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《Taiwanese journal of obstetrics & gynecology》2023,62(2):363-368
ObjectiveHeterotopic pregnancy (HP) is the coexistence of extra- and intrauterine gestation implantation sites. A rare case of a second-trimester ruptured cornual HP (CHP) treated with laparoscopic cornual resection with the primary repair is presented. Risk factors, clinical presentations, treatments, and outcomes of CHPs are also reviewed.Case reportA 35-year-old pregnant woman with CHP presented with lower abdominal pain with hemoperitoneum and her hemoglobin level dropped. Laparoscopic management of a ruptured HP was performed, leaving the surplus intrauterine fetus intact. She delivered a 2360 g male infant via cesarean section at 34 weeks’ gestation due to preterm premature rupture of membranes. We found a well-healed wound over the left uterine cornua during the cesarean section.ConclusionRuptured CHP is a rare but life-threatening complication of an obstetric emergency. Although the pregnant uterus becomes congested and fragile, using reliable laparoscopic energy devices and barbed sutures, successful treatment is feasible. 相似文献
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Heterotopic pregnancy is the simultaneous development of an intrauterine pregnancy and ectopic pregnancy. We report a rare case of corneal heterotopic pregnancy at 9 weeks of amenorrhoea in a 30-year-old woman, after IVF. Because of the massive intraabdominal hemorrhage laparotomy was performed. Cornual resection and suture was performed and intrauterine pregnancy was evacuated. Doctors must be alert to the fact that confirming an intrauterine pregnancy does not exclude the coexistence of an ectopic pregnancy, particularly after IVF. 相似文献
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Sheikh HH 《The Journal of reproductive medicine》2007,52(7):654-656
BACKGROUND: The simulated presence of intrauterine and extrauterine pregnancies is a rare condition. Diagnosis is difficult, accomplished on grounds of strong suspicion (as in assisted reproductive treatment cases), on the presence of predisposing factors (pathology of salpinx) or as a coincidental finding in the emergency room when a patient presents after an elective or spontaneous abortion. An intrauterine pregnancy may be discovered in a patient who presents with ectopic pregnancy. CASE: A 40-year-old multigravida was diagnosed with coexisting extrauterine and intrauterine pregnancies when she presented with a right ectopic pregnancy in the emergency room. The patient underwent partial right salpingectomy and an elective abortion. CONCLUSION: Patients who present with acute pelvic pain must be investigated for coexisting ectopic pregnancy even though they have a proven intrauterine pregnancy. Such an investigation is even more important if the patient is undergoing assisted reproductive treatment. In patients who have had spontaneous or elective abortion, especially in cases of a gestation <4 weeks, the differential diagnosis should include coexisting ectopic pregnancy. Failure to diagnose this condition can have serious consequences. 相似文献
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J S Dericks-Tan C Scholz H D Taubert 《European journal of obstetrics, gynecology, and reproductive biology》1987,25(3):181-185
Twelve patients with silent (occult) ectopic pregnancy were clinically managed by a non-surgical conservative approach. The laparoscopic findings in 4 patients were not conclusive enough to justify laparotomy, and there was only minimal clinical symptomatology. The serum hCG level in these cases did not exceed 2000 IU/l and no typical rise was found. Serum hCG was measured serially under careful clinical observation until it reached non-pregnant levels over a period of 20-45 days. Tubal patency could be demonstrated 6 months later in 2 patients who desired to become pregnant. 相似文献
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A case is reported of spontaneous ectopic pregnancy in a non patent fallopian tube of a patient with a contralateral unicornuate uterus without rudimentary horn. A hemoperitoneum, due to the rupture of the tube, occurred with a HCG level of 48 I.U./l. A laparoscopy was therefore performed and the fallopian tube removed. 相似文献
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BACKGROUND: A viable intrauterine pregnancy with salpingitis has been reported rarely. CASE: A 27-year-old woman at 10 weeks' gestation developed abdominal pain, fever, leukocytosis, peritoneal signs, closed cervix and a viable pregnancy. Progression from acute salpingitis to septic abortion was documented. CONCLUSION: Acute salpingitis in the presence of a viable pregnancy warrants aggressive intervention. 相似文献
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Iacob Marcovici MD Bert Scoccia MD 《American journal of obstetrics and gynecology》1997,177(6):1545-1546
Spontaneous bilateral ectopic pregnancy is extremely rare. An unsuspected case of spontaneous bilateral ectopic pregnancy with failure of single-dose methotrexate is presented. We question whether the recommended dose of methotrexate for unilateral ectopic pregnancy is adequate for bilateral tubal pregnancy.(Am J Obstet Gynecol 1997;177:1545-6.) 相似文献
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Fernando Bugatto Rocío Quintero-Prado Janette Kirk-Grohar Victoria Melero-Jiménez Blas Hervías-Vivancos José L. Bartha 《Archives of gynecology and obstetrics》2010,282(6):601-606
Introduction
Heterotopic triplets hardly take place, but nowadays the extended use of assisted reproductive technologies is increasing the ectopic pregnancies rate and subsequently the heterotopic pregnancies, leading to a potentially dangerous condition for the woman and the intrauterine pregnancy. 相似文献13.
