New frontiers in ectopic pancreatic tissue management

The pancreatic development variations are relatively frequent but are often overlooked in clinical practice.This is due to the fact that they do not present with a distinct clinical picture and are usually asymptomatic.It also refers to the ectopic pancreatic tissue in the stomach.This anomaly can be diagnosed in any part of the digestive system,but it is mostly seen in the upper gastrointestinal tract,especially in the stomach,duodenum and jejunum.The management of this condition has evolved due to the development of minimally invasive procedures.

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.

Treatment of fat-poor renal angiomyolipoma with ectopic blood supply by fluorescent laparoscopy:A case report and review of literature

BACKGROUND Renal angiomyolipoma and renal cell carcinoma are the most common benign and malignant tumors of the kidney respectively,and the preoperative differential diagnosis is crucial due to the wide difference in treatment methods.Fat-poor renal angiomyolipoma is a relatively rare type of in renal angiomyolipoma.Its fat imaging features are not obvious,and it is easily misdiagnosed as renal cell carcinoma.CASE SUMMARY We report the case of a 41-year-old man who complained of osphyalgia.Subsequent abdominal computed tomography scans revealed that a heterogeneous mass was seen in the lower pole of the right kidney,with the size of about 53 mm×47 mm.And showed two right renal arteries,with the mass supplied by an ectopic vessel from the abdominal aorta.Fluorescent laparoscopic blockade of the right renal heterotopic artery and partial nephrectomy was performed.Based on histological and immunohistochemical findings,the tumor was diagnosed as fatpoor renal angiomyolipoma.CONCLUSION The use of fluorescent laparoscopy can effectively help intraoperative management,and the fluorescence pattern provided by intravenous indocyanine green can help suggest the final diagnosis,effectively guide the surgical decisionmaking,and avoid preoperative imaging diagnosis leading to nephrectomy for benign renal tumors,through fluorescent navigation of tumor supply vessel precise block,minimize the loss of renal function.

Endoscopic removal of gastric ectopic pancreas:An initial experience with endoscopic submucosal dissection

AIM:To evaluate the therapeutic usefulness and safety of endoscopic resection in patients with gastric ectopic pancreas.METHODS:A total of eight patients with ectopic pancreas were included.All of them underwent endoscopic ultrasonography before endoscopic resection.Endo-scopic resection was performed by two methods:endo-scopic mucosal resection(EMR)by the injection-and-cut technique or endoscopic mucosal dissection(ESD).RESULTS:We planned to perform EMR in all eight cases but EMR was successful in only four cases.In the other four cases,saline spread into surrounding normal tissues and the lesions becameattened,which made it impossible to remove them by EMR.Inthose four cases,we performed ESD and removed the lesions without any complications.CONCLUSION:If conventional EMR is difficult to remove gastric ectopic pancreas,ESD is a feasible alternative method for successful removal.

Overview of ectopic pancreas

This editorial discusses the article written by Zheng et al that was published in the latest edition of the World Journal of Gastrointestinal Surgery.Our primary focus is on the causes,location,diagnosis,histological classification,and therapy of ectopic pancreas.Ectopic pancreas refers to the presence of pancreatic tissue that is situated in a location outside its usual anatomical placement,and is not connected to the normal pancreas in terms of blood supply or anatomical struc-ture.Currently,the embryological origin of ectopic pancreas remains uncertain.The most prevalent form of ectopic pancreatic is gastric ectopic pancreas.Endoscopic ultrasonography examination can visualize the morphological charac-teristics of the ectopic pancreatic lesion and pinpoint its anatomical location.The histological categorization of ectopic pancreas evolves.Endoscopic treatment has been widely advocated in ectopic pancreas.

Ectopic expression of soybean GmKNT1 in Arabidopsis results in altered leaf morphology and flower identity

Plant morphology is specified by leaves and flowers, and the shoot apical meristem （SAM） defines the architecture of plant leaves and flowers. Here, we reported the characterization of a soybean KNOX gene GmKNT1, which was highly homologous to Arabidopsis STM. The GmKNT1 was strongly expressed in roots, flowers and developing seeds. Its expression could be induced by IAA, ABA and JA, but inhibited by GA or cytokinin. Staining of the transgenic plants overexpressing GmKNT1-GUS fusion protein revealed that the GmKNT1 was mainly expressed at lobe region, SAM of young leaves, sepal and carpel, not in seed and mature leaves. Scanning electron microscopy （SEM） disclosed multiple changes in morphology of the epidermal cells and stigma. The transgenic Arabidopsis plants overexpressing the GmKNT1 showed small and lobed leaves, shortened internodes and small clustered inflorescence. The lobed leaves might result from the function of the meristems located at the boundary of the leaf. Compared with wild type plants, transgenic plants had higher expression of the SAM-related genes including the CUP, WUS, CUC1, KNAT2 and KNAT6. These results indicated that the GmKNT1 could affect multiple aspects of plant growth and development by regulation of downstream genes expression.

