Hepatic ectopic pregnancy with hemorrhage secondary diaphragmatic adhesion:A case report

BACKGROUND Primary abdominal pregnancy is an extremely rare form of ectopic pregnancy.Ectopic pregnancies that occur in the liver and diaphragm are even rarer,limited case reports are available in the literature.CASE SUMMARY A woman of childbearing age was transferred to the emergency department due to lumbar and abdominal pain radiating to the back toward the lower right.After a series of physical and auxiliary examinations,she was clinically diagnosed with hepatic ectopic pregnancy.Laparoscopic surgery was performed to remove the pregnancy tissue and achieve hemostasis.After a period of follow-up,the patient was successfully cured.CONCLUSION Paying attention to the patient's signs and utilizing imaging examination methods can help avoid missed diagnoses of liver pregnancy.

Conservative Management of Unruptured Ectopic Pregnancy—A Retrospective Study

An ectopic pregnancy (EP) is defined as any pregnancy that occurs outside the uterine cavity. The most common site of ectopic pregnancy is the fallopian tube. The goal of this retrospective study is to address medical and conservative surgical management of unruptured fallopian tube EP as an effective manner to preserve tubes to prevent secondary infertility. This study was conducted between January 1, 2010, and April 30, 2024, in Ponni Hospital, Madurai. It included 319 women, out of 6248 pregnant women diagnosed with ectopic pregnancy by using an Inexecreen kit, trans-abdominal scan, trans-vaginal scan, and doubling of beta-human chorionic gonadotropin (β-HCG) in 48 hours and Magnetic Resonance Imaging (MRI). Medical and conservative surgical management were given to those patients effectively. Out of 319 patients, 62 patients (19.4%) had a ruptured ectopic pregnancy and underwent surgical treatment;257 patients (80.6%) had an unruptured ectopic pregnancy. The conservative medical management was provided to 257 patients. Out of 257 patients, 235 patients were treated by injecting methotrexate and folic acid rescue when the criteria were met. 14 patients had salpingostomy and injection methotrexate (Inj. Methotrexate) and inj. Prostaglandin F2 alpha was administered into the tubal wall to preserve tubes. 8 patients had a live ectopic pregnancy;for those patients, Inj. Methotrexate was injected into the gestational sac through ultrasound guidance. 225 out of 257 patients reached out to us to seek fertility treatment;the remaining 32 patients were not seeking fertility. All fertility-seeking patients had successful pregnancies. We lost follow-up of 12 patients in this study. Out of 213 patients who came for fertility treatment, a 76.1% success rate was achieved with live birth, the recurrent ectopic pregnancy rate was 13.6%, the miscarriage and stillbirth rates were 10.3%. 32 patients, who were not seeking fertility, had quality life without surgical scars for ectopic pregnancy and cost-effective treatment. 25 patients out of 32 had laparoscopic sterilization later, and 7 patients followed temporary contraception as per our advice. This clinical data was retrieved from medical records.

Evaluation of Spontaneous Fertility after Medical Treatment of Tubal Ectopic Pregnancy in Two Hospitals in the City of Yaounde

Background: Ectopic pregnancy is a major cause of maternal morbidity and mortality, estimated to occur in 1% - 2% of pregnancies worldwide. This condition also has an adverse effect on the fertility prospects of women who experience it. Objective: To determine the outcomes of subsequent spontaneous fertility after medical treatment of patients with methotrexate (MTX) in patients with ectopic pregnancy at two university teaching hospitals of Yaounde. Methodology: We carried out a cross-sectional study with retrospective data collection in two university teaching hospitals of Yaounde during a six years period from 1st January 2015 to 31st May 2021. Seventy records of patients who had medical treatment for ectopic pregnancy were included in this study. Statistical analysis was performed using SPSS. 23. The Chi-2 statistical test was used to compare qualitative variables. Binary logistic regression method was performed to identify independent risk factors associated with infertility after medical treatment of tubal ectopic pregnancy (TEP). The significance level was set at 0.05. Results: The mean age in our study population was 27.8 ± 3.8 years. According to the past medical history, 52.9% had a pelvic inflammatory disease (PID) and the most frequently germ found was C. trachomatis (47.1%). Almost 15% of our study population had previous surgery for EP. The median Fernandez score was 11 with a minimum score of 4 and a maximum score of 13. The route of administration of methotrexate was intramuscular in all our patients, and the single-dose protocol was used most frequently (58.6%). After medical treatment of the EP, we found a spontaneous conception rate of 58.6%. After multivariate analysis, we were unable to confirm that there was an association between a history of sexually transmitted infections (STIs) and fertility prognosis. Conclusion: The spontaneous fertility rate after medical management of EP was 58.6%, of which 73.2% were term pregnancies and 14.6% were recurrent ectopic pregnancies.

