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Akdaş Reis Y, Akay A, Özkan M, Yılmaz Ergani S, Özkan S, Kınay T, Erkaya S. Non-tubal ectopic pregnancy treatment experiences of a tertiary care center. Arch Gynecol Obstet 2024:10.1007/s00404-023-07338-5. [PMID: 38252304 DOI: 10.1007/s00404-023-07338-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 12/07/2023] [Indexed: 01/23/2024]
Abstract
AIM To evaluate the incidence, the risk factors, and the treatment outcomes of Non-tubal ectopic pregnancies (NTEP) treated in a tertiary care center. MATERIAL AND METHODS A total of 110 NTEP cases treated between 2014 and 2019 were included in the retrospective study. The study cohort was divided into 6 groups according to the pregnancy localization: 87 cesarean scar pregnancies (CSPs), 7 ovarian pregnancies, 6 interstitial pregnancies, 4 rudimentary horn pregnancies, 4 abdominal pregnancies, and 2 cervical pregnancies. One woman rejected all treatment modalities. Demographic characteristics, treatment modalities, and outcomes of each group were evaluated. RESULTS In the study cohort, expectant management was performed in one (0.9%) woman. The methotrexate (MTX) treatment was administered in 29 (26.3%) women. Seventeen (15.4%) women underwent surgery, and 63 (57.2%) women underwent manual vacuum aspiration (MVA). A woman rejected all treatment modalities. Although 70.1% (n = 61) of CSPs were cured with MVA, 24.1% (n = 21) of them were treated with a single-dose MTX regimen in addition to MVA. The higher mean gestational sac size (33,9 ± 12,96 mm vs. 17,34 ± 9,87 mm), the higher mean gestational week (8,43 ± 1,16w vs. 6,66 ± 1,49w), the presence of fetal heartbeat (FHB) (90.5% vs. 26,2%) and the history of pelvic ınflammatory disease (PID) (38.1% vs. 6,6%) were found in the CSPs with MVA treatment failure (p < 0.05). CONCLUSION The management of NTEPs should be individualized according to the clinical and ultrasonographic findings. The size of the ectopic pregnancy mass, the gestational week, the presence of FHB, and the PID history were the predictive factors for the failure of MVA in CSP cases.
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Affiliation(s)
- Yıldız Akdaş Reis
- Department of Obstetrics and Gynecology, Etlik Zübeyde Hanım Maternity and Women's Health Teaching and Research Hospital, Ankara, Turkey.
| | - Arife Akay
- Department of Obstetrics and Gynecology, Etlik Zübeyde Hanım Maternity and Women's Health Teaching and Research Hospital, Ankara, Turkey
- Bingöl Maternity and Children Hospital, Bingöl, Turkey
| | - Merve Özkan
- Department of Perinatology, Etlik City Hospital, Ankara, Turkey
| | | | - Sadullah Özkan
- Department of Perinatology, Etlik City Hospital, Ankara, Turkey
| | - Tuğba Kınay
- Department of Obstetrics and Gynecology, Etlik Zübeyde Hanım Maternity and Women's Health Teaching and Research Hospital, Ankara, Turkey
| | - Salim Erkaya
- Department of Obstetrics and Gynecology, Bilkent City Hospital, Ankara, Turkey
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Ishikawa Y, Nakanishi K, Tsumura A, Murakami K, Nishiwaki K. Early abdominal wall ectopic pregnancy treated with laparoscopic surgery: A case report and literature review. J Obstet Gynaecol Res 2023; 49:2544-2548. [PMID: 37424208 DOI: 10.1111/jog.15739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 06/28/2023] [Indexed: 07/11/2023]
Abstract
The abdominal wall is a rare site of ectopic implantation. Laparoscopic surgery for early abdominal pregnancy, in contrast to its use for tubal ectopic pregnancy, remains controversial because of concerns regarding heavy bleeding at the implantation site. Treatment of early abdominal pregnancy must be individualized for each implantation site. Herein, we present a case of an early abdominal pregnancy implanted in the anterior abdominal wall that was successfully treated with laparoscopic surgery. A 28-year-old multiparous woman with a 6-week amenorrhea presented with acute abdominal pain. An ectopic pregnancy was suspected because of elevated serum human chorionic gonadotropin levels without a visible gestational sac on transvaginal ultrasonography. Diagnostic laparoscopy revealed a gestational sac hanging from the anterior abdominal wall near the previous cesarean section wound. Laparoscopic surgery was successfully performed, and the patient was discharged on postoperative day three. In the present case, laparoscopic surgery was beneficial.
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Affiliation(s)
- Yuta Ishikawa
- Department of Obstetrics and Gynecology, Wakkanai City Hospital, Wakkanai, Hokkaido, Japan
| | - Kentaro Nakanishi
- Department of Obstetrics and Gynecology, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Ai Tsumura
- Department of Obstetrics and Gynecology, Wakkanai City Hospital, Wakkanai, Hokkaido, Japan
| | - Koji Murakami
- Department of Obstetrics and Gynecology, Wakkanai City Hospital, Wakkanai, Hokkaido, Japan
| | - Kunihiko Nishiwaki
- Department of Obstetrics and Gynecology, Wakkanai City Hospital, Wakkanai, Hokkaido, Japan
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Dunphy L, Boyle S, Cassim N, Swaminathan A. Abdominal ectopic pregnancy. BMJ Case Rep 2023; 16:e252960. [PMID: 37775278 PMCID: PMC10546113 DOI: 10.1136/bcr-2022-252960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/01/2023] Open
Abstract
An ectopic pregnancy (EP) accounts for 1-2% of all pregnancies, of which 90% implant in the fallopian tube. An abdominal ectopic pregnancy (AEP) is defined as an ectopic pregnancy occurring when the gestational sac is implanted in the peritoneal cavity outside the uterine cavity or the fallopian tube. Implantation sites may include the omentum, peritoneum of the pelvic and abdominal cavity, the uterine surface and abdominal organs such as the spleen, intestine, liver and blood vessels. Primary abdominal pregnancy results from fertilisation of the ovum in the abdominal cavity and secondary occurs from an aborted or ruptured tubal pregnancy. It represents a very rare form of an EP, occurring in <1% of cases. At early gestations, it can be challenging to render the diagnosis, and it can be misdiagnosed as a tubal ectopic pregnancy. An AEP diagnosed >20 weeks' gestation, caused by the implantation of an abnormal placenta, is an important cause of maternal-fetal mortality due to the high risk of a major obstetric haemorrhage and coagulopathy following partial or total placental separation. Management options include surgical therapy (laparoscopy±laparotomy), medical therapy with intramuscular or intralesional methotrexate and/or intracardiac potassium chloride or a combination of medical and surgical management. The authors present the case of a multiparous woman in her early 30s presenting with heavy vaginal bleeding and abdominal pain at 8 weeks' gestation. Her beta-human chorionic gonadotropin (bHCG) was 5760 IU/L (range: 0-5), consistent with a viable pregnancy. Her transvaginal ultrasound scan suggested an ectopic pregnancy. Laparoscopy confirmed an AEP involving the pelvic lateral sidewall. Her postoperative 48-hour bHCG was 374 IU/L. Due to the rarity of this presentation, a high index of clinical suspicion correlated with the woman's symptoms; bHCG and ultrasound scan is required to establish the diagnosis to prevent morbidity and mortality.