Laparoscope resection of retroperitoneal ectopic insulinoma: A rare case

Ectopic insulinoma is a very rare and dormant tumor.Here we report the case of a 79-year-old female who presented with repeated episodes of hypoglycemia and was diagnosed with insulinoma based on laboratory and imaging examinations.Computed tomography and positron emission tomography revealed a tumor in the retroperitoneum under and left of the hepatoduodenal ligament, which was resected successfully using a laparoscopic approach.Pathologic results revealed an ectopic insulinoma, which was confirmed immunohistochemically.Ectopic insulinomas are accompanied by hypoglycemia that can be misdiagnosed as drug- or disease-induced.These tumors are difficult to diagnose and locate, particularly in atypical cases or for very small tumors.Synthetic or targeted examinations, including low blood glucose, elevated insulin, proinsulin, and C-peptide levels, 48-h fasting tests, and relevant imaging methods should be considered for suspected cases of insulinoma.Surgery is the treatment of choice for patients with insulinoma, and laparoscopic resection is a feasible and effective method for select ectopic insulinoma cases.

Effect of rhBMP-2 sustained-release nanocapsules on the ectopic osteogenesis process in Sprague-Dawley rats

Objective:To explore the effect of sustained-release recombinant human bone morphogenetic protein-2(rhBMP-2) on ectopic osteogenesis in the muscle pouches of rats through preparing rhBMP-2 sustained-release capsules by wrapping morphogenesis protein bones-2(BMP-2)using chitosan nanoparticles,and compositing collagen materials.Methods:Twenty four SpragueDawley rats were randomly divided into four groups with six rats in each group,that is Group A(control group),Group B(only treated with collagen),Group C(rhBMP-2+collagen treated group) and Group D(rhBMP-2/cs+collagen treated group).The composite materials for each group were implanted in the bilateral peroneal muscle pouches in rats.The peroneal muscles were only separated without implanting any materials in control group.Rats were sacrificed 2 weeks and 4 weeks post treatment and samples were cut off for general observation,Micro CT scans and histological observation.Results:General observation showed no new bone formation in Groups A and B mice,while new bones were formed in Groups C and D mice.Two weeks after treatment Micro CT scans showed that The bone volume fraction(BVF),trabecular thickness(Tb. Th),bone mineral density(BMD) in Group C mice were all higher than that in Group D(P<0.05). At the fourth week,the BVK,Tb.Th and BMD were significantly higher than that at the second week(P<0.01).Conclusions:The slow-release effect of rhBMP-2/cs sustained-release capsules can significantly promote ectopic osteogenesis.Its bone formation effect is better than that of rhBMP-2 burst-release group.

The Expression and Change of the β_3 Integrin Subunit and Fibronectin in Normal Human Oviductal Tissue and Tubal Ectopic Pregnant Tissue

Objective To investigate the expression and change of the β3 integrin subunit and fibronectin in normal human oviductal tissue during various phases of the menstrual cycle and tubal ectopic pregnant tissueMethods Samples of normal ( n=29 ) and pregnant fallopian tube ( n=22 ) tissues were obtained from women who had normal cycle and history of normal pregnancy. Normal oviductal tissue samples were divided into 4 groups based on their menstrual cycle. Both expression and distribution of the β3 subunit and fibronectin were determined with the immunohistochemical method and the image analysis.Results The β3 subunit was expressed in the cytoplasm of ciliated cells. The expression level of the β3 subunit was higher after ovulation than that before ovulation in isthmus epithelium (P<0.001), and declined significantly after ovulation in ampullae epithelium (P<0.001). In umbrella epithelium within 4 days after ovulation, the expression level of the β3 subunit was observed at rather higher level among other phases (P <0.001). The ciliated and secretory cells of the epithelium except for where the pregnancy occurred in tubal pregnancy expressed the β3 subunit, and no significant relationship was found between the normal tubal tissue of the secretory phase and tubal ectopic pregnant tissue (P>0.05). Fibronectin was expressed in the basement membrane of human oviductal epithelium and matrix. The expression level of fibronectin was higher in the hyperplastic phase than that in the secretory one (P<0.001). And it was lower in normal tubal tissue of the secretory phase than that in tubal ectopic pregnant tissue (P<0.001).Conclusion Theβ3 integrin subunit was expressed in the ciliated cells of human oviductal epithelium, and fibronectin was expressed in the basement membrane of human oviductal epithelium and matrix. Their expression and change in oviductal tissue is based on different phases of menstrual cycle. The β3 subunit could not related to the occurrence of tubal ectopic pregnancy. Fibronectin could be the potential molecular basis for the tubal ectopic pregnancy.

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.

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.

Rare entity: Ectopic liver tissue in the wall of the gallbladder- A case report

Ectopic liver tissue(ELT) is a rare condition, which is usually not diagnosed preoperatively, but coincidentally during abdominal surgery. While the location of ELT can vary, it is usually localized on the gallbladder wall or in close proximity. ELT is associated with various complications, a major complication being extrahepatic hepatocellular carcinoma. A 59-year-old female underwent elective surgery for chronic cholecystitis with stones. During laparoscopic exploration, a 2-cm-diameter ELT was detected in the anterior gallbladder wall and a laparoscopic cholecystectomy was performed. The case is presented due to the rare nature of ELT and as a reminder of ELT-related complications.

