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.

Abdominal pregnancy secondary to iatrogenic uterine perforation: A case report and literature review

Abdominal pregnancy is a rare and life-threatening form of ectopic pregnancy.It is defined as an ectopic pregnancy in a region of the peritoneal cavity that does not include the fallopian tubes,ovaries,or their associated ligamentous structures.Many abdominal pregnancies are caused by secondary implantation in the peritoneal cavity after tubal abortion,rupture,or uterine rupture.Here,we report a case of abdominal pregnancy resulting from iatrogenic uterine perforation during the induced abortion of an early intrauterine pregnancy,which had been misdiagnosed as a ruptured corpus luteum cyst due to the sudden rupture of the abdominal gestational sac,complicating intra-abdominal hemorrhage.The true diagnosis was missed by vaginal ultrasound and confirmed by laparoscopic exploration.We discuss the details of the case management and review the relevant literature.©2023 Zhejiang University.

Abdominal Pregnancy with Hemorrhagic Placenta: About a Case at the Mother and Child Health Center of Zinder

Background: In developing countries maternal mortality and morbidity are most often due to the late to consult, poverty and ignorance. Added to this is, the under-medicalization of the health system. The objective of study is to report a case of late consultation and its consequences and make recommendations to improve: case of abdominal pregnancy with hemorrhagic placenta at the Health and Mother Center (CSME) in Zinder/Niger. Clinical Observation: We describe a case of abdominal pregnancy with hemorrhagic placenta in a 24-year-old woman, without profession, resident in the city of Zinder with a low economic level, consulted for abdomino-pelvic pain. She had a notion of amenorrhea for 5 months without any consultation made. She was pale, feverish and had abdominal pain. Ultrasound revealed a 23-week-old fetus and an empty uterus. The diagnosis was abdominal pregnancy. A laparotomy was performed and a The morbidity was hysterectomy and anemia. The postoperative period course was complicated with anemia. The patient was cured on the 9th day with a good vital prognosis. Conclusion: Abdominal pregnancy occurred in a patient who presented a risk factor. Ultrasound was the key diagnostic test. Surgery was the treatment of choice and the prognosis depends on the earliness of the consultation. Community awareness and early consultation with health services can improve the prognosis of abdominal pregnancy.

Management of a Second-Trimester Abdominal Pregnancy: A Case Report and Review of the Literature

Introduction: The abdominal pregnancy is a rare pathology that can threaten the vital prognosis of the mother. The positive diagnosis is difficult to establish. It is most often made in an acute context, leading to a high fetomaternal morbidity and mortality. Our objective is to recall the diagnostic approach and optimal management of this condition. Case report: We present the case of an abdominal pregnancy at 18 weeks of amenorrhea with partial placental abruption in a 26-year-old patient who presented with abdominal pain in emergency obstetrical department of university hospital center of Agadir. The ultrasound revealed the presence of an evolving abdominal pregnancy. The MRI allowed precisely the localization of the placenta and its relationship with the surrounding organs. A laparotomy revealed the insertion of the placenta on the right adnexa. The right adnexectomy allowed removal of the placenta without incident. Conclusion: Abdominal pregnancy is difficult to diagnose. It is essential to be well informed about the clinical and ultrasonographic semiology of this pregnancy, in order to avoid operative surprises and to ensure the appropriate treatment.

Successful Management of Rare Advanced Abdominal Pregnancy with Severe Preeclampsia: A Case Report and Literature Review

