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.

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.

Uterine artery embolization in association with methotrexate infusion for the treatment of tubal ectopic pregnancy

Objective To investigate the safety, feasibility, and effectiveness of uterine artery embolization in association with methotrexate(MTX) infusion for the treatment of tubal ectopic pregnancy. Methods Fifty-one patients with tubal ectopic pregnancy were referred for interventional management. All patients received super-selective arteriography of the uterine artery, were infused with 50–100 mg methotrexate(MTX) through a catheter, and underwent embolization of the uterine artery with a gel-foam pledge. Clinical presentation, findings of physical examination, β-HCG values, and the size of the ectopic mass were documented for comparison. The concentration of MTX in blood was evaluated at 0.5, 6, 12, 24, 36, and 48 hours after the procedure. Results Forty-seven out of the 51 patients had clinical resolution of their tubal pregnancy(92.2%). The average time for the β-HCG value to decrease and come back to normal was 9.16 ± 2.54 days(mean +/-SD). MTX levels in peripheral blood could not be detected for patients who received 50 or 75 mg MTX at 36 hours after the procedure, while the MTX level was 0.01 μmol/L at 48 hours after the procedure for patients who received 100 mg. Out of the 4 cases whose ectopic mass size was ≥5 cm, 3 failed to respond to the treatment; however, those whose ectopic mass size was ≤5 cm responded positively to the treatment, regardless of the β-HCG concentration and abdominal bleeding, except for 1 patient who had to undergo laparoscopy for severe abdominal pain and who showed a reduction in her β-HCG level. Conclusion Uterine artery embolization in association with methotrexate infusion is safe and effective in the treatment of tubal ectopic pregnancy, especially for those women with mild to moderate bleeding, or for those at risk of a major hemorrhage. The selection criterion of mass size >5 cm should, therefore, be carefully considered.

Heterotopic tubal pregnancy with live twin birth complicating ovulation induction assisted cycle

Heterotopic pregnancy is an uncommon clinical entity in Nigeria even though some of the risk factors are highly prevalent in the population. We report a case of heterotopic pregnancy following ovulation induction with clomiphene citrate. A favourable outcome resulting in live twin birth was recorded despite the presence of poor clinical features that affects pregnancy and foetal outcome.

Intratubal Methotrexate Injection Combined with Chinese Herbal Medicine for Tubal Pregnancy and Following Pregnancy Prognosis

Objective: To compare the effects of treatment of tubal pregnancy (TP)and its following second pregnancy by intratubal methotrexate injection(IMI) alone and combination of IMI with Chinese herbal medicine. Methods: Thirty-five patients suffering from unruptured TP were divided into two groups at random, to the 19 patients in the treated group, the treatment of combined IMI with Ectopic Pregnancy decoction No. 2 (EP2, a traditional Chinese medical decoction) was applied, and to the other 16 patients in the control group, IMI alone was applied for control. Serum concentrations of human chorionic gonadotro-pinβ(β-HCG), size of the gestational sac, existent time of fetal cardiac beat and peritoneal fluid were measured before and after treatment. And hysterosalpingography were performed 6 months after ending the treatment to verify the presence of tubal obstruction and the condition of relapse.Results: The treatment of all the 35 women was successful. The recovery duration of serumβ-HCG, disappearance duration of TP sac and existent time of peritoneal fluid in the treated group were 20.0±7. 8 days, 1.2±0. 7 months and 10. 7±2. 9 days respectively, which were significantly different from those in the control group (24. 4 ±8.1 days, 3.6±1.7 months and 19.1±3. 2 days respectively(P<0. 05, P<0.01 and P<0. 05 respectively), but the existent time of fetal cardiac beat in the two groups (8.8±1. 9 days vs 9.0±1. 3 days) was not significantly different (P>0.05). The post-treatment oviduct obstructive rate in the two groups was 10.5% and 43.8% respectively, that in the treatment group was less significant (P<0.05). The relapse rate of EP in the treatment group was insignificantly different from that in the control group (5.3% vs 18.8%, P>0.05). Conclusion: The two therapies (IMI alone and IMI combined with EP2) could obtain e-qual efficacy in curing TP. Compared with IMI alone, the combined therapy appears to have the effects of accelerating the resorption of gestational sac and peritoneal fluid, improving the patency of fallopian tube and ameliorating the circumstance of pregnancy, which is favorable to improvement of the re-pregnancy rate and reduction of the re-occurrence of ectopic pregnancy as well as to the enhancement of the effect of IMI in killing trophocytes. But there is not enough proof to show the potency of EP2 in killing embryo.

