Hysteroscopic Intact Removal of an Angular Pregnancy with a 5Fr Electrode

Study Objective

Angular pregnancy is a rare and life-threatening condition in which the embryo is implanted in the lateral angle of the uterine cavity, medial to the uterotubal junction and round ligament. Angular pregnancy is associated with a high risk of uterine rupture of about 23% [1]. No consensus has been achieved regarding the diagnostic and therapeutic approach of angular pregnancy [2]. Thus, the aim of this study was to report a case of hysteroscopic treatment of an angular pregnancy in a 34-year-old women.

A Novel Approach to Transmural Access to the Uterine Cavity in Cases of an Inaccessible Uterine Cavity: A Case Series

Access to the uterine cavity can sometimes be a challenge or even impossible because of various causes such as prior surgery. We report our experience with a novel approach to this problem in 8 cases using ultrasound-guided transmural injection of dye; afterward, the cavity was successfully found in all cases by ultrasound-guided hysteroscopy following the colored epithelium.     

Retrospective Study on Laparoscopic Management of Ectopic Pregnancy

Purpose

To evaluate various laparoscopic methods for management of tubal ectopic pregnancy and study the incidence of ectopic pregnancy including the incidence of cornual ectopic pregnancy and conversion to laparotomy during laparoscopic procedure.

Methods

A retrospective study was conducted in North Point Hospital, Delhi, on all laparoscopies conducted in 4 years, i.e., from January 2008 to December 2011.

Results

Incidence of ectopic pregnancy was 4.62 % (out of all laparoscopic surgeries over 4 years) and that for cornual pregnancy was 4.65 % (out of all ectopic pregnancies); no laparotomy was done for the management of ectopic pregnancy. The site of ectopic pregnancy in the tubal pregnancy varied, with 76.75 % in the ampullary region, 16.27 % isthumic, 2.33 % fimbrial, and 4.65 % in the cornual region. Salpingectomy was done in 53.5 % cases and 46.5 % of patients underwent a conservative approach in the form of salpingostomy.

Conclusion

The laparoscopic management of ectopic pregnancy is a safe and effective option with greatly reduced morbidity.     

Laparoscopic management of a cornual ectopic pregnancy associated with persistant gestational throphoblastic disease: a case report

A 30-year-old woman underwent laparoscopy for diagnosis and treatment of ectopic pregnancy. A dark-red bulging mass was observed in the right uterine horn. Laparoscopic hysterotomy was performed. The histological examination revealed a hydatidiform mole, which was confirmed by DNA ploidy analysis showing triploidy (69 XXY) as apartial hydatidiform mole after the cytogenetic examination. On the third postoperative day, the thoracic computed tomography scan revealed punctuate lesions. These lesions disappeared after single-agent chemotherapy with methothrexate. To the best of our knowledge, this is the first case of cornual persistent gestational trophoblastic neoplasia managed by laparoscopic surgery.     

Laparoscopic management of cornual pregnancy without sutures

Introduction Cornual pregnancy is a rare form of ectopic pregnancy. The incidence is reported as 3% of all ectopic pregnancies accounting 20% of deaths due to ectopic pregnancy. When an unruptured cornual pregnancy is diagnosed, there are a variety of management options. Many successful endoscopic management options for cornual pregnancy have been reported. Case report In this case, cornual resection was performed. Discussion The other possible treatment options were reviewed.     

Laparoscopical management of cornual pregnancies: a report of three cases

Objective

Cornual pregnancy refers to the implantation and development of a gestation in one of the upper and lateral portions of the uterus; authors report their experience in laparoscopic therapeutic procedures on three singleton cornual pregnancies.

Study design

Three healthy women were admitted in General Hospitals with suspect of cornual pregnancies by clinical examination, increasing of β-hCG value and transvaginal ultrasonography. One of them had a haemoperitoneum. Surgeons performed all operative laparoscopies, by incision and enucleating of ectopic cornual mass, coagulating of its surrounding vessels and suturing of the uterine incision site.

Results

Patients were successfully treated only by laparoscopy, post-operative recovery period was normal in all women, with no further therapeutically intervention in the follow-up course. The aftermath was uneventful at the follow-up of 2 years.

Conclusion

In cornual pregnancies, the minimally invasive surgical treatment by salpingotomy or resection of the cornual region of the uterus and the suturing of the incision site, should be the option in women interested in future fertility.     

A Rare Case of Gestational Choriocarcinoma Presenting as Cornual Ectopic Pregnancy

Background

Choriocarcinoma associated with cornual pregnancy is extremely rare. To our knowledge, only three other cases have been reported in the literature.