Ruptured Ectopic Pregnancy: Epidemiology and Management in the General Surgery Department of the Ignace Deen National Hospital, Conakry University Hospital

Introduction: The aim of this study was to contribute to improving the quality of GEUR management in the general surgery department and in the maternity ward of the Ignace Deen national hospital, Conakry University Hospital. Methodology: This was a retrospective, descriptive study lasting two years (January 1, 2020 to December 31, 2022), carried out in the general surgery and gyneco-obstetrics departments of the Ignace Deen national hospital, Conakry University Hospital. We included all patients with a ruptured ectopic pregnancy who received surgical treatment during the study period. Results: We collected 13,524 cases of surgical interventions in the two services, among them, we recorded 89 cases or 0.66% GEUR. The average age of the patients was 24.26 years. Brides were the most represented with 80.96% of cases. Women practicing a liberal profession were 51.69% (n = 46) and housewives 26.97% (n = 24). Clinically, amenorrhea was noted in all patients, i.e. 100%, abdominal-pelvic pain in 95.2% (n = 85) of cases, metrorrhagia in 94.08% (n = 84), abdominal-pelvic sensitivity in 97.44% (n = 87) of cases and anemia in 85.39% of cases. The GEUR was ampullary in 69.66% (n = 62) cases. Salpingectomy was performed in 90.72% (n = 81). The surgical outcomes were satisfactory in 98.87% (n = 88) of cases. We recorded one case of surgical site infection. We have not recorded any deaths. The average length of hospitalization was 4 days. Conclusion: GEUR is relatively high in our context. A good understanding of the prognostic factors of GEUR, awareness and family planning could reduce GEUR.

Comparison of the application value of transvaginal ultrasound and transabdominal ultrasound in the diagnosis of ectopic pregnancy

BACKGROUND Ectopic pregnancy(EP) is one of the most common acute abdominal diseases in gynecology. Once the condition of EP is delayed, it may lead to massive hemorrhage, shock, and even death in a short time, seriously threatening the patient’s life. Early diagnosis is the key to preventing and improving the prognosis of EP.Transabdominal ultrasound(TAS) and transvaginal ultrasound(TVS) are the main diagnostic methods for abdominal diseases. The purpose of this study is to explore the application value and effect of TAS and TVS in the diagnosis of EP,hoping to provide more valuable references for the diagnosis of EP.AIM To explore the application value of TAS and TVS in the diagnosis of EP and to improve the level of clinical diagnosis.METHODS A total of 140 patients with EP admitted to our hospital from July 2018 to July 2020 were selected for this study. All patients were divided into two groups according to the examination methods. 63 patients who underwent abdominal ultrasound examination were set as the TAS group, while 77 patients who underwent TVS examination were set as the TVS group. We compared the diagnostic accuracy and misdiagnosis rates between the two types of ultrasound examinations, as well as the postoperative pathological results of the two diagnostic methods for different types of ectopic pregnancies. We also analyzed the sonograms for the presence of mixed ectopic masses,adnexal masses, ectopic gestational sacs, the presence or absence of visible embryo and fetal heart in the ectopic sac shadow, and the detection of fluid in the rectal fossa of the uterus, such as the adnexal area, yolk sac, and embryo, etc. In addition, the diagnosis time, days of gestational sac appearance, operation time, endometrial thickness, and blood flow resistance index were compared as well.RESULTS After performing both types of ultrasound examinations in 140 patients with EP, we found that the diagnostic accuracy of TVS was significantly higher than that of TAS, and the misdiagnosis rate was significantly lower than that of TAS. The differences were statistically significant(P < 0.05). In addition, the detection rate of TVS was better than that of TAS for the presence of mixed masses,adnexal masses, ectopic gestational sacs, the presence or absence of visible embryo and fetal heart in the shadow of the ectopic sac, and sonograms such as the adnexal area, yolk sac, and embryo,etc. The coincidence rate of its postoperative pathological examination results was significantly higher than those of TAS. The diagnosis time and the days of gestational sac appearance by TVS were significantly shorter than that by TAS, and the operation time was earlier than that by TAS.What’s more, the detection rates of the endometrial thickness ￡ 1.5 mm and blood flow resistance ￡0.5 were significantly higher in TVS diagnosis of EP than in TAS. All differences were statistically significant(P < 0.05).CONCLUSION Compared with TAS, TVS has the advantages of high detection accuracy and good sonogram performance.

