Cassim
- Department of Obstetrics and Gynaecology, Leighton Hospital, Crewe, UK
| | - Ajay Swaminathan
- Department of Obstetrics and Gynaecology, Leighton Hospital, Crewe, UK
| |
Collapse
|
6
|
Dai J, Chen J, Xu X, Gao N, Wang Y. A case report of dangerous pelvic infundibulum ligament in the second trimester of pregnancy with massive hemorrhage. Medicine (Baltimore) 2023; 102:e35230. [PMID: 37747006 PMCID: PMC10519526 DOI: 10.1097/md.0000000000035230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/15/2023] [Accepted: 08/24/2023] [Indexed: 09/26/2023] Open
Abstract
RATIONALE Abdominal pregnancy is a rare ectopic pregnancy and its diagnosis and treatment are more challenging than those of other ectopic pregnancies. Because of a variable pregnancy site, abdominal pregnancy is associated with an increased risk of fatal abdominal hemorrhage, and consequently, an increased risk of maternal death compared with intrauterine pregnancy. DIAGNOSES Pelvic infundibulum ligament pregnancy complicated with massive hemorrhage. PATIENT CONCERNS 42-year-old pregnant woman who did not undergo an obstetric examination during the first trimester presented with sudden abdominal pain during the second trimester. Abdominal pregnancy was confirmed after emergency treatment, causing difficulty in the comprehensive preoperative evaluation.Interventions: In order to save the patient life, we actively carried out surgical treatment. OUTCOMES The patient recovered well after the operation and was discharged on the 11th postoperative day. Blood β-human chorionic gonadotropin (β-hCG) levels and routine blood test results were normal 1 month after the surgery, and the patient had recovered. LESSONS Several challenges are encountered in the diagnosis of abdominal pregnancy with regard to insufficient economic, cultural, and medical resources. In case of ectopic pregnancies, surgery should be the first choice of treatment, and preparations of blood transfusion are essential to combat the risk of rapid hemorrhagic shock caused by placenta implantation in the infundibulum ligament of the pelvis. The operation must be performed by experienced obstetricians and gynecologists.
Collapse
Affiliation(s)
- Jiahui Dai
- Clinical Medical College, Jining Medical University, Jining, Shandong, China
| | - Jin Chen
- Program for Scientific Research Innovation Team in Precision Medicine of Gynecologic Oncology, Affiliated Hospital of Jining Medical University, Jining, Shandong China
| | - Xiaohan Xu
- Clinical Medical College, Jining Medical University, Jining, Shandong, China
| | - Ni Gao
- Clinical Medical College, Jining Medical University, Jining, Shandong, China
| | - Yunfei Wang
- Program for Scientific Research Innovation Team in Precision Medicine of Gynecologic Oncology, Affiliated Hospital of Jining Medical University, Jining, Shandong China
| |
Collapse
|
7
|
Ishikawa H, Shozu M. Early peritoneal pregnancy in the pouch of Douglas identified by transvaginal ultrasound. Int J Gynaecol Obstet 2023; 160:1050-1052. [PMID: 36200653 DOI: 10.1002/ijgo.14494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 09/07/2022] [Accepted: 09/29/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Hiroshi Ishikawa
- Department of Reproductive Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Makio Shozu
- Department of Reproductive Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan
| |
Collapse
|
8
|
Yang GBS, Nianyu XMS, Shengmin ZMD, Ying CMS. One Case of Retroperitoneal Ectopic Pregnancy Accurately Diagnosed by Ultrasound. ADVANCED ULTRASOUND IN DIAGNOSIS AND THERAPY 2023. [DOI: 10.37015/audt.2023.230008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
|
9
|
Biopsychosocial Approach for Conservative Management of Abdominal Pregnancy in Previously Infertile Mother. Case Rep Med 2022; 2022:3021097. [PMID: 36082316 PMCID: PMC9448616 DOI: 10.1155/2022/3021097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 05/27/2022] [Accepted: 07/19/2022] [Indexed: 11/17/2022] Open
Abstract
Background Abdominal pregnancy is a rare condition in which early termination is generally recommended. However, there are cases of abdominal pregnancies treated using expectant management with satisfactory outcomes. This management may be considered in special cases, such as previously infertile couples. Case A case of a 27-year-old woman with infertility history complaining of vaginal bleeding was presented. Physical and ultrasound examination revealed an abdominal pregnancy with 18 weeks of gestation. Although she was ready to abort the pregnancy, she insisted to try expectant management for her pregnancy. Her baby was finally born at 25 weeks via laparotomy. Conclusion Abdominal pregnancy is a rare and highly morbid form of ectopic pregnancy. It demands a skilled approach in management. A comprehensive and holistic approach is required to deliver the best outcome for the patient and her family.
Collapse
|
10
|
Tang P, Li X, Li W, Li Y, Zhang Y, Yang Y. The trend of the distribution of ectopic pregnancy sites and the clinical characteristics of caesarean scar pregnancy. Reprod Health 2022; 19:182. [PMID: 35987835 PMCID: PMC9392275 DOI: 10.1186/s12978-022-01472-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 07/10/2022] [Indexed: 12/02/2022] Open
Abstract
Background Ectopic pregnancy is a life-threatening occurrence and is an important cause of pregnancy-related mortality. We launched the study to investigate the distribution and its variation trend of the ectopic pregnancy sites and the clinical characteristics of caesarean scar pregnancy, to provide information for further clinical practice.
Methods A total of 3915 patients were included in our study to calculate the distribution of the implantation sites of ectopic pregnancies. Then, we performed a χ2 test for trend and calculated the quantity of each type of ectopic pregnancy during 2012–2015 and 2016–2019 to analyse the variation trend. Results (1) The proportion of each site of ectopic pregnancy was as follows: tubal pregnancy (84.70%), ovarian pregnancy (1.56%), caesarean scar pregnancy (8.63%), abdominal pregnancy (0.61%), cornual pregnancy (2.68%), cervical pregnancy (0.49%), heterotopic pregnancy (0.43%). (2) Through the χ2 test for trend, the ratio of caesarean scar pregnancy to ectopic pregnancy showed an upward trend (P = 0.005). From 2012 to 2015 and 2016–2019, the ratio of caesarean scar pregnancy to ectopic pregnancy increased from 5.74 to 11.81% (P < 0.001). (3) A total of 72.78% (246/338) caesarean scar pregnancy patients had one caesarean delivery, 25.15% (85/338) had two caesarean deliveries, and 2.07% (7/338) had three caesarean deliveries. A total of 80.18% (271/338) had aborted before. The most common clinical manifestations were amenorrhea (98.52%), abdominal pain (25.74%) and vaginal bleeding (67.76%), the most common sign was uterine enlargement (46.75%). Conclusion As the ratio of caesarean scar pregnancy increases, the caesarean delivery rate should be decreased to decrease the morbidity of caesarean scar pregnancy. Ectopic pregnancy occurs when a fertilized ovum implants outside the endometrium of the uterine cavity, which is a life-threatening occurrence and is an important cause of pregnancy-related mortality. With the increase in pelvic and intrauterine operations, the distribution of ectopic sites has been changing, but the variation has been insufficiently studied. To investigate the distribution of ectopic sites and its variation trend in depth, we collected the data of 3915 ectopic pregnancy cases from the third affiliated hospital of Sun Yat-Sen University. Through χ2 test for trend, the ratio of caesarean scar pregnancy to ectopic pregnancy showed an upward trend (P = 0.005). From 2012 to 2015 and 2016–2019, the ratio of caesarean scar pregnancy to ectopic pregnancy increased from 5.74 to 11.81% (P < 0.001). As the increasing of the ratio of caesarean scar pregnancy to ectopic pregnancy, the clinical characteristics of caesarean scar pregnancy was analysed. A total of 72.78% (246/338) caesarean scar pregnancy patients had one caesarean delivery, 25.15% (85/338) had two caesarean deliveries, and 2.07% (7/338) had three caesarean deliveries. A total of 80.18% (271/338) had aborted before. The most common clinical manifestations were amenorrhea (98.52%), abdominal pain (25.74%) and vaginal bleeding (67.76%), the most common sign was uterine enlargement (46.75%). As the ratio of caesarean scar pregnancy increases, the caesarean delivery rate should be decreased to decrease the morbidity of caesarean scar pregnancy.
