Medicine › Public Health, Environmental and Occupational Health

Ectopic Pregnancy Diagnosis and Management

Works Count: 39300

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Description

This cluster of papers focuses on the diagnosis and management of ectopic pregnancies, including those implanted in the cesarean scar, tubal ectopic pregnancies, and other unusual locations. It covers topics such as ultrasound diagnosis, medical treatment with methotrexate, risk factors, reproductive outcomes, and the implications of early pregnancy events.

Keywords

Ectopic Pregnancy; Cesarean Scar Pregnancy; Tubal Ectopic Pregnancy; Ultrasound Diagnosis; Medical Management; Risk Factors; Early Pregnancy; Methotrexate Treatment; Reproductive Outcome; Uterine Scar Implantation

Treatment of interstitial ectopic pregnancy with methotrexate: report of a successful case

1982-06-01

Toshinobu Tanaka , Hiroshi Hayashi , T Kutsuzawa +2 more

Abdominal pregnancy in the United States: frequency and maternal mortality.

1987-03-01

H K Atrash , Andrew Friede , Carol J. Hogue

From an analysis of 11 abdominal pregnancy-related deaths and an estimated 5221 abdominal pregnancies in the United States, we estimated that there were 10.9 abdominal pregnancies per 100,000 live births … From an analysis of 11 abdominal pregnancy-related deaths and an estimated 5221 abdominal pregnancies in the United States, we estimated that there were 10.9 abdominal pregnancies per 100,000 live births and 9.2 per 1000 ectopic pregnancies; the mortality rate was 5.1 per 1000 cases. Although the risk of having an ectopic pregnancy is rising, the risk of abdominal pregnancy, which is probably always a sequel of a missed ruptured ectopic pregnancy, is apparently declining; this may be due to improved prenatal care. However, only one of nine women who reached the hospital alive had an accurate preoperative diagnosis of abdominal pregnancy, which suggests that preventing abdominal pregnancy-related death may depend, at least in part, upon increasing physicians' awareness of its clinical features.

Interventions for tubal ectopic pregnancy

2007-01-24

Petra J. Hajenius , Femke Mol , Ben W. Mol +3 more

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Arias-stella phenomenon in spontaneous and therapeutic abortion

1972-03-01

Steven G. Silverberg

Plasma estrone, estradiol, estriol, progesterone, and 17-hydroxyprogesterone in human pregnancy

1972-04-01

Dan Tulchinsky , Calvin J. Hobel , Elizabeth Yeager +1 more

Combined intrauterine and extrauterine gestations: A review

1983-06-01

E. Albert Reece , Roy H. Petrie , Meredith F. Sirmans +2 more

Risk factors for ectopic pregnancy: a meta-analysis

1996-06-01

Willem M. Ankum , Ben W. Mol , Fulco van der Veen +1 more

Future pregnancy outcome in unexplained recurrent first trimester miscarriage

1997-02-01

K. Clifford , Raj Rai , L. Regan

The future pregnancy outcome of 201 consecutive women, median age 34 years (range 22-43), with a history of unexplained recurrent first trimester miscarriage (median 3; range 3-13), was studied. All … The future pregnancy outcome of 201 consecutive women, median age 34 years (range 22-43), with a history of unexplained recurrent first trimester miscarriage (median 3; range 3-13), was studied. All women and their partners had normal peripheral blood karyotypes; none had antiphospholipid antibodies and none hypersecreted luteinizing hormone (LH). No pharmacological treatment was prescribed and early pregnancy supportive care was encouraged. Women aged < or = 30 years had a subsequent miscarriage rate of 25% (14/57) which rose to 52% (13/25) in women aged > or = 40 years (P = 0.02). After three consecutive miscarriages, the risk of miscarriage of the next pregnancy was 29% (34/119) but increased to 53% (9/17) after six or more previous losses (P = 0.04). A past history of a livebirth did not influence the outcome of the next pregnancy. Supportive care in early pregnancy conferred a significant beneficial effect on pregnancy outcome. Of 160 women who attended the early pregnancy clinic, 42 (26%) miscarried in the next pregnancy compared with 21 out of 41 (51%) who did not attend the clinic (P = 0.002). After thorough investigation, women with unexplained recurrent first trimester miscarriage have an excellent pregnancy outcome without pharmacological intervention if offered supportive care alone in the setting of a dedicated miscarriage clinic.