Ectopic Molar Pregnancy with Coexistent Normal Intrauterine Pregnancy: A Report of an Unusual Diagnosis managed in Yaoundé Gyneco-Obstetric and Pediatric Hospital, Cameroon

Background: Heterotopic pregnancy is a very rare event in a natural cycle. Its incidence is rising mostly due to induction of ovulation or Assisted Reproductive Technique. Most ectopic in heterotopic pregnancies are localized in the fallopian tubes. The occurrence of molar tubal ectopic pregnancy coexisting with intrauterine pregnancy is uncommon and consequently not often considered a diagnostic possibility. Case Report: We report the case of a 25-year-old woman, gravida 4 para 1, who complained of vaginal spotting and lower abdominal pain after 6 weeks of amenorrhea following clomiphene citrate ovarian stimulation. Transvaginal Ultrasonography revealed an intrauterine pregnancy and an unruptured left tubal ectopic pregnancy. She underwent successful laparoscopic salpingectomy while the intra-uterine pregnancy was allowed to continue. The ectopic pregnancy tissue histology reported an ectopic partial molar pregnancy. She subsequently had a normal vaginal delivery at 39 weeks and 3 days and her follow-up was uneventful. Conclusion: Heterotopic pregnancy is a rare but life-threatening condition. It should be suspected in a pregnant woman with a risk factor of multiple gestations who presents vaginal bleeding and lower abdominal pain in the context of early pregnancy. Laparoscopic surgery is effective for confirming the diagnosis and treating the ectopic component. Routine histological examination of tubal specimens must be taken very seriously because some findings like molar pregnancies may require specific management.

Rare uterine serosal pregnancy after in vitro fertilization in a woman with bilateral salpingectomy

Objective:To improve the understanding of ectopic pregnancy after bilateral salpingectomy through case analysis and literature review.Method:A case of uterine serosal pregnancy after in vitro fertilization and embryo transfer(IVF-ET)in a woman with bilateral salpingectomy was reported in detail and summarized,and relevant literatures searched in Pubmed were analyzed.Results:The patient had a sudden abdominal pain 18 days after transplantation.Ultrasound showed no pregnancy sac in the intrauterine cavity and bilateral adnexal areas,but there was a large amount of fluid in the Pouch of Douglas,which was an indication for surgical exploration.During the operation,the pregnancy tissue was found on the uterine serosal and cleared in time.And the patient recovered well after surgery.Review of the literatures showed that most of ectopic pregnancies after bilateral salpingectomy were treated surgically and had a good prognosis.Conclusion:Ectopic pregnancy after bilateral salpingectomy is extremely rare and should be early judged by the patients’signs.Surgical treatment timely can achieve good outcome.