多胎妊娠早期选择性减胎术17例分析

目的研究多胎妊娠早期选择性减胎术的可行性、安全性及对妊娠的影响.方法17例多胎妊娠孕早期在B超引导下,将穿刺针选择性进入1个或2个胚胎的心管搏动处,反复抽吸或注入少量药物致心搏停止.结果14例经阴道减胎术单次成功,3例经腹部减胎2～3次成功.2例足月剖宫分娩,2例孕32周、孕34周提前剖宫术.5例晚期流产.2例因感染而分别于术后第3、第7天流产.6例继续妊娠.多胎妊娠的减胎术成功率88.2%(15/17).总流产率41.2%(7/17).已分娩的8个新生儿健康.结论在B超引导下,多胎妊娠早期选择性减胎术是安全、有效治疗多胎妊娠的方法.     

Population-Based Study on the Effect of Socioeconomic Factors and Race on Management and Outcomes of 35,535 Inpatient Ectopic Pregnancies

Study ObjectiveTo evaluate whether socioeconomic variables influence the management and outcomes of ectopic pregnancies.DesignRetrospective cohort study (Canadian Task Force classification II-2).SettingHospitals in the United States participating in the Health Care Cost and Utilization Project.PatientsWomen (n = 35 535) with a primary discharge diagnosis of ectopic pregnancy.InterventionsEffect of socioeconomic factors and race/ethnicity on management and adverse outcomes of ectopic pregnancy.Measurements and Main ResultsDuring the 9-year study, 35 535 ectopic pregnancies were identified. The development of hemoperitoneum in 8706 patients (24.50%) was the most common complication. Asian race was the sociodemographic variable most predictive of hemoperitoneum (odds ratio [OR], 1.41; 95% confidence interval [CI], 1.24–1.61; p < .01) and transfusion (OR, 1.62; 95% CI, 1.39–1.89; p < .01), and Medicare status was most influential on prolonged hospitalization (OR, 1.83; 95% CI, 1.36–2.47; p < .01). Major complications were not affected by socioeconomic factors. Laparotomy in 25 075 patients (70.6%) was the most common treatment option. Patients of Asian or Pacific Islander descent were least likely to be treated non-surgically (OR, 0.62; 95% CI, 0.51–0.76; p < .01), whereas Medicare recipients were most likely to be treated non-surgically (OR, 1.70; 95% CI, 1.32–2.18; p < .01). All non-white groups were less likely to undergo a laparoscopic approach.ConclusionMajor complications from ectopic pregnancy are not influenced by socioeconomic variables; however, less serious complications and management approaches are persistently affected.     

Treatment with methotrexate of a cornual pregnancy following endometrial resection

ABSTRACT

Objectives Endometrial resection is a procedure often performed for treatment of menorrhagia. Despite the fact that amenorrhoea frequently ensues, some normal endometrium can remain present and become the implantation site of a pregnancy. Such an event is uncommon (0.7%); however, the likelihood of an ectopic pregnancy is increased. This case report calls the reader's attention to the risk of intra- and extrauterine pregnancies and the necessity for contraception after endometrial resection, even in cases where amenorrhoea supervenes.

Case A 46-year-old woman with prior endometrial resection and subsequent amenorrhoea, was diagnosed with a cornual pregnancy. She was successfully treated with systemic methotrexate, which was given in an outpatient clinic.

Conclusion Clinicians should be aware of the increased likelihood of an ectopic pregnancy after endometrial resection. All women submitting to this procedure should be counselled about the need for contraception, even in cases where amenorrhoea develops.     

An advanced second trimester tubal pregnancy: Case report

BackgroundLack of early ultrasound examination and proper antenatal care in rural areas explain why most ectopic pregnancies are presented to our center only after they become disturbed. However, this is almost always restricted to the first trimester.CaseA middle aged woman presented with acute abdomen and hemodynamic instability was admitted at our emergency department. History revealed an unexpected definite period of amenorrhea of 18 weeks and 2 days duration and pregnancy test was found positive. Ultrasound examination showed hemoperitoneum and a right large adnexal swelling with a viable fetus inside and as such immediate exploration was decided. Laparotomy revealed profound intra-abdominal and pelvic blood collection and an advanced right tubal pregnancy with intact gestational sac. Right salpingectomy was done and the patient had a smooth postoperative course until being discharged.ConclusionAccording to this case, tubal pregnancy should always be considered even in the second trimester if the clinical presentation is relevant, and ultrasound examination is mandatory to identify pregnancy location.     