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First‐trimester diagnosis and management of pregnancies implanted into the lower uterine segment Cesarean section scar

2003-02-18

D. Jurkovic , K. Hillaby , B. Woelfer +3 more

To describe first-trimester ultrasound diagnosis and management of pregnancies implanted into uterine Cesarean section scars.All women referred for an ultrasound scan because of suspected early pregnancy complications were screened for … To describe first-trimester ultrasound diagnosis and management of pregnancies implanted into uterine Cesarean section scars.All women referred for an ultrasound scan because of suspected early pregnancy complications were screened for pregnancies implanted into a previous Cesarean section scar. The management of Cesarean section scar pregnancies included transvaginal surgical evacuation, medical treatment with local injection of 25 mg methotrexate into the exocelomic cavity and expectant management.Eighteen Cesarean section scar pregnancies were diagnosed in a 4-year period. The prevalence in the local population was 1 : 1800 pregnancies. Surgical treatment was used in eight women and it was successful in all cases. The respective success rates of medical treatment and expectant management were 5/7 (71%) and 1/3 (33%). Five women (28%) required blood transfusion and one woman (6%) had a hysterectomy.Cesarean section scar pregnancies are more common than previously thought. When the diagnosis is made in the first trimester the prognosis is good and the risk of hysterectomy is relatively low.

PERFORATING HEMORRHAGIC (CHOCOLATE) CYSTS OF THE OVARY

1921-09-01

John A. Sampson

The serious, though unusual, hemorrhage of ovarian origin into the peritoneal cavity simulating ruptured tubal pregnancy is well known to every abdominal surgeon, even though he may have encountered but … The serious, though unusual, hemorrhage of ovarian origin into the peritoneal cavity simulating ruptured tubal pregnancy is well known to every abdominal surgeon, even though he may have encountered but few such instances in his own practice. The literature on this subject has been recently reviewed by Novak<sup>1</sup>and by Smith.<sup>2</sup>The larger ovarian cysts, also with hemorrhagic contents due to twisting of the pedicle of the cyst or from other conditions, are so obvious as to make it impossible to overlook them. Ovarian hematomas due to various causes have been reported by Savage,<sup>3</sup>Wolf,<sup>4</sup>Hedley,<sup>5</sup>Novak<sup>6</sup>and others. There is, however, one type of hemorrhagic ovarian cyst or ovarian hematoma which should receive more careful attention; not only on account of its frequency but because of the nature of the adhesions resulting from the escape of its contents into the peritoneal cavity. These

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Does Obesity Increase the Risk of Miscarriage in Spontaneous Conception: A Systematic Review

2011-11-01

Christina E. Boots , Mary D. Stephenson

Obesity has become an epidemic in developed societies. Retrospective studies suggest that obesity is associated with miscarriage in assisted reproduction. The objective of this study was to evaluate whether obesity … Obesity has become an epidemic in developed societies. Retrospective studies suggest that obesity is associated with miscarriage in assisted reproduction. The objective of this study was to evaluate whether obesity is associated with miscarriage in spontaneous conception. We conducted a systematic review of published studies with pooled analysis. A literature review was performed. Studies in which fertility drugs or in vitro fertilization were used were excluded, unless data could be extracted for spontaneous conception. Data were compared for obese (body mass index [BMI]: ≥28 or 30 kg/m2), overweight (BMI: 25 to 29 kg/m2), and normal-weight (BMI: <25 kg/m2) women, with pooled odds ratios (ORs). Recurrent miscarriage data were analyzed separately. Six studies met the criteria for a cohort of 28,538 women. Pooled analysis revealed a higher miscarriage rate of 13.6% in 3800 obese versus 10.7% in 17,146 normal-BMI women (OR: 1.31; 95% confidence interval [CI], 1.18 to 1.46). Although the cohort was small, there was a higher prevalence of recurrent early miscarriage in obese versus normal-BMI women (0.4% versus 0.1%; OR: 3.51; 95% CI, 1.03 to 12.01). In women with recurrent miscarriage, there was a higher miscarriage rate in the obese versus nonobese women (46% versus 43%; OR: 1.71; 95% CI, 1.05). Based on retrospective studies, we concluded that obesity is associated with a higher miscarriage rate in women who conceive spontaneously. Larger prospective studies are urgently needed to verify these preliminary results.