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Affiliation(s)
- Louise Dunphy
- Department of Obstetrics and Gynaecology, Leighton Hospital, Crewe, UK
| | - Stephanie Boyle
- Department of Obstetrics and Gynaecology, Leighton Hospital, Crewe, UK
| | - Nadia Cassim
- Department of Obstetrics and Gynaecology, Leighton Hospital, Crewe, UK
| | - Ajay Swaminathan
- Department of Obstetrics and Gynaecology, Leighton Hospital, Crewe, UK
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Suryawan A, Rahardjo TM, Suparman E, Mahardhika JC. Right abdominal pregnancy with hemorrhagic shock after previous left tubal pregnancy: A case report. SAGE Open Med Case Rep 2023; 11:2050313X231180757. [PMID: 37359286 PMCID: PMC10285589 DOI: 10.1177/2050313x231180757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 05/22/2023] [Indexed: 06/28/2023] Open
Abstract
Abdominal pregnancy is the rarest ectopic pregnancies, with an incidence of 1 per 10,000 live births, and life-threatening because the symptoms are not specific and diagnosis is made after abdominal pain, amenorrhea and vaginal bleeding occur. We present a rare case of abdominal pregnancy in a 31-year-old Indonesian woman with severe abdominal pain within 24 hours before hospital admission, accompanied by nausea, vomiting, dizziness and weakness. She felt the pain increasing since the last 2 weeks and limiting her movement. She has a history of a left tubal pregnancy 5 years ago. Ultrasonography examination revealed an ectopic pregnancy, and she was rushed to the operation room for emergency exploratory laparotomy. An abdominal pregnancy was found, located in the right adnexa with excessive fluid in cavum Douglass and a foetus in around 11-12 weeks of gestation accompanied by free fluid in the subdiaphragmatic, subhepatic and pelvic cavity. The surgery was a successful, four units of whole blood were transfused, and the patient was safely discharged from the hospital. The current concept on management of abdominal pregnancy supports immediate surgical intervention with pregnancy termination, as found in this case, because the patient's condition is hemodynamically unstable indicating hemorrhagic shock correlated with massive hemoperitoneum. A prompt diagnosis and good teamwork in treatment plays an important role for such a life-threatening condition to avoid maternal morbidity and mortality in a case of abdominal pregnancy.
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Affiliation(s)
- Aloysius Suryawan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Maranatha Christian University, Bandung, Indonesia
| | - Theresia Monica Rahardjo
- Department of Anesthesia and Intensive Care, Faculty of Medicine, Maranatha Christian University, Bandung, Indonesia
| | - Erna Suparman
- Department of Obstetrics and Gynecology, Prof. Dr. R. D. Kandou Hospital, Faculty of Medicine, Sam Ratulangi University, Manado, Indonesia
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Mamo A, Adkins K. Abdominal Pregnancy: Pathophysiology, Diagnosis, and Treatment. J Gynecol Surg 2022. [DOI: 10.1089/gyn.2022.0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Andrina Mamo
- University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Katlynn Adkins
- University of Colorado School of Medicine, Aurora, Colorado, USA
- Department of Obstetrics and Gynecology, Denver Health and Hospital Authority, Denver, Colorado, USA
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Sohner M. Hidden between the Folds: An Exceedingly Rare Omental Pregnancy. J Minim Invasive Gynecol 2021; 28:1966-1968. [PMID: 34329745 DOI: 10.1016/j.jmig.2021.07.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 07/19/2021] [Accepted: 07/25/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Marie Sohner
- Department of Maternal-Child Heatlh, Health Corporation of America (HCA) Houston Healthcare Tomball, Tomball, TX.
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Diagnosis and Management of Ectopic Pregnancy: A Comparative Review of Major National Guidelines. Obstet Gynecol Surv 2021; 75:611-623. [PMID: 33111962 DOI: 10.1097/ogx.0000000000000832] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Importance Ectopic pregnancies (EPs) represent a severe early pregnancy complication that is associated with increased risks of maternal morbidity and mortality. Over the years, there has been a significant reduction in the mortality from this complication by improving the diagnostic tools and the treatment options. Objective The aim of this study was to review and compare the recommendations from published guidelines on this potentially fatal condition. Evidence Acquisition A descriptive review of guidelines from the Royal College of Obstetricians and Gynaecologists, the Royal College of Physicians of Ireland, the Society of Obstetricians and Gynaecologists of Canada, the American College of Obstetricians and Gynecologists, and the National Institute for Health and Care Excellence on EP was carried out. Results All the guidelines point out the crucial role of sonography in the prompt diagnosis of EP and describe similar sonographic findings. There is a consensus on the indications and contraindications to the use of methotrexate, the post-treatment surveillance, and the criteria of expectant management. The indications for a surgical approach are not well established, although the Royal College of Obstetricians and Gynaecologists, the Royal College of Physicians of Ireland, the American College of Obstetricians and Gynecologists, and the National Institute for Health and Care Excellence agree that a laparoscopy is preferred to laparotomy for hemodynamically stable patients. The latter is considered a better option only in emergency conditions. However, there is controversy in the recommended methotrexate protocols and the evaluation of β-human chorionic gonadotrophin and progesterone levels. Conclusion It is of paramount importance to build consistent international protocols, so as to help clinicians all over the world diagnose EPs in the most timely and accurate way and subsequently treat them effectively as a nonurgent medical condition, with the intention to lower the mortality and morbidity rate.