Efficacy of transvaginal ultrasound-guided local injections of absolute ethanol for ectopic pregnancies with intrauterine implantation sites

BACKGROUND Cervical pregnancies,interstitial tubal pregnancies,and cesarean scar pregnancies,which are ectopic pregnancies with intrauterine implantation sites exhibit increasing trends with the recent widespread use of assisted reproductive technologies and increased rate of cesarean deliveries.The development of highsensitivity human chorionic gonadotropin testing reagents and the increased precision of transvaginal ultrasonic tomography have made early diagnosis possible and have enabled treatment.Removal of ectopic pregnancies using methotrexate therapy and/or uterine artery embolization has been reported.However,delayed resumption of infertility treatments after methotrexate therapy is indicated,and negative effects on the next pregnancy after uterine artery embolization have been reported.AIM To examine the efficacy and safety of ultrasound-guided topical absolute ethanol injection in ectopic pregnancies with an intrauterine implantation site.METHODS In this study,we retrospectively examined the medical records of 21 patients who were diagnosed with an ectopic pregnancy with an intrauterine implantation site at our hospital,between April 2010 and December 2018,and underwent transvaginal ultrasound-guided local injections of absolute ethanol to determine the treatment outcomes.We evaluated the treatment methods,treatment outcomes,presence of bleeding requiring hemostasis measures and blood transfusion,complications,and treatment periods.Successful treatment was defined as the completion of treatment using transvaginal ultrasound-guided local injections of absolute ethanol alone.RESULTS There were 21 total cases comprising 10 cervical pregnancies,10 interstitial tubal pregnancies,and 1 cesarean scar pregnancy.All patients completed treatment with this method.No massive hemorrhaging or serious adverse reactions were observed during treatment.The mean gestation ages at the time of diagnosis were 5.9 wk(SD,±0.9 wk)for cervical and 6.9 wk(SD,±2.1 wk)for interstitial tubal pregnancies.The total ethanol doses were 4.8 mL(SD,±2.2 mL)for cervical pregnancies and 3.3 mL(SD,±2.2 mL)for interstitial pregnancies.The treatment period was 28.5days(SD,±11.7 d)for cervical pregnancies and 30.0±8.1 d for interstitial pregnancies.Positive correlations were observed between the bloodβ-human chorionic gonadotropin level at the beginning of treatment and the total ethanol dose(r=0.75;P=0.00008),as well as between the total ethanol dose and treatment period(r=0.48;P=0.026).CONCLUSION Transvaginal ultrasound-guided local injections of absolute ethanol could become a new option for intrauterine ectopic pregnancies when fertility preservation is desired.

LAPAROSCOPIC SURGERY IN PATIENTS WITH HYPOVOLEMIC SHOCK DUE TO ECTOPIC PREGNANCY

Objective To evaluate the feasibility and safety of operative laparoscopy for ectopic pregnancy with hypovolemic shock. Methods Two hundred and fifteen women with ectopic pregnancy underwent operative laparoscopy. These patients were divided into two groups. The study group included 21 patients with shock and intraperitoneal hemorrhage more than 1000 mL, and control group included 194 patients, hemodynamically stable, with blood loss less than 1000 mL. Clinical data of perio-perative periods in two groups were retrospectively analyzed. Results All patients were tubal pregnancies. The occurrence rate of tubal rupture was higher in study group than in control group (80.95% vs. 15.98%, P < 0.001). Intraabdominal blood loss was significantly higher in study group than in control group (1900 mL vs. 300 mL, P < 0.001), and autologous blood transfusions were given to 95.24% and 9.3% of patients in study and control group, respectively (P < 0.001). Laparoscopic salpingectomy was performed on 85.7 % and 50.5% of patients in study and control group (P < 0.001). The operative time was somewhat longer in study group than that in control group (60 minutes vs. 45 minutes), but with no significant difference. All patients had no perioperative complications. Conclusion Operative laparoscopy in patients with hopovolemic shock can be safely and effectively performed by experi-enced laparoscopists with the aid of optimal anesthesia, advanced cardiovascular monitoring, and autologous blood transfusion.

