Cesarean section scar ectopic pregnancy: a clinical case series

Cesarean scar implantation represents a rare, though growing subset of potentially life-threatening ectopic pregnancy. Because of the global increase in cesarean sections as well as the improved diagnostic abilities of transvaginal ultrasound, incidence rates have continued to rise since the first reported case in 1978. Uterine rupture and catastrophic hemorrhage can ensue when diagnosis is delayed. Additionally, a higher rate of concurrent trophoblastic myometrial invasion may increase the incidence of retained products of conception or post procedural bleeding. Endovaginal ultrasound has a reported sensitivity of 85 % for detection. In difficult cases, magnetic resonance imaging is often useful as a problem solving exam in confirming diagnostic suspicions and guiding therapeutic decisions. We present a series of five illustrative cases illustrating the range of clinical and imaging findings.     

Rupture of ectopic pregnancy after medical therapy with methotrexate: a case series

Medical treatment of ectopic pregnancy with methotrexate has become the standard of care in many areas of the U.S. Rupture of ectopic pregnancy after medical treatment presents a diagnostic challenge to the Emergency Physician. We review a series of 11 patients with ectopic pregnancy treated with methotrexate who then required surgical treatment for rupture.     

A case of double ectopic pregnancy dealed with a laparoscopic management

Uterine horn pregnancy is a very rare condition and is associate with a high rate of maternal morbidity and mortality. The standard treatment is laparotomy. CASE: A 40-year-old woman, previosly undegone laparotomy surgery for extrauterine pregnancy, was admitted to hospital "Casa di Cura Malzoni" because ectopic pregnancy was diagnosed. The patient was treated with laparoscopic surgery.     

超声引导下局部注射药物治疗异位妊娠的进展

异位妊娠是育龄妇女常见的疾病,早期诊断使大多数患者得到保守治疗,超声引导下局部注射药物是其中的一种,该方法应用近20年,是治疗异位妊娠安全有效的微创治疗方法。本文就该治疗方法的治疗目的、适应证、禁忌证、疗效判定及并发症进行综述。     

Transvaginal sonographic diagnosis of live monochorionic twin ectopic pregnancy.

Ectopic pregnancy is a leading cause of pregnancy-related deaths; its incidence has progressively increased in recent years. Spontaneous twin ectopic pregnancy, however, is extremely rare. Among more than 100 reported cases of twin tubal pregnancies, only 5 cases in which fetal cardiac motion has been visualized in both embryos have been reported. We describe an additional case of a live monochorionic twin ectopic pregnancy in a patient with no predisposing factor. With transabdominal sonography, we initially diagnosed a single ectopic pregnancy, visualized as an ill-defined mass in the left adnexa. However, with transvaginal sonography, we determined the left adnexal mass to contain a single monochorionic gestational sac with 2 embryos, each with cardiac motion. These findings were confirmed with color Doppler sonography and at laparotomy. The introduction of high-resolution transvaginal sonography has resulted in the earlier diagnosis of ectopic pregnancy and has contributed to a recent decrease in the maternal mortality and morbidity associated with this condition.     

Caesarean scar ectopic pregnancy: a case report

This case study discusses a recent diagnosis of a rare form of ectopic pregnancy within a Caesarean section scar. Evidence indicates that the prevalence of this form of ectopic pregnancy is escalating due to the increasing number of Caesarean sections performed. As ultrasound plays a major role in diagnosing this rare life-threatening condition, we recommend key points for practitioners to consider for meticulous assessment and accurate diagnosis.     

Cervical ectopic pregnancy: a case report and literature review.

We report a case of cervical ectopic pregnancy that was diagnosed using transabdominal ultrasound. Conservative management with methotrexate administration was undertaken and, following a period of heavy bleeding, bilateral uterine artery embolization was performed. Two weeks after presentation, the gestational sac was shown to have reduced in size. We describe the ultrasound findings in this case and discuss those reported in the literature along with the available management options.     

Successful management of a consecutive cervical pregnancy by sonographically guided transvaginal local injection: case report and review of the literature.

OBJECTIVE: The purpose of this study was to describe the successful management of a recurrent cervical pregnancy with local injection and to review similarly treated cases to determine adverse outcomes. METHODS: A case of a recurrent cervical pregnancy treated with transvaginal local injection was reported. A MEDLINE English language search identified 90 cases of cervical pregnancy treated with local therapy. This literature was analyzed with regard to the various demographic and outcome variables described. RESULTS: Successful use of the transvaginal local approach is described. A review of cases identified a mean maternal age of 33.6 years with a mean gestational age at diagnosis of 7.5 weeks. Bleeding was the most common presenting sign (79%). The mean beta-human chorionic gonadotropin level at the time of diagnosis was 27,798 IU with an average time to resolution of 7.5 weeks. The most common risk factor was a history of curettage (69%), followed by previous cesarean delivery (35%). An additional dose of methotrexate was needed in 6% of cases. Bleeding requiring alternate procedures was present in 5% of cases. There were no complications in 81% of cases. The need for transfusion and development of infection were seen in 3% of cases each. There was 1 case (1.1%) requiring hysterectomy, and no maternal deaths were reported. CONCLUSIONS: Conservative management of cervical pregnancy using local injection has been reported to have a low complication rate and a high efficacy for cure.     

The non-surgical management of ectopic pregnancy.

Ectopic pregnancy can now be detected at earlier gestations in asymptomatic women. As a consequence conservative treatment strategies may be more appropriate than surgical intervention. This review aims to discuss the diagnosis and the non-surgical management options for ectopic pregnancy, in particular expectant management and the use of methotrexate.     