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Bhinder KK, Sarfraz A, Sarfraz Z, Riaz S, Aslam S, Ameena Z. Uterine artery embolization combined with methotrexate for broad ligament ectopic pregnancy in a 30-year old primigravida. Radiol Case Rep 2021; 16:2248-2251. [PMID: 34188737 PMCID: PMC8217555 DOI: 10.1016/j.radcr.2021.05.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 05/10/2021] [Indexed: 11/13/2022] Open
Abstract
We present the case of 30-year old primigravida female at 11 weeks' gestation who was diagnosed to have ectopic pregnancy on obstetric ultrasound. An MRI pelvis was ordered to assess invasion into the posterior myometrium which confirmed a single right-sided broad ligament-extra uterine pelvic ectopic pregnancy with extrinsic mass effect on the right lower uterine segment without frank myometrial invasion. On an urgent basis, a uterine artery embolization (UAE) was performed by targeting the right femoral artery. Selective catheterization was performed of both uterine arteries and the right side showed a major feeder of the gestational sac. Supplied dose of methotrexate (95mg) was infused in the right uterine artery and both arteries were then embolized by gel foam slurry. Thus, prompt treatment reduced the risk of infertility and saved the patient from obstetrical emergency. Further exploration needs to be done in this field to explore conservative management options to preserve fertility.
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Affiliation(s)
| | - Azza Sarfraz
- The Aga Khan University, Karachi, Pakistan,Corresponding author: Azza Sarfraz, MBBS, Research Associate, Department of Pediatrics and Child Health Faculty, Office Building, Aga Khan University, P.O Box 3500, Stadium Road Karachi, 74800, Pakistan.
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Po L, Thomas J, Mills K, Zakhari A, Tulandi T, Shuman M, Page A. Guideline No. 414: Management of Pregnancy of Unknown Location and Tubal and Nontubal Ectopic Pregnancies. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2021; 43:614-630.e1. [PMID: 33453378 DOI: 10.1016/j.jogc.2021.01.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To provide an evidence-based algorithm to guide the diagnosis and management of pregnancy of unknown location and tubal and nontubal ectopic pregnancy. TARGET POPULATION All patients of reproductive age. BENEFITS, HARMS, AND COSTS The implementation of this guideline aims to benefit patients with positive β-human chorionic gonadotropin results and provide physicians with a standard algorithm for expectant, medical, and surgical treatment of pregnancy of unknown location and tubal pregnancy and nontubal ectopic pregnancies. EVIDENCE The following search terms were entered into PubMed/Medline and Cochrane in 2018: cesarean section, chorionic gonadotropin, beta subunit, human/blood, fallopian tubes/surgery, female, fertility, humans, infertility, laparoscopy, methotrexate, methotrexate/administration & dosage, methotrexate/therapeutic use, pregnancy (abdominal, angular, cervix, cornual, ectopic, ectopic/diagnosis, ectopic/diagnostic imaging, ectopic/drug therapy, ectopic/epidemiology, ectopic/mortality, ectopic/surgery, heterotopic, interstitial, isthmo-cervical, ovarian, tubal, unknown location), recurrence, risk factors, salpingectomy, salpingostomy, tubal pregnancy, ultrasonography, doppler ultrasonography, and prenatal. Articles included were randomized controlled trials, meta-analyses, systematic reviews, observational studies, and case reports. Additional publications were identified from the bibliographies of these articles. Only English-language articles were reviewed. VALIDATION METHODS The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and weak recommendations). INTENDED AUDIENCE Obstetrician-gynaecologists, family physicians, emergency physicians, midwives, registered nurses, nurse practitioners, medical students, and residents and fellows. SUMMARY STATEMENTS (GRADE RATINGS IN PARENTHESES) RECOMMENDATIONS (GRADE RATINGS IN PARENTHESES).
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Fessehaye A, Gashawbeza B, Daba M, Arusi M, Terefe T. Abdominal ectopic pregnancy complicated with a large bowel injury: a case report. J Med Case Rep 2021; 15:127. [PMID: 33745446 PMCID: PMC7983259 DOI: 10.1186/s13256-021-02713-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 02/02/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Abdominal pregnancy accounts for 0.6 to 4% of all ectopic pregnancies. Due to delays in diagnosis and difficulties in the management of abdominal pregnancy, the risk of mortality is significantly higher than for uncomplicated ectopic pregnancies. A 23 years-old gravida-II, ectopic-I Ethiopian woman was initially managed as a case of missed second trimester abortion. Later on, abdominal ectopic pregnancy was diagnosed with ultrasound and she underwent a laparotomy. Though fetus and placenta was removed successfully without significant hemorrhage, there was inadvertent sigmoid colon injury. CONCLUSION In the management of abdominal ectopic pregnancy, the possibility of bowel injury during entry to the abdominal cavity at laparotomy should always be considered and an experienced general surgeon should always be in attendance before opening the abdomen, to prevent it from happening.
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Affiliation(s)
- Abraham Fessehaye
- Department of Obstetrics and Gynecology, Saint Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Biruck Gashawbeza
- Department of Obstetrics and Gynecology, Saint Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Mekdes Daba
- Department of Obstetrics and Gynecology, Saint Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Muhudin Arusi
- St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Tsega Terefe
- Department of Surgery, Saint Paul’s Hospital millennium Medical College, Addis Ababa, Ethiopia
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Wong CH, Wang YL, Huang JP. Postoperative reproductive outcomes in women with ovarian pregnancy: A retrospective analysis. Taiwan J Obstet Gynecol 2021; 60:295-298. [PMID: 33678330 DOI: 10.1016/j.tjog.2021.01.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2020] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE The reproductive outcomes of ovarian pregnancy are currently unknown. Therefore, the objective of our study was to report the pregnancy outcomes of women with laparoscopically treated ovarian pregnancy. MATERIALS AND METHODS In this retrospective case analysis, unpublished cases of ovarian pregnancy between 2009 and 2016 were reviewed. Women were followed up for 3 years to obtain subsequent pregnancy data. RESULTS A total of 21 women who intended to become pregnant were included in this study. Predisposing risk factors for ovarian pregnancy including previous pelvic surgery (23.81%), presentation of pelvic endometriosis (23.81%), and prior intrauterine device insertion (9.52%) were identified. The major symptom at presentation was abdominal pain (85.71%), and no preoperative sonographic diagnosis of ovarian pregnancy was identified. Laparoscopic wedge resection was performed in most women (90.48%). During the 3-year follow-up period, spontaneous intrauterine pregnancy was observed in 13 women (61.90%), 2 women (9.52%) became pregnant through artificial insemination treatment, and 6 women are not able to get pregnant (28.57%). None of the women experienced recurrent ectopic pregnancy. CONCLUSION The postoperative pregnancy outcomes of women with ovarian pregnancy were encouraging. In this study, the spontaneous intrauterine pregnancy rate was favorable, and no cases of recurrent ectopic pregnancy were reported.
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Affiliation(s)
- Chian-Huey Wong
- Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan
| | - Yeou-Lih Wang
- Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan
| | - Jian-Pei Huang
- Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan.
