Interstitial twin pregnancy: A unique case presentation

Early recognition and timely treatment of an interstitial pregnancy is imperative to avoid the high morbidity and mortality of this type of ectopic pregnancy. We report a case of twin interstitial pregnancy that was initially missed on initial sonogram and was subsequently recognized at our institution by transvaginal sonography. The patient underwent open laparoscopic surgery with cornual wedge resection but suffered infundibulopelvic ligament hemorrhage and subsequently required ipsilateral salpingo‐oophorectomy. She did well and was discharged home a day later. © 2014 Wiley Periodicals, Inc. J Clin Ultrasound 43 :447–450, 2015     

A case of intrauterine molar pregnancy with coexistent ectopic pregnancy

We describe a woman who presented to the Emergency Department (ED) with vaginal bleeding and abdominal pain. She was initially diagnosed by the emergency physician with a molar pregnancy by transvaginal ultrasound, which was confirmed and treated by the consulting obstetrical service with a dilatation and curettage the following day. The patient was discharged home later that same day and subsequently returned to the ED after several hours complaining of an acute worsening of her abdominal pain with associated fatigue and lightheadedness. Transabdominal ultrasound performed by the emergency physician demonstrated intra-abdominal free fluid, and the obstetrical service was immediately contacted. Subsequent operative management identified a separate ruptured ectopic pregnancy in the fallopian tube that was confirmed by pathologic analysis after laparoscopic removal.     

Hypotension after medical termination of pregnancy: think outside of the uterus

Background

Under usual circumstances, an ectopic pregnancy would not be generally considered in the initial differential diagnosis of shock after voluntary termination of pregnancy.

Objective

To present a rare case of a young woman with shock after voluntary termination of pregnancy due to undiagnosed ectopic pregnancy with concealed hemorrhage.

Case Report

A 37-year-old woman presented to the Emergency Department (ED) 3 days after termination of pregnancy with clinical features of shock. The patient had some evidence of infection and was initially managed as a case of septic shock secondary to possible complication of recent termination of pregnancy. Subsequent work-up led to suspicion of internal bleeding, and ruptured ectopic pregnancy was confirmed and managed successfully.

Conclusion

Ruptured ectopic pregnancy can present with a wide range of symptoms and under variable circumstances. Recognition of subtle signs of hemorrhage and consideration of the diagnosis of ruptured pregnancy in the ED will lead to early diagnosis and appropriate management.     

B超诊断异位妊娠（附201例分析）

目的 通过对异位妊娠声像图特征的分析,以提高其诊断及鉴别诊断的水平。方法 回顾分析２０１例异位妊娠的超声特征,对术前Ｂ超诊断与术后病理诊断进行对比分析。结果 Ｂ超诊断符合率为９０．５％（１８２／２０１）。主要表现为盆腔内不同回声的包块,伴子宫增大或腹腔内游离游体。结论 Ｂ超是简便、无创伤诊断异位妊娠最理想的检查方法,应做首选。     

Cervical ectopic pregnancy case report: findings for the bedside sonographer

The evaluation of first trimester vaginal bleeding or pelvic pain is an important task for the emergency physician. The early identification of an ectopic pregnancy can help prevent significant morbidity and mortality for patients seeking emergency care. The increased use of bedside sonography by the emergency physician in the evaluation of these patients requires an increased knowledge about the variants and their appearance on sonogram. We present the case of a patient found to have a cervical ectopic pregnancy. A discussion of the diagnosis and management, as well as the findings on bedside sonogram are presented.     

经阴道超声诊断早期异位妊娠的临床价值

目的探讨经阴道超声诊断早期异位妊娠的临床效果及应用价值。方法回顾性分析85例早期异位妊娠患者的一般资料,所有患者均经腹部与经阴道超声检查,主要观察患者的子宫及双附件区,并将检查结果与临床病理对照,比较两种检查方法的诊断符合率。结果 85例早期异位妊娠患者经住院手术及病理检查结果证实,术前经阴道超声检查诊断符合率明显高于术前经腹部超声检查,差异具有统计学意义(χ2=43.92,P<0.01)。结论经阴道超声诊断早期异位妊娠效果明显优于经腹部超声,诊断符合率较好,能够更好地为患者提供治疗方案,改善患者的病情及预后,提高患者的生活质量,具有较高的临床应用价值,为诊断早期异位妊娠的首选方法。     