Collapse
|
11
|
Multidisciplinary treatment of retroperitoneal ectopic pregnancy: a case report and literature review. BMC Pregnancy Childbirth 2022; 22:472. [PMID: 35672717 PMCID: PMC9175374 DOI: 10.1186/s12884-022-04799-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 05/31/2022] [Indexed: 11/17/2022] Open
Abstract
Background Retroperitoneal ectopic pregnancy (REP) is an extremely rare type of ectopic pregnancy, with a total of less than 32 cases reported in the English literature. Early diagnosis of REP is very difficult and all treatments entail a high risk of life-threatening complications. Case presentation A 29-year-old nulliparous woman presented a history of 50-day amenorrhea and 7-day upper abdominal pain without vaginal spotting. The serum beta-human chorionic gonadotropin (β-hCG) value was 65,004 m-international units per milliliter (mIU/mL), but no intrauterine gestational sac was found via transvaginal sonography (TVS). Then transabdominal ultrasonography (TAS) and abdominal contrast-enhanced computer tomography (CT) identified a retroperitoneal ectopic pregnancy (REP) tightly adjacent to the inferior vena cava and the abdominal aorta. After consultation from a multidisciplinary team, systemic methotrexate (MTX, intramuscular 20 mg daily for 5 consecutive days) combined with ultrasound-guided local potassium chloride solution injection into the gestational sac was scheduled firstly for the patient. However, serum β-hCG continued to increase and the patient experienced worsening abdominal pain. Laparotomy was performed jointly by a gynecologist and a vascular surgeon. During the operation, the gestational sac with fetal bud measuring about 4.5 × 4.0x3.0 cm, tightly adherent to the surface of inferior vena cava and the left side of abdominal aorta, was carefully dissociated out from the surrounding tissues and removed en bloc. Histopathology examination confirmed the diagnosis of REP. The patient recovered uneventfully and her serum β-hCG returned to normal range on the 23th postoperative day. Conclusions Considering the possibility of REP and combined radiological examinations, such as ultrasonography and CT, are crucial for the early diagnosis of this rare condition. A multidisciplinary team is necessary to treat REP.
Collapse
|
12
|
Mamo A, Adkins K. Abdominal Pregnancy: Pathophysiology, Diagnosis, and Treatment. J Gynecol Surg 2022. [DOI: 10.1089/gyn.2022.0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Andrina Mamo
- University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Katlynn Adkins
- University of Colorado School of Medicine, Aurora, Colorado, USA
- Department of Obstetrics and Gynecology, Denver Health and Hospital Authority, Denver, Colorado, USA
| |
Collapse
|
13
|
Factors Associated with Ruptured Ectopic Pregnancy: A 10-Year Review at a District Hospital in Ghana. Obstet Gynecol Int 2022; 2022:1491419. [PMID: 35295562 PMCID: PMC8920631 DOI: 10.1155/2022/1491419] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/20/2022] [Accepted: 02/11/2022] [Indexed: 11/17/2022] Open
Abstract
Background Approximately 1–2% of all pregnancies are ectopic. Despite a decline in ectopic pregnancy-related mortality, there is still a paucity of information on the factors associated with clinical presentation and outcomes in Sub-Saharan Africa which is essential in determining the most appropriate treatment modalities. Methods We performed a ten-year retrospective chart review of cases of ectopic pregnancies managed at the Lekma hospital and assessed them for peculiar risk factors, clinical presentation, and outcomes. Associations between patients' sociodemographic characteristics, clinical presentation, and treatment outcome were evaluated using multiple logistic regression and reported as adjusted odds ratios (AOR). The confidence interval (CI) was set at 95%, and a p value <0.05 were considered significant. Results Over the ten-year period, there were 115 ectopic pregnancies and 14,450 deliveries (7.9/1,000). The mean age ± standard deviation of the 115 patients was 27.61 ± 5.56. More than half of the patients were single (59/115, 51.3%). The majority (71.3%) of the patients presented with a ruptured ectopic pregnancy. After adjusting for covariates, the odds of an ectopic pregnancy presenting as ruptured among single patients was 2.63 times higher than that of married patients (AOR = 3.63, 95% CI: 1.33–9.93, p=0.01). Ectopic pregnancies located in the isthmic region of the tube had a 77% lower odds of presenting as ruptured than those located in the ampullary region (AOR = 0.23, 95% CI: 0.07–0.74, p=0.01). The odds of rupturing were 1.69 times increased for every additional week after the missed period (AOR = 2.69, 95% CI: 1.56–4.64, p < 0.01). No mortalities were reported as a result of an ectopic pregnancy. Conclusion Most of the cases of ectopic pregnancy presented ruptured. Marital status and period of amenorrhoea were significantly associated with rupture.
Collapse
|
14
|
Wilcox A, Bowers S, Luciano D. Title: Laparoscopic Removal of an Abdominal Ectopic Pregnancy Requiring Partial Cecectomy. J Minim Invasive Gynecol 2022; 29:592-595. [PMID: 35033686 DOI: 10.1016/j.jmig.2021.12.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/29/2021] [Accepted: 12/30/2021] [Indexed: 11/27/2022]
|
15
|
Owie E, Lewu A, Anumni C. A case report of an advanced abdominal pregnancy with sepsis. J OBSTET GYNAECOL 2022; 42:1556-1557. [PMID: 35014933 DOI: 10.1080/01443615.2021.2002833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Emmanuel Owie
- Department of Obstetrics and Gynaecology, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Abosede Lewu
- Department of Obstetrics and Gynaecology, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Chinedu Anumni
- Department of Obstetrics and Gynaecology, Lagos University Teaching Hospital, Lagos, Nigeria
| |
Collapse
|
16
|
|
17
|
Li Y, Geng J, He Q, Lu J, Xu J, Zhang Y, Zhang C. Abdominal ectopic pregnancy following a frozen embryo transfer cycle: a case report. BMC Pregnancy Childbirth 2021; 21:707. [PMID: 34674658 PMCID: PMC8532271 DOI: 10.1186/s12884-021-04133-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 09/22/2021] [Indexed: 12/02/2022] Open
Abstract
Background Abdominal ectopic pregnancy (AEP) is a rare form of ectopic pregnancy. As the number of in-vitro fertilization (IVF) procedures continues to increase, the incidence of AEP will also rise. However, the rarity and atypical presentation of AEP make early diagnosis challenging. Case presentation Herein, we report an AEP following frozen-thawed embryo transfer (FET) in an artificial cycle. The patient was misdiagnosed with implantation failure when the serum human chorionic gonadotropin (hCG) level was detected as 2.59mIU/ml at fourteenth day after embryo transfer. Therefore, she was suggested to stop luteal phase support. However, a ruptured AEP was developed 33 days following embryo transfer, which was diagnosed by laparoscopic surgery. Conclusions The case highlighted the delayed serum β-hCG and massive intraperitoneal hemorrhage may be clues to make early diagnosis of AEP. Clinicians must attach great importance to close monitoring and bear in mind the possibility of abdominal pregnancy.
Collapse
Affiliation(s)
- Yan Li
- Reproductive Medical Center, People's Hospital of Zhengzhou University, Henan Provincial People's Hospital, Weiwu Road, Zhengzhou, 450003, Henan, China
| | - Jiaxuan Geng
- Reproductive Medical Center, People's Hospital of Zhengzhou University, Henan Provincial People's Hospital, Weiwu Road, Zhengzhou, 450003, Henan, China
| | - Qiaohua He
- Reproductive Medical Center, People's Hospital of Zhengzhou University, Henan Provincial People's Hospital, Weiwu Road, Zhengzhou, 450003, Henan, China
| | - Jin Lu
- Reproductive Medical Center, People's Hospital of Zhengzhou University, Henan Provincial People's Hospital, Weiwu Road, Zhengzhou, 450003, Henan, China
| | - Jin Xu
- Reproductive Medical Center, People's Hospital of Zhengzhou University, Henan Provincial People's Hospital, Weiwu Road, Zhengzhou, 450003, Henan, China
| | - Ying Zhang
- Reproductive Medical Center, People's Hospital of Zhengzhou University, Henan Provincial People's Hospital, Weiwu Road, Zhengzhou, 450003, Henan, China
| | - Cuilian Zhang
- Reproductive Medical Center, People's Hospital of Zhengzhou University, Henan Provincial People's Hospital, Weiwu Road, Zhengzhou, 450003, Henan, China.
