Ovarian pregnancy rupture following ovulation induction and intrauterine insemination: A case report

BACKGROUNDOvarian pregnancy after assisted reproductive technology treatment has rarely been reported; ovarian pregnancy following intrauterine insemination (IUI) is even rarer, and only nine cases have previously been reported. CASE SUMMARYWe report a case of ovarian pregnancy rupture after ovulation induction and IUI. The patient presented with bilateral lower abdominal pain and was referred to the emergency department. Ultrasound examination revealed ovarian pregnancy and intraperitoneal bleeding. Laparoscopy revealed an ovarian pregnancy with hemoperitoneum, which was subsequently removed. Pelvic adhesions were detected intraoperatively, which were treated immediately. The patient spontaneously conceived an intrauterine pregnancy 3 mo later, which was ongoing at the time of writing this study. CONCLUSIONClose attention should be paid to any history of pelvic inflammatory disease before commencing IUI treatment,and patients with such a history should be closely followed up after IUI. Early measurement of serum β-human chorionic gonadotropin levels and ultrasonic examination are essential for timely diagnosis of ovarian pregnancy after ovulation induction and IUI to avoid more serious complications.     

宫内宫外同时妊娠1例

患者女,33岁,因停经39天就诊,尿HCG阳性.经阴道超声检查:子宫前位,体积增大,宫内见一0.2 cm×0.1 cm的液性暗区,未见胚芽回声.右附件区探及一个混合回声结节,大小为1.0 cm×0.9 cm.双侧卵巢大小正常,盆腔未探及液性暗区.B超提示:①宫内液性暗区;②右附件区混合回声结节,建议3～5天后复查.4天后复查经阴道超声:子宫内见大小0.8 cm×0.35 cm的孕囊,其内可见卵黄囊,未见胚芽.右附件区混合回声包块大小为2.0 cm×1.6 cm(图1).盆腔未探及液性暗区.B超提示:①宫内早孕;②右附件区混合回声包块,建议结合临床.患者2天后接受人工流产.9天后患者因腹痛、阴道少许流血夜间入院,尿HCG阳性,后穹隆穿刺抽出不凝血约2 ml.急诊手术,术后病理示右输卵管妊娠.     

超声诊断宫角妊娠破裂1例

<正>患者女,35岁,停经65 d,孕4产2。因急性腹部胀痛6 h来院急诊,伴有头晕、乏力。无手术史。妇科超声检查:子宫增大,大小约112 mm×72 mm×74 mm,前位,宫腔内未见异常回声,于子宫右侧角见大小约55 mm×39 mm的孕囊回声(图1),内见胚胎回声,未见胎心搏动,孕囊周边可见完整的肌壁组织,双侧卵巢大小正常,腹腔内可见大片无回声区。超声提示:异位妊娠,考虑右侧宫角妊娠可     

Post-salpingectomy interstitial heterotopic pregnancy after in vitro fertilization and embryo transfer: A case report

BACKGROUNDHeterotopic pregnancy (HP) refers to the coexistence of ectopic pregnancy and intrauterine pregnancy. Salpingectomy is proposed as a pretreatment before in vitro fertilization and embryo transfer (IVF-ET) to reduce the risk of HP. HP after IVF-ET occurs in women who had already underwent bilateral salpingectomy, even though it is extremely rare.CASE SUMMARYA case of a 29-year-old woman with recurrent interstitial HP after IVF-ET following salpingectomy is presented. The main symptom was a sudden and worsening pelvic pain. Physical examinations revealed signs of peritoneal bleeding and irritation with stable vital signs. Transvaginal ultrasound showed a live intrauterine pregnancy and another live embryo with cardiac activity in the left cornu extending beyond the lateral edge of the uterus. Her hemoglobin concentration was 8.0 g/dL, and serum human chorionic gonadotropin value was 171116.9 mIU/mL. With the diagnosis of ruptured HP with internal bleeding, an emergency laparoscopic resection of left cornu was performed. The interstitial pregnancy was removed with caution to protect the intrauterine pregnancy. After the surgical treatment, the intrauterine pregnancy continued with no complications. A healthy baby was delivered by caesarean section at 39 wk. Outcomes of another three cases are further summarized.CONCLUSIONPost-salpingectomy HP is a rare but challenging condition. Surgical treatment is preferred in the case with a viable intrauterine pregnancy.     