Challenges in the diagnosis and management of interstitial and cornual ectopic pregnancies

Interstitial ectopic pregnancy is a term loosely used in the literature to describe three different entities. The first is the true interstitial ectopic pregnancy, which occurs in the interstitial or intramural segment of the Fallopian tubes. The term cornual ectopic pregnancy should be reserved for pregnancy in women with a single uterine horn, a bicornuate uterus, or a septate uterus. Angular pregnancy is a term that is rarely used and should be limited to a pregnancy in one of the angles of the uterus, but not inside the Fallopian tube.Historically, interstitial pregnancy was considered safe to manage conservatively until over 12 weeks because of the delayed risk of rupture as a result of the protection offered by the muscle of the uterus. However, over the last decade evidence now suggests that early rupture is not uncommon. The management of an interstitial pregnancy should be ascertained by ultrasonography, particularly three-dimensional ultrasonography. Depending on the size and viability of the pregnancy, management should be planned accordingly. Laparoscopic management is ideal for surgeons comfortable with the principles of laparoscopic surgery and suturing. However, laparotomy is a suitable alternative that will always provide a safe outcome. Adequate suturing of uterine cornua could prevent the risk of rupture during subsequent pregnancies. Minimizing blood loss during and after surgery is a priority.     

Recurrent heterotopic pregnancy after bilateral salpingectomy in an IVF patient: Case report

Purpose: To report a rare clinical case of recurrent heterotopic pregnancy in the same patient following bilateral salpingectomy and in-vitro fertilization (IVF) treatments. Methods: A 35 year-old woman, suffering from mechanical infertility, was treated by IVF, resulting in two episodes of heterotopic pregnancies within 2 years. The first episode ended in bilateral salpingectomy due to unilateral tubal pregnancy and contralateral severely damaged tube. The intrauterine pregnancy ended in early missed abortion. The second heterotopic pregnancy presented as bleeding cornual pregnancy, managed by laparoscopic resection of the tubal stump, and ended in a term singleton delivery. Conclusion: The possibility of cornual heterotopic pregnancy following bilateral salpingectomy, though very rare, should be considered by every gynecologist treating IVF patient.     

Perinatal Outcome of Pregnancies After Assisted Reproduction: A Case–Control Study

Purpose: A matched case–control study of all pregnancies obtained after either IVF or ICSI was conducted to investigate the perinatal outcome. Methods: Three hundred eleven singleton and 115 twin pregnancies obtained after assisted reproduction were studied. Controls were selected from a regional register and were matched for maternal age, parity, singleton or twin pregnancy, and date of delivery. Results: No significant difference was observed for gestational age at delivery, birth weight, incidence of congenital anomalies, and incidence of perinatal mortality between ART (singleton and twin) pregnancies and spontaneous controls. ART twin pregnancies showed a higher incidence of preterm deliveries than control pregnancies (52 vs 42%; P < 0.05) and needed more neonatal intensive care (47 vs 26%; P < 0.05). Conclusions: From this case–control study it is concluded that the perinatal outcome of ART singleton pregnancies is not different from that in matched controls. ART twin pregnancies showed a higher incidence of preterm deliveries than control pregnancies and needed more neonatal intensive care.     

Cervical pregnancy: Case reports and current concepts in diagnosis and treatment

Summary Cervical pregnancy produces profuse but painless vaginal bleeding. After ultrasound diagnosis early in pregnancy, preservation of the uterus is possible. After the 12th week, hysterectomy is almost always necessary. We review current concepts in the diagnosis and management of cervical pregnancy.     

A Novel Treatment for Cervical and Cesarean Section Scar Pregnancies by Transvaginal Injection of Absolute Ethanol to Trophoblasts: Efficacy in 19 Cases

Study Objective

To evaluate the efficacy of a nonsurgical treatment for cervical pregnancy (CP) and cesarean section scar pregnancy (CSP).

A case of a cornual heterotopic pregnancy laparoscopically treated with the endoloop technique

Heterotopic pregnancy is defined as the coexistence of an intrauterine and an ectopic pregnancy. The estimated incidence is one in 30,000 spontaneous pregnancies, with a tenfold increase in women who underwent assisted reproductive technologies. Diagnosis of a heterotopic pregnancy is often delayed because of the presence of the intrauterine gestational sac. Treatment of a heterotopic pregnancy should consist of termination of the ectopic pregnancy without damaging the ongoing intrauterine pregnancy. The least invasive procedure should therefore be used. We present a case of a heterotopic pregnancy consisting of a viable intrauterine pregnancy and an ectopic cornual pregnancy. Because of the viable intrauterine pregnancy, we decided to treat the cornual pregnancy laparoscopically by the endoloop technique. This technique is simple, safe, effective and nearly bloodless. It offers a good prognosis for the ongoing intrauterine pregnancy.