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Rokhgireh S, Gorginzadeh M, Mehdizadehkashi A, Tahermanesh K, Alizadeh S. Broad ligament pregnancy in the presence of an intrauterine contraceptive device: A case report. Int J Surg Case Rep 2021; 79:421-423. [PMID: 33529821 PMCID: PMC7851414 DOI: 10.1016/j.ijscr.2021.01.080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 01/15/2021] [Accepted: 01/15/2021] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Abdominal pregnancy though scarce is associated with considerable morbidity and mortality. Few cases till now have been diagnosed or managed by laparoscopy. CASE PRESENTATION In this study, a case of an abdominal pregnancy in a woman with intrauterine contraceptive device (IUD) in situ and a history of cesarean section is described. CLINICAL DISCUSSION Our case was a brief description of a broad ligament pregnancy as a subcategory of abdominal pregnancy .It was located medial to the pelvic sidewall, lateral to the uterus, inferior to the fallopian tube and superior to the pelvic floor. CONCLUSION The pregnancy was in the location of the left broad ligament which was diagnosed on laparoscopic evaluation.
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Affiliation(s)
- Samaneh Rokhgireh
- Endometriosis Research Center, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Mansoureh Gorginzadeh
- Endometriosis Research Center, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | | | - Kobra Tahermanesh
- Endometriosis Research Center, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Shima Alizadeh
- Department of Obstetrics & Gynecology, Emam Complex, Vali-e-Asr Hospital, Tehran University of Medical Science(TUMS), Tehran, Iran.
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Po L, Thomas J, Mills K, Zakhari A, Tulandi T, Shuman M, Page A. Directive clinique n o 414 : Prise en charge des grossesses de localisation indéterminée et des grossesses ectopiques tubaires et non tubaires. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2021; 43:631-649.e1. [PMID: 33453377 DOI: 10.1016/j.jogc.2021.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIF Fournir un algorithme fondé sur des données probantes pour orienter le diagnostic et la prise en charge de la grossesse de localisation indéterminée et de la grossesse ectopique tubaire ou non tubaire. POPULATION CIBLE Toutes les patientes en âge de procréer. BéNéFICES, RISQUES ET COûTS: La mise en œuvre de la présente directive a pour objectif de bénéficier aux patientes ayant obtenu un résultat positif pour la sous-unité bêta de la gonadotrophine chorionique et de fournir aux médecins un algorithme normalisé pour l'expectative et le traitement pharmacologique ou chirurgical en cas de grossesse de localisation indéterminée et de grossesse ectopique tubaire ou non tubaire. DONNéES PROBANTES: Les termes de recherche suivants ont été entrés dans les bases de données PubMed-Medline et Cochrane en 2018 : cesarean section, chorionic gonadotropin, beta subunit, human/blood, fallopian tubes/surgery, female, fertility, humans, infertility, laparoscopy, methotrexate, methotrexate/administration & dosage, methotrexate/therapeutic use, pregnancy (abdominal, angular, cervix, cornual, ectopic, ectopic/diagnosis, ectopic/diagnostic imaging, ectopic/drug therapy, ectopic/epidemiology, ectopic/mortality, ectopic/surgery, heterotopic, interstitial, isthmo-cervical, ovarian, tubal, unknown location), recurrence, risk factors, salpingectomy, salpingostomy, tubal pregnancy, ultrasonography, doppler ultrasonography et prenatal. Les articles retenus sont des essais cliniques randomisés, des méta-analyses, des revues systématiques, des études observationnelles et des études de cas. Des publications supplémentaires ont été sélectionnées à partir des notices bibliographiques de ces articles. Seuls les articles en anglais ont été examinés. MéTHODES DE VALIDATION: Les auteurs ont évalué la qualité des données probantes et la solidité des recommandations en utilisant la méthodologie GRADE (Grading of Recommendations Assessment, Development and Evaluation). Voir l'annexe A en ligne (tableau A1 pour les définitions et tableau A2 pour l'interprétation des recommandations fortes et faibles). PUBLIC VISé: Obstétriciens-gynécologues, médecins de famille, urgentologues, sages-femmes, infirmières autorisées, infirmières praticiennes, étudiants en médecine, résidents et moniteurs cliniques. DÉCLARATIONS SOMMAIRES (CLASSEMENT GRADE ENTRE PARENTHèSES): RECOMMANDATIONS (CLASSEMENT GRADE ENTRE PARENTHèSES).
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Abstract
BACKGROUND Non-tubal ectopic pregnancy is the implantation of an embryo at a site lying outside the uterine cavity or fallopian tubes. Sites include a caesarean scar, the cornua uteri, the ovary, the cervix, and the abdomen. There has been an increasing trend in the occurrence of these rare conditions, especially caesarean scar pregnancy (CSP). OBJECTIVES To evaluate the clinical effectiveness and safety of surgery, medical treatment, and expectant management of non-tubal ectopic pregnancy in terms of fertility outcomes and complications. SEARCH METHODS We searched the Cochrane Gynaecology and Fertility (CGF) Group Specialised Register of Controlled Trials, CENTRAL, MEDLINE, Embase, ClinicalTrials.gov, the World Health Organization (WHO) search portal and nine other databases to 12 December 2019. We handsearched reference lists of articles retrieved and contacted experts in the field to obtain additional data. SELECTION CRITERIA We included randomized controlled trials (RCTs) published in all languages that examined the effects and safety of surgery, medical treatment, and expectant management of non-tubal ectopic pregnancy. DATA COLLECTION AND ANALYSIS We used Cochrane standard methodological procedures. Primary outcomes were treatment success and complications. MAIN RESULTS We included five RCTs with 303 women, all reporting Caesarean scar pregnancy. Two compared uterine arterial embolization (UAE) or uterine arterial chemoembolization (UACE) plus methotrexate (MTX) versus systemic MTX and subsequent dilation and suction curettage; one compared UACE plus MTX versus ultrasonography-guided local MTX injection; and two compared suction curettage under hysteroscopy versus suction curettage under ultrasonography after UAE/UACE. The quality of evidence ranged from moderate to very low. The main limitations were imprecision (small sample sizes and very wide confidence intervals (CI) for most analyses), multiple comparisons with a small number of trials, and insufficient data available to assess heterogeneity. UAE/UACE versus