Heterotopic pregnancy following intrauterine insemination: successful management with salpingectomy and continuation of intrauterine pregnancy

We report the first case of a heterotopic pregnancy (HP) following ovulation induction and intrauterine insemination (IUI) with resultant normal intrauterine pregnancy after salpingectomy. A 41-year-old para 0 +0 that presented with primary infertility due to azoospermia and polycystic ovaries after laparoscopic evaluation. She had induction of ovulation with Clomiphene citrate, gonadotropin stimulation (hCG), and intrauterine insemination using donor sperm. The resulting pregnancy was later diagnosed as heterotopic pregnancy following rupture of the tubal component at 8 weeks' gestation after an initial misdiagnosis as corpus luteum cyst of pregnancy. She had an emergency laparotomy and left salpingectomy, and the intrauterine pregnancy has continued subsequently to 25 weeks of gestation as at 01/04/2011.This report demonstrates that HP may occur after ovulation induction and IUI. The ectopic component could be misdiagnosed as corpus luteum cyst. It is recommended that pregnancies following this procedure be followed up with serial trans-vaginal ultrasound in the first trimester. Presence of corpus luteum cyst of pregnancy in early ultrasound should be an index of suspicious of a possible heterotopic pregnancy. Early diagnosis and prompt intervention is essential to salvage the intrauterine pregnancy and avoid maternal morbidity and mortality.     

体外受精-胚胎移植后宫内外同时妊娠腹腔镜围手术期的护理

目的探讨体外受精-胚胎移植（IVF－ET）后宫内外同时妊娠（HP）患者腹腔镜围手术期的护理经验。方法回顾性分析及总结13例IVF-ET后HP患者腹腔镜手术围手术期的护理要点。结果13例患者术程顺利。9例术后继续妊娠至足月分娩，3例术后胚胎停止发育行清宫术，1例术后难免流产。结论细致的护理和熟练的手术配合，对保证IVF－ET后HP患者手术顺利进行及宫内胎儿继续妊娠具有重要意义。     

Evaluation of endometrial urocortin secretion for prediction of pregnancy after intrauterine insemination

BACKGROUND: Urocortin is a neuropeptide produced by the human endometrium and has biological effects putatively important for promoting blastocyst implantation. We measured urocortin concentrations in samples of endometrial wash fluid collected from women with unexplained infertility who underwent intrauterine insemination (IUI). METHODS: Patients 28-42 years of age (n = 71) were consecutively enrolled after a complete clinical evaluation. Endometrial wash fluid was retrieved before IUI, at the time of ultrasound evaluation of endometrial thickness. Urocortin concentrations were assayed with a specific ELISA. RESULTS: After IUI, 28 patients (39%) became pregnant. Urocortin concentrations were significantly higher in women who became pregnant than in those who did not (0.38 microg/L vs 0.13 microg/L, P <0.0001). At a cutoff of 0.321 microg/L, urocortin results were positive in 61% [95% confidence interval (CI), 41%-78%] of women who had successful implantation and negative in 98% (95% CI, 88%-99.6%) of those who did not. The pregnancy rate for women with urocortin concentrations >0.32 microg/L was 94%, which differed significantly (P <0.05) from the overall pregnancy rate of 39% in the study population. CONCLUSIONS: Urocortin is measurable in endometrial wash fluid, and its concentrations before IUI are higher in women who subsequently achieve pregnancy. These data suggest that the probability of having a successful pregnancy-producing IUI may be better estimated by measuring urocortin in endometrial wash fluid.     

Predictors of pregnancy after intrauterine insemination in women with polycystic ovary syndrome

ObjectiveTo evaluate the effects of body mass index (BMI) in patients with polycystic ovary syndrome (PCOS) undergoing controlled ovarian stimulation (COS) with intrauterine insemination (IUI).MethodsThis retrospective study evaluated couples with PCOS undergoing COS and IUI. The relationship between cumulative IUI pregnancy outcomes and BMI, treatment cycles, treatment schemes, number of dominant follicles, endometrial thickness, infertility duration and type of infertility was analysed.ResultsThe study evaluated 831 IUI cycles in 451 couples with PCOS. Compared with normoweight women, overweight and obese women required more human menopausal gonadotropin (hMG) doses and more days of COS. Gestational diabetes mellitus occurred more frequently in the obese group than in the other BMI groups. The clinical pregnancy and live birth rates in the hMG, clomiphene citrate (CC) + hMG and letrozole (LE) + hMG groups were significantly higher than those in the CC and LE groups. The clinical pregnancy rate was higher in the secondary infertility group compared with the primary infertility group.ConclusionObese women might require more hMG doses and more days of COS to overcome the effects of weight. As BMI increases, the incidence of gestational diabetes might also increase. The number of cycles and type of infertility may have a predictive value for pregnancy outcomes.     