| |
Collapse
|
18
|
Ozawa N, Shibata M, Mitsui M, Umehara N, Samura O, Sago H. Spontaneously conceived heterotopic pregnancy with abdominal pregnancy implanted on the vesicouterine pouch: A case report and literature review. J Obstet Gynaecol Res 2021; 47:3720-3726. [PMID: 34342369 DOI: 10.1111/jog.14967] [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: 12/30/2020] [Revised: 07/10/2021] [Accepted: 07/23/2021] [Indexed: 11/28/2022]
Abstract
We report the case of a 36-year-old woman with spontaneously conceived heterotopic pregnancy with abdominal pregnancy. She visited the hospital at 5 weeks and 4 days of gestation and transvaginal ultrasonography revealed a normal intrauterine pregnancy. Two days later, she was urgently transported to the hospital due to extreme abdominal pain. Emergent laparotomy was performed to investigate the cause of massive intraperitoneal bleeding, which was confirmed to have been due to an abdominal pregnancy that implanted on the vesicouterine pouch. The hematic mass, including chorionic villi, was successfully removed from the peritoneum. The subsequent course of the intrauterine pregnancy was uneventful and a healthy baby was born at term. To the best of our knowledge, this is an extremely rare case report of a spontaneously conceived heterotopic abdominal pregnancy, in which the intrauterine pregnancy showed a successful outcome despite the collapse of the abdominal pregnancy at a very early stage.
Collapse
Affiliation(s)
- Nobuaki Ozawa
- Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Megumi Shibata
- Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Mari Mitsui
- Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Nagayoshi Umehara
- Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Osamu Samura
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo, Japan
| | - Haruhiko Sago
- Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| |
Collapse
|
19
|
Diagnostic Challenges of an Abdominal Pregnancy in the Second Trimester. Case Rep Obstet Gynecol 2021; 2021:7887213. [PMID: 34395003 PMCID: PMC8355995 DOI: 10.1155/2021/7887213] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 07/24/2021] [Indexed: 11/18/2022] Open
Abstract
Abdominal pregnancies are a rare form of ectopic pregnancy, which presents a significant risk of maternal morbidity and mortality. We describe an unusual case of a late diagnosis of an abdominal pregnancy in the second trimester, which due to diagnostic challenges, was not detected on 1st trimester and subsequent antenatal ultrasound scans (USS). The abdominal pregnancy was later diagnosed at the repeat anomaly scan and confirmed with a pelvic MRI. This case of abdominal pregnancy is unique when compared to other reported cases, as the fetus was initially enclosed within the amniotic sac with normal liquor volume. Both transvaginal and transabdominal scans appeared to demonstrate an intrauterine pregnancy. The diagnosis of abdominal pregnancy was only made possible following rupture of the amniotic sac, leading to anhydramnios, which resulted in the repositioning of the fetus to the upper maternal abdomen. This case represents the challenges faced by obstetricians in diagnosing, managing, and counselling a woman when faced with an abdominal pregnancy.
Collapse
|
20
|
Ma R, Guan J, Chen J, Sun K, Zhang L, Chen R. Broad ligament pregnancy with pelvic congestion syndrome: A case report. J Obstet Gynaecol Res 2021; 47:3712-3715. [PMID: 34278659 DOI: 10.1111/jog.14942] [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: 04/08/2021] [Revised: 06/29/2021] [Accepted: 07/07/2021] [Indexed: 11/30/2022]
Abstract
We present the first case that describes a right broad ligament pregnancy patient complicated with pelvic congestion syndrome. A 23-year-old female referred to the gynecological emergency room with pelvic pain and amenorrhea. Serum beta-human chorionic gonadotropin (β-hCG) test of the patient was positive, and ultrasonography indicated that there were mixed mass signals and a large number of blood flow signals in the right parauterine area. Considering the possibility of a diagnosis of ectopic pregnancy, we performed laparoscopic exploration for this patient. According to the intraoperative situation, we formally diagnosed the right broad ligament pregnancy. Although the intraoperative hemorrhage was fierce, we still successfully completed the resection of the lesion and performed the ipsilateral salpingectomy. We performed three-dimensional CT vascular reconstruction on the patient after surgery, and diagnosed right pelvic congestion syndrome combined with the patient's usual chronic pelvic pain symptoms.
Collapse
Affiliation(s)
- Ruyue Ma
- Department of Gynecology and Obstetrics, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, China
| | - Junhua Guan
- Department of Gynecology and Obstetrics, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, China
| | - Jina Chen
- Department of Gynecology and Obstetrics, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, China
| | - Ke Sun
- Department of Gynecology and Obstetrics, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, China
| | - Liwen Zhang
- Department of Gynecology and Obstetrics, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, China
| | - Rujun Chen
- Department of Gynecology and Obstetrics, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, China
| |
Collapse
|
21
|
Po L, Thomas J, Mills K, Zakhari A, Tulandi T, Shuman M, Page A. Guideline No. 414: Management of Pregnancy of Unknown Location and Tubal and Nontubal Ectopic Pregnancies. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2021; 43:614-630.e1. [PMID: 33453378 DOI: 10.1016/j.jogc.2021.01.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To provide an evidence-based algorithm to guide the diagnosis and management of pregnancy of unknown location and tubal and nontubal ectopic pregnancy. TARGET POPULATION All patients of reproductive age. BENEFITS, HARMS, AND COSTS The implementation of this guideline aims to benefit patients with positive β-human chorionic gonadotropin results and provide physicians with a standard algorithm for expectant, medical, and surgical treatment of pregnancy of unknown location and tubal pregnancy and nontubal ectopic pregnancies. EVIDENCE The following search terms were entered into PubMed/Medline and Cochrane in 2018: cesarean section, chorionic gonadotropin, beta subunit, human/blood, fallopian tubes/surgery, female, fertility, humans, infertility, laparoscopy, methotrexate, methotrexate/administration & dosage, methotrexate/therapeutic use, pregnancy (abdominal, angular, cervix, cornual, ectopic, ectopic/diagnosis, ectopic/diagnostic imaging, ectopic/drug therapy, ectopic/epidemiology, ectopic/mortality, ectopic/surgery, heterotopic, interstitial, isthmo-cervical, ovarian, tubal, unknown location), recurrence, risk factors, salpingectomy, salpingostomy, tubal pregnancy, ultrasonography, doppler ultrasonography, and prenatal. Articles included were randomized controlled trials, meta-analyses, systematic reviews, observational studies, and case reports. Additional publications were identified from the bibliographies of these articles. Only English-language articles were reviewed. VALIDATION METHODS The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and weak recommendations). INTENDED AUDIENCE Obstetrician-gynaecologists, family physicians, emergency physicians, midwives, registered nurses, nurse practitioners, medical students, and residents and fellows. SUMMARY STATEMENTS (GRADE RATINGS IN PARENTHESES) RECOMMENDATIONS (GRADE RATINGS IN PARENTHESES).
Collapse
|
22
|
ELmiski F, Ouafidi B, Elazzouzi E, Elquasseh R, Lamrissi A, Fichtali K, Bouhya S. Abdominal pregnancy diagnosed by ultrasonography and treated successfully by laparotomy: Two cases report. Int J Surg Case Rep 2021; 83:105952. [PMID: 34020404 PMCID: PMC8142248 DOI: 10.1016/j.ijscr.2021.105952] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 04/17/2021] [Accepted: 04/22/2021] [Indexed: 12/02/2022] Open
Abstract
Introduction Abdominal pregnancy is one of the rare types of ectopic pregnancies that has a high rate of mortality. Its clinical presentation is similar to those of the other types of ectopic pregnancies. Cases presentation we report two cases of abdominal pregnancies whose the diagnosis was made by ultra-sonography and successfully treated by laparotomy in emergency obstetrical department of Ibn Rochd University Hospital of Casablanca. Clinical discussion the ultra-sonography based on precise criteria represents the fundamental paraclinical examination in the diagnosis of abdominal pregnancies. The treatment of early form is based on surgery; And despite the advent of laparoscopic surgery, laparotomy retains its indications including forms with hemorrhagic shock. Conclusion Due to the high risk of complications and maternal mortality, abdominal pregnancies should be surgically treated as soon as possible when the diagnosis is confirmed. Abdominal pregnancy is an exceptional type of ectopic pregnancies. Their diagnosis is difficult to distinguish from other types of ectopic pregnancies. Abdominal pregnancies should be surgically treated as soon as possible when the diagnosis is confirmed.