Background: Abdominal pregnancy is a rare ectopic pregnancy in which the baby grows up in the peritoneal cavity exclusive of tubal, ovarian, or intraligamentary implantations. Abdominal pregnancy has very high maternal and fetal morbidity and mortality. Therefore, early recognition and prompt management remain challenges for the treating physician. A thorough examination of the newborn is critical to rule out congenital anomalies. We reported a 24-year-old woman primigravida 40 weeks post-date with spontaneous conception who was admitted to the hospital with complaints of diffuse abdominal pain, symptoms, and signs of severe preeclampsia (headache, vomiting, high blood pressure, blurred vision, and swelling of the feet, ankles, face, and hands). Moreover, she had recurrent vaginal spotting, nausea, loss of appetite, and occasional vomiting. She was diagnosed with a progressive abdominal pregnancy later. A live male fetus stained with meconium was removed from the abdominal cavity, and the placenta was completely removed without significant blood loss. Conclusion: Abdominal pregnancy is a rare ectopic pregnancy requiring high clinical suspicion, early identification, and prompt management to avoid maternal morbidity and mortality. Abdominal pregnancy can be prevented by avoiding miscarriage and treating adhesions and chronic inflammatory diseases.

Abdominal Pregnancy, Case Report from Latifa Hospital DHA, Dubai, UAE

Abdominal pregnancy is a rare form of ectopic pregnancy. A high index of suspicion enables early diagnosis and prompt management. Ultrasound is a gold standard tool for diagnosis and Magnetic Resonance imaging has a limited role. Appropriate management of the condition is important to avoid grave maternal morbidity.

Intra-abdominal hemorrhage during pregnancy: Four case reports

BACKGROUND Intra-abdominal hemorrhage during pregnancy is a rare and dangerous complication of pregnancy.In this article,we report 4 cases of intra-abdominal hemorrhage during pregnancy,including the spontaneous rupture of uterine veins,spontaneous rupture of liver,rupture of external iliac vessel branch,and rupture of right renal hamartoma.CASE SUMMARY The clinical manifestations of three patients lacked specificity,and the localization of the bleeding was not clear prior to surgery.All 4 pregnant women were successfully treated,while only one full-term infant survived.CONCLUSION There are diverse causes of intra-abdominal hemorrhage during pregnancy in clinic,and it is clinically characterized by acute abdominal pain during pregnancy.Clear diagnosis before surgery is rather difficult.Early diagnosis,timely and appropriate treatment and surgery,and multidisciplinary cooperation are key to saving pregnant females’lives and improving the outcomes of perinatal infants.

Management Dilemma in Case of Abdominal Pregnancy: A Case Report

Introduction: Abdominal pregnancy is a rare form of ectopic pregnancy demanding high index of suspicion for diagnosis. We present a case of secondary abdominal pregnancy which was missed at a peripheral centre and referred to us with laparostomy wound after attempts were made to terminate it without proper diagnosis which resulted in excessive bleeding. Case Presentation: A 30-year-old primigravida was referred to us from a private clinic with a laparostomy wound. She had gone to the private clinic for termination of her 5-month-old pregnancy. Medical method was attempted initially failing which surgical evacuation was planned at second visit which resulted in excessive bleeding. The patient was opened up, fetus was removed from assumed uterine cavity?and attempted to remove the placenta caused torrential bleeding. The abdominal cavity was?packed and she was referred to a higher centre. Here she was taken up for re-exploration;ectopic sac was separated from neighboring structures, right cornu was found ruptured and was repaired. The patient also had wound dehiscence on post op day 7 for which secondary abdominal closure was done. Conclusion: Secondary abdominal pregnancy poses as a challenge to clinicians working in remote areas with limited diagnostic facilities. The condition may be life threatening if not handled meticulously.

Challenges in the Management of a Case of Secondary Abdominal Pregnancy

Introduction: Abdominal pregnancy, one of the rare forms of ectopic pregnancy demands a high index of suspicion for its timely diagnosis and intervention so as to prevent both maternal and neonatal complications. We presented a case of secondary abdominal pregnancy which was missed at the first instance at a private centre and came to us with nonspecific abdominal symptoms after an attempted termination of pregnancy by surgical means (dilation and curettage). Case presentation: A 24-year-old third gravida with two live issues at 10-week gestation came to us with complaints of pain lower abdomen, vomiting and inability to pass stool. She gave history of undergoing dilation and curettage (D&C) at a private hospital for termination of pregnancy about 20 days back. After thorough work-up and investigations, the diagnosis of secondary abdominal pregnancy was established and she was taken up for exploratory laparotomy with the removal of fetus with placenta. The patient progressed well with the postoperative period remaining uneventful. Conclusion: Secondary abdominal pregnancy poses as a challenge to clinicians working with limited diagnostic facilities. The condition may be life threatening if not handled meticulously.