宫内早孕合并左侧宫外孕1例

患者,37岁.急诊以"早孕,先兆流产"收入我院.孕2产0,一年前有右侧宫外孕手术史.超声所见(如图):膀胱充盈良好.子宫增大,长径98 mm,宽径76 mm,宫内可见65 mm×42 mm妊娠囊回声,内见35 mm×36 mm胚芽组织,未见胎心搏动.     

超声诊断腹膜后异位妊娠一例

患者女性,33岁,已婚,因"停经64 d,阴道不规则出血1次"于2019年7月14日收入唐山市工人医院.患者平素月经规律,月经周期24～25 d,经期7 d,末次月经时间为2019年5月11日,停经后无明显早孕反应.2019年6月16日自测尿妊娠试验阳性;2019年6月20日无诱因发生阴道不规则出血1次,出血量相当于以...     

Miscarriage and ectopic pregnancy 2: management

This two-part unit explores miscarriage and ectopic pregnancy. This part, part 2, outlines diagnosis, management and key nursing interventions. It also discusses the emotional impact of pregnancy loss.     

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.     

Diagnosis and management of ectopic pregnancy

Ectopic pregnancy is a high-risk condition that occurs in 1.9 percent of reported pregnancies. The condition is the leading cause of pregnancy-related death in the first trimester. If a woman of reproductive age presents with abdominal pain, vaginal bleeding, syncope, or hypotension, the physician should perform a pregnancy test. If the patient is pregnant, the physician should perform a work-up to detect possible ectopic or ruptured ectopic pregnancy. Prompt ultrasound evaluation is key in diagnosing ectopic pregnancy. Equivocal ultrasound results should be combined with quantitative beta subunit of human chorionic gonadotropin levels. If a patient has a beta subunit of human chorionic gonadotropin level of 1,500 mIU per mL or greater, but the transvaginal ultrasonography does not show an intrauterine gestational sac, ectopic pregnancy should be suspected. Diagnostic uterine curettage may be appropriate in patients who are hemodynamically stable and whose beta subunit of human chorionic gonadotropin levels are not increasing as expected. Appropriate treatment for patients with nonruptured ectopic pregnancy may include expectant management, medical management with methotrexate, or surgery. Expectant management is appropriate only when beta subunit of human chorionic gonadotropin levels are low and declining. Initial levels determine the success of medical treatment. Surgical treatment is appropriate if ruptured ectopic pregnancy is suspected and if the patient is hemodynamically unstable.     

Ruptured ectopic pregnancy on a tubal stump: A case report

Tubal stump ectopic pregnancy is a rare event. Early diagnosis and management can spare patients from significant morbidity; however, patients usually present with hemoperitoneum in developing countries. A long tubal stump might increase the risk for tubal stump pregnancy; hence, the length of fallopian tube should be minimized during salpingectomy.     

超声诊断宫内孕合并多发宫外妊娠一例

1临床资料患者,女,33岁。婚后3年未孕,在外院行促排卵药物HCG治疗,治疗量为3000U/次,1次/d,肌肉注射,连续用药1个疗程,共7d。此次因停经56d,阴道少量流血来我院就     

输卵管妊娠腹腔镜下注射MTX术后大出血1例

1　资料患者2 5岁,因停经35d后不规则阴道流血15d ,于2 0 0 2年9月2 2日入院。LMP 2 0 0 2年8月2日,9月7日开始少量不规则阴道流血,9月10日外院检查尿HCG( ) ,B超提示“早孕”以先兆流产予保胎治疗。1998年曾因右输卵管妊娠行右输卵管切除术,G4P1,孕8月引产1次,人流3次。体格检查,生命体征正常。妇科检查,子宫饱满,活动,轻压痛:左附件区触及一3cm直径大包块,压痛,右侧(- )。辅助检查,B超提示子宫形态大小正常,子宫左后方见5 8mm×35mm×2 8mm包块,内见孕囊回声,有胚芽及胎心搏动,血HCG 30 990mIU/ml。入院诊断,左输卵管妊娠。于2 0 0 …     

Fertility outcomes following expectant management of tubal ectopic pregnancy.

OBJECTIVES: To evaluate fertility outcome after the expectant management of tubal ectopic pregnancy. METHODS: Our dedicated early pregnancy database was searched for all women diagnosed with a tubal ectopic pregnancy between January 1999 and June 2003 who were either managed expectantly or underwent a salpingectomy. They were contacted to enquire about their ability to conceive following the ectopic pregnancy and about the outcomes of any subsequent pregnancies. RESULTS: Four hundred and forty-four women had a diagnosis of tubal ectopic pregnancy, and 173 (39%) were successfully contacted. A total of 146/173 (84.4%; 95% CI, 79-89.8%) tried for another pregnancy: 49/59 (83.1%; 95% CI, 73.4-92.6%) in the expectant management and 97/114 (85.1%; 95% CI, 78.4-91.6%) in the salpingectomy group (P > 0.05). Spontaneous intrauterine pregnancy occurred in 41/49 (83.7%; 95% CI, 73.3-94.2%) women managed expectantly and in 62/97 (63.9%; 95% CI, 54.4-73.5%) women managed surgically (odds ratio 2.89; 95% CI, 1.22-6.86%). The risk of recurrent ectopic pregnancy was not significantly different between the two management groups. CONCLUSIONS: Fertility outcomes following the expectant management of tubal ectopic pregnancy are comparable to those following salpingectomy.