Collapse
Affiliation(s)
- F ELmiski
- Obstetrics And Gynecology Department, University Hospital Center Ibn Rochd, Casablanca 20100, Morocco.
| | - B Ouafidi
- Obstetrics And Gynecology Department, University Hospital Center Ibn Rochd, Casablanca 20100, Morocco
| | - E Elazzouzi
- Obstetrics And Gynecology Department, University Hospital Center Ibn Rochd, Casablanca 20100, Morocco
| | - R Elquasseh
- Obstetrics And Gynecology Department, University Hospital Center Ibn Rochd, Casablanca 20100, Morocco
| | - A Lamrissi
- Obstetrics And Gynecology Department, University Hospital Center Ibn Rochd, Casablanca 20100, Morocco
| | - K Fichtali
- Obstetrics And Gynecology Department, University Hospital Center Ibn Rochd, Casablanca 20100, Morocco
| | - S Bouhya
- Obstetrics And Gynecology Department, University Hospital Center Ibn Rochd, Casablanca 20100, Morocco
| |
Collapse
|
23
|
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
|
24
|
Compadre AJ, Ukoha EP, Zhang W. Combined surgical and medical management of a broad ligament ectopic pregnancy: A case report. Case Rep Womens Health 2021; 31:e00316. [PMID: 34036051 PMCID: PMC8134953 DOI: 10.1016/j.crwh.2021.e00316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/13/2021] [Accepted: 04/15/2021] [Indexed: 11/25/2022] Open
Abstract
Broad ligament ectopic pregnancies rare. Several case reports illustrate treatment with laparoscopy. A 31-year-old woman, gravida 2 para 1, presented at 6 weeks 6 days of gestation with vaginal bleeding. She had a β-hCG level of 7424 IU/L and ultrasound showed a 1.8 cm ectopic pregnancy with fetal cardiac activity in the left adnexa. Diagnostic laparoscopy revealed a left broad ligament ectopic pregnancy. The products of conception were removed surgically, and she received prophylactic two-dose methotrexate. Her β-hCG returned to non-pregnant levels within one month. This is the first case report to describe laparoscopy with postoperative prophylactic methotrexate for successful treatment of a broad ligament pregnancy. This treatment protocol with methotrexate can be considered in future cases. Broad ligament ectopic pregnancies are rare and often diagnosed intraoperatively. Several case reports document successful treatment of these pregnancies with surgery. Prophylactic methotrexate can be considered if there is concern for retained trophoblastic tissue.
Collapse
Affiliation(s)
- Amanda J Compadre
- Department of Obstetrics, Gynecology, & Reproductive Sciences, University of California San Francisco, USA
| | - Erinma P Ukoha
- Department of Obstetrics, Gynecology, & Reproductive Sciences, University of California San Francisco, USA
| | - Wenjia Zhang
- Department of Obstetrics, Gynecology, & Reproductive Sciences, University of California San Francisco, USA
| |
Collapse
|
25
|
The many faces of ectopic pregnancies: demystifying the common and less common entities. Abdom Radiol (NY) 2021; 46:1104-1114. [PMID: 32889610 DOI: 10.1007/s00261-020-02681-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/16/2020] [Accepted: 07/21/2020] [Indexed: 12/11/2022]
Abstract
Ectopic pregnancy is a major cause of 1st trimester pregnancy deaths. It occurs in various locations in the abdominopelvic cavity. Ultrasonography is a first-line, rapid, and noninvasive modality for ectopic pregnancy evaluation. MRI can help clarify equivocal cases. When in doubt about the location, one should give an intrauterine pregnancy the benefit of the doubt with close ultrasound and hCG follow-up. Here, we will review the imaging findings and mimickers of ectopic pregnancies.
Collapse
|
26
|
Managing Ruptured Splenic Ectopic Pregnancy Without Splenectomy: Case Report and Literature Review. Reprod Sci 2021; 28:2323-2330. [PMID: 33638134 PMCID: PMC7909380 DOI: 10.1007/s43032-021-00476-8] [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: 10/05/2020] [Accepted: 01/24/2021] [Indexed: 12/04/2022]
Abstract
Splenic ectopic pregnancy is extremely rare but carries a high risk of uncontrollable life-threatening bleeding. Our aim is to try to diagnose those cases earlier and to include splenic preservation as good alternative for selected cases. Extensive review of the literature has been performed. Thirty-one case reports were identified, of which 4 have been excluded because they were not written in English. A 36-year-old woman presented to the Emergency Department with haemorrhagic shock. Despite the levonorgestrel intrauterine system (LNG-IUS) being in situ for 4 months, urinary and serum tests were both positive for pregnancy, and an ultrasound scan revealed haemoperitoneum suggestive of a ruptured ectopic pregnancy. An emergency Pfannenstiel laparotomy was performed and a diagnosis of spontaneous tubal abortion was made and the abdomen was subsequently closed. Following a period of cardiovascular instability on the Intensive Care Unit postoperatively, an urgent CT scan was performed which revealed bleeding from the spleen. A midline laparotomy was performed by the general surgeon, which involved resection of the gestational sac and splenorrhaphy. Twenty-seven cases were reviewed, and 73% of them presented as an emergency and 21 cases (81%) had been managed with splenectomy. CT scan had been used in eight of the previous case reports of splenic ectopic pregnancy with 100% diagnostic accuracy rate. Non-tubal ectopic pregnancies are very rare. Splenorrhaphy is a safe alternative to splenectomy in cases of splenic ectopic pregnancy. CT abdomen and pelvis with intravenous contrast can be very helpful in relatively stable patients with a vaginal ultrasound demonstrating an empty uterus, no clear adnexal masses or free fluid.
Collapse
|
27
|
Rokhgireh S, Gorginzadeh M, Mehdizadehkashi A, Tahermanesh K, Alizadeh S. Broad ligament pregnancy in the presence of an intrauterine contraceptive device: A case report. Int J Surg Case Rep 2021; 79:421-423. [PMID: 33529821 PMCID: PMC7851414 DOI: 10.1016/j.ijscr.2021.01.080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 01/15/2021] [Accepted: 01/15/2021] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Abdominal pregnancy though scarce is associated with considerable morbidity and mortality. Few cases till now have been diagnosed or managed by laparoscopy. CASE PRESENTATION In this study, a case of an abdominal pregnancy in a woman with intrauterine contraceptive device (IUD) in situ and a history of cesarean section is described. CLINICAL DISCUSSION Our case was a brief description of a broad ligament pregnancy as a subcategory of abdominal pregnancy .It was located medial to the pelvic sidewall, lateral to the uterus, inferior to the fallopian tube and superior to the pelvic floor. CONCLUSION The pregnancy was in the location of the left broad ligament which was diagnosed on laparoscopic evaluation.
Collapse
Affiliation(s)
- Samaneh Rokhgireh
- Endometriosis Research Center, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Mansoureh Gorginzadeh
- Endometriosis Research Center, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | | | - Kobra Tahermanesh
- Endometriosis Research Center, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Shima Alizadeh
- Department of Obstetrics & Gynecology, Emam Complex, Vali-e-Asr Hospital, Tehran University of Medical Science(TUMS), Tehran, Iran.