Abdominal Pregnancy: Epidemiological, Diagnostic, Therapeutic and Prognostic Aspects: A Case Report from the Yaounde Central Hospital (Cameroon)

Abdominal pregnancy (AP) is a relatively rare and potentially serious form of ectopic pregnancies (EPs). We report the case of a haemorrhagic abdominal pregnancy at 15 weeks of amenorrhea complicated by hypovolaemic shock, with a favorable outcome. Our aim is to outline the epidemiological, clinical, therapeutic and prognostic features of this condition.

Abdominal Pregnancy: About a Case Observed at the Maternity of the Community University Hospital Center, Bangui, Central African Republic

Abdominal pregnancy is a life threat to both mother and fetus requiring surgery regardless of the age of pregnancy. We report a case of abdominal pregnancy, delivered by laparotomy with a live newborn. This is a 31-year-old woman with 34 weeks and 2 days of amenorrhea whose ultrasound showed an abdominal pregnancy. Laparotomy extracted a newborn female weighing 3000 grams with APGAR at birth rated at 7/10 at one minute. The postoperatives were simple. The patient was discharged on the 14th postoperative day on 20 mg methrotrexate injection once a week for four weeks.

Abdominal Advanced Pregnancy: A Case Report

Abdominal advanced pregnancy is a rare form of ectopic pregnancy. The diagnosis can be difficult, especially in advanced forms. The management is mainly surgical. The materno-fetal mortality is very high with a high risk of bleeding. We report a case of a 22 years old primiparous who presented an abdominal pregnancy with intraoperative discovery. Through this case managed in our structure, we will present the diagnostic and management difficulties.

Full term secondary abdominal pregnancy in a Jehovah’s witness: A case report

We describe a rare case of full term abdominal pregnancy in a Jehovah’s witness patient;she underwent laparotomy successfully without blood transfusion. Despite their belief regarding transfusion, Jehovah’s witnesses may not necessarily have a higher morbidity or mortality rate following a complex obstetric surgery as seen in the present case.

Advanced Abdominal Ectopic Pregnancy: A Case Report

A 35-year-old unbooked gravida 6 para 5+0 woman with 4 living children, who was unsure of her last menstrual period but she adjudged her index pregnancy to be term. She presented to the emergency unit with six months history of progressive weight loss, difficulty in breathing and abdominal pain that suddenly got worse about two days prior to presentation after an attempted external cephalic version by a traditional birth attendant. Ultrasound diagnosed abdominal pregnancy. An emergency laparotomy revealed collapsed fetal membranes with a rent of about 10 centimeters in diameter on the right and straw-colored amniotic fluid of about 2 litres in peritoneal cavity. A live male fetus was delivered with birth weight of 2.9 kilograms. The umbilical cord was cut and tied short close to the placenta which was left in situ and methotrexate was given. Post operative condition was satisfactory and patient had a brisk recovery. She was adequately counseled and discharged home on the 12th day after surgery and followed up subsequently.

Calcified Abdominal Pregnancy with Five Years of Evolution (Lithopedion): A Case Report

Lithopedion is a rare phenomenon resulting from an extra-uterine pregnancy that advances to fetal demise and calcification and there are less than 300 cases reported in 400 years of medical literature. This rare condition was first described by a surgeon of the Arabic era of medicine in the 10th century. This case report is a 26-year-old, multiparous woman who had presented a lower abdominal pain for long time and she had never attended in pre-natal clinic. She came to our hospital with pain and tumoral mass in infra-umbilical area and then we referred to radiology center, after that ultrasound examination of radiology center demonstrated an extra-uterine abdominal 30-week pregnancy measuring the femoral length, this for first diagnosis of radiology center. After laparotomy was performed we met an oval shaped mass that attached the omentum in peritoneal cavity and this mass was a fetus retention of 5 years without calcified ovular membranes but the fetus was calcified so this type is called lithopedion that describes according to the Kuechenmeister classification in 1881. She made good post-operative recovery after extraction the stone baby.