systemic MTX prior to suction curettage Two studies reported this comparison. One compared UAE with systemic MTX and one compared UACE plus MTX versus systemic MTX, in both cases followed by a suction curettage. We are uncertain whether UAE/UACE improved success rates after initial treatment (UAE: risk ratio (RR) 1.00, 95% CI 0.90 to 1.12; 1 RCT, 72 women; low-quality evidence; UACE: RR 0.87, 95% CI 0.54 to 1.38; 1 RCT, 28 women; low-quality evidence). We are uncertain whether UAE/UACE reduced rates of complications (UAE: RR 0.47, 95% CI 0.13 to 1.75; 1 RCT, 72 women; low-quality evidence; UACE: RR 0.62, 95% CI 0.26 to 1.48; 1 RCT, 28 women; low-quality evidence). We are uncertain whether UAE/UACE reduced adverse effects (UAE: RR 1.58, 95% CI 0.41 to 6.11; 1 RCT, 72 women; low-quality evidence; UACE: RR 1.16, 95% CI 0.32 to 4.24; 1 RCT, 28 women; low-quality evidence), and it was not obvious that the types of events had similar values to participants (e.g. fever versus vomiting). Blood loss was lower in UAE/UACE groups than systemic MTX groups (UAE: mean difference (MD) -378.70 mL, 95% CI -401.43 to -355.97; 1 RCT, 72 women; moderate-quality evidence; UACE: MD -879.00 mL, 95% CI -1135.23 to -622.77; 1 RCT, 28 women; moderate-quality evidence). Data were not available on time to normalize β-human chorionic gonadotropin (β-hCG). UACE plus MTX versus ultrasonography-guided local MTX injection We are uncertain whether UACE improved success rates after initial treatment (RR 0.95, 95% CI 0.56 to 1.60; 1 RCT, 45 women; very low-quality evidence). Adverse effects: the study reported the same number of failed treatments in each arm (RR 0.88, 95% CI 0.40 to 1.92; 1 RCT, 45 women). We are uncertain whether UACE shortened the time to normalize β-hCG (MD 1.50 days, 95% CI -3.16 to 6.16; 1 RCT, 45 women; very low-quality evidence). Data were not available for complications. Suction curettage under hysteroscopy versus under ultrasonography after UAE/UACE. Two studies reported this comparison. One compared suction curettage under hysteroscopy versus under ultrasonography after UAE, and one compared these interventions after UACE. We are uncertain whether suction curettage under hysteroscopy improved success rates after initial treatment (UAE: RR 0.91, 95% CI 0.81 to 1.03; 1 RCT, 66 women; very low-quality evidence; UACE: RR 1.02, 95% CI 0.96 to 1.09; 1 RCT, 92 women; low-quality evidence). We are uncertain whether suction curettage under hysteroscopy reduced rates of complications (UAE: RR 4.00, 95% CI 0.47 to 33.91; 1 RCT, 66 women; very low-quality evidence; UACE: RR 0.18, 95% CI 0.01 to 3.72; 1 RCT, 92 women; low-quality evidence). We are uncertain whether suction curettage under hysteroscopy reduced adverse effects (UAE: RR 3.09, 95% CI 0.12 to 78.70; 1 RCT, 66 women; very low-quality evidence; UACE: not estimable; 1 RCT, 92 women; very low-quality evidence). We are uncertain whether suction curettage under hysteroscopy shortened the time to normalize β-hCG (UAE: MD 4.03 days, 95% CI -1.79 to 9.85; 1 RCT, 66 women; very low-quality evidence; UACE: MD 0.84 days, 95% CI -1.90 to 3.58; 1 RCT, 92 women; low-quality evidence). Non-tubal ectopic pregnancy other than CSP No studies reported on non-tubal ectopic pregnancies in locations other than on a caesarean scar. AUTHORS' CONCLUSIONS For Caesarean scar pregnancies (CSP) it is uncertain whether there is a difference in success rates, complications, or adverse events between UAE/UACE and administration of systemic MTX before suction curettage (low-quality evidence). Blood loss was lower if suction curettage is conducted after UAE/UACE than after administration of systemic MTX (moderate-quality evidence). It is uncertain whether there is a difference in treatment success rates, complications, adverse effects or time to normalize β-hCG between suction curettage under hysteroscopy and under ultrasonography (very low-quality evidence). There are no studies of non-tubal ectopic pregnancy other than CSP and RCTs for these types of pregnancy are unlikely.
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Affiliation(s)
- Ying Long
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Huili Zhu
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Yuanyuan Hu
- Department of Obstetrics and Gynaecology, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Licong Shen
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Jing Fu
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Wei Huang
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China
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Wong JQE, Lim YH. Early Abdominal Ectopic Pregnancy Masquerading as a Missed Miscarriage. J Med Cases 2020; 11:169-173. [PMID: 34434391 PMCID: PMC8383645 DOI: 10.14740/jmc3484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 05/07/2020] [Indexed: 11/30/2022] Open
Abstract
A 43-year-old lady, gravida 2 para 0, presented to our emergency department with complaints of vaginal bleeding and lower abdominal pain. Her urine pregnancy test was positive. She was unable to recall her last menstrual period. A trans-vaginal ultrasound revealed a pregnancy with a crown rump length of 47 mm corresponding to 11.4 weeks with no fetal heartbeat detected. She was diagnosed with a missed miscarriage and was sent for a second confirmatory scan. The repeat scan was concordant with the initial scan and she was counseled for an evacuation of uterus. Her serum beta human chorionic gonadotropin level was 45,195 IU/L and her hemoglobin level was 6.5 g/dL. She underwent an evacuation of uterus as planned, but the Hegar dilator was only able to be advanced to a cavity length of 6 cm with minimal products of conception obtained. A bedside ultrasound was performed and it showed that the Hegar dilator was in the uterine cavity but not in continuity with the gestational sac and fetus. The diagnosis of an ectopic pregnancy was made and the surgery was converted to a diagnostic laparoscopy. On entry into the abdominal cavity, there was frank hemoperitoneum with adhesions limiting access to the pelvis, therefore decision was made to convert to laparotomy. The findings at laparotomy revealed a large inflamed left tubo-ovarian complex with tubal rupture and expulsion of the entire fetus and placenta into the Pouch of Douglas (POD). The diagnosis of a secondary implantation of the ectopic pregnancy in the POD after tubal rupture was confirmed and we performed adhesiolysis and left salpingectomy. The patient recovered uneventfully and the final histology showed products of conception within the lumen of the left fallopian tube in keeping with ruptured tubal ectopic pregnancy.