A A Arkutu 《International journal of gynaecology and obstetrics》1980,17(4):396-398
A case of concurrent intrauterine and advanced ovarian pregnancy is reported. The condition was discovered after spontaneous vaginal delivery of the intrauterine baby. Laparotomy was performed on the day after delivery of the first baby and only then was ovarian pregnancy diagnosed and later confirmed histologically; a macerated fetus was excised from the ovarian mass at laparotomy. The intrauterine baby was discharged alive along with the mother 12 days after the operation. 相似文献
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BACKGROUND: Concurrent ectopic pregnancy and acute appendicitis is rarely encountered. Since 1960, only 22 cases have been reported. No case of concurrent interstitial ectopic pregnancy and appendicitis has ever been reported. CASE: A 24-year-old, African American woman, gravida 4, para 3, had a right interstitial ectopic pregnancy. She was managed as an inpatient with parenteral methotrexate and her beta-human chorionic gonadotropin level decreased appropriately. She was discharged 3 days after treatment but subsequently returned with right lower quadrant pain, nausea, vomiting and fever. The patient underwent laparoscopy with removal of a suppurative appendix. A stable interstitial ectopic pregnancy was visualized and left in situ. CONCLUSION: The discipline to consider concomitant abdominal pathology is paramount. The perceived rarity of an ectopic pregnancy and appendicitis should not obscure a thorough clinical evaluation. 相似文献
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Soriano D Shrim A Seidman DS Goldenberg M Mashiach S Oelsner G 《The Journal of the American Association of Gynecologic Laparoscopists》2002,9(3):352-358
STUDY OBJECTIVE: To compare the diagnosis and management of ectopic (EP) and heterotopic pregnancies (HP). DESIGN: Retrospective comparative study (Canadian Task Force classification II-2). SETTING: University tertiary referral center for endoscopic surgery. PATIENTS: Twelve women with HP and 210 women with laparoscopically confirmed EP. INTERVENTION: Laparoscopic treatment. MEASUREMENTS AND MAIN RESULTS: Among the 12 women with HP, all but 1 had received ovulation induction, 10 underwent in vitro fertilization-embryo transfer, and 1 conceived with clomiphen citrate. In the EP group 33 patients (15.7%) conceived spontaneously (p <0.05). Six women (50%) with HP had had previous pelvic surgery and three had a history of EP and salpingectomy. Four patients (33.4%) with HP and 29 (13.8%) with EP suffered from hypovolemic shock and required blood transfusion (p <0.05). Three of these four women with HP experienced physician and patient delays before admission. The sonographic diagnosis was correct in all women with HP and in 94.3% of women with EP. The median gestational age at diagnosis was 7.5 and 7.2 weeks for HP and EP, respectively. Six (50%) women with HP had evidence of fetal pulse in the ectopic gestation compared with 17 (8.1%) with EP (p <0.05). In addition, 66.7% and 24.7%, respectively, had ruptured tube (p <0.05). Mean +/- SD hemoperitoneum was 833.4 +/- 777 and 305 +/- 121 ml, respectively (p <0.05). Conversion to laparotomy was required in one (8.3%) and eight (3.8%) women, respectively (p <0.05). No major operative or postoperative maternal complications occurred in either group. Two women with HP had miscarriages, two have a continuing pregnancy, and eight delivered healthy newborns. CONCLUSION: Women with HP are at significantly greater risk for hypovolemic shock and requiring blood transfusion than those with EP. The diagnosis of EP in cases of HP is difficult due to the presence of an intrauterine gestational sac and hyperstimulated ovaries. A greater level of suspicion may allow early laparoscopic intervention before life-threatening intraabdominal bleeding has occurred. 相似文献
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