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.     

Heterotopic pregnancy: discovery of ectopic pregnancy after elective abortion

We report a case of combined intrauterine and tubal pregnancy in a 23-year-old woman. The patient came to the emergency department complaining of lower abdominal pain after having had an elective abortion 2 weeks earlier. Her physician had done pelvic ultrasonography, noting an intrauterine pregnancy before the abortion. Our working diagnosis in the emergency department was retained products of conception versus postabortion endometritis. Pelvic ultrasonography in the emergency department revealed an ectopic pregnancy without evidence of retained products of conception, and the patient had a right salpingotomy with removal of the ectopic fetus without complications.     

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.     

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     

宫内早孕与异位妊娠子宫内膜的声像图特征分析

目的探讨宫内早孕与异位妊娠子宫内膜变化的声像图特征。方法 107例患者分为宫内早孕组51例和异位妊娠组56例,经腹超声观察其子宫内膜回声特征和血流频谱性质,测量子宫内膜厚度、动脉舒张期最低血流速度(Vmin)及阻力指数(RI),直至子宫宫腔内或宫腔外部位出现妊娠囊,计算子宫内膜增长速度,结果进行对比分析。结果宫内早孕组和异位妊娠组子宫内膜增长速度分别为(0.52±0.14)mm/d和(0.15±0.15)mm/d;子宫内膜厚度分别为(16.29±2.21)mm和(9.14±2.48)mm,差异有统计学意义(U=12.76、15.89,均P0.01);以子宫内膜增长速度﹤0.4 mm/d为诊断异位妊娠的分界点,其敏感性为85.7%,特异性为82.4%。异位妊娠组子宫内膜呈线状强回声48例,呈磨玻璃样改变8例,宫内早孕组51例均呈磨玻璃样改变,差异有统计学意义(χ2=62.34,P0.01);宫内早孕组检出2例子宫内膜周边滋养动脉,异位妊娠组无一例检出子宫内膜滋养动脉,差异无统计学意义(χ2=2.21)。结论超声检测子宫内膜增长速度、子宫内膜厚度及回声特征,有利于宫内早孕和异位妊娠之间的鉴别诊断。     

The management of Cesarean scar ectopic pregnancy following treatment with methotrexate--a clinical challenge.

We present a case of Cesarean scar ectopic pregnancy, complicated by the persistence of clinical symptoms despite a rapid and complete biochemical response to a single systemic injection of methotrexate. A 34-year-old woman with three previous Cesarean sections was diagnosed with a Cesarean scar ectopic pregnancy following in-vitro fertilization treatment. The diagnosis was suggested by three-dimensional (3D) ultrasound scan and confirmed with magnetic resonance imaging (MRI). Management involved administration of a single systemic injection of methotrexate and follow-up with serial ultrasound assessments and serum beta-human chorionic gonadotropin (beta-hCG) measurements. The main challenge was the persistence of clinical symptoms despite adequate medical treatment, as judged by complete resolution of biochemical trophoblastic activity, which resulted in repeated admissions to the hospital. Serial transvaginal ultrasound scans showed an initial increase in the size of the mass, which led to increasing anxiety in the couple. Eventually, 15 weeks after the administration of methotrexate, the couple requested surgical intervention. An uneventful surgical resection of the abnormal area, which showed appearances suggestive of trophoblastic tissue, was undertaken to good effect. In summary, despite a rapid normalization of serum beta-hCG following the administration of methotrexate, the patient remained symptomatic and had ultrasound appearances suggestive of incomplete resorption of trophoblast, necessitating surgical intervention.     

宫内节育器异位高危因素分析及手术处理——附40例报告

目的:探讨宫内节育器(IUD)异位的高危因素和手术处理方法.方法:选择40例IUD异位患者(IUD异位组,包括IUD部分异位至子宫肌层6例,完全异位至子宫肌层2例,异位至子宫外32例)及同期因其他妇科疾病(卵巢囊肿)住院患者中IUD位置正常的40例患者(对照组),比较两组的施术者经验、置器时间、节育器类型和施术医院级别...     