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Affiliation(s)
- Joy Qing En Wong
- Division of Obstetrics and Gynaecology, KK Women's and Children's Hospital, Singhealth, Singapore
| | - Yu Hui Lim
- Division of Obstetrics and Gynaecology, KK Women's and Children's Hospital, Singhealth, Singapore
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16
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Dolinko AV, Vrees RA, Frishman GN. Non-tubal Ectopic Pregnancies: Overview and Treatment via Local Injection. J Minim Invasive Gynecol 2018; 25:287-296. [DOI: 10.1016/j.jmig.2017.07.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 07/10/2017] [Accepted: 07/13/2017] [Indexed: 12/11/2022]
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Alalade AO, Smith FJE, Kendall CE, Odejinmi F. Evidence-based management of non-tubal ectopic pregnancies. J OBSTET GYNAECOL 2017. [PMID: 28631522 DOI: 10.1080/01443615.2017.1323852] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Recent advances in ultrasonography and the use of other modalities including magnetic resonance imaging scans have led to the early and more accurate diagnosis of non-tubal ectopic pregnancies (NTE). As a result, the management of these pregnancies has evolved. This article addresses the management options currently available for NTE. While surgical management remains the mainstay of treatment for ovarian, abdominal and cornual ectopics, there is growing evidence that some of these can be managed medically. Many authors have utilised a combination of medical and surgical approaches in the management of cervical and caesarean section (CS) scar ectopic pregnancies with good outcome. The availability of dedicated early pregnancy units has further improved diagnosis and more importantly the follow-up care for these patients. The rarity of cases and the difficulty of ethically organising randomised trials for NTE remain a problem in formulating consistent pathways for optimum management of women with NTE.
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Affiliation(s)
- Aderemi Olaoluwa Alalade
- a Department of Obstetrics and Gynaecology , Wrexham Maelor Hospital, Betsi Cadwaladr University Health Board , Wrexham , UK
| | - Fredrick John Ennis Smith
- b Cochrane Medical Education Centre, Institute of Medical Education, Cardiff University School of Medicine, Cardiff University , Cardiff , UK
| | - Charlotte Emma Kendall
- b Cochrane Medical Education Centre, Institute of Medical Education, Cardiff University School of Medicine, Cardiff University , Cardiff , UK
| | - Funlayo Odejinmi
- c Department of Obstetrics and Gynaecology, Barts Health NHS Trust , Whipps Cross University Hospital , London , England
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18
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Yasumoto K, Sato Y, Ueda Y, Ito T, Kawaguchi H, Nakajima M, Muneshige A. Expectant management for abdominal pregnancy. Gynecol Minim Invasive Ther 2016; 6:82-84. [PMID: 30254883 PMCID: PMC6113971 DOI: 10.1016/j.gmit.2016.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Revised: 09/18/2016] [Accepted: 11/09/2016] [Indexed: 12/25/2022] Open
Abstract
This is the first English language report describing the expectant management for abdominal pregnancy. The patient was a 31-year-old multiparous woman who was transferred to our hospital on suspicion of ectopic pregnancy. Her serum human chorionic gonadotropin was positive, and a poorly-vascularized mass measuring about 4 cm was visualized in the Douglas pouch by transvaginal ultrasonography, as well as by pelvic magnetic resonance imaging. Because the bilateral adnexa were apparently intact, she was diagnosed with abdominal pregnancy, and expectant management was commenced. Unexpectedly, the mass remained in situ for nearly 3 years after her serum human chorionic gonadotropin tested negative. Laparoscopic removal of the mass was finally required because of persistent defecation pain. This case illustrates that some abdominal pregnancies can be managed expectantly, as is the case with tubal pregnancies. During the expectant management, however, it should be considered that the abdominal pregnancy mass may persist for a longer period and cause moderate symptoms necessitating surgical removal.
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Affiliation(s)
- Koji Yasumoto
- Department of Obstetrics and Gynecology, Nagahama Red Cross Hospital, Nagahama, Japan
| | - Yukiyasu Sato
- Department of Obstetrics and Gynecology, Otsu Red Cross Hospital, Otsu, Japan
| | - Yusuke Ueda
- Department of Obstetrics and Gynecology, Nagahama Red Cross Hospital, Nagahama, Japan
| | - Takuma Ito
- Department of Obstetrics and Gynecology, Nagahama Red Cross Hospital, Nagahama, Japan
| | - Hiromi Kawaguchi
- Department of Obstetrics and Gynecology, Nagahama Red Cross Hospital, Nagahama, Japan
| | - Masataka Nakajima
- Department of Obstetrics and Gynecology, Nagahama Red Cross Hospital, Nagahama, Japan
| | - Akira Muneshige
- Department of Obstetrics and Gynecology, Nagahama Red Cross Hospital, Nagahama, Japan
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19
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Hishikawa K, Fukuda T, Inoue H, Kohata Y, Monma M, Ochiai N, Kubo Y, Watanabe R, Ako S, Aihara Y, Kusaka T. Laparoscopic Management of Abdominal Pregnancy with Local Injection of Vasopressin Solution: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2016; 17:637-40. [PMID: 27587187 PMCID: PMC5012457 DOI: 10.12659/ajcr.898554] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Patient: Female, 32 Final Diagnosis: Abdominal pregnancy Symptoms: Severe abdominal pain Medication: — Clinical Procedure: Laparoscopic treatment Specialty: Obstetrics and Gynecology
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Affiliation(s)
- Kenji Hishikawa
- Department of Obstetrics and Gynecology, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Takanori Fukuda
- Department of Obstetrics and Gynecology, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Hiromi Inoue
- Department of Obstetrics and Gynecology, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Yutaka Kohata
- Department of Obstetrics and Gynecology, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Mika Monma
- Department of Obstetrics and Gynecology, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Naomi Ochiai
- Department of Obstetrics and Gynecology, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Yuina Kubo
- Department of Obstetrics and Gynecology, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Remi Watanabe
- Department of Obstetrics and Gynecology, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Shiho Ako
- Department of Obstetrics and Gynecology, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Yuri Aihara
- Department of Obstetrics and Gynecology, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Takeshi Kusaka
- Department of Obstetrics and Gynecology, Shonan Kamakura General Hospital, Kanagawa, Japan
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21
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Panelli DM, Phillips CH, Brady PC. Incidence, diagnosis and management of tubal and nontubal ectopic pregnancies: a review. FERTILITY RESEARCH AND PRACTICE 2015; 1:15. [PMID: 28620520 PMCID: PMC5424401 DOI: 10.1186/s40738-015-0008-z] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 09/29/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND Ectopic pregnancy is a potentially life-threatening condition occurring in 1-2 % of all pregnancies. The most common ectopic implantation site is the fallopian tube, though 10 % of ectopic pregnancies implant in the cervix, ovary, myometrium, interstitial portion of the fallopian tube, abdominal cavity or within a cesarean section scar. FINDINGS Diagnosis involves a combination of clinical symptoms, serology, and ultrasound. Medical management is a safe and effective option in most clinically stable patients. Patients who have failed medical management, are ineligible, or present with ruptured ectopic pregnancy or heterotopic pregnancy are most often managed with excision by laparoscopy or, less commonly, laparotomy. Management of nontubal ectopic pregnancies may involve medical or surgical treatment, or a combination, as dictated by ectopic pregnancy location and the patient's clinical stability. Following tubal ectopic pregnancy, the rate of subsequent intrauterine pregnancy is high and independent of treatment modality. CONCLUSION This review describes the incidence, risk factors, diagnosis, and management of tubal and non-tubal ectopic and heterotopic pregnancies, and reviews the existing data regarding recurrence and future fertility.