| |
Collapse
|
28
|
Po L, Thomas J, Mills K, Zakhari A, Tulandi T, Shuman M, Page A. Directive clinique n o 414 : Prise en charge des grossesses de localisation indéterminée et des grossesses ectopiques tubaires et non tubaires. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2021; 43:631-649.e1. [PMID: 33453377 DOI: 10.1016/j.jogc.2021.01.001] [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: 10/22/2022]
Abstract
OBJECTIF Fournir un algorithme fondé sur des données probantes pour orienter le diagnostic et la prise en charge de la grossesse de localisation indéterminée et de la grossesse ectopique tubaire ou non tubaire. POPULATION CIBLE Toutes les patientes en âge de procréer. BéNéFICES, RISQUES ET COûTS: La mise en œuvre de la présente directive a pour objectif de bénéficier aux patientes ayant obtenu un résultat positif pour la sous-unité bêta de la gonadotrophine chorionique et de fournir aux médecins un algorithme normalisé pour l'expectative et le traitement pharmacologique ou chirurgical en cas de grossesse de localisation indéterminée et de grossesse ectopique tubaire ou non tubaire. DONNéES PROBANTES: Les termes de recherche suivants ont été entrés dans les bases de données PubMed-Medline et Cochrane en 2018 : cesarean section, chorionic gonadotropin, beta subunit, human/blood, fallopian tubes/surgery, female, fertility, humans, infertility, laparoscopy, methotrexate, methotrexate/administration & dosage, methotrexate/therapeutic use, pregnancy (abdominal, angular, cervix, cornual, ectopic, ectopic/diagnosis, ectopic/diagnostic imaging, ectopic/drug therapy, ectopic/epidemiology, ectopic/mortality, ectopic/surgery, heterotopic, interstitial, isthmo-cervical, ovarian, tubal, unknown location), recurrence, risk factors, salpingectomy, salpingostomy, tubal pregnancy, ultrasonography, doppler ultrasonography et prenatal. Les articles retenus sont des essais cliniques randomisés, des méta-analyses, des revues systématiques, des études observationnelles et des études de cas. Des publications supplémentaires ont été sélectionnées à partir des notices bibliographiques de ces articles. Seuls les articles en anglais ont été examinés. MéTHODES DE VALIDATION: Les auteurs ont évalué la qualité des données probantes et la solidité des recommandations en utilisant la méthodologie GRADE (Grading of Recommendations Assessment, Development and Evaluation). Voir l'annexe A en ligne (tableau A1 pour les définitions et tableau A2 pour l'interprétation des recommandations fortes et faibles). PUBLIC VISé: Obstétriciens-gynécologues, médecins de famille, urgentologues, sages-femmes, infirmières autorisées, infirmières praticiennes, étudiants en médecine, résidents et moniteurs cliniques. DÉCLARATIONS SOMMAIRES (CLASSEMENT GRADE ENTRE PARENTHèSES): RECOMMANDATIONS (CLASSEMENT GRADE ENTRE PARENTHèSES).
Collapse
|
29
|
Kirk E, Ankum P, Jakab A, Le Clef N, Ludwin A, Small R, Tellum T, Töyli M, Van den Bosch T, Jurkovic D. Terminology for describing normally sited and ectopic pregnancies on ultrasound: ESHRE recommendations for good practice. Hum Reprod Open 2020; 2020:hoaa055. [PMID: 33354626 PMCID: PMC7738750 DOI: 10.1093/hropen/hoaa055] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 10/09/2020] [Indexed: 11/24/2022] Open
Abstract
STUDY QUESTION What recommendations can be provided to improve terminology for normal and ectopic pregnancy description on ultrasound? SUMMARY ANSWER The present ESHRE document provides 17 consensus recommendations on how to describe normally sited and different types of ectopic pregnancies on ultrasound. WHAT IS KNOWN ALREADY Current diagnostic criteria stipulate that each type of ectopic pregnancy can be defined by clear anatomical landmarks which facilitates reaching a correct diagnosis. However, a clear definition of normally sited pregnancies and a comprehensive classification of ectopic pregnancies are still lacking. STUDY DESIGN SIZE DURATION A working group of members of the ESHRE Special Interest Group in Implantation and Early Pregnancy (SIG-IEP) and selected experts in ultrasound was formed in order to write recommendations on the classification of ectopic pregnancies. PARTICIPANTS/MATERIALS SETTING METHODS The working group included nine members of different nationalities with internationally recognised experience in ultrasound and diagnosis of ectopic pregnancies on ultrasound. This document is developed according to the manual for development of ESHRE recommendations for good practice. The recommendations were discussed until consensus by the working group, supported by a survey among the members of the ESHRE SIG-IEP. MAIN RESULTS AND THE ROLE OF CHANCE A clear definition of normally sited pregnancy on ultrasound scan is important to avoid misdiagnosis of uterine ectopic pregnancies. A comprehensive classification of ectopic pregnancy must include definitions and descriptions of each type of ectopic pregnancy. Only a classification which provides descriptions and diagnostic criteria for all possible locations of ectopic pregnancy would be fit for use in routine clinical practice. The working group formulated 17 recommendations on the diagnosis of the different types of ectopic pregnancies on ultrasound. In addition, for each of the types of ectopic pregnancy, a schematic representation and examples on 2D and 3D ultrasound are provided. LIMITATIONS REASONS FOR CAUTION Owing to the limited evidence available, recommendations are mostly based on clinical and technical expertise. WIDER IMPLICATIONS OF THE FINDINGS This document is expected to have a significant impact on clinical practice in ultrasound for early pregnancy. The development of this terminology will help to reduce the risk of misdiagnosis and inappropriate treatment. STUDY FUNDING/COMPETING INTERESTS The meetings of the working group were funded by ESHRE. T.T. declares speakers' fees from GE Healthcare. The other authors declare that they have no conflict of interest. TRIAL REGISTRATION NUMBER N/A. DISCLAIMER This Good Practice Recommendations (GPR) document represents the views of ESHRE, which are the result of consensus between the relevant ESHRE stakeholders and where relevant based on the scientific evidence available at the time of preparation. ESHRE's GPRs should be used for informational and educational purposes. They should not be interpreted as setting a standard of care or be deemed inclusive of all proper methods of care nor exclusive of other methods of care reasonably directed to obtaining the same results. They do not replace the need for application of clinical judgement to each individual presentation, nor variations based on locality and facility type. Furthermore, ESHRE's GPRs do not constitute or imply the endorsement, recommendation or favouring of any of the included technologies by ESHRE.
Collapse
Affiliation(s)
| | - Emma Kirk
- Early Pregnancy and Emergency Gynaecology Unit, Royal Free Hospital London, London, UK
| | - Pim Ankum
- Amsterdam Medical Centre, Amsterdam, the Netherlands
| | - Attila Jakab
- Department of Obstetrics and Gynecology, University of Debrecen, Debrecen, Hungary
| | | | - Artur Ludwin
- Department of Gynecology and Oncology, Jagiellonian University Medical College, Krakow, Poland
| | - Rachel Small
- Heart of England NHS Foundation Trust, Birmingham, UK
| | - Tina Tellum
- Department of Gynecology, Oslo University Hospital, Ullevål, Oslo, Norway
| | | | - Thierry Van den Bosch
- Department of Obstetrics and Gynaecology, University Hospital Leuven, Belgium
- Laboratory for Tumor Immunology and Immunotherapy, Leuven, KU, Belgium
| | - Davor Jurkovic
- Department of OB/GYN, University College Hospital, London, UK
| |
Collapse
|
30
|
Jones DD, Kummer T, Schoen JC. Ruptured Ectopic Pregnancy with an Intrauterine Device: Case Report and Sonographic Considerations. Clin Pract Cases Emerg Med 2020; 4:559-563. [PMID: 33217272 PMCID: PMC7676810 DOI: 10.5811/cpcem.2020.7.48258] [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: 05/17/2020] [Revised: 07/17/2020] [Accepted: 07/24/2020] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Ectopic pregnancy carries a high morbidity and mortality; patients are at risk for rupture and life-threatening hemorrhage. CASE REPORT We present a rare case of ruptured abdominal ectopic pregnancy in a patient with a well-positioned intrauterine device (IUD) and discuss the diagnostic utility that transabdominal point-of-care ultrasound (POCUS) can have when performed at the bedside. CONCLUSION While pregnancy with an IUD in place is rare, when it is encountered the emergency provider should maintain a high degree of suspicion for extrauterine pregnancy and perform prompt evaluation for hemorrhagic shock using diagnostic POCUS.
Collapse
Affiliation(s)
- Derick D. Jones
- Mayo Clinic, Department of Emergency Medicine, Rochester, Minnesota
- Mayo Clinic Health System Albert Lea and Austin, Department of Emergency Medicine, Austin, Minnesota
| | - Tobias Kummer
- Mayo Clinic, Department of Emergency Medicine, Rochester, Minnesota
| | - Jessica C. Schoen
- Mayo Clinic, Department of Emergency Medicine, Rochester, Minnesota
- Mayo Clinic Health System Albert Lea and Austin, Department of Emergency Medicine, Austin, Minnesota
| |
Collapse
|
31
|
Splenic pregnancy treated with transcatheter embolization and methotrexate. Arch Gynecol Obstet 2020; 303:55-59. [PMID: 32926206 DOI: 10.1007/s00404-020-05778-x] [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: 04/09/2020] [Accepted: 08/28/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Primary splenic pregnancy is a rare entity, usually treated with splenectomy. CASE PRESENTATION AND REVIEW OF THE LITERATURE We report the first case of conservative management of splenic pregnancy with selective embolization and intramuscular methotrexate administration. Postoperative treatment was uneventful. We have further systematically reviewed the literature upon the treatment options in case of splenic pregnancy. It has been evident that most cases were treated with spleenectomy, especially in case of active hemorrhage. Spleen preservation is rarely achieved, only in cases of hemodynamically stable, uncomplicated patients. CONCLUSION Splenic selective embolization could be a treatment option in case of uncomplicated splenic pregnancy with the benefit of splenic preservation.