Prediction of Gestational Diabetes Mellitus in Early Pregnancy: Is Abdominal Skin Fold Thickness 20 mm or More an Independent Risk Predictor?

Background: Gestational Diabetes Mellitus (GDM) is associated with several maternal and perinatal complications. Early detection and treatment can improve pregnancy outcomes. Objectives: To determine the prevalence, risk factors and predictors of GDM in early pregnancy at the University of Port Harcourt Teaching Hospital, (UPTH), Port Harcourt Nigeria. Methods: A cohort of 235 mothers who registered for antenatal care between 15 - 18 weeks of gestation at UPTH was prospectively studied. Their socio-demographic data, examination findings, anthropometric measurements, fasting blood sugar at booking and OGTT results at 28 weeks gestation were collated and entered into PC with SPSS for windows version 21.0 which was also used for the analysis. Variables were expressed as absolute numbers, percentages or means with standard deviations and significant differences determined using chi square test or the student “t” test as appropriate. The level of significance was set at P < 0.05. Results: Of the 235 participants, 35 (14.9%) developed GDM. Women who had GDM were significantly older (P = 0.001), had higher weight (t = 2.95, P = 0.01), BMI (t = 2.29, P = 0.02), abdominal skin fold thickness (t = 4.15, P = 0.001), blood pressure (t = 3.38, P = 0.001) compared to women who did not. Previous history of GDM was significantly different between two groups as χ2 = 93.56 and P = 0.001. Abdominal skin fold thickness and prior GDM history were found to be independent predictors of GDM on application of multiple logistic regression analysis. Conclusion: The prevalence of GDM in Port Harcourt is 14.9% and major risk factors are obesity, previous GDM history, advanced age and hypertension. Abdominal skin fold thickness ≥ 20 mm is an independent predictor. The risk of developing GDM can be predicted in early second trimester using algorithm incorporating risk factor screening and anterior abdominal wall skin fold thickness estimation.

Pre-Rupture Aneurysm of the Juxta and Sub-Renal Abdominal Aorta in Early Pregnancy: A Case Report

Aneurysm of the abdominal aorta is the result of a weakening of the arterial wall and corresponds to abnormal dilatations of the arteries defined as an increase ≥ 50% of the arterial diameter compared to the normal segments. A long asymptomatic, abdominal aortic aneurysm can be a catastrophic maternal-fetal situation due to the high risk of rupture induced by pregnancy. A rare association between aneurysm and pregnancy poses a problem of diagnosis and standardized management. The lack of knowledge of this condition regularly leads to a delay in management, which is a source of excess mortality. We report the case of a patient with a progressive pregnancy of 12 weeks of amenorrhea who presented with a large sub renal abdominal aortic aneurysm with thrombosis and fissuring in order to discuss the diagnostic and management aspects of this association.

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.

Should we perform decompressive laparotomy during severe acute pancreatitis with intra-abdominal hypertension below 25 mmHg:Only the gut knows

We suggest that during severe acute pancreatitis(SAP)with intra-abdominal hypertension,practitioners should consider decompressive laparotomy,even with intra-abdominal pressure(IAP)below 25 mmHg.Indeed,in this setting,non-occlusive mesenteric ischemia(NOMI)may occur even with IAP below this cutoff and lead to transmural necrosis if abdominal perfusion pressure is not promptly restored.We report our experience of 18 critically ill patients with SAP having undergone decompressive laparotomy of which one third had NOMI while IAP was mostly below 25 mmHg.

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.