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Affiliation(s)
- Danielle M. Panelli
- Department of Obstcpetrics and Gynecology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St., Boston, MA 02115 USA
| | - Catherine H. Phillips
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA USA
| | - Paula C. Brady
- Department of Obstcpetrics and Gynecology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St., Boston, MA 02115 USA
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22
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Gidiri MF, Kanyenze M. Advanced abdominal ectopic pregnancy: lessons from three cases from Zimbabwe and a literature appraisal of diagnostic and management challenges. ACTA ACUST UNITED AC 2015; 11:275-9. [PMID: 26102467 DOI: 10.2217/whe.15.3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
We report three cases illustrating difficulties in diagnosis and challenges with management of the placenta in a low-resource country where ultrasound scanning, methotrexate, interventional radiology or blood products are often not accessible for the majority of patients. Even in situations where an ultrasound scan is available prenatally as in our three cases, the diagnosis is often missed. All the cases presented with vague abdominal symptoms, which are common in pregnancy anyway. Only one case was correctly diagnosed before surgery by ultrasound scan. For the two cases in the second trimester as expected the fetuses did not survive. The one advanced pregnancy had a good perinatal outcome. Maternal morbidity and mortality usually results from perioperative hemorrhage from the placental attachment site. The most important aspect of management is the management of the placenta. In the two cases with second trimester pregnancies, it was possible to remove the placentas, even though blood loss was significant, hemostasis was achieved at surgery. All three mothers recovered well and survived.
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Affiliation(s)
- Muchabayiwa F Gidiri
- Academic Department of Obstetrics & Gynaecology, University of Zimbabwe College of Health Sciences, Parirenyatwa University Hospital, Mazowe Street, PO Box A178, Avondale Harare, Zimbabwe
| | - Miriam Kanyenze
- Mutare Provincial Hospital, Department of Obstetrics & Gynaecology, PO Box 30, Mutare, Zimbabwe
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23
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Miyauchi A, Yamada M, Furuya M, Matsumura S, Murayama S, Yoshimura Y, Tanaka M. Peritoneal pregnancy with massive hemoperitoneum in early gestation: two case reports. Clin Case Rep 2015; 3:431-7. [PMID: 26185643 PMCID: PMC4498857 DOI: 10.1002/ccr3.266] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Revised: 12/21/2014] [Accepted: 02/20/2015] [Indexed: 11/09/2022] Open
Abstract
Peritoneal pregnancy may cause severe abdominal bleeding without genital bleeding as early as the fifth week of gestation. Awareness that pregnancy can exist in unusual locations is imperative.
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Affiliation(s)
- Azumi Miyauchi
- Department of Obstetrics and Gynecology, Keio University School of Medicine 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Mitsutoshi Yamada
- Department of Obstetrics and Gynecology, Keio University School of Medicine 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Masataka Furuya
- Department of Obstetrics and Gynecology, Eiju General Hospital 2-23-16 Higashiueno, Taito-ku, Tokyo, 110-0015, Japan
| | - Satoko Matsumura
- Department of Obstetrics and Gynecology, Keio University School of Medicine 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Shinji Murayama
- Department of Obstetrics and Gynecology, Keio University School of Medicine 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Yasunori Yoshimura
- Department of Obstetrics and Gynecology, Keio University School of Medicine 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Mamoru Tanaka
- Department of Obstetrics and Gynecology, Keio University School of Medicine 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
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24
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Zahran KM, Ismail AM, Ali MK, Badran EY, Khalil MM, Shazly SA. Advanced Abdominal Pregnancy: An Unexpected Late Pregnancy Presentation. J Gynecol Surg 2015. [DOI: 10.1089/gyn.2014.0011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Kamal Mohammed Zahran
- Department of Obstetrics and Gynecology, Faculty of Medicine, Women's Health Hospital Assiut University, Assiut, Egypt
| | - Alaa M. Ismail
- Department of Obstetrics and Gynecology, Faculty of Medicine, Women's Health Hospital Assiut University, Assiut, Egypt
| | - Mohammed Khairy Ali
- Department of Obstetrics and Gynecology, Faculty of Medicine, Women's Health Hospital Assiut University, Assiut, Egypt
| | - Esraa Y. Badran
- Department of Obstetrics and Gynecology, Faculty of Medicine, Women's Health Hospital Assiut University, Assiut, Egypt
| | - Maraey M. Khalil
- Department of Obstetrics and Gynecology, Faculty of Medicine, Women's Health Hospital Assiut University, Assiut, Egypt
| | - Sherif A. Shazly
- Department of Obstetrics and Gynecology, Faculty of Medicine, Women's Health Hospital Assiut University, Assiut, Egypt
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25
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Yasutake N, Tsunematsu R, Oishi H, Yahata H, Uchida S, Kobayashi H, Kato K. Successfully treated abdominal pregnancy causing hemoperitoneum using combined surgical and systemic methotrexate therapy: a case report and review of cases treated at Kyushu University Hospital. Gynecol Obstet Invest 2013; 76:188-92. [PMID: 23969319 DOI: 10.1159/000353980] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Accepted: 06/19/2013] [Indexed: 11/19/2022]
Abstract
Abdominal pregnancy is a rare condition that accounts for only 1% of all ectopic pregnancies but results in high maternal morbidity and mortality. We present a case of abdominal pregnancy with massive peritoneal bleeding successfully treated using systemic methotrexate (MTX). A 34-year-old woman with amenorrhea for 8 weeks and a positive pregnancy test was referred for evaluation of ectopic pregnancy. Transvaginal ultrasonographic scan showed a gestational sac measuring 25 mm in diameter containing a viable embryo in the cul-de-sac and a considerable amount of free fluid in the patient's lower abdomen and pelvis. Laboratory parameters showed that her hemoglobin concentration was 5.8 g/dl and serum human chorionic gonadotropin concentration was 13,195 mIU/ml. Emergency surgery revealed an abdominal pregnancy in the cul-de-sac and a massive intra-abdominal hemorrhage. After a hemostasis procedure, the patient was successfully treated using systemic MTX. We also present the review of abdominal pregnancy cases treated using systemic MTX at our institution over 10 years. Systemic MTX treatment for abdominal pregnancy is safe and effective and makes it possible to avoid the risk of excessive bleeding by surgical resection of the implantation site.
