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Lugata J, Mrosso O, Mwidibo Y, Batchu N, Mchome B, Mbise FB. Second trimester broad ligament ectopic pregnancy: a case report. J Surg Case Rep 2024; 2024:rjae084. [PMID: 38404442 PMCID: PMC10884735 DOI: 10.1093/jscr/rjae084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 02/03/2024] [Indexed: 02/27/2024] Open
Abstract
An ectopic pregnancy occurs when the fertilized egg is implanted and develops outside the endometrium, i.e. in the fallopian tubes, cervix, ovary, or abdomen. It commonly presents with a history of amenorrhoea, lower abdominal pain, and slight vaginal bleeding. The fallopian tube is the most typical location for ectopic pregnancy. Two percent of reported pregnancies are ectopic pregnancy. Ectopic pregnancy remains a public health threat for women in reproductive age, and a major cause of maternal mortalities in the first trimester. In East Africa, these reports are limited, despite a great need for documentation addressing key considerations for diagnosis and management of ectopic pregnancy in these resource limited settings. In this case study, we report on 26-years-old female Gravida 5 Para 4 Living 4, who reported history of amenorrhoea for 3 months complaining of slight per vagina bleeding and lower abdominal pain for 5 days more marked at left iliac region along with generalized weakness for 2 weeks. Her vitals were stable. Pelvic ultrasound revealed empty uterus and live fetus at the left adnexa corresponding to 14 weeks 6 days with minimal free fluid in the Douglas Cul-de-sac. The patient's final diagnosis was live extra-uterine pregnancy at 14 weeks 6 days that was managed by emergency laparotomy with salpingectomy. The patient recovered completely after surgery and was discharged in a stable condition. Ectopic pregnancy still remains one of the major causes of maternal morbidity and mortality. Early diagnosis and referral in hemodynamically state along with use of minimal access surgery or management can change the scenario of ectopic pregnancy in the developing world. Late attendance to first visit clinics is still a major concern in low resource limited settings as this could have been picked early and intervened. Key message: Management of broad ligament ectopic pregnancy in the second trimester is still challenging especially in low resource settings where the clients do not attend clinics and because of unavailability of ultrasound machines to diagnose it.
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Affiliation(s)
- John Lugata
- Department of Obstetrics and Gynecology, Kilimanjaro Christian Medical Centre, Sokoine Road, Moshi Urban Municipal, Moshi, Tanzania
- Faculty of Medicine, Kilimanjaro Christian Medical University College, Sokoine Road, Moshi Urban Municipal, Moshi, Tanzania
| | - Onesmo Mrosso
- Department of Obstetrics and Gynecology, Kilimanjaro Christian Medical Centre, Sokoine Road, Moshi Urban Municipal, Moshi, Tanzania
- Faculty of Medicine, Kilimanjaro Christian Medical University College, Sokoine Road, Moshi Urban Municipal, Moshi, Tanzania
| | - Yusuph Mwidibo
- Department of Obstetrics and Gynecology, Kilimanjaro Christian Medical Centre, Sokoine Road, Moshi Urban Municipal, Moshi, Tanzania
- Faculty of Medicine, Kilimanjaro Christian Medical University College, Sokoine Road, Moshi Urban Municipal, Moshi, Tanzania
| | - Nasra Batchu
- Department of Obstetrics and Gynecology, Kilimanjaro Christian Medical Centre, Sokoine Road, Moshi Urban Municipal, Moshi, Tanzania
- Faculty of Medicine, Kilimanjaro Christian Medical University College, Sokoine Road, Moshi Urban Municipal, Moshi, Tanzania
| | - Bariki Mchome
- Department of Obstetrics and Gynecology, Kilimanjaro Christian Medical Centre, Sokoine Road, Moshi Urban Municipal, Moshi, Tanzania
- Faculty of Medicine, Kilimanjaro Christian Medical University College, Sokoine Road, Moshi Urban Municipal, Moshi, Tanzania
| | - Fredrick B Mbise
- Department of Obstetrics and Gynecology, Kilimanjaro Christian Medical Centre, Sokoine Road, Moshi Urban Municipal, Moshi, Tanzania
- Faculty of Medicine, Kilimanjaro Christian Medical University College, Sokoine Road, Moshi Urban Municipal, Moshi, Tanzania
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Huang J, Zuo X, Sun Y, Wu X, Zhu H, Cui W. Ectopic pregnancy adjacent to iliac vessels managed successfully by minimally invasive treatment using local methotrexate injection: An extremely rare case and literature review. J Gynecol Obstet Hum Reprod 2023; 52:102691. [PMID: 37931894 DOI: 10.1016/j.jogoh.2023.102691] [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: 09/21/2023] [Revised: 10/23/2023] [Accepted: 11/03/2023] [Indexed: 11/08/2023]
Abstract
A case report of successfully treated retroperitoneal ectopic pregnancy (REP) is presented. A 36-year-old woman, gravida 3, para 2, was admitted to hospital for suspected ectopic pregnancy with light vaginal bleeding and mild abdominal pain for 3 days at 45 days of gestation by the last menstrual period.Multiple transvaginal ultrasonography and two times laparoscopic probes led to the diagnosis of REP located to the iliac blood vessels closely. Eventually the patient was cured with the treatment using local methotrexate injection under real-time ultrasound guidance and systemic methotrexate administration. We also summarized another 31 cases of REP to further understand this disease, sharing them to arouse clinical attention for the diagnosis and treatment of REP timely.
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Affiliation(s)
- Jin Huang
- Department of Gynecology and obstetrics, The Affiliated Yixing Hospital of Jiangsu University, Yixing 214200, China
| | - Xin Zuo
- Department of Gynecology and obstetrics, The Affiliated Yixing Hospital of Jiangsu University, Yixing 214200, China
| | - Yaoxiang Sun
- Department of Clinical Laboratory, The Affiliated Yixing Hospital of Jiangsu University, Yixing 214200, China
| | - Xiaoyun Wu
- Department of Ultrasound, The Affiliated Yixing Hospital of Jiangsu University, Yixing 214200, China
| | - Hongdi Zhu
- Department of Gynecology and obstetrics, The Affiliated Yixing Hospital of Jiangsu University, Yixing 214200, China
| | - Wei Cui
- Department of Gynecology and obstetrics, The Affiliated Yixing Hospital of Jiangsu University, Yixing 214200, China.
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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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Nanda S, Sharma N, Dahiya K, Hooda More R. Eyes Do Not See What the Mind Does Not Know: Pitfalls in the Diagnosis of Intraligamentary Pregnancy. J Gynecol Surg 2004. [DOI: 10.1089/gyn.2004.20.131] [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)
- Smiti Nanda
- Department of Obstetrics and Gynecology, PGIMS, Haryana, India
| | - Neeraj Sharma
- Department of Obstetrics and Gynecology, PGIMS, Haryana, India
| | - Krishna Dahiya
- Department of Obstetrics and Gynecology, PGIMS, Haryana, India
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Atalla RK, Murphy PC, Balachandar C. Combined intrauterine and broad ligament ectopic pregnancy. J OBSTET GYNAECOL 1997; 17:203. [PMID: 15511824 DOI: 10.1080/01443619750113898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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