Normal pregnancy after laser salpingostomy, blighted ovum, and right tubal pregnancy treated with methotrexate

The 8-years lasting primary infertility in 28 years old woman was caused by bilateral hydrosalpinx, anovulation and husband's oligozoospermia. CO2 laser salpingostomy, treatment of the husband and ovulation induction with clomiphene citrate were successful. The consecutive pregnancies were achieved: 1. blighted ovum, 2. right tubal pregnancy cured with (MTX), 3. normal pregnancy.     

Intravaginal 400 microg misoprostol for pregnancy termination in cases of blighted ovum: a randomised controlled trial

OBJECTIVE: To investigate the effectiveness and side effects of intravaginal misoprostol 400 micrograms compared with a placebo for facilitating complete abortion in cases of blighted ovum. DESIGN: A prospective randomised placebo-controlled trial. SETTING: Rajavithi Hospital, Thailand between 1 July 1998 and 31 January 1999. SAMPLE: Fifty-four pregnant women with gestations of up to 12 weeks whose diagnosis of blighted ovum had been made by transvaginal ultrasound. METHODS: The patients were assigned randomly into two equal groups; the study group received two tablets of vaginal misoprostol (200 micrograms/tablet), and the control group received two tablets of a vaginal placebo. RESULTS: The complete abortion rate was significantly higher in the women receiving misoprostol (63%) compared with those receiving the placebo (18.5%) (p < 0.05). Lower abdominal pain (74.1%) and fever (14.8%) were significantly higher in the study group than in the placebo group (22.2%) and (0%) respectively, (p < 0.05). CONCLUSION: Intravaginal 400 microg misoprostol is significantly more effective for termination of blighted ovum than placebo, but lower abdominal pain and fever are signifcantly higher in the misoprostol group.     

Twin pregnancy (intrauterine and cervical) after hemihysterectomy: case reports

This case report describes a twin pregnancy in a hemihysterectomized patient who had a pyhemocervix present in 1/2 of a double uterus. An ultrasonic scan of this 29-year-old patient presenting with a history of 12 weeks amenorrhea revealed a retroverted uterus which contained a single fetus and a placenta situated on the anterior uterine wall. 1 week later, she was admitted with painless vaginal bleeding, and 6 days later aborted a complete gestational sac which contained a female fetus. 2 days later a large cystic mass, the size of a 3-month pregnancy, was incised and found to house an ectopic pregnancy. This is believed to be the 1st report of a combined intrauterine and cervical pregnancy following a hemihysterectomy.     

Successful management of intrauterine twin and concomitant cervical pregnancy: a case report

Use of in vitro fertilization techniques increases the frequency of pathological implantation. However, simultaneous pregnancies are a rarity. Ectopic implantation of the embryo may occur in the cervical canal. This is the first case report, which describes successful management of an intrauterine twin pregnancy which occurred simultaneously with a cervical pregnancy. Diagnostic and therapeutic options are discussed along with the outcome of pregnancies. The cervical pregnancy was removed by aspiration, without dilation of cervical canal, which saved the lives of intrauterine fetuses and preserved fertility for following pregnancies. Finally we review the advanced methods in the literature.     

Endocervical curettage after cryotherapy for cervical intraepithelial neoplasia

Two hundred forty-five patients were studied prospectively to determine the value of endocervical curettage (ECC) in the follow-up of patients having undergone cryotherapy for cervical intraepithelial neoplasia (CIN). Patients at high risk of treatment failure were divided into three groups: (I) CIN grade 3 lesions confined strictly to the ectocervix (86 patients), (II) CIN grade 1-3 lesions involving the endocervix to a depth of up to 5 mm and a negative ECC prior to cryotherapy (64 patients), and (III) CIN grade 1-3 lesions confined to the ectocervix or extending into the endocervix to a depth of up to 5 mm and a positive ECC (27 patients). A fourth group, 68 patients with CIN grade 1 and 2 lesions confined to the ectocervix, was considered to be at low risk of treatment failure and served as controls. All the patients had satisfactory colposcopy. ECC was performed at 6 and 12 months after cryotherapy. Recurrent or persistent CIN was diagnosed in 19 of 245 patients (8%) and was found in group I (6 of 86, or 8%), II (6 of 64, or 9%), III (3 of 27, or 11%) and IV (4 of 68, or 6%). The rates of treatment failure did not differ significantly between the various groups (p greater than 0.1). ECC was positive in 4 of 19 (21%) of the cryotherapy failures (group I, 1 of 6; II, 2 of 6; III, 1 of 3; IV, 0 of 4). In two cases of a positive follow-up ECC, cervical cytology was also positive.(ABSTRACT TRUNCATED AT 250 WORDS)     