A case of retroperitoneal para‐aortic ectopic pregnancy detected by sonography

Retroperitoneal ectopic pregnancy is extremely rare. We present a case of a retroperitoneal ectopic pregnancy with a gestational sac located to the left of the abdominal aorta and of the left renal vessels at 9 weeks of gestation. Careful transabdominal sonographic examination is suggested when an ectopic pregnancy is suspected and the examination of the pelvis is negative.     

输卵管妊娠腹腔镜术后持续性异位妊娠的预防

目的 探讨输卵管妊娠腹腔镜术后持续性异位妊娠（PEP）发生的可能病因及预防措施。方法 回顾性分析该院2001年10月～2004年6月异位妊娠腹腔镜手术135例。结果发生PEP2例，发生率为1．48％，均为腹腔镜保守性手术后。结论 输卵管妊娠腹腔镜保守性手术后PEP发生可能性大，仔细、彻底清除妊娠组织，术中常规病灶两端输卵管及系膜注入氨甲喋呤（MTX），正确选择保守性手术病例，可以有效避免输卵管妊娠保守性手术后PEP的发生。术后严密监测β-HCG下降情况，及时静脉滴注MTX，可降低PEP的危险。     

少见部位异位妊娠超声漏误诊分析的临床价值

目的 分析少见部位异位妊娠病例的超声漏误诊原因,探讨其临床应用价值。 方法 回顾性分析2015年1月-2017年8月我院经手术病理证实的325例少见部位异位妊娠超声图像特征,漏误诊原因。结果 子宫瘢痕处妊娠占37.5%;输卵管间质部妊娠占37.2%,其中误诊4例,漏诊1例;子宫角妊娠占11.7%,误诊5例,漏诊1例;卵巢妊娠占7.4%;宫颈妊娠占1.8%,误诊2例;盆腔妊娠占1.5%,漏诊1例;残角子宫妊娠、腹腔妊娠及肌壁间妊娠各占0.9%,肌壁间妊娠误诊1例。 结论 充分掌握超声声像图特征、漏误诊原因,有望提高少见部位异位妊娠的检出率、降低漏误诊率。     

输卵管间质部妊娠42例分析

目的 :分析 42例输卵管间质部妊娠的临床特征。方法 :采用回顾性分析方法对输卵管间质部妊娠的发生因素及临床特征进行分析。结果 :本组病例输卵管间质部妊娠占异位妊娠总数的 8.2 3 %。临床特征为孕 8周前易误诊为宫内早孕 ,破裂前不易确诊。结论 :输卵管间质部妊娠一旦破裂 ,病情凶险 ,无论破裂与否 ,确诊后均应手术治疗。     

腹腔镜手术在异位妊娠中的应用

目的 探讨腹腔镜下异位妊娠手术的疗效及应用前景。方法 对145例开腹行异位妊娠（输卵管妊娠142例，卵巢妊娠2例，残角子宫妊娠1例）手术的患者及168例腹腔镜手术的异位妊娠患者（均为输卵管妊娠）资料进行回顾性分析。结果 两组患者在异位妊娠类型的构成比、年龄、体重、孕产次等方面差异无显著性；在术中失血量、术后恢复、术后止痛药应用、住院时间及术后输卵管复通等方面差异有显著性。结论 腹腔镜下异位妊娠手术完全可安全有效地用于临床，且具有创伤小、恢复快的特点。     

术后重复异位妊娠79例病因分析及应对措施

目的探讨重复异位妊娠发生的病因及应对措施。方法回顾性分析79例术后重复性异位妊娠患者的资料。结果重复异位妊娠多发生于人工流产、药物流产后,也常发生于无妊娠史者;两次异位妊娠的间隔时间多为1-2年;病变部位均发生在输卵管,手术切除输卵管的患者的发生部位多在对侧和原患侧,两者间差异有显著性（P〈0．01）。结论重复异位妊娠发生的危险因素应对措施为预防反复流产,采取有效避孕措施,积极治疗盆腔炎性疾病,选择正确的手术方式。     

