Embarazo ectópico primario en epiplón. Reporte de caso

Abdominal pregnancy occurs in one out of 10,000 deliveries. Omental ectopic pregnancy is the least common of these pregnancies and diagnosis is generally made during laparotomy. We report the case of a 28-year-old woman, secundigesta, secundípara, who presented with menstrual delay, cutaneous-mucosal pallor, and severe abdominal pain. During laparotomy, the presence of omentum was observed in the pelvis and uterus. Both adnexa were normal. A tumor was found on the inferior border of the omentum. The tumor was removed and partial omentectomy was performed. A primary omental ectopic pregnancy was diagnosed.     

Embarazo ectópico: de la cirugía de urgencia al tratamiento médico. Evolución de la terapéutica en nuestro centro

Objective

To analyze changing trends in the management of ectopic pregnancy in the previous 9 years.

Material and methods

We performed a retrospective study of 355 patients with ectopic pregnancy treated at the Virgen de las Nieves University Hospital from 1998 to 2006. We reviewed and analyzed changes in treatment trends over this 9-year period.

Results

Medical treatment was initiated in 139 patients (39.15%), with a failure rate of 10.07%. Surgery was performed in 230 women (60.85%). Of these, laparoscopy was performed in 121 and laparotomy in 109.

Conclusions

Laparoscopic surgery is currently the first-line therapeutic option in the management of tubal ectopic pregnancy. However, in the last few years, medical treatment has been shown to be safe and effective, allowing a less invasive approach.     

Embarazo ectópico abdominal. Diagnóstico y tratamiento médico con metotrexato

Abdominal pregnancy is a rare form of ectopic pregnancy and is associated with high maternal and fetal morbidity and mortality. The diagnosis of this entity is difficult and is generally delayed. We report the case of a patient with an abdominal pregnancy diagnosed by transvaginal ultrasound in the first trimester of pregnancy. The patient was treated with methotrexate until complete resolution. We provide a review of the literature on the risk factors, diagnostic tests and therapeutic options for abdominal pregnancy.     

Tratamiento médico del embarazo ectópico instersticial: descripción de un caso clínico

Traditional management of interstitial pregnancy involves laparotomy with cornual resection. Recent advances in transvaginal ultrasonography and sensitive beta-hCG assays have led to earlier diagnosis of these cases. We report a case of interstitial pregnancy successfully treated with parenteral methotrexate. Prompt recognition of interstitial pregnancy allows conservative approachment and systemic methotrexate presents as an effective and safe option.     

Embarazo ectópico recurrente ipsolateral

An ectopic pregnancy is a common pathology in the first trimester, with an increasing incidence due to several factors. Ruptured ectopic pregnancy is one of the most dangerous emergencies in the obstetric patient, since this is a condition responsible for most pregnancy-related deaths in the first trimester. Any woman in fertile age with vaginal bleeding and/or abdominal pain can have an ectopic pregnancy, therefore we must always be aware of it, even more so if our patient has risk factors, such as previous tubal surgery.     

Embarazo ectópico gemelar

Twin ectopic pregnancy is a rare diagnosis. The estimated incidence is 1/125,000 pregnancies. Among ectopic pregnancies, twin ectopic pregnancy represents a proportion of 1/200.     

Embarazo ectópico bilateral con embrión vivo en la trompa izquierda

Bilateral ectopic pregnancy with a live embryo is a rare occurrence. We report a case of bilateral ectopic pregnancy with live embryo in one tube and an interrupted gestation in the other tube, in a patient with no risk factors. When there is a unilateral ectopic pregnancy, even without risk factors, the other adnexal area and abdominal cavity should also be examined.     

Embarazo ectópico cervical: diagnóstico y tratamiento

We report a case of cervical ectopic pregnancy treated with methotrexate and abdominal hysterectomy.     

Abordaje conservador del embarazo ectópico cervical

Cervical pregnancy is a rare form of ectopic pregnancy with a high risk of hemorrhage. Early diagnosis is an important prognostic factor for survival and preserved fertility in these patients. We present the case of a patient diagnosed with cervical ectopic pregnancy in her seventh week of gestation. The therapeutic management was conservative and involved the combination of systemic and intra-amniotic methotrexate Because of the lower associated morbidity and mortality and the possibility of maintaining the patient’s fertility, conservative treatment is a viable therapeutic approach in cases such as that presented herein.     

Embarazo ectópico bilateral espontáneo

Spontaneous bilateral ectopic pregnancy is a rare event and is difficult to diagnose preoperatively. We report a case diagnosed by transvaginal ultrasonography in a patient without risk factors. Laparoscopic left salpingectomy and right linear salpingostomy were performed. This case illustrates the importance of carefully examining both adnexa when ultrasound examination or surgery are performed.     