Management of Ectopic Pregnancy in a Broad Ligament and Recurrent Tubal Pregnancy: A Case Report

Broad ligament pregnancy is a rare event and always delays in diagnosis. A pregnant woman in early twenties presented for our center. Routine ultra-sonography revealed a first trimester abdominal pregnancy. Broad ligament pregnancy was diagnosed intraoperation and treated with laparoscopic resection successfully. The patient has a history of right tubal pregnancy 2 years ago and terminated with Laparoscopic Salpingostomy. According to the long term followed-up for the patient, we found that she had recurrent right tubal pregnancy 5 months after the broad ligment ectopic pregnancy. She received the salpingectomy laparoscopically. We presented the case to discuss the clinical management of broad ligament ectopic pregnancy and options of surgical treatments of tubal pregnancy to reduce the risk of recurrent.

Incidental Serous Tubal Intraepithelial Carcinoma Detected by a Surgery for Ectopic Pregnancy

Serous tubal intraepithelial carcinoma is a putative precursor of high-grade serous carcinoma, which is the most common histological type of ovarian or pelvic peritoneal cancer. Serous tubal intraepithelial carcinoma is commonly found in patients with breast cancer susceptibility gene mutations who undergo risk-reducing salpingo-oophorectomy. Incidental serous tubal intraepithelial carcinoma found by a non-prophylactic surgery is rare. A 33-year-old woman referred to our hospital for a diagnosis of ectopic pregnancy. She underwent a laparoscopic right salpingectomy. Pathologically, ectopic pregnancy in the ampulla of the right fallopian tube was confirmed and serous tubal intraepithelial carcinoma was observed in the fallopian tube. Subsequently, she underwent a laparoscopic hysterectomy, bilateral oophorectomy, and left salpingectomy as additional treatment. She has experienced no recurrence thus far for 37 months since the surgery.

Comparison between laparoscopic surgery and laparotomy for the treatment of acute ruptured ectopic pregnancy

Objective: To study the stress reaction after laparoscopic surgery and laparotomy for the treatment of acute ruptured ectopic pregnancy. Methods: 68 patients with acute ruptured ectopic pregnancy who received emergency surgical treatment in Pangang Group General Hospital between July 2013 and September 2016 were selected and analyzed retrospectively, including 29 patients with laparoscopic surgery and 39 patients with laparotomy who were included in the laparoscopy group and laparotomy group respectively. Before operation as well as 1d and 3d after operation, serum was collected to detect biochemical indexes and stress hormones. Results: 1d and 3d after operation, serum Alb, AST, ALT, BUN, Scr and UA levels were not significantly different between laparoscopy group and laparotomy group (P>0.05);serum NE (149.65±17.58 vs. 186.61±23.52, 162.32±20.15 vs. 295.86±28.97 pg/ml), E (135.28±19.85 vs. 179.55±22.52, 152.11±18.52 vs. 231.38±29.58 pg/ml), ACTH (3.88±0.49 vs. 5.12±0.82, 4.39±0.52 vs. 6.58±0.92 pmol/L), Cor (177.64±20.12 vs. 224.59±35.55, 185.21±22.12 vs. 289.45±41.28 ng/ml), Ins (12.21±1.86 vs. 17.58±2.52, 18.95±2.68 vs. 27.61±4.12 IU/mL), PRA (1.65±0.25 vs. 2.18±0.35, 1.73±0.21 vs. 2.55±0.47ng/ml), AngⅡ (44.12±7.64 vs. 59.63±7.92, 52.27±7.95 vs. 76.12±9.35 pg/ml) and ALD (155.22±19.76 vs. 205.62±24.52, 189.10±22.58 vs. 316.85±42.85 pg/ml) levels of laparoscopy group were significantly lower than those of laparotomy group (P<0.05). Conclusions: Laparoscopic surgery for acute ruptured ectopic pregnancy causes less adrenal stress reaction and RAAS system stress reaction, and the overall level of trauma is lower than that of laparotomy.