Collapse
|
32
|
Hajji A, Toumi D, Laakom O, Cherif O, Faleh R. Early primary abdominal pregnancy: Diagnosis and management. A case report. Int J Surg Case Rep 2020; 73:303-306. [PMID: 32731177 PMCID: PMC7393397 DOI: 10.1016/j.ijscr.2020.07.048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 07/13/2020] [Accepted: 07/14/2020] [Indexed: 11/16/2022] Open
Abstract
The clinical presentaion of early abdominal pregnancy is similar to that of tubal ectopic pregnancy in the majority of cases. Surgical laparoscopy must be the first choice in management of early abdominal pregnancy. Medical treatment should be reserved when a surgical intervention is deemed to be potentially very hemorrhagic.
Introduction Abdominal pregnancy is a rare type of ectopic pregnancies associated with a high mortality rate. Symptoms are not specific and usually resemble the other types of ectopic pregnancies. Medical management is used in cases where a potentially lethal hemorrhage can be anticipated. Nowadays, laparoscopic surgery has become the most common choice especially in cases diagnosed during the first trimester. Presentation of case A 35-year-old woman consulted for a pelvic pain and menstruation delay. She had a stable hemodynamic status and hypogastric tenderness during deep abdominal palpation. The βHCG rate was at 16041 IU/l. Pelvic ultrasonography revealed a gestational sac next to the right adnexa of 1.2 cm. Laparoscopic exploration was performed finding normal fallopian tubes and ovaries with a 2 cm mass on the vesical peritoneum. Resection of ectopic pregnancy was successfully performed and patient was discharged the next day with no postoperative complications. Discussion To date, there is no therapeutic protocol that has been established and there are no predictive criteria of success concerning medical management for ectopic pregnancy. Surgery is the most common choice in the therapeutic management of ectopic abdominal pregnancy. Laparotomy was preferred to the laparoscopic surgery because of the high risk of perioperative hemorrhage which can be uncontrollable from the implantation site. Nowadays, laparoscopic surgery should be the first measure if the abdominal pregnancy is diagnosed at an early stage (< 12 weeks) or if the implantation site allows a non-hemorrhagic surgical excision. Conclusion Laparoscopic management of abdominal pregnancies is an encouraging choice to laparotomy.
Collapse
Affiliation(s)
- Ahmed Hajji
- Department of Gynecology, Monastir Maternity Center, Monastir, Tunisia.
| | - Dhekra Toumi
- Department of Gynecology, Monastir Maternity Center, Monastir, Tunisia
| | - Ons Laakom
- Department of Gynecology, Monastir Maternity Center, Monastir, Tunisia
| | - On Cherif
- Department of Gynecology, Monastir Maternity Center, Monastir, Tunisia
| | - Raja Faleh
- Department of Gynecology, Monastir Maternity Center, Monastir, Tunisia
| |
Collapse
|
33
|
Volante SN, Urquhart H, Math V, Von Papen M. Lessons learnt from a rare case of splenic ectopic pregnancy. ANZ J Surg 2020; 90:E225-E227. [PMID: 32678517 DOI: 10.1111/ans.16021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 05/14/2020] [Accepted: 05/15/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Sonia N Volante
- Obstetrics and Gynaecology, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Hamish Urquhart
- Colorectal Surgery, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Vanitha Math
- Obstetrics and Gynaecology, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Michael Von Papen
- Colorectal Surgery, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| |
Collapse
|
34
|
Wong JQE, Lim YH. Early Abdominal Ectopic Pregnancy Masquerading as a Missed Miscarriage. J Med Cases 2020; 11:169-173. [PMID: 34434391 PMCID: PMC8383645 DOI: 10.14740/jmc3484] [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: 04/30/2020] [Accepted: 05/07/2020] [Indexed: 11/30/2022] Open
Abstract
A 43-year-old lady, gravida 2 para 0, presented to our emergency department with complaints of vaginal bleeding and lower abdominal pain. Her urine pregnancy test was positive. She was unable to recall her last menstrual period. A trans-vaginal ultrasound revealed a pregnancy with a crown rump length of 47 mm corresponding to 11.4 weeks with no fetal heartbeat detected. She was diagnosed with a missed miscarriage and was sent for a second confirmatory scan. The repeat scan was concordant with the initial scan and she was counseled for an evacuation of uterus. Her serum beta human chorionic gonadotropin level was 45,195 IU/L and her hemoglobin level was 6.5 g/dL. She underwent an evacuation of uterus as planned, but the Hegar dilator was only able to be advanced to a cavity length of 6 cm with minimal products of conception obtained. A bedside ultrasound was performed and it showed that the Hegar dilator was in the uterine cavity but not in continuity with the gestational sac and fetus. The diagnosis of an ectopic pregnancy was made and the surgery was converted to a diagnostic laparoscopy. On entry into the abdominal cavity, there was frank hemoperitoneum with adhesions limiting access to the pelvis, therefore decision was made to convert to laparotomy. The findings at laparotomy revealed a large inflamed left tubo-ovarian complex with tubal rupture and expulsion of the entire fetus and placenta into the Pouch of Douglas (POD). The diagnosis of a secondary implantation of the ectopic pregnancy in the POD after tubal rupture was confirmed and we performed adhesiolysis and left salpingectomy. The patient recovered uneventfully and the final histology showed products of conception within the lumen of the left fallopian tube in keeping with ruptured tubal ectopic pregnancy.
Collapse
Affiliation(s)
- Joy Qing En Wong
- Division of Obstetrics and Gynaecology, KK Women's and Children's Hospital, Singhealth, Singapore
| | - Yu Hui Lim
- Division of Obstetrics and Gynaecology, KK Women's and Children's Hospital, Singhealth, Singapore
| |
Collapse
|
35
|
Helvacioglu C, Trabulus DC, Yardimci EAS, Turan H. Ruptured primary sigmoidal pregnancy; a case report. JOURNAL OF CLINICAL AND INVESTIGATIVE SURGERY 2020. [DOI: 10.25083/2559.5555/5.1/56.58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
|
36
|
Zhang N, Yang L, Wang Y, Li X, Zhang C, Xu J. Primary hepatic ectopic pregnancy in a patient with polycystic ovary syndrome: A case report. Medicine (Baltimore) 2020; 99:e19649. [PMID: 32221090 PMCID: PMC7220081 DOI: 10.1097/md.0000000000019649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Hepatic ectopic pregnancy is an extremely rare ectopic pregnancy. This study aimed to report a case of primary hepatic pregnancy in a patient with polycystic syndrome. PATIENT CONCERNS A 30-year-old woman presented with vaginal bleeding after 63 days of amenorrhea. DIAGNOSIS The patient was initially diagnosed with liver ectopic pregnancy using abdominal ultrasound and abdominal computed tomography (CT). INTERVENTIONS The patient underwent laparoscopic exploration to reconfirm the gestational sac in the liver and abdominal surgery to remove liver gestation. The postoperative review of abdominal CT and the level of serum human chorionic gonadotropin (hCG) was performed. OUTCOMES The postoperative pathological examination revealed a fluffy tissue in the liver tissue and a blood clot. The patient's vital signs were normal, and she was advised regular follow-up after discharge from the hospital. One month later, the serum hCG level reduced to 0.32 mIU/mL (reference range 0-5 mIU/mL). LESSONS If the level of beta-human chorionic gonadotropin (β-HCG) is higher than normal in women of childbearing age and no gestational sac is found in the uterine cavity, the location of pregnancy and gestational sac should be positively confirmed. Also, the possibility of ectopic pregnancy in the abdominal cavity should be considered, and the relevant imaging and biochemical examinations should be improved to avoid delay in diagnosis and treatment.