宫颈妊娠及宫内孕合并宫颈妊娠的保守治疗

目的:探讨宫颈妊娠的病因、诊断及保守性治疗方法。方法:回顾分析我院1996年1月1日至2010年12月31日收治的宫颈妊娠及体外授精胚胎移植术后宫内孕合并宫颈妊娠患者36例,探讨宫颈妊娠保守治疗方式的选择,并随访患者术后情况。结果:29例单纯宫颈妊娠:6例外院误诊为"难免流产",误诊率20.69%;10例经阴道B超引导下宫颈妊娠囊局部穿刺+MTX注射治疗,6例行子宫动脉栓塞术,6例MTX肌内注射治疗,7例腰麻下宫腔镜检查宫颈妊娠清除手术。7例宫内孕合并宫颈妊娠:1例阴道B超引导下局部妊娠囊穿刺注入KCl 1ml,3例期待疗法后清除宫颈妊娠物,3例腹部B超引导下宫颈妊娠物清除术。结论:阴道彩超用于宫颈妊娠的早期诊断有较大的价值,术前应充分评估,制定个体化的治疗方案。宫内孕合并宫颈妊娠的患者在腹部B超监测下清除宫颈妊娠物是有效的治疗方式之一,但要及时手术并且加强抗感染治疗。     

Heterotopic cervical and intrauterine pregnancy in a spontaneous cycle

BACKGROUND: Myomectomy is classically performed via laparotomy. Endoscopic surgery is limited for some indications. Vaginal myomectomy is a surgical procedure that has recently been evaluated. The aim of this study was to evaluate the feasibility, reproducibility and complication rate of vaginal myomectomy via posterior colpotomy. METHODS: A retrospective study was performed from November 1998 to February 2001 in three departments of gynaecology. RESULTS: Forty-five patients were involved, 17 (37.8%) of whom underwent laparoscopy before vaginal myomectomy for evaluation or treatment of a second pelvic disorder. Myomectomy was performed vaginally in 40 (89%) of the 45 patients. Peroperative laparotomy was required in five patients (11%), either because vaginal myomectomy proved impossible (four cases) or because of rectal injury (one case). One patient needed supplementary laparotomy on day 8 for the treatment of a pelvic abscess. CONCLUSION: Posterior vaginal myomectomy seems to be a feasible and reproducible surgical procedure. The success rate of vaginal myomectomy in this study was over 80%. Further randomised studies are needed to compare this procedure with laparotomy and laparoscopy.     

Treatment of heterotopic cervical and intrauterine pregnancy

OBJECTIVE: To find a suitable technique to selectively terminate a cervically implanted embryo while maintaining viability of a concomitant intrauterine pregnancy. METHODS: A 34-year-old patient achieved a twin pregnancy after 4 IVF attempts. Ultrasound revealed a viable intrauterine and cervical pregnancy. Given our experience with KCl injection for fetal reduction, we offered the patient an attempt to reduce the cervical pregnancy. RESULTS: Best visualization in this case was obtained by transabdominal scanning. A 6-inch 20-gauge spinal needle was inserted transcervically and maneuvered into the thorax of the embryo. Fetal heart rate ceased even before KCl could be injected. Then 3 cm(3) of saline were injected to provide better visualization of the cervical fetus, and to confirm absence of heart beat. The patient had minor vaginal bleeding for several days. The intrauterine pregnancy progressed uneventfully through 36(1)/(2) weeks with delivery of a healthy, 2, 700-gram newborn. CONCLUSION: Cervical pregnancy is usually considered a life-threatening event. Other factors such as concomitant intrauterine pregnancy and the patient's infertility history generally would be secondary concerns. In this case, we were able to selectively terminate the cervical pregnancy, while preserving the intrauterine one, allowing this couple to have a healthy newborn. Further cases will be necessary to appropriately define risk rates for such an approach.     

Successful transvaginal ultrasound-guided ablation of a cervical pregnancy in a patient with simultaneous intrauterine pregnancy after in vitro fertilization and embryo transfer

Heterotopic pregnancy, or simultaneous intrauterine and extrauterine gestation, is a relatively rare condition. However, induced ovulation and assisted reproductive technologies have markedly increased the incidence of this condition. In this article, a case of heterotopic pregnancy after in vitro fertilization and embryo transfer is presented in which the viable cervical pregnancy was treated by transvaginal ultrasound-guided puncture and injection of potassium chloride in conjunction with methotrexate at week 6 of gestation. At week 12 of gestation, the intrauterine gestation was viable and complete resorption of the cervical pregnancy had occurred. At week 30 of gestation, a healthy baby was delivered by Caesarian section after prelabour rupture of membranes.     

Successful transvaginal ultrasound-guided ablation of a cervical pregnancy in a patient with simultaneous intrauterine pregnancy after in vitro fertilization and embryo transfer

Heterotopic pregnancy, or simultaneous intrauterine and extrauterine gestation, is a relatively rare condition. However, induced ovulation and assisted reproductive technologies have markedly increased the incidence of this condition. In this article, a case of heterotopic pregnancy after in vitro fertilization and embryo transfer is presented in which the viable cervical pregnancy was treated by transvaginal ultrasound-guided puncture and injection of potassium chloride in conjunction with methotrexate at week 6 of gestation. At week 12 of gestation, the intrauterine gestation was viable and complete resorption of the cervical pregnancy had occurred. At week 30 of gestation, a healthy baby was delivered by Caesarian section after prelabour rupture of membranes.     

Concurrent intrauterine and ovarian pregnancy: a case report

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.