电视腹腔镜下手术治疗输卵管间质部妊娠18例临床分析

目的探讨电视腹腔镜手术在输卵管间质部妊娠治疗中的可行性，寻求一种输卵管间质部妊娠治疗的新型手术方法。方法应用Storz公司生产的电视腹腔镜系统对该院近10年间的18例输卵管间质部妊娠患者进行电视腹腔镜下手术治疗。结果18例患者中17例均在电视腹腔镜下顺利完成手术，无手术并发症，手术成功率99．4％，其中1例患者妊娠包块过大，术中因创面活动性出血，镜下止血失败而中转开腹行惠侧宫角切除术。结论腹腔镜下治疗输卵管间质部妊娠手术，避免了过去输卵管间质部妊娠必须进行的开腹手术，为患者提供了新的选择，腹腔镜手术不失为输卵管间质部妊娠的首选治疗方法。     

Three‐Dimensional Sonography in the Differential Diagnosis of Interstitial,Angular, and Intrauterine Pregnancies in a Septate Uterus

Interstitial, angular, and cornual pregnancies and intrauterine pregnancies in an anomalous uterus are separate entities, and the impact of each condition on obstetric outcomes is completely different. However, there is considerable confusion in understanding and managing the natural course of each condition due to a lack of uniform terminology. The single most important factor for differentiating these types of pregnancies is to make an early diagnosis. The differences between interstitial, angular, and cornual pregnancies on 2‐dimensional (2D) sonography are subtle. Although magnetic resonance imaging can be used to differentiate these conditions, it is not preferred as the initial assessment tool because of its limited availability and cost‐effectiveness. Three‐dimensional (3D) sonography has the advantage of providing views of the uterus that cannot be obtained with conventional 2D sonography. We describe 3 cases of interstitial, angular, and intrauterine pregnancies in a septate uterus that were clearly differentiated by 3D sonography. We demonstrate the differences in diagnostic imaging findings and emphasize the importance of 3D sonography in differentiating these entities.     

输卵管妊娠腹腔镜手术后持续性异位妊娠的发生

目的探讨输卵管妊娠病人腹腔镜手术后持续性异位妊娠(DEP)发生的可能原因，并提出可行的预防措施。方法回顾性分析该院1999年1月～2002年12月间124例接受腹腔镜手术并经病理证实为输卵管妊娠的病例。结果5例腹腔镜手术中转开腹，2例发生PEP，发生率为1．7％(2／119)。结论虽然异位妊娠腹腔镜手术后。PEP的发生率较高，但通过术式的正确选择、操作技巧的改进，以及药物性预防和医生警惕性的提高是可以减少甚至避免其发生的，与此同时也减少了治疗费用并最大限度保障了生育功能。     

自体血回输在异位妊娠内出血中的运用（附17例分析）

目的 探讨自体血回输在异位妊娠内出血急诊手术中的运用价值.方法 2004年10月至2005年10月,采用京精-2000型自体血液回收机对17例异位妊娠内出血病人进行术中自体血回输.分别记录术中出血量和回收血量.结果 17例患者共回收自体血24053ml,回输血12290ml,所有患者均顺利恢复,无自体输血相关并发症.结论 异位妊娠内出血急诊手术中运用自体血液回输安全有效,可迅速获得大量新鲜红细胞,有效地维持循环,减少术中血液丢失,减少异体血输入量和降低输血后并发症,提高抢救成功率.     

Heterotopic pregnancy diagnosed by emergency ultrasound

We present a case of heterotopic pregnancy rapidly diagnosed by an emergency physician. To the best of our knowledge, this is the first report of an emergency physician using bedside ultrasound to diagnose an ectopic pregnancy present simultaneously with an intrauterine pregnancy. Other unique features of this case include the diagnosis being made on initial evaluation and the patient's lack of risk factors for heterotopic pregnancy. A review of the cases of heterotopic pregnancy reported in the emergency medicine literature, the rising prevalence of the disease, and factors that may facilitate in making the diagnosis are discussed as well.