1例宫内合并右侧输卵管妊娠病人成功保留宫内胎儿的护理

宫内妊娠及宫外妊娠同时存在称为复合妊娠（heterotopic pregnancy，HP），是一种罕见的异位妊娠，其发生率约为1：15000-1：30000^[1]。但近20年来由于性传播疾病的蔓延，促排卵治疗的应用以及辅助生育技术的发展，使复合妊娠的发病率明显升高。有文献报道，在应用了助孕技术的病人中复合妊娠发生率为0．2％～0．3^[2]。本文所讨论的病例即多年不孕．经促排卵药物治疗后，造成宫内合并右侧输卵管妊娠。经我院腹腔镜手术治疗异位妊娠病灶同时保胎治疗成功，足月分娩，现将护理报道如下     

1例宫内合并右侧输卵管妊娠病人成功保留宫内胎儿的护理

宫内妊娠及宫外妊娠同时存在称为复合妊娠(heterotopic pregnancy,HP),是一种罕见的异位妊娠,其发生率约为1∶15 000～1∶30 000[1].但近20年来由于性传播疾病的蔓延,促排卵治疗的应用以及辅助生育技术的发展,使复合妊娠的发病率明显升高.     

异位妊娠的早期诊断和治疗

异位妊娠 (ectopic pregnancy,EP)是指受精卵种植并发育于宫腔以外的器官或组织 ,是妇产科常见的疾病之一 ,多年来一直受到人们的关注。最近 ,不少学者对 EP的早期诊断和治疗进行了进一步探索 ,提出了许多新的观点和经验 ,本文就此综述如下。1　病因近年 ,EP发生率明显上升 ,其病因也变得越来越复杂和多元化。其中 ,输卵管炎症一直是 EP发生的首要病因 ,最近的回顾性研究也证实了这一点。过去认为 ,宫内节育器(intrauterine device,IU D)可使 EP发生增加 ,目前这一观点有争议。调查发现 ,在 EP患者中 ,放置者占 5 .36 % ,未放置者为 4…     

MTX联合米非司酮保守治疗异位妊娠的临床疗效观察

目的 观察MTX联合米非司酮保守治疗异位妊娠的临床疗效.方法 选择2006年1月至2007年8月我院收治的182例异位妊娠要求保守治疗的病例,随机分成两组:治疗组91例采用MTX联合米非司酮治疗,对照组91例采用MTX单药治疗.结果 治疗组治愈82例,治愈率90.10%;对照组组治愈75例,治愈率75.82%.结论 MTX联合米非司酮疗效理想.而且具有安全,方便,在临床工作中值得推广.     

Parents' satisfaction at the birth of a handicapped child following a family intervention

The aim of this study is to estimate parents' satisfaction following a surgical procedure on their child. This includes support as well as additional information and documentation for the individual parent (cognitive and emotional), conjugal, parental and other family members. The majority of parents are satisfied with the treatment program, realizing that the treatment enables them to adapt to their new situation, that is, as parents of a newborn child suffering from health problems. This support allows them to recognize and talk about their own fears and emotions as well as those of their partner, to be reassured when facing their child's treatment, and to better understand the available resources. The results of the study show that there are significant differences in regards to the sex of the parent, the diagnosis of the child and the level of income. Mothers of children inflicted with Down's syndrome are more emotionally satisfied with the treatment than fathers, and lower income families are more satisfied with the treatment as well as with the sub-system of family health-care than middle and upper-income families. Parents of children with a labial and/or palatine cleft are more satisfied with the treatment in regards to the family plan than parents of children with Down's syndrome. These results raise several questions that, with more profound deliberation on the adequacy of early medical procedures with regards to the parents of children with health problems, shall not be overlooked. Let us highlight the heuristic qualities of this evaluative approach which possess the same relevance as the questionnaires developed in order to assess the families' satisfaction. After modifications, these questionnaires could eventually be used on different clientele as well.     

MTX联合米非司酮保守治疗异位妊娠的临床疗效观察

目的观察MTX联合米非司酮保守治疗异位妊娠的临床疗效。方法选择2006年1月至2007年8月我院收治的182例异位妊娠要求保守治疗的病例,随机分成两组：治疗组91例采用MTX联合米非司酮治疗,对照组91例采用MTX单药治疗。结果治疗组治愈82例,治愈率90．10％;对照组组治愈75例,治愈率75．82％。结论MTX联合米非司酮疗效理想。而且具有安全,方便,在临床工作中值得推广。