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Affiliation(s)
- Nobuko Yasutake
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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26
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Orazulike NC, Konje JC. Diagnosis and Management of Ectopic Pregnancy. WOMENS HEALTH 2013; 9:373-85. [DOI: 10.2217/whe.13.35] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Ectopic pregnancy remains to be an important cause of maternal morbidity and mortality worldwide, although the incidence has remained unchanged especially in developed countries over the last decade. Several factors are responsible for this, including misdiagnosis and failure to institute timely appropriate treatment aimed at preserving fertility and minimizing the associated morbidity. Recent advances in imaging and biomonitoring have reduced the number of women presenting with ruptured ectopic pregnancy. Any attempt to reduce the consequences of ectopic pregnancies must, therefore, focus on improving the diagnosis of the unruptured type and evidenced-based treatment, which is cost effective. In this review, the authors discuss the diagnosis and treatment of this complication in the light of the recent evidence highlighting how improvements can be made to reduce the consequences.
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Affiliation(s)
- Ngozi C Orazulike
- Department of Obstetrics & Gynaecology, Faculty of Clinical Sciences, College of Health Sciences, University of Port Harcourt, Rivers State, Nigeria
| | - Justin C Konje
- Reproductive Sciences Section, Cancer Studies & Molecular Medicine, Robert Kilpatrick Clinical Sciences Building, Leicester Royal Infirmary, Leicester University, Leicester, LE2 7LX, UK
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27
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Fylstra DL. Ectopic pregnancy not within the (distal) fallopian tube: etiology, diagnosis, and treatment. Am J Obstet Gynecol 2012; 206:289-99. [PMID: 22177188 DOI: 10.1016/j.ajog.2011.10.857] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2011] [Revised: 09/29/2011] [Accepted: 10/16/2011] [Indexed: 12/16/2022]
Abstract
Ectopic pregnancy is a very common diagnosis (2% of pregnancies), and implantation location varies. Although 97% of ectopics are implanted within the fallopian tube, associated with commonly recognized risk factors, ectopic implantation can occur in other pelvic and abdominal locations that may not have such predisposing risk factors. After an extensive review of the literature, along with the author's personal experience, implantation frequency, etiologic possibilities, and treatment options for each ectopic pregnancy location are presented. When ectopic pregnancy is diagnosed early, before rupture, regardless of location, conservative, fertility-sparing treatment options can be successful in terminating the pregnancy. Predisposing risk factors and treatment options can vary and can be ectopic-location specific.
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Affiliation(s)
- Donald L Fylstra
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC, USA
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28
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Gorry A, Morelli ML, Olowu O, Shahid A, Odejinmi F. Laparoscopic management of abdominal ectopic pregnancy using FLOSEAL Hemostatic Matrix. Int J Gynaecol Obstet 2012; 117:83-4. [PMID: 22236450 DOI: 10.1016/j.ijgo.2011.11.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2011] [Revised: 11/08/2011] [Accepted: 12/06/2011] [Indexed: 11/19/2022]
Affiliation(s)
- Anwen Gorry
- Whipps Cross University Hospital NHS Trust, Leytonstone, London, UK.
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29
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Poole A, Haas D, Magann EF. Early Abdominal Ectopic Pregnancies: A Systematic Review of the Literature. Gynecol Obstet Invest 2012; 74:249-60. [DOI: 10.1159/000342997] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Accepted: 08/23/2012] [Indexed: 11/19/2022]
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30
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Secondary abdominal pregnancy and its associated diagnostic and operative dilemma: three case reports. J Med Case Rep 2009; 3:7382. [PMID: 19830195 PMCID: PMC2737786 DOI: 10.4076/1752-1947-3-7382] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2008] [Accepted: 01/27/2009] [Indexed: 11/17/2022] Open
Abstract
Introduction Abdominal pregnancy is extremely rare and has historically been defined as an implantation in the peritoneal cavity, exclusive of tubal, ovarian or intraligamentary pregnancy. Case presentations Three cases are reported. All came from a lower middle-income group and all of them were subjected to surgery. The first patient was a 30-year-old woman, who was pregnant for the fourth time, who presented at 16 weeks with an abdominal pregnancy. She was admitted with constant abdominal pain and retention of urine. She was hemodynamically stable and was administered a pre-operative intramuscular injection of methotrexate. During laparotomy she had only minor blood loss, the major part of the placenta was removed easily and she did not require any blood transfusion. Serum beta human chorionic gonadotrophin values and ultrasound follow-up revealed a normal study four weeks after surgery. The second patient was a 26-year-old woman, pregnant for the third time, admitted at 14 weeks with an abdominal pregnancy with hemoperitoneum, and the third patient was a 24-year-old woman, pregnant for the first time, who presented at 36 weeks gestation. She was only diagnosed as having an abdominal pregnancy during surgery, experienced excessive blood loss and required a longer hospital stay. Conclusions We hypothesize that treatment with pre-operative systemic methotrexate with subsequent laparotomy for removal of the fetus and placenta may minimize potential blood loss, and would be a reasonable approach in the care of a patient with an abdominal pregnancy with placental implantation to the abdominal viscera and blood vessels. This treatment option should be considered in the management of this potentially life-threatening condition. During surgery, if the placenta is attached to vital organs it should be left behind. Early diagnosis can help in reducing associated maternal morbidity and mortality.
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Treating non-tubal ectopic pregnancy. Best Pract Res Clin Obstet Gynaecol 2009; 23:529-38. [PMID: 19230785 DOI: 10.1016/j.bpobgyn.2008.12.011] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2008] [Accepted: 12/15/2008] [Indexed: 12/28/2022]
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Current world literature. Curr Opin Obstet Gynecol 2008; 20:602-7. [PMID: 18989138 DOI: 10.1097/gco.0b013e32831ceeb3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Retroperitoneal Abdominal Pregnancy at Left Paracolic Sulcus. J Minim Invasive Gynecol 2008; 15:660-1. [DOI: 10.1016/j.jmig.2008.05.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2008] [Accepted: 05/10/2008] [Indexed: 11/22/2022]
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Bäumler M, Faure JM, Couture A, Flunker S, Boulot P. Prenatal 3D ultrasound and MRI assessment of horizontal uterine synechia. Prenat Diagn 2008; 28:874-5. [DOI: 10.1002/pd.2078] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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