Bilateral Tubal Molar and Embryonic Pregnancy

Aim: To report a case of bilateral tubal molar and embryonic pregnancy diagnosed and treated at the Yalgado Ouedraogo Teaching Hospital in Ouagadougou, Burkina Faso. Observation: It was an 18-year-old patient, G2P0 with no known pathological history. She was received in obstetric emergencies for suspicion of ectopic pregnancy in a two-month amenorrhea context. At the admission, the physical examination had found a sensitivity of the hypogastric region with a cry of the umbilicus and the bleeding. At pelvic ultrasound, the uterus was empty with a medium-abundance pelvic effusion and a left extra uterine mass. The initial rate of beta HCG was 5700 ml IU per ml. A framed laparotomy was carried out. The operative exploration has revealed a right tubal pregnancy cracked and a left unbroken tubal pregnancy. The diagnosis of a bilateral ectopic pregnancy was retained. A right salpingectomy and a left tubal caesarean section were carried out. Histological analysis confirmed the diagnosis of a left embryonic ectopic pregnancy associated with a right molar ectopic pregnancy. Conclusion: The systematic use of histological analysis for any extra uterine pregnancy treatment is required to not ignore an associated molar pregnancy.

Analysis of Perinatal Outcomes of Twin Pregnancy in a Referral Hospital for High Risk

Introduction: The incidence of twin pregnancies has increased significantly in recent decades. These pregnancies require more attention due to their worse outcomes than singleton pregnancies. Objective: To analyze the characteristics and perinatal outcomes of twin pregnancies at the Caxias do Sul General Hospital. Methods: This is a descriptive and retrospective study that included all births related to twin pregnancies between March 1998 and June 2018. Maternal and perinatal variables were analyzed. Descriptive analyses were carried out using measures of central tendency and dispersion for continuous variables (mean and standard deviation or median and interquartile range), according to a prior assessment of distribution using the Shapiro-Wilk test, and absolute (n) and relative (n%) frequencies for categorical variables. Results: 172 pairs of twins/21,972 births (0.8%) were identified. There was a high percentage of interpartum interval of less than 12 months, adherence and prenatal visits, body mass index, and need for neonatal intensive care. Stillbirth and neomortality rates were within acceptable parameters. Conclusion: The sample studied showed a percentage similar to that in the literature, a high rate of maternal and perinatal complications, characterizing it as a high-risk fetal pregnancy.

Ectopic Tubal Molar Pregnancy: A Case Report

Background: Molar pregnancy is a rare condition;its ectopic form is even rarer occurring in 1.5 per 1,000,000 pregnancies. Aim: We report a case of ectopic molar pregnancy located in the fallopian tube and draw attention to the importance of systematic histological examination in any ectopic pregnancy. Case report: A 32-year-old primigravida woman presented with metrorrhagia in a context of about 2 months of amenorrhea. An ectopic pregnancy was diagnosed by ultrasonography. A Laparotomy was performed and a ruptured left ampullary ectopic pregnancy was found, and a total left salpingectomy was performed. The pathologic examination and the histological examination show an aspect of a partial molar ectopic tubal pregnancy. Conclusion: Ectopic molar pregnancy is a rare entity, its diagnosis requires histological confirmation. Beta-HCG monitoring is the essential tool for monitoring the postoperative evolution.

Spontaneous Bilateral Tubal Ectopic Pregnancy:A Case Report

Bilateral ectopic pregnancy is the rarest form of ectopic pregnancy. We report a case of spontaneous bilateral tubal ectopic pregnancy diagnosed intra operatively. A 30-year-old patient was admitted to the emergency room of N’Djamena mother and child hospital complaining of vaginal bleeding and abdominal pain. Salpingectomy left tube and salpingotomy right tube were performed without complication and that histopathological report confirmed the diagnosis.

Correlates of Mistimed Pregnancy and Unmet Need for Family Planning among Women of Reproductive Age in Sandema, Ghana

Background: Globally, an estimated 80 million unintended pregnancies comprising both mistimed and unwanted pregnancies are recorded yearly. Yet only half of the women at risk of mistimed pregnancy use contraceptives. In developing countries, over 100 million females have unmet need, and national surveys in Ghana indicate 23% unmet need rate. Methods: Using a cross-sectional community-based approach, a sample size of 300 women of reproductive age were selected using multi-step cluster sampling techniques. The study was quantitative, using structured interviewer-administered questionnaires. Results: Two-third (66%) of the women in reproductive age still had unmet need, 71% were currently pregnant, and more than a third (36%) confirmed ever having a mistimed pregnancy. Fifty-three percent (53%) of the women confirmed never communicating with their partners on family planning issues, a little below half (45%) took their own health care decisions. Seventy nine percent (79%) ever received family planning services from a health professional. Factors related to unmet needs included mistimed pregnancy, level of education, preferred birth/pregnancy interval, communication between partners and the autonomy to spend self-earnings. Conclusion: Considering that high rates of unmet need results in mistimed pregnancy, improved policies around the influence of unmet need on mistimed pregnancies are needed.