Conservative treatment of unruptured Ectopic pregnancy in Jamaica

Medical treatment with methotrexate is now successfully replacing conservative surgical treatment in selected patients. We reviewed patients treated with methotrexate, compared to salpingectomy and salpingostomy between 1990 to 1995 and 2000 to 2003. For 1990-1995 there were 21 conservative surgical treatments (5.3% ectopic pregnancies). The ratio of ectopic to normal deliveries was 1:24. Medical treatment was done for 19 pregnancies (3.4% of ectopic pregnancies) for 2000 to 2003. During the period there was an ectopic rate of 1:16.8 births. Patients treated medically were similar to those treated surgically except that none reportedly having rebound tenderness and only 1/18 having an ultrasound scan showing a foetal heart and none with a gestational sac >4cm. In the medically treated group the success rate was 68% while in the surgically treated groups success was 100%. There was no significant difference in the parameters in the conservative surgical and medically treated

Place of Autologous Intraoperative Blood Transfusion in the Treatment of Broken Ectopic Pregnancy (EP) at the Chiphra Hospital of Ouagadougou, Burkina Faso

Objective: To describe the role of autologous regenerative intraoperative bleeding of recent intra-cavity losses over the ectopic pregnancy ruptured at the Schiphra Hospital of Ouagadougou. Methodology: It has been a cross-sectional descriptive study over a period of 18 months from January 1st 2014 to June 30th 2015 in the obstetrics and gynecology department at the schiphra hospital of Ouagadougou. In our study, we included all pregnant women having received emergency with a diagnosis of broken ectopic pregnancy complicated by a significant array of clinical haemoperitoneum and who have consented to participate in the survey. Results: During the study period, we recorded 322 cases of ectopic pregnancy, among which 106 were broken. Autotransfusion was performed in 59 patients, that is to say 18.3%. The average age of patients was 27 years (18 - 40). The average rate of childbirth was 5.25 (0 - 11). The general condition of the patients was pretty good at 8.5% and poor in 91.5% of cases. The average amount of blood transfused per patient was 935 ml with a range of 400 and 1600 ml. After autotransfusion, 62% of patients had greater improvement in hemoglobin 10 g/dl. Maternal prognosis was marked by a case of fever with a morbidity rate of 1.9% and a death post autotransfusion case fatality rate of 1.9%. Conclusion: In the context of shortage of blood products, autologous transfusion could be an alternative in the treatment of ruptured ectopic pregnancy in developing countries.

Epidemiology and Management of Ectopic Pregnancy in Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Southeast, Nigeria

Background: Ectopic pregnancy is a common cause of maternal morbidity and mortality in the 1st trimester of pregnancy;without timely diagnosis and intervention, ruptured ectopic pregnancy can become a life threatening condition. Objective: This study aims to give baseline indices on the incidence, clinical presentation, risk factors and the management of cases of ectopic pregnancy that presented in Alex Ekwueme Federal University Teaching Hospital, Abakaliki over a 5-year period. Materials and Method: This is a 5-year retrospective study of patients who were diagnosed with ectopic pregnancy between January 1st 2012 and December 31st 2016. The statistical analysis was done using SPSS version 22. Result: During the study period, there were 11,932 deliveries while 7725 Gynaecology patients were admitted. Over the same period there were 156 patients diagnosed and managed for ectopic pregnancy, accounting for 1.31% of all deliveries and 2.0% of all Gynaecological admissions. The modal age group was 26 - 30 years 68 (43.6%), 122 (78.2%) were married, while 34 (21.7%) were single. Nulliparous were 41 (26.3%) and primiparous were 33 (21.2%). The commonest presenting complaints were lower abdominal pain and amenorrhea, and the commonest identified risk factor was previous pelvic inflammatory disease. Most of the cases were ruptured prior to presentation and partial salpingectomy was the management in all tubal pregnancy while two cases were unruptured and had salpingostomy and another case was abdominal pregnancy and had exploratory laparotomy only. Out of 156 women that presented with ectopic pregnancy, 8 (5.1%) died before surgery could be done due to late presentation. Fifty-seven women presented in a state of shock and 9 (5.8%) of the cases were complicated with acute renal failure. Conclusion: Ruptured ectopic pregnancy is a major cause of maternal morbidity and early pregnancy loss. Late presentation is a common feature in our environment;hence widespread advocacy on case identification and early presentation is urgently needed.

Methotrexate Treatment of Ectopic Pregnancy: Prognosis at Senlis Hospital

Introduction: Ectopic pregnancy is dreadful and can lead to the death of the patient if it is ignored. Diagnosed early, it offers the possibility of medical treatment with methotrexate. Objective: To describe the prognosis of ectopic pregnancies treated methotrexate. Patients and Methods: Retrospective study of the management of ectopic pregnancy by Methotrexate at Senlis hospital from June 2020 to May 2021 were included in the study, patients with a Fernandez score of less than 13, and having received Methotrexate as first-line treatment. Data were collected using gynecological emergency admission registers, and telephone interviews. Results: 35 cases were identified. The average age of the patients was 32 years old. Forty-nine percent were smokers. The mean gestational age was 5 weeks + 2 days. The diagnosis was made in all of our patients with the combination of the kinetics of ß-hcg and vaginal ultrasound. The size of adnexal mass was less than 4 cm with an average size of 20 mm. The average value of ß-hcg was 1405 IU/L. All patients had received a single dose of methotrexate 1 mg/kg intramuscularly. A second dose was administered to 17.1% of patients for stagnation or re-ascension of the ß-hcg level. The success rate was 91.4%. Thirty percent were obtained spontaneous intra uterine pregnancy, the first year following methotrexate treatment. Conclusion: The success rate of medical treatment for ectopic pregnancy is high in terms of meeting the eligibility criteria for treatment. The subsequent prognosis of fertility is generally preserved.

Avoiding misdiagnosing an early intrauterine pregnancy as an ectopic pregnancy

In women at risk for an ectopic pregnancy, every effort should be made to exclude the presence of an intrauterine pregnancy before embarking on an irreversible treatment for ectopic pregnancy. The diagnosis of ectopic pregnancy, unless directly visualized with transvaginal ultrasound, is made with the exclusion of an intrauterine pregnancy. Measurement of human chorionic gonadotrophin and progesterone levels, and transvaginal ultrasound are the tools used to evaluate early pregnancy. In women at risk for an ectopic pregnancy, every effort should be made to exclude the presence of an intrauterine pregnancy before embarking on an irreversible treatment course. Methotrexate is an antimetabolite that inhibits DNA synthesis and repair and cell replication. It is administered to ostensible destroy a pregnancy, especially ectopic pregnancies. When administered to an intrauterine pregnancy, embryonic death and missed abortion is the most common result, but early embryos that survive this exposure are likely to have multiple anomalies. The mistaken administration of methotrexate to an intrauterine pregnancy is made because of misinterpretation of the discriminatory zone of human chorionic gonadotropin(h CG), misinterpretation of early h CG serum levels, misinterpretation of early transvaginal ultrasound images, and failure to clinically correlate h CG levels and ultrasound findings.

The Association between <i>Chlamydia Trachomatis</i>and Ectopic Pregnancy in Lagos, Nigeria—A Case Control Study

Objectives: To determine the seropositivity of Chlamydia antibody in patients with ruptured ectopic pregnancy compared to normal pregnant women and the risk factors for ectopic pregnancy. Study Design: This was a prospective case-control study of 85 cases of ruptured ectopic pregnancy and 100 cases of second trimester on-going intrauterine pregnant controls presenting in Lagos State University Teaching Hospital (LASUTH) between September 2009 and March 2010. Study Site: This was at the gynaecological emergency room and antenatal clinic in the Department of Obstetrics and Gynaecology. Ethical approval was sought and granted by the ethics review committee of LASUTH. Study Participants: Patients presenting with ruptured ectopic pregnancy were recruited as cases while the controls were made up of those with uncomplicated second trimester intrauterine pregnancy. A semi-structured questionnaire containing socio-demographic and clinical characteristics was administered following informed consent. Five milliliters of venous blood was taken from each participant and tested for?Lymphogranuloma Venerum?(LGV) type 2 broadly reacting antigen of?Chlamydia trachomatis.?Data Analysis: Data gathered from the case notes and laboratories were imputed into the computer and analyzed using the statistical package?Epi-Info 3.51, Atlanta, USA. Frequency tables were generated for continuous variables and?chi-square analysis used to determine association between variables, with p values <0.05 considered statistically significant. Results: There were 91 cases of ectopic pregnancy among a total of 2468 deliveries giving an incidence of 3.68% or 1 in 27 deliveries. Factors which significantly contributed to increased incidence of ectopic pregnancy in this study were: level of education (p = 0.001), socio-economic status (p = 0.001), parity (p = 0.005), early age of sexual debut (p = 0.001), multiple sexual partners (p = 0.001), previous pelvic inflammatory disease (p = 0.003), previous induced abortion (p = 0.013) and previous?postabortal/puerperal sepsis (p = 0.013). The seropositivity of?Chlamydia IgG (62.4%) in the cases was significantly higher than that of 29% in the control (p < 0.0001). Conclusion: There was a high incidence of ectopic during the period of study and the seropositivity of Chlamydia IgG antibody was significantly higher amongst the cases. Risk factors identified were low level of education, low socio-economic status, low parity, early age of sexual debut, multiple sexual partners, previous history of pelvic inflammatory disease, previous induced abortion and previous postabortal/puerperal sepsis.

Interstitial Ectopic Pregnancy Treated with Multi-Dose Methotrexate Protocol

Interstitial ectopic pregnancies are very rare, however, they are extremely dangerous. Treatment consists of either surgical or medical management. This patient presented with no prior pregnancies, an inappropriately rising b-hCG, and eventually had ultrasound findings consistent with interstitial ectopic pregnancy. She was seen through the Emergency Department and had no insurance. She strongly desired to avoid surgery, and was successfully given a multi-dose regimen of methotrexate. Contraindication to methotrexate management includes an inability to follow-up, so a close therapeutic alliance was maintained to enable safe resolution of this case. She has since successfully carried an uncomplicated intrauterine pregnancy to term.

Ectopic Pregnancy: Epidemiological, Clinical, Therapeutical, Anatomopathological Aspects and Prognosis at the Department of Obstetrics and Gynecology of the Teaching Hospital Souro Sanou of Bobo-Dioulasso: About 79 Cases and Literature Review

Objective: To study the epidemiological, clinical, therapeutical, anatomopathological aspects and prognosis of the ectopic pregnancy. Methodology: It was a transversal and descriptive study from January 1st to December 31st 2018 at the department of obstetrics and gynecology of the Teaching Hospital Sourô Sanou of Bobo-Dioulasso. Results: During the study period, we registered 4706 deliveries with 1272 cases of cesareans and 79 cases of ectopic pregnancy with a frequency of 1 ectopic pregnancy for 60 deliveries and 6 ectopic pregnancies for 100 caesareans. The average age of the patients in our study was 28.66 years old (19 - 45 years) and the average parity of 1.96 [0 - 6]. Married women represented 83.54 % of the workforce. The risk factors were dominated by sexual transmitted diseases (25.31%) and abortions (20.25%). Clinical signs were dominated by pelvic pain (100% of cases), metrorrhagea (86.5% of cases) and amenorrhea (64.6% of cases). Culdocentesis brought lysed incoagulable blood in 83.7% cases. The immunological pregnancy test was positive in 100% of cases. Plasma beta dosage was carried out in 2 cases. Salpingectomy was performed in 97.4% cases. The site of the ectopic pregnancy was interstitial in 11.3% cases, isthmic in 8.86% cases, infundibular in 11.3% cases, ampullar in 77.22% cases. On the anatomopathological level, we noted an acute salpingitis in 23.38% cases and a chronic salpingitis in 44.94% cases. Postoperative were simple in 97.7% of cases and we deplored one case maternal death. Conclusion: Ectopic pregnancy is a surgical emergency of the first trimester pregnancy. The delay in diagnosis is common in our context, with as consequence a mutilated treatment. The etiological factors are dominated by the chronic salpingitis and the acute salpingitis. The prevention is based on combatting genital infections, promoting contraceptive methods and a good post abortion care.