彩色多普勒超声诊断肝脏内异位妊娠1例

正患者女,34岁,孕3产1。停经50 d,因"尿妊娠试验阳性,右上腹隐痛1周"就诊。体格检查:腹部平坦,右上腹压痛明显,脾脏未发现异常,肾区无叩痛。妇科检查无明显异常。实验室检查:血清HCG 8865.0 U/L,孕酮35.7 nmol/L。超声检查:子宫切面形态、大小正常,内膜厚度约1.2 cm,宫腔内未见明显妊娠囊回声,双侧附件区未见明显包块回声。肝脏形态大小正常,包膜完     

胃壁异位胰腺1例超声表现

患者，女，60岁。因胃部不适行胃镜检查。胃镜示：浅表性胃炎，另疑胃窦部大弯侧黏膜下占位。患者饮用均匀有回声型造影剂（速溶胃肠超声助显剂）500ml后行超声检查。超声示：胃窦部小弯侧胃壁内可见19mm&#215;9mm低回声结节，呈扁圆形，表面光滑，基底较宽；结节表面黏膜光滑连续．结节周围胃壁层次清晰（图1）。CDFI：结节内未探及明显血流信号。超声提示：胃壁实体占位（胃平滑肌瘤可能性大），未治。40天后复查超声，肿物大小为19mm&#215;13mm（图2），住院治疗。胃部CT：胃壁局限性增厚。术中冰冻：胰腺组织。     

1例人工授精后正常妊娠合并侵袭性葡萄胎患者的护理

报告了1例人工授精后正常妊娠合并侵袭性葡萄胎患者的治疗及护理,通过产前对血HCG、胎盘功能、胎儿发育、自我病情等的监测和产后对病情的追踪观察、合并症及产后化疗的护理,了解转移灶的发展情况、产后的恢复情况.严密观察阴道出血量及24 h尿蛋白定量、血压的变化,严格称量产后化疗期间每日净体重等,并积极采取措施预防感染,进行必要的乳房护理,同时对患者进行心理疏导,使患者顺利于剖宫产术后即行化疗,效果满意,新生儿情况良好,母婴平安.     

促排卵周期宫腔内人工授精后妊娠失败的影响因素分析

目的探讨促排卵周期宫腔内人工授精(IUI)后妊娠失败的影响因素。方法选择完成促排卵周期IUI的200例患者及其配偶为研究对象。观察患者临床妊娠结局;自制调查问卷,记录患者相关资料;分析促排卵周期IUI后妊娠失败的影响因素。结果 151例患者促排卵周期IUI后妊娠失败,妊娠失败率为75.50%。肥胖、子宫内膜异位症(EMs)、焦虑/抑郁均是促排卵周期IUI后妊娠失败的影响因素(OR 0,P 0.05)。结论促排卵周期IUI后患者妊娠失败风险高,可能与肥胖、EMs、焦虑/抑郁等因素有关,临床应及时评估风险因素,并针对性实施干预,提高IUI后妊娠率。     

正常形态精子百分率对宫腔内人工授精妊娠率的影响

目的探讨正常形态精子百分率与处理后前向运动精子总数达标率的关系及其对宫腔内人工授精临床妊娠率的影响。方法行夫精宫腔内人工授精的426对不孕夫妇（563个周期）,依据正常形态精子百分率分为3组,正常形态精子百分率〈4％为A组,≥4％～15％为B组,〉15％为C组,比较各组精液处理后前向运动精子总数达标率及对宫腔内人工授精临床妊娠率。结果A组精液处理后前向运动精子总数达标率低于B、C组（P〈0．05）,B组低于c组（P〈0．05）;A组周期妊娠率（7．77％）明显低于B、C组（16．21％、18．05％）（P〈0．05）。结论正常形态精子百分率对精液处理后前向运动精子总数达标率有明显影响,二者共同影响宫腔内人工授精结局;正常形态精子百分率≥4％可获较高临床妊娠率。