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.

Vascularization and osteogenesis in ectopically implanted bone tissue-engineered constructs with endothelial and osteogenic differentiated adipose-derived stem cells

BACKGROUND A major problem in the healing of bone defects is insufficient or absent blood supply within the defect.To overcome this challenging problem,a plethora of approaches within bone tissue engineering have been developed recently.Bearing in mind that the interplay of various diffusible factors released by endothelial cells(ECs)and osteoblasts(OBs)have a pivotal role in bone growth and regeneration and that adjacent ECs and OBs also communicate directly through gap junctions,we set the focus on the simultaneous application of these cell types together with platelet-rich plasma(PRP)as a growth factor reservoir within ectopic bone tissue engineering constructs.AIM To vascularize and examine osteogenesis in bone tissue engineering constructs enriched with PRP and adipose-derived stem cells(ASCs)induced into ECs and OBs.METHODS ASCs isolated from adipose tissue,induced in vitro into ECs,OBs or just expanded were used for implant construction as followed:BPEO,endothelial and osteogenic differentiated ASCs with PRP and bone mineral matrix;BPUI,uninduced ASCs with PRP and bone mineral matrix;BC(control),only bone mineral matrix.At 1,2,4 and 8 wk after subcutaneous implantation in mice,implants were extracted and endothelial-related and bone-related gene expression were analyzed,while histological analyses were performed after 2 and 8 wk.RESULTS The percentage of vascularization was significantly higher in BC compared to BPUI and BPEO constructs 2 and 8 wk after implantation.BC had the lowest endothelial-related gene expression,weaker osteocalcin immunoexpression and Spp1 expression compared to BPUI and BPEO.Endothelial-related gene expression and osteocalcin immunoexpression were higher in BPUI compared to BC and BPEO.BPEO had a higher percentage of vascularization compared to BPUI and the highest CD31 immunoexpression among examined constructs.Except Vwf,endothelial-related gene expression in BPEO had a later onset and was upregulated and well-balanced during in vivo incubation that induced late onset of Spp1 expression and pronounced osteocalcin immunoexpression at 2 and 8 wk.Tissue regression was noticed in BPEO constructs after 8 wk.CONCLUSION Ectopically implanted BPEO constructs had a favorable impact on vascularization and osteogenesis,but tissue regression imposed the need for discovering a more optimal EC/OB ratio prior to considerations for clinical applications.

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.

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.

Viable Second Trimester Cervical Ectopic Pregnancy Managed Successfully with Uterine Preservation: Case Report

Cervical pregnancy is a rare clinical entity that accounts for less than 1% of all ectopic pregnancies. It results from implantation of the blastocyst in the cervical canal below the level of the internal os. Although non-tubal ectopic pregnancies account for only 5% of ectopics, they contribute to a significant morbidity. The cornerstone in the management of cervical ectopic is early diagnosis by high index of suspension and a qualified sonographer. Management options for cervical ectopic pregnancies range from conservative drug treatment to radical hysterectomy. Over the last few years, the mortality and morbidity rates of ectopic pregnancies have been reduced. This is mainly due to the early recognition of the condition and the wide availability of minimally invasive surgical procedures. We present a case of a 33-year-old woman that was 16 weeks pregnant. She presented initially with recurrent vaginal bleeding followed by minimal lower abdominal pain. Her early US scans were misleading. Several weeks later, a follow up MRI scan suggested cervical ectopic. She was managed surgically with uterine preservation.

Using laparoscope to remove an ectopic intrauterine device in the anterior wall of urinary bladder:A case report

BACKGROUND An intrauterine device(IUD)is a contraceptive device placed in the uterine cavity and is a common contraceptive method for Chinese women.However,an IUD may cause complications due to placement time,intrauterine pressure and other factors.Ectopic IUDs are among the most serious complications.Ectopic IUDs are common in the myometrium and periuterine organs,and there are few reports of ectopic IUDs in the urinary bladder,especially in the anterior wall.CASE SUMMARY A 52-year-old woman was hospitalized due to a urinary bladder foreign body found via abdominal ultrasound and computed tomography(CT)examination.The patient had a 2-year history of recurrent abdominal distension and lower abdominal pain,accompanied by frequent urination,urgency,dysuria and other discomfort.Ultrasound examination revealed foreign bodies in the bladder cavity,with calculus on the surface of the foreign bodies.CT revealed a circular foreign body on the anterior wall of the urinary bladder,suggesting the possibility of an ectopic IUD.After laparoscopic exploration,an annular IUD was found in the anterior wall of urinary bladder,and an oval calculus with a diameter of approximately 2 cm was attached to the surface of the bladder cavity.The IUD and calculus were successfully and completely removed.The patient recovered well after surgery.CONCLUSION Abdominal ultrasound and CT are effective methods for detecting ectopic IUDs.The IUD is located in the urinary bladder and requires early surgical treatment.The choice of surgical method is determined by comprehensively considering the depth of the IUD in the bladder muscle layer,the situation of complicated calculus,the situation of intravesical inflammation and medical technology and equipment.

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.

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.