Prevalence and Individual-Level Determinants of Uptake of Three or More Doses of Sulphadoxine-Pyrimethamine for Intermittent Preventive Treatment of Malaria in Pregnancy in Busia County, Kenya

Background: Malaria in pregnancy causes maternal anemia, low birth weight, intrauterine growth retardation, and preterm deliveries. In malaria-endemic regions in Kenya, percentage of pregnant women hospitalized with malaria reach up to 60%. WHO recommends at least three doses of sulphadoxine pyrimethamine for Intermittent Preventive Treatment of Malaria in Pregnancy (IPTp) antenatally. This study sought to ascertain the prevalence and individual-level factors influencing the uptake of IPTp-SP3+. Methods: A facility-based cross-sectional study at Busia County Referral Hospital. 384 mothers were consecutively sampled at the maternity unit during delivery. Semi-structured questionnaires were used to collect data. Odds ratio (OR) and adjusted OR were used to determine statistical significance of individual factors influencing uptake of three or more IPTp-SP. Results: 43.0% of participants took IPTp-SP3+. Individual factors that affected the uptake of IPTp-SP3+ included starting ANC visits in the first trimester (adjusted odds ratio (aOR) = 2.1, 95% CI: 1.23 – 3.67, p = 0.046), having more than four ANC visits (aOR = 3.1, 95% CI: 1.49 – 6.50, p = 0.002), having a higher monthly income (aOR = 2.6, 95% CI: 1.24 – 5.36, p = 0.012), being aware of the advantages of IPTp-SP medications (aOR = 3.7, 95% CI: 1.40 – 9.74, p = 0.008), and having a positive attitude toward ANC services (aOR = 3.2, 95% CI: 1.61 – 6.31, p = 0.001). Conclusion: Less than half of the pregnant mothers are complyingIPTp-SP3+. There should be aggressive efforts by the County and National Ministries of Health promoting initiation of ANC attendance early and attendance of all the recommended eight visits together with ensuring availability of the drugs.

Bilateral tubal pregnancy: A diagnostic dilemma

Bilateral tubal ectopic pregnancy is very rare and usually occurs following ovulation stimulation. Moreover preoperative diagnosis is very difficult. We are presenting a case of bilateral tubal ectopic pregnancy occurring spontaneously. Hence careful follow-up with combination of color Doppler and serum beta HCG estimation of patients after laparoscopic or open surgery for ectopic pregnancies is needed to avoid such unusual event.

Recurrent tubal pregnancy following ipsilateral partial salpingectomy

A 34-year-old woman came into the Emergency Department of PUMCH with the complaint of sudden lower abdominal pain lasting 4 hours on May 1st, 2004. She had normal menstruation cycle with a period of 30 days. But her last menstruation was started 37 days ago. She experienced laparosalpingectomy for right tubal pregnancy on Jan. 23rd, 2003. During that operation, it was found that she had pelvic adhesions in the Douglas pouch.

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.

A Study on the Correlation of Body Mass Management During Pregnancy with Adverse Pregnancy Outcomes and Labor Progression

Objective:To investigate the effects of body mass management during pregnancy on adverse pregnancy outcomes,duration of labor,and neonatal birth weight.Methods:472 pregnant women who visited Beijing Anzhen Hospital from January to December 2023 were selected,and the pregnant women were divided into 236 each in the observation group and the control group.Body mass of pregnant women was measured and BMI was calculated in early and late pregnancy respectively,and the pregnant women in the control group were guided by routine management,while the observation group was guided by body mass management during pregnancy.The growth of maternal body mass,mode of delivery,postpartum hemorrhage,neonatal score,neonatal blood glucose at birth,and umbilical artery blood,as well as the comparison of the duration of labor,were observed.Results:The observation group was significantly better than the control group in terms of mode of delivery,postpartum hemorrhage,and body mass growth,with statistically significant differences(P<0.05),and there was no statistical significance in terms of neonatal scores,neonatal blood glucose at birth,and umbilical artery blood(P>0.05);the time of the first stage of labor and the time of the second stage of labor of the mothers in the observation group was significantly better than that of the control group,with statistical differences(P<0.05),and the time of the third stage of labor of the mothers in the observation group was statistically better than that of the control group.There was no statistically significant difference between the time of the third stage of labor in the observation group and the control group(P>0.05),and the time of the total stage of labor in the observation group was statistically better than that in the control group(P<0.05).Conclusion:Body mass management during pregnancy can effectively improve maternal control of weight gain,reduce labor time,and decrease the occurrence of adverse pregnancy outcomes.

Analysis of Cardiac Functional Status and Factors Influencing Adverse Pregnancy Outcomes in Pregnant Women with Combined Heart Disease

Objective:To investigate the cardiac function of pregnant women with complicated heart disease during pregnancy and the factors influencing the adverse pregnancy outcome.Methods:A total of 162 cases of pregnant women with complicated heart disease admitted to the Beijing Anzhen Hospital from October 2021 to December 2023 were selected to compare the occurrence of adverse pregnancy outcomes in pregnant women with complicated heart disease at different levels of cardiac function and to analyze the single and multi factors leading to adverse pregnancy outcomes in pregnant women with complicated heart disease.Results:Among 162 pregnant women with combined heart disease in pregnancy,the highest percentage of heart disease type was congenital heart disease(80/49.38%),and the lowest percentage was other(9/5.56%);the overall incidence of adverse pregnancy outcomes in pregnant women with combined heart disease in pregnancy with cardiac function grades of 3–4 cardiac function(30/68.18%)was higher than that in pregnant women with combined heart disease in cardiac function grades of 1–2(40/33.90%)(P=0.000);age,marital status,hypertension,and past history of all pregnant women were not statistically significant(P>0.05);gestational age,type of heart disease,and cardiac function grading were statistically significant(P<0.05),and these factors were all independent risk factors for adverse pregnancy resolution in pregnant women with combined heart disease(P<0.05).Conclusion:The overall incidence of adverse pregnancy outcomes was higher in pregnant women with heart disease than in those with heart disease grades 1–2,and the number of pregnancies,the type of heart disease,and heart function grades were all independent risk factors for adverse pregnancy outcomes in pregnant women with heart disease.

Emergency department management of acute agitation in the reproductive age female and pregnancy

BACKGROUND:Agitation is a common presentation within emergent departments(EDs).Agitation during pregnancy should be treated as an obstetric emergency,as the distress may jeopardize both the patient and fetus.The safety of psychotropic medications in the reproductive age female has not been well established.This review aimed to explore a summary of general agitation recommendations with an emphasis on ED management of agitation during pregnancy.METHODS:A literature review was conducted to explore the pathophysiology of acute agitation and devise a preferred treatment plan for ED management of acute agitation in the reproductive age or pregnant female.RESULTS:While nonpharmacological management is preferred,ED visits for agitation often require medical management.Medication should be selected based on the etiology of agitation and the clinical setting to avoid major adverse effects.Adverse effects are common in pregnant females.For mild to moderate agitation in pregnancy,diphenhydramine is an effective sedating agent with minimal adverse effects.In moderate to severe agitation,high-potency typical psychotropics are preferred due to their neutral effects on hemodynamics.Haloperidol has become the most frequently utilized psychotropic for agitation during pregnancy.Second generation psychotropics are often utilized as second-line therapy,including risperidone.Benzodiazepines and ketamine have demonstrated adverse fetal outcomes.CONCLUSION:While randomized control studies cannot be ethically conducted on pregnant patients requiring sedation,animal models and epidemiologic studies have demonstrated the effects of psychotropic medication exposure in utero.As the fetal risk associated with multiple doses of psychotropic medications remains unknown,weighing the risks and benefits of each agent,while utilizing the lowest effective dose remains critical in the treatment of acute agitation within the EDs.

A pregnant patient with type II osteogenesis imperfecta pregnancy

Osteogenesis imperfecta(OI)is a primary bone fragility disorder with an estimated prevalence of 1/15,000 births and is a hereditary syndrome characterized by one or more of the following:fractures,blue sclerae,impaired hearing,defective dentition,and hyperlaxibility throughout life.[1,2]We report a pregnant woman with type II OI and review her prenatal counseling,diagnosis,and pregnancy management to assist obstetricians in understanding the disease and managing it in emergency situations.

Iron supplementation during malaria infection in pregnancy and childhood:A review

Malaria presents a significant global public health challenge,with severe malarial anaemia being a primary manifestation of the disease.The understanding of anaemia caused by malaria remains incomplete,making the treatment more complex.Iron is a crucial micronutrient essential for haemoglobin synthesis,oxygen delivery,and other vital metabolic functions in the body.It is indispensable for the growth of human beings,as well as bacteria,protozoa,and viruses in vitro and in vivo.Iron deficiency is among the most common nutritional deficiencies and can have detrimental effects during developmental stages of life.Malaria-induced iron deficiency occurs due to the hemolysis of erythrocytes and the suppression of erythropoiesis,leading to anaemia.Meeting iron requirements is particularly critical during pivotal life stages such as pregnancy,infancy,and childhood.Dietary intake alone may not suffice to meet adequate iron requirements,thus highlighting the vital role of iron supplementation.While iron supplementation can alleviate iron deficiency,it can exacerbate malaria infection by providing additional iron for the parasites.However,in the context of pregnancy and childhood,iron supplementation combined with malaria prevention and treatment has been shown to be beneficial in improving birth outcomes and ensuring proper growth and development,respectively.This review aims to identify the role and impact of iron supplementation in malaria infection during the life stages of pregnancy and childhood.