Collapse
Affiliation(s)
- Ning Zhang
- School of Clinical Medicine, Jining Medical University
| | | | | | - Xiaoyu Li
- Department of Otolaryngology-Head and Neck Surgery, The Affiliated Hospital of Jining Medical University, Jining, Shandong Province, China
| | - Chao Zhang
- School of Clinical Medicine, Jining Medical University
| | | |
Collapse
|
37
|
Lo TK, So CH, Cheng LF. Percutaneous medical therapy to treat colonic ectopic pregnancy. Eur J Obstet Gynecol Reprod Biol 2020; 247:264. [PMID: 32089318 DOI: 10.1016/j.ejogrb.2020.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 01/25/2020] [Accepted: 02/11/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Tsz-Kin Lo
- Department of Obstetrics and Gynecology, Princess Margaret Hospital, HKSAR, China.
| | - Chun-Hong So
- Department of Obstetrics and Gynecology, Princess Margaret Hospital, HKSAR, China
| | - Lik-Fai Cheng
- Department of Radiology, Princess Margaret Hospital, HKSAR, China
| |
Collapse
|
38
|
Chen L, Liu J, Shu J, Zeng W, Zhao X. Successful laparoscopic management of diaphragmatic pregnancy:a rare case report and brief review of literature. BMC Pregnancy Childbirth 2019; 19:99. [PMID: 30922250 PMCID: PMC6438013 DOI: 10.1186/s12884-019-2248-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 03/18/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Abdominal ectopic pregnancies are rare category of ectopic pregnancies.We describe a ectopic pregnancy implanted on the surface of diaphragm and highlight the difficult clinical course of an abdominal ectopic pregnancy managed with strategic procedural intervention. CASE PRESENTATION A 33-year-old Chinese woman with abdominal pain was diagnosed with ectopic pregnancy implanted in the liver according to CT and advised to transfer the patient to tertiary referral center. The patient had a significant increasing abdominal pain and intense reflex sensitivity in the right shoulder when she presented to our hospital. Laparoscopic surgery was decided immediately with the impression of ruptured abdominal pregnancy and hemorrhagic shock. It was found that ectopic pregnancy was implanted on the diaphragmatic surface.The pregnant tissue was completely resected from the diaphragm and bipolar electrocoagulation was used to control bleeding. The patient was stable and discharged 3 days after surgery in a good condition. CONCLUSION CT or MRI should be considered as an alternative to TVS in the management of ectopic pregnancy patients with unusual presentations. A thorough observation of the entire pelvis and upper abdomen during laparoscopic exploration is crucial for diagnosis.
Collapse
Affiliation(s)
- Lifeng Chen
- Departments of Gynecology, Zhejiang Provincial People’s Hospital, People’s Hospital Of Hangzhou Medical College, No. 158 Shangtang Rd, Hangzhou, 310014 People’s Republic of China
| | - Jinwei Liu
- Departments of Gynecology, Zhejiang Provincial People’s Hospital, People’s Hospital Of Hangzhou Medical College, No. 158 Shangtang Rd, Hangzhou, 310014 People’s Republic of China
| | - Jing Shu
- Departments of Gynecology, Zhejiang Provincial People’s Hospital, People’s Hospital Of Hangzhou Medical College, No. 158 Shangtang Rd, Hangzhou, 310014 People’s Republic of China
| | - Wenjie Zeng
- Departments of Gynecology, Zhejiang Provincial People’s Hospital, People’s Hospital Of Hangzhou Medical College, No. 158 Shangtang Rd, Hangzhou, 310014 People’s Republic of China
| | - Xiaofeng Zhao
- Departments of Gynecology, Zhejiang Provincial People’s Hospital, People’s Hospital Of Hangzhou Medical College, No. 158 Shangtang Rd, Hangzhou, 310014 People’s Republic of China
| |
Collapse
|
39
|
Magnetic resonance imaging of common, uncommon, and rare implantation sites in ectopic pregnancy. Abdom Radiol (NY) 2018; 43:3425-3435. [PMID: 29713741 DOI: 10.1007/s00261-018-1604-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To review the MRI appearances of tubal and non-tubal implantation sites in ectopic pregnancy. CONCLUSION Transvaginal ultrasound is the primary imaging modality in ectopic pregnancy and MRI is used as a problem-solving tool in selected indications as detailed in the article. MRI features of tubal, interstitial, cervical, cesarean scar, cornual, ovarian, abdominal, and heterotopic pregnancies are provided to familiarize the radiologists with their appearances thereby assisting them in making early and accurate diagnosis.
Collapse
|
40
|
Sib SR, Ouédraogo I, Sanogo M, Kiemtoré S, Sawadogo YA, Zamané H, Bonané B. A full term abdominal pregnancy with an isthmic tubal implantation of the placenta. BMC Pregnancy Childbirth 2018; 18:448. [PMID: 30453918 PMCID: PMC6245774 DOI: 10.1186/s12884-018-2071-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Accepted: 10/23/2018] [Indexed: 01/07/2023] Open
Abstract
Background Abdominal pregnancy is defined as the partial or total insertion of the embryo into the abdominal cavity. It is rare, and can evolve towards the full term if it is not recognized in the early pregnancy. It carries a high risk of maternal-fetal morbidity and mortality. Case presentation We report a case of a 22 year-old gravida IV, para II with an asymptomatic and undiagnosed abdominal pregnancy presumed full term, in a context of health centers under-equipment. She had attended 5 routine antenatal care, but had not performed any ultrasound scan. She had been transferred from a medical center to the Hospital of Ouahigouya (Burkina Faso) for bowel sub-obstruction and intrauterine fetal death, with failure of labor induction. On admission, the hypothesis of uterine rupture or abdominal pregnancy with antepartum fetal demise was considered. A laparotomy was then performed, where an abdominal pregnancy was discovered, and a dead term baby weighing 3300 g delivered. The placenta which was implanted into the ruptured isthmus of the left fallopian tube was removed by salpingectomy. Postoperative follow-up was uneventful. Conclusion This case report exposes the necessity for the practitioner to think about the possibility of abdominal pregnancy in his clinical and sonographic practice, irrespective of the gestational age, mainly in contexts where there is under-equipment of the health centers.
Collapse
Affiliation(s)
| | - Issa Ouédraogo
- Ouahigouya University Teaching Hospital, Ouahigouya, BP, 36, Burkina Faso
| | - Moussa Sanogo
- Ouahigouya University Teaching Hospital, Ouahigouya, BP, 36, Burkina Faso
| | - Sibraogo Kiemtoré
- Yalgado Ouédraogo University Teaching Hospital of Ouagadougou, 03 BP 7022, Ouagadougou, 03, Burkina Faso
| | - Yobi Alexis Sawadogo
- Yalgado Ouédraogo University Teaching Hospital of Ouagadougou, 03 BP 7022, Ouagadougou, 03, Burkina Faso
| | - Hyacinthe Zamané
- Yalgado Ouédraogo University Teaching Hospital of Ouagadougou, 03 BP 7022, Ouagadougou, 03, Burkina Faso
| | - Blandine Bonané
- Yalgado Ouédraogo University Teaching Hospital of Ouagadougou, 03 BP 7022, Ouagadougou, 03, Burkina Faso
| |
Collapse
|
41
|
Primary hepatic pregnancy: report of a case treated with laparoscopic approach and review of the literature. Fertil Steril 2018; 110:925-931.e1. [DOI: 10.1016/j.fertnstert.2018.05.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 05/16/2018] [Accepted: 05/17/2018] [Indexed: 12/25/2022]
|
42
|
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
|
43
|
Osanyin GE, Yakubu C, Okunade KS, Oye-Adeniran BA. Advanced Abdominal Pregnancy with Favorable Fetomaternal Outcome in Lagos, Nigeria. J Gynecol Surg 2018. [DOI: 10.1089/gyn.2017.0098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Gbemisola Eniola Osanyin
- Department of Obstetrics & Gynaecology, College of Medicine, University of Lagos/Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
| | - Caleb Yakubu
- Department of Radiodiagnosis, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
| | - Kehinde S. Okunade
- Department of Obstetrics & Gynaecology, College of Medicine, University of Lagos/Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
| | - Boniface Adedeji Oye-Adeniran
- Department of Obstetrics & Gynaecology, College of Medicine, University of Lagos/Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
| |
Collapse
|
44
|
Trail CE, Watson A, Schofield AM. Case of hepatic flexure ectopic pregnancy medically managed with methotrexate. BMJ Case Rep 2018; 2018:bcr-2017-220480. [PMID: 29550756 PMCID: PMC5878386 DOI: 10.1136/bcr-2017-220480] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2018] [Indexed: 11/03/2022] Open
Abstract
Abdominal pregnancies represent 1.4% of extrauterine pregnancies. A literature search of six cases involving bowel ectopic pregnancies provided anecdotal treatment options. This case involves a woman admitted at 6 weeks gestation with right iliac fossa and shoulder tip pain. An ultrasound scan revealed an empty uterus with free fluid in both adnexa and a 31×21 mm heterogenous mass adjacent to the right ovary. At laparoscopy, an ectopic pregnancy was identified at the hepatic flexure. The patient received two doses of methotrexate and monitored until the beta human chorionic gonadotropin reduced. The decision to manage with methotrexate was balanced against reported cases of bowel perforation and the possibility that a section of bowel may need removal if the pregnancy showed signs of invasion. Maternal mortality rate with abdominal pregnancy is 20% due to the risk of massive haemorrhage from placental separation or invasion of bowel vasculature. Medical treatment here was successful and avoided extensive surgery.