Sonar Measurement of Fetal Crown-Rump Length as Means of Assessing Maturity in First Trimester of Pregnancy

1973-10-06

Hugh P. Robinson

A method is reported by which the “in utero” crown-rump length of the fetus may be determined by sonar in the first trimester of pregnancy. The accuracy of the technique … A method is reported by which the “in utero” crown-rump length of the fetus may be determined by sonar in the first trimester of pregnancy. The accuracy of the technique was assessed by comparing the sonar and the direct postabortum measurements of fetuses in cases of missed abortion. A normal curve of fetal crown-rump length was derived from 214 examinations on 80 patients and by using these values in a further “blind” series it was found possible to predict the maturity of pregnancy to within three days, between the sixth and the 14th weeks of pregnancy.

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Cesarean Scar Ectopic Pregnancies

2006-06-01

Michael Rotas , Shoshana Haberman , Michael Levgur

To clarify the appropriate way to diagnose and treat an ectopic pregnancy in the uterine scar of a prior cesarean delivery.Articles written in English that were published from January 1966 … To clarify the appropriate way to diagnose and treat an ectopic pregnancy in the uterine scar of a prior cesarean delivery.Articles written in English that were published from January 1966 to August 2005 and quoted in the computerized database MEDLINE/PubMed retrieved by using the words "cesarean section," "cesarean delivery," "cesarean section scar pregnancy," and "ectopic pregnancy." Additional articles were obtained from reference lists of pertinent case reports and reviews.Fifty-nine articles that met the inclusion criteria provided data on the clinical presentation, diagnosis, and treatment modalities of 112 cases of cesarean delivery scar pregnancies.Review of the 112 cases revealed a considerable increase in the incidence of this condition over the last decade, with a current range of 1:1,800 to 1:2,216 normal pregnancies. More than half (52%) of the reported cases had only one prior cesarean delivery. The mean gestational age was 7.5 +/- 2.5 weeks, and the most frequent symptom was painless vaginal bleeding. Endovaginal ultrasonography was the diagnostic method in most cases, with a sensitivity of 84.6% (95% confidence interval 0.763-0.905). Expectant management of 6 patients resulted in uterine rupture that required hysterectomy in 3 patients. Dilation and curettage was associated with severe maternal morbidity. Wedge resection and repair of the implantation site via laparotomy or laparoscopy were successful in 11 of 12 patients. Simultaneous administration of systemic and intragestational methotrexate to 5 women, all with beta-hCG exceeding 10,000 milli-International Units/mL required no further treatment.Surgical treatment or combined systemic and intragestational methotrexate were both successful in the management of cesarean delivery scar pregnancy. Because subsequent pregnancies may be complicated by uterine rupture, the uterine scar should be evaluated before, as well as during, these pregnancies.

Caesarean scar pregnancy

2007-02-13

A. Ash , A. Smith , D. J. Maxwell

Caesarean scar pregnancy is one of the rarest forms of ectopic pregnancy. Little is known about its incidence and natural history. With increasing incidence of caesarean section worldwide, more and … Caesarean scar pregnancy is one of the rarest forms of ectopic pregnancy. Little is known about its incidence and natural history. With increasing incidence of caesarean section worldwide, more and more cases are diagnosed and reported. Transvaginal ultrasound and colour flow Doppler provides a high diagnostic accuracy with very few false positives. A delay in diagnosis and/or treatment can lead to uterine rupture, major haemorrhage, hysterectomy and serious maternal morbidity. Early diagnosis can offer treatment options of avoiding uterine rupture and haemorrhage, thus preserving the uterus and future fertility. Management plan should be individually tailored. Available data suggest that termination of pregnancy is the treatment of choice in the first trimester soon after the diagnosis. Expectant treatment has a poor prognosis because of risk of rupture. There are no reliable scientific data on the risk of recurrence of the condition in future pregnancy, role of the interval between the previous caesarean delivery and occurrence of caesarean scar pregnancy, and effect of caesarean wound closure technique on caesarean scar pregnancy. In this article, we aim to find the demography, pathophysiology, clinical presentation, most appropriate methods of diagