Primary omental pregnancy

Omental pregnancy is a rare form of ectopic pregnancy, and can be seen primarily or secondary to a tubal pregnancy. A 25-year-old woman presented with abdominal distention with pain and anemia without vaginal bleeding. After a provisional diagnosis of ruptured ectopic pregnancy, laparotomy was performed. On surgical exploration, the bilateral tubes and ovaries were intact, however, an omental pregnancy was detected as the cause of hemoperitoneum. Partial omentectomy was performed. Although most cases are secondary, presented here is an additional case of primary omental pregnancy at 12 weeks according to Studdiford's criteria. Histological evidence of neovascularization into the supporting tissue confirmed our diagnosis. A primary omental pregnancy should always be considered as a possible explanation for severe hemoperitoneum in ectopic pregnancies presenting with acute abdomen, and with intact adnexes on surgical exploration.     

Successful laparoscopic treatment of an abdominal pregnancy in the broad ligament

Laparoscopic management of tubal ectopic pregnancy is the ideal form of treatment in most tertiary centres. Approximately 1% of ectopic pregnancies are abdominal pregnancies and these are usually managed by laparotomy. We present the first report of successful laparoscopic treatment of a 6.5 cm abdominal pregnancy located in the broad ligament of a 25-year-old woman.     

A case of seven recurrent ectopic pregnancies

If a woman with previous ectopic pregnancy ever gets pregnant again, the risk of a repeat ectopic pregnancy is said to be 4-fold. We present a rare case of 7 recurrent ectopic pregnancies in a 39-year-old Saudi woman, together with a literature review of the reproductive performance after recurrent ectopic pregnancy.     

Clinics in diagnostic imaging (106). Viable left tubal twin ectopic pregnancy

Live twin ectopic gestations are extremely rare. There are more than 100 reported twin tubal pregnancies but less than ten have foetal cardiac motions demonstrated in both embryos. We describe an additional patient with live twin ectopic gestation. A 32-year-old woman presented with increasing left-sided abdominal pains. She had a high beta-hCG level and a significant history of subfertility with previous surgical intervention. Transvaginal ultrasonography showed viable left tubal twin ectopic pregnancy. The diagnosis was confirmed at surgery. Factors that contribute to the risk of ectopic pregnancy, diagnosis and the management of this condition are described.     

特殊部位异位妊娠(附106例临床分析)

目的探讨特殊部位异位妊娠的临床特点、误诊原因及治疗方法,以降低误诊率。方法对我院2003-01~2007-04间106例特殊部位异位妊娠进行回顾性分析。结果特殊部位异位妊娠占同期输卵管妊娠的4.52%,误诊率63.21%。宫颈妊娠以无痛性反复性阴道流血为主要表现,宫角妊娠表现为子宫不对称性增大,腹腔妊娠早期为一过性下腹痛,卵巢妊娠因其早期表现和体征不明显,术前不易确诊,往往以急腹症而就诊。结论特殊部位异位妊娠既有其共性,又有其特殊性,早期诊断困难,易致急腹症、休克,我们应提高对该病的认识以避免误诊。     

Heterotopic pregnancy with spontaneous intrauterine conception: A rare clinical entity with diagnostic dilemma.

Twenty-one years old primigravida presented to emergency with amenorrhoea for 2 months and complaints of severe abdominal pain for few hours. The pain was associated with 2 episodes of fainting attacks in emergency during the period of observation. Viable intrauterine pregnancy of 8-9 weeks along with collection of fluid in the Pouch of Douglas was detected by ultrasound examination and on laparotomy ectopic pregnancy was confirmed with haemoperitoneum of 2 litres with 500gms of clots. Histopathology report confirmed the tubal ectopic pregnancy and postlaparotomy, transvaginal sonography confirmed the salvage of the intrauterine pregnancy. Despite massive haemoperitoneum, the pregnancy continued till 40+6 weeks with uneventful antenatal period. She underwent emergency caesarean section for meconium stained liquor with foetal distress and delivered of an alive healthy female of 2.5 kg with good Apgar score. Key words: Ectopic, Heterotopic pregnancy.     

35例特殊部位异位妊娠临床分析

目的：探讨特殊部位异位妊娠的临床特征及误诊原因,降低误诊率。方法;对35例特殊部位异位妊娠进行回顾性分析。结果：其发生率占同期异位妊娠的9.04%,误诊率80％。输卵管间质部妊娠易引起致命性腹腔出血、宫角妊娠子宫不对称性增大,腹腔妊娠孕早期一过性下腹痛,卵巢妊娠术前不易确诊,宫颈妊娠以无痛性阴道反复流血为主要临床表现。结论：提高对特殊部位异位妊娠的认识、详询病史,重视临床表现,结合β-HCG、B超及腹腔镜等综合分析、避免误诊。     

Incidence, trends, and risks of ectopic pregnancy in a population of women

In a 20-year longitudinal study on ectopic pregnancy in a defined population of women aged 15-39 years the rate of ectopic pregnancy per 1000 diagnosed conceptions increased from 5.8 during 1960-4 to 11.1 during 1975-9. The mean annual incidence of ectopic pregnancy per 1000 women increased from 0.6 to 1.2 during the same period. The numbers of ectopic pregnancies per 1000 diagnosed conceptions increased with increasing age of the women and were 4.1, in the teenage group 6.9, in women aged 20-29 years, and 12.9 in women aged 30-39. Among 20- to 29-year-old sexually active women at risk of pregnancy who had never had acute salpingitis the rates of ectopic pregnancy per 100 woman-years were the same in those who did not use contraceptives as in those using non-medicated or copper-medicated intrauterine contraceptive devices (IUCDs; 0.3/100 woman years). The risk of an ectopic pregnancy increased sevenfold after acute salpingitis. These findings confirm the increased risk of ectopic pregnancy after salpingitis and suggest that the increase in the incidence of ectopic pregnancy in Lund from 1960 to 1979 was partly accounted for by the use of IUCDs.     

体外受精助孕并发异位妊娠92例分析

目的：探讨体外受精助孕中异位妊娠的发生率与影响因素。方法：对接受体外受精（invitro fertilization and embryo transfer，IVF）、单精子卵胞浆内注射（intracytoplasmic sperm injection，ICSI）、冻融胚胎移植（frozen-thawing embryo transfer，FET）助孕后发生异位妊娠病例的助孕指征、助孕方式、异位妊娠类型等进行回顾总结。结果：6007人次接受助孕治疗者，临床妊娠2322人次（38．7％），94人次为异位妊娠，发生率4．05％。其中输卵管妊娠92人次，发生率3．96％，占总异位妊娠病例的97．87％（92／94），其他部位2人次（腹腔妊娠和子宫角妊娠各1人次），发生率为0．86‰，占异位妊娠比例为2．32％。宫内宫外合并妊娠20人次，发生率为0．86％（20／2322），占异位妊娠病例的21．28％（20／94）。86例患者助孕指征为输卵管因素和／或盆腔粘连，占91．49％，其中24人有异位妊娠史（25．53％）。3种助孕方式（IVF-ET，ICSI和FET）比较，其总妊娠率差异无统计学意义（P〉0．05）。3组间异位妊娠发生率比较。IVF-ET组显著高于ICSI和FET组（均P〈0．05）；FET组亦显著高于ICSI组（P〈0．05）。结论：体外受精助孕异位妊娠发生率较自然受孕人群高，有输卵管病变史是发生异位妊娠的主要原因。     

Clinics in diagnostic imaging (98). Heterotopic pregnancy with an intrauterine blighted ovum and a live tubal ectopic pregnancy

A 26-year-old woman who was six weeks amenorrhoeic presented with vaginal spotting and mild abdominal pain. She had been coming to the 24 hours women's clinic at two-day intervals for the past week with the same symptoms. Ultrasonography two days ago showed one intrauterine gestational sac (IUGS) with a yolk sac within. Her pregnancy was clomiphene-related. Repeat transvaginal ultrasonography during this admission showed an IUGS, together with a left live tubal ectopic pregnancy. Heterotopic pregnancies used to be a rare entity. Now, given the increasing rise in assisted reproduction techniques, there should be a high index of suspicion for heterotopic pregnancy as this would impact upon clinical management. The ultrasonographical features of heterotopic pregnancy and its differential diagnoses are discussed.     

Ectopic pregnancy in previous Caesarean section scar

We report two cases of Caesarean scar pregnancies that were managed surgically. The first case was a 33-year-old woman who presented at 21 weeks of gestation with lower abdominal pain. An exploratory laparotomy was performed as she was hypotensive and had a drastic drop in haemoglobin level. Intraoperatively, a ruptured scar ectopic pregnancy with placenta percreta was found. A hysterectomy was performed in view of uncontrolled haemorrhage. The second case was a 30-year-old woman who presented with irregular per vaginal spotting without abdominal pain. Ultrasonography revealed a gestational sac at a previous Caesarean scar, with interval increase in size and development of a yolk sac. On laparoscopy, the diagnosis of scar pregnancy was confirmed, and the gestational sac and surrounding myometrium were excised. Our case report shows that early diagnosis of scar pregnancy is important, as timely intervention can prevent life-threatening complications and preserve fertility.     

特殊部位异位妊娠149例临床分析

目的探讨特殊部位异位妊娠的临床特点及诊治方法。方法回顾性分析2003年1月-2011年12月汕头大学医学院第一附属医院收治的149例特殊部位异位妊娠患者的临床资料。结果特殊部位异位妊娠的发生率占同期异位妊娠的534％,其中输卵管间质部妊娠61例,宫角妊娠27例,子宫瘢痕14例,宫颈妊娠11例,卵巢妊娠24例,腹腔妊娠9例,残角子宫妊娠2例,阔韧带妊娠1例。其中手术治疗126例,包括腹腔镜手术23例,其余为非手术治疗。结论特殊部位异位妊娠临床表现不典型,早期诊断困难,怀疑该病时应尽早明确诊断及治疗,治疗效果良好。     

异位妊娠相关因素的logistic回归分析

目的探讨引起异位妊娠的相关因素。方法异位妊娠孕妇210例作为观察组,按照1∶2随机选择同期正常妊娠者420例作为对照组,对可能影响异位妊娠的因素资料进行单因素分析与logistic回归分析。结果单因素分析共筛选出9个因素与异位妊娠有关;以异位妊娠为应变量,其他统计量作为自变量赋值后进行logistic非条件多因素分析,结果筛选出5个主要的危险因素为妇科炎症、孕产史、宫内节育器、腹部手术史、应用紧急避孕药物。结论异位妊娠与多种因素有关,对异位妊娠的高危人群加强监测,并进行指导：采取安全有效避孕措施;治疗妇科炎症;提高人工流产手术操作技术和其他宫腔操作技术;掌握IUD置放的适应证。     

异位妊娠发生相关危险因素分析及临床诊治体会

目的:探讨异位妊娠发生的相关危险因素以及临床诊治体会。方法:选择60例异位妊娠患者作为研究组,选取同期60例正常妊娠孕妇作为对照组,分析影响异位妊娠发生的相关危险因素。结果:通过单因素以及多因素Logistic回归分析显示孕产次、妇科炎性反应、腹部手术史、使用节育器以及服用紧急避孕药物与异位妊娠密切相关。结论:妇科炎性反应、多次孕产、腹部手术史、使用宫内节育器等因素与异位妊娠发生密切相关,积极预防妇女的生殖道炎性反应,合理避孕,避免流产可有效降低异位妊娠的发生率。     

Reproductive performance among patients with tubal ectopic pregnancy

Researchers studied 68 cases of tubal ectopic pregnancy that occurred at the university hospital in Benin city, Nigeria from February 1973- January 1976. Medical records existed for only 53 cases. The ratio of ectopic pregnancy to deliveries stood at 1:58 (incidence: 1.7%). Excluding maternity cases, these 68 cases represented 6.5% of all gynecological and adult female admissions. 1 of 40 abdominal surgeries performed at this hospital was due to a tubal ectopic pregnancy. Therefore it represents a significant condition in Nigeria. 90% of the women were 40 years old. 68% of the cases already had between 2-5 children. Average parity stood at 2.6. Only 9.4% of the women were nulliparous. Spontaneous abortions occurred in 26.48% of the women. Further, the investigators observed that the lower the parity the higher the incidence of spontaneous abortion. For example, the abortion rate for women with no children and those with 1 stood at 100% and 73.9% respectively while for women with 5 and 5 children it stood at 11.76% and 10.8% respectively. 58% of the cases had experienced a previous pelvic infection. Since there was an association between a high abortion rate and tubal ectopic pregnancy, the researchers also pointed out a possible common etiological factor causing both spontaneous abortions and tubal ectopic pregnancies. therefore a woman who may be likely to experience an early spontaneous abortion may be just as likely to have a tubal ectopic pregnancy and vice versa. Health practitioners should consider any pregnant woman who has had a tubal pregnancy to be at risk of a spontaneous abortion or early labor.     

Severe ovarian hyperstimulation syndrome coexisting with a bilateral ectopic pregnancy

Management of severe ovarian hyperstimulation syndrome (OHSS) includes hospitalization for fluid and electrolyte management. Abdominal paracentesis is also used as minimally invasive form of management in selected cases of severe OHSS following ovulation induction. However, if pregnancy ensues, the syndrome persists for a longer period, and the clinical manifestations of severe OHSS could mask the picture of a bleeding gestational sac. It could be easily overlooked unless the possibility of an ectopic pregnancy is kept in mind in cases of severe OHSS exacerbated by early pregnancy with or without a previous ectopic pregnancy history. We report a case of severe OHSS with simultaneous bilateral tubal pregnancy following intrauterine insemination (IUI). A 31-year-old woman with polycystic ovarian disease developed severe OHSS during the therapeutic course of IUI. An emergent exploratory laparotomy was performed 14 days after admission, and the operative findings showed persistent profuse bleeding from the bilateral fimbrial ends with marked enlargement of the ampullary portions. A linear salpingotomy was performed by a longitudinal incision along the area of maximal distension of the dilated fallopian tubes to preserve her fertility. We recommend that in cases of severe OHSS exacerbated by early pregnancy, serial serum beta-hCG and transvaginal ultrasound follow-up may be necessary due to the potential association of severe OHSS in pregnancy with an ectopic pregnancy.     

双侧输卵管妊娠分析

一女患者,因＂停经61d,阴道流血伴下腹隐痛15d＂于2008年9月4日＂拟异位妊娠＂收治入院。因患者无生育要求,故行双侧输卵管切除术,术中分别切开输卵管均见新鲜绒毛样组织,术后切除组织分别送病理确诊为双侧输卵管妊娠。     

特殊部位异位妊娠的临床分析

[目的]探讨特殊部位异位妊娠的临床特点、误诊原因及诊疗方法。[方法]对33例特殊部位异位妊娠患者的临床资料进行回顾性分析。[结果]特殊部位异位妊娠(33例)占同期异位妊娠(488例)的6.7%,其中输卵管间质部妊娠5例,卵巢妊娠5例,宫角妊娠12例,腹腔、阔韧带妊娠各1例,剖腹产术后疤痕妊娠3例,宫颈、宫内外合并妊娠2例,残角子宫合并异位妊娠2例。[结论]特殊部位异位妊娠既有其共性,又有其特殊性,早期诊断较困难,一旦怀疑及时处理。     

Progesterone in diagnosis of ectopic pregnancy.

Previous reports suggest that serum progesterone value may be useful in the diagnosis of ectopic pregnancy. These studies have based discriminatory thresholds on a limited number of patients without using statistical correction for biologic variability in an infinitely large population. This study was designed to determine the ability of a single progesterone value to discriminate between normal, ectopic and blighted pregnancies. Sera were obtained from all positive beta HCG tests at Shands Hospital, University of Florida. All samples were assayed simultaneously with a solid phase RIA for progesterone and the results compared with pregnancy outcome. The mean progesterone for normal pregnancies was 32.8 +/- 4.25 ng/ml (n = 49), for ectopic pregnancies 7.8 +/- 0.79 ng/ml (n = 51), and pregnancies which spontaneously aborted 8.1 +/- 0.91 ng/ml (n = 74). Using individual prediction limits progesterone greater than 24 ng/ml would exclude an ectopic pregnancy in 99% of patients. Thus, this test may be useful in selected patients when the diagnosis is unsure after beta HCG and transvaginal ultrasound have been performed.     

Ectopic pregnancy occurred after oocyte intrauterine transfer (OUT)--a case report

Although still an experimental procedure, it is hoped that oocyte intrauterine transfer (OUT) could become a convenient technique for initiating pregnancy. A 33-year old woman received OUT treatment after a period of infertility lasting for 3 years. Two weeks later the result of pregnancy test was positive, but shortly thereafter she complained of vaginal bleeding. Ultrasonography revealed a cystic lesion in her right adnexal area without any ascites. At laparotomy, a right side tubal pregnancy was confirmed. This is the first case report of ectopic pregnancy occurring after OUT. It was speculated that the OUT may have caused the tubal pregnancy. However, since the precise mechanism for embryonic implantation to the tubal epithelium is unknown, the causal relationship between OUT and tubal pregnancy remains unclear.