Collapse
Affiliation(s)
| | - Andrew Watson
- Department of Obstetrics and Gynaecology, Tameside NHS Foundation Trust, Ashton-under-Lyne, UK
| | - Alice Martha Schofield
- Department of Obstetrics and Gynaecology, Tameside NHS Foundation Trust, Ashton-under-Lyne, UK
| |
Collapse
|
45
|
Dolinko AV, Vrees RA, Frishman GN. Non-tubal Ectopic Pregnancies: Overview and Treatment via Local Injection. J Minim Invasive Gynecol 2018; 25:287-296. [DOI: 10.1016/j.jmig.2017.07.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 07/10/2017] [Accepted: 07/13/2017] [Indexed: 12/11/2022]
|
46
|
Deng MX, Zou Y. Evaluating a magnetic resonance imaging of the third-trimester abdominal pregnancy: What the radiologist needs to know. Medicine (Baltimore) 2017; 96:e8986. [PMID: 29310411 PMCID: PMC5728812 DOI: 10.1097/md.0000000000008986] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION A 33-week abdominal pregnancy is an extremely rare type of ectopic pregnancy that is potentially life-threatening for the mother and fetus. Reports of using magnetic resonance imaging (MRI) in the third-trimester abdominal pregnancy are very few. PATIENT CONCERNS A 24-year-old woman (gravida 2, para 1, living 0) at 33 weeks' gestation presented to local hospital complaining of vaginal bleeding for 2 months and lower abdominal pain for 2 days. Then, the woman was transferred to our hospital for suspected abdominal pregnancy, which was confirmed at our hospital on ultrasonography and further evaluated in detail on MRI. DIAGNOSES The woman was diagnosed as having abdominal pregnancy. INTERVENTIONS The woman was managed surgically, the unviable fetus was removed, and the placenta was left in situ. Then, the woman was managed with fluids, blood transfusion, antibiotics, and systemic methotrexate after surgery. OUTCOMES At 42 days postoperatively, the affected woman was discharged in a good condition. CONCLUSIONS By using MRI, we can accurately diagnose an abdominal pregnancy. MRI provides more details than ultrasonography, and explains the possible mechanism of abdominal pregnancy. We advocate using MRI to help surgical planning and improve outcome in cases of abdominal pregnancy.
Collapse
|
47
|
Phillips CH, Wortman JR, Ginsburg ES, Sodickson AD, Doubilet PM, Khurana B. First-trimester emergencies: a radiologist's perspective. Emerg Radiol 2017; 25:61-72. [PMID: 28948411 DOI: 10.1007/s10140-017-1556-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 09/13/2017] [Indexed: 12/27/2022]
Abstract
The purpose of this article is to help the practitioner ensure early diagnosis and response to emergencies in the first trimester by reviewing anatomy of the developing embryo, highlighting the sonographic appearance of common first-trimester emergencies, and discussing key management pathways for treating emergent cases. First-trimester fetal development is a stepwise process that can be challenging to evaluate in the emergency department (ED) setting. This is due, in part, to the complex anatomy of early pregnancy, subtlety of the sonographic findings, and the fact that fewer than half of patients with ectopic pregnancy present with the classic clinical findings of a positive pregnancy test, vaginal bleeding, pelvic pain, and tender adnexa. Ultrasound (US) has been the primary approach to diagnostic imaging of first-trimester emergencies, with magnetic resonance imaging (MRI) and computed tomography (CT) playing a supportive role in a small minority of cases. Familiarity with the sonographic findings diagnostic of and suspicious for early pregnancy failure, ectopic pregnancy, retained products of conception, gestational trophoblastic disease, failed intrauterine devices, and complications associated with assisted reproductive technology (ART) is critical for any emergency radiologist. Evaluation of first-trimester emergencies is challenging, and knowledge of key imaging findings and familiarity with management pathways are needed to ensure early diagnosis and response.
Collapse
Affiliation(s)
- Catherine H Phillips
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
| | - Jeremy R Wortman
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Elizabeth S Ginsburg
- Department of Infertility and Reproductive Surgery, Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Aaron D Sodickson
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Peter M Doubilet
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Bharti Khurana
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| |
Collapse
|
48
|
Tucker K, Bhardwaj NR, Clark E, Espey E. Delayed diagnosis and management of second trimester abdominal pregnancy. BMJ Case Rep 2017; 2017:bcr-2017-221433. [PMID: 28864560 PMCID: PMC5589052 DOI: 10.1136/bcr-2017-221433] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Second trimester abdominal ectopic pregnancies are rare and life threatening. Early diagnosis and treatment are paramount in reducing maternal morbidity and mortality. We describe an unusually late diagnosis of abdominal pregnancy despite multiple ultrasounds beginning in early pregnancy. A 28-year-old G2P1001 sought pregnancy termination at 22 weeks’ gestation after fetal anomalies were noted on an 18-week ultrasound during evaluation for elevated maternal serum alfa-fetoprotein. Due to abortion restrictions in her home state, she travelled over 500 miles for abortion care. During dilation and evacuation, suspected uterine perforation led to the finding of a previously undiagnosed abdominal pregnancy. At laparotomy, she underwent left salpingo-oophorectomy and removal of abdominal pregnancy and placenta. A multidisciplinary team approach was paramount in optimising the patient’s outcome. Abortion restrictions requiring travel away from the patient’s home community interrupted her continuity of care and created additional hardships, complicating management of an unexpected, rare and life-threatening condition.
Collapse
Affiliation(s)
- Katherine Tucker
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, The University of North Carolina, Chapel Hill, North Carolina, USA
| | - Neha Rani Bhardwaj
- Department of Obstetrics and Gynecology, Mount Sinai St. Luke's and Mount Sinai West, New York, USA.,Department of Obstetrics and Gynecology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Elizabeth Clark
- Department of Obstetrics and Gynecology, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Eve Espey
- Department of Obstetrics and Gynecology, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| |
Collapse
|
49
|
Huang YT, Liang IT, Wang CJ. Tubo-Omental Ectopic Pregnancy. J Minim Invasive Gynecol 2017; 25:569-570. [PMID: 28826954 DOI: 10.1016/j.jmig.2017.08.648] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Accepted: 08/14/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Yi-Ting Huang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
| | - I-Ting Liang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
| | - Chin-Jung Wang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan.
| |
Collapse
|
50
|
Successful laparoscopic management of uterine serosal pregnancy. Obstet Gynecol Sci 2017; 60:391-395. [PMID: 28791274 PMCID: PMC5547090 DOI: 10.5468/ogs.2017.60.4.391] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 02/23/2017] [Accepted: 02/24/2017] [Indexed: 11/08/2022] Open
Abstract
Uterine serosal pregnancy is an extremely rare form of ectopic pregnancy. This is a report of a 35-year-old primigravida woman who was diagnosed with uterine serosal pregnancy via laparoscopic intervention. A 35-year-old woman (gravida 1, para 0) was referred from a local clinic for a ruptured left tubal pregnancy at amenorrhea 5+0 weeks with elevated serum beta human chorionic gonadotropin (16,618 mIU/mL). A pregnancy on the left posterior wall of the uterine serosa was diagnosed during the operation and successfully treated with laparoscopic surgery as a conservative management strategy to enable fertility preservation. With the advantages of ultrasonography and laparoscopy, an early diagnosis of a primary abdominal pregnancy located on the left posterior wall of the uterine serosa was made, prior to the occurrence of severe intra-abdominal massive hemorrhage, which was then treated laparoscopically as a conservative management strategy enabling the preservation of fertility.
Collapse
|