Embarazo ectópico sobre cicatriz de cesárea previa. Caso clínico

Ectopic cesarean scar pregnancy is a very rare process that has the potential for very severe complications. However, due to the low frequency of this entity, there are no clear protocols for its treatment and many different treatment plans, both medical and surgical, are currently applied.We report the case of a patient with an ectopic pregnancy in a previous cesarean scar, diagnosed by transvaginal ultrasound scan and treated by total abdominal hysterectomy, since the patient did not wish to preserve her fertility.     

Embarazo ectópico ovárico

Ovarian pregnancy is an uncommon type of ectopic pregnancy. Preoperative diagnosis is difficult. Some cases are diagnosed during surgery and most need to be confirmed by histopathological study. The treatment of choice is conservative ovarian surgery to preserve fertility such as enucleation of the gestational sac or wedge resection of the ovary, preferably by laparoscopy. In some cases intramuscular methotrexate could be effective. We report two cases of ectopic ovarian pregnancy in our hospital.     

Tratamiento médico de la gestación ectópica cervical: Nuevos avances

We report a case of cervical ectopic pregnancy with successful conservative treatment. The patient was treated with systemic methotrexate injections, which initially proved effective. However, severe genital bleeding subsequently developed, requiring cervical dilation and curettage for resolution. A radical change in the therapeutic approach was not required.     

Tratamiento del embarazo ectópico cervical con metotrexato y rescate con leucovorina

Objective

To present two cases of cervical ectopic pregnancy successfully treated with systemic methotrexate.

Subjects and methods

Two women with a cervical ectopic pregnancy. Interventions: alternative day regime of methotrexate 1 mg/kg (days 1,3,5 and 7) with folinic acid rescue (days 2, 4, 6, and 8). End points: successful treatment.

Results

Two cases of ectopic cervical pregnancy were successfully treated and preserved their reproductive capability.

Conclusions

Conservative medical treatment of cervical ectopic pregnancy with systemic methotrexate is safe and effective.     

Evaluación del tratamiento médico del embarazo ectópico con metotrexato

Objectives

To evaluate the efficacy of medical treatment with methotrexate in ectopic pregnancy.

Material and methods

We performed a prospective observational study of the use and effectiveness of medical treatment with methotrexate in patients diagnosed with ectopic pregnancy in the Ciudad Real University General Hospital from 2008 to 2009. A single intramuscular dose was administered in patients who met the inclusion criteria. Medical treatment was considered to have failed when surgery was required. We analyzed the economic costs of medical and surgical treatment.

Results

We diagnosed 63 cases of ectopic pregnancy. Forty patients (63.5%) were treated with methotrexate, and 23 women (36.5%) who did not meet the criteria for inclusion in the protocol for medical treatment were treated surgically (laparoscopic salpingectomy). Among patients who received methotrexate, 30 (82.5%) required only one dose and 10 (17.5%) required two doses. Methotrexate treatment was successful in 30 patients (75%) and failed in 10 (25%), who underwent a laparoscopic salpingectomy. The cost per case of medical treatment was 580 €, which was less than the cost of laparoscopic surgical treatment (3,465.8 €).

Conclusions

Methotrexate treatment of ectopic pregnancy in selected patients is as effective as the standard treatment with laparoscopy with less cost and with high acceptance by patients.     

Embarazo ectópico intersticial: tratamiento laparoscópico

The interstitial ectopic pregnancy is a rare condition, accounting for 2-4% of all ectopic pregnancies. It is difficult to diagnose both for its location and for its rarity. The treatment of choice is laparoscopic management. We present a case of interstitial ectopic pregnancy in which laparoscopy was useful in two ways, as a diagnostic tool and for its treatment.     

Saco y pseudosaco. Su importancia en el diagnóstico diferencial ecográfico de la gestación ectópica

We report the case of a pregnant woman who presented to the emergency department with slight vaginal bleeding in the first trimester of pregnancy. The the differential diagnosis between eutopic, heterotopic and tubal ectopic pregnancy was hampered by the presence of an intrauterine pseudosac. The clinical course was complicated by spontaneous rupture of a tubal ectopic pregnancy, which required curettage and laparotomic salpingectomy. The postoperative outcome was favorable.     

Manejo actual del embarazo ectópico en la paciente estéril y en la que se desea conservar su fertilidad futura. Actualización

This article aims to provide an update on the most effective treatment of ectopic pregnancy (EP) in patients wishing to preserve future fertility.     

Gigantomastia gravídica asociada a tejido mamario ectópico vulvar

We report the case of a primigravida who had previously undergone breast reduction and who developed gigantomastia associated with a vulvar adenoma, diagnosed as an ectopic mammary adenoma. Despite its low frequency, physicians should be familiar with this entity due to its major effects on the patient and health team, requiring decisions with important repercussions on the health – and sometimes life – of the woman and fetus.     

Tratamiento conservador del embarazo ectópico cornual

Cornual pregnancy is and infrequent type of ectopic pregnancy. With the use of transvaginal ultrasounds we can make an earlier diagnostic and try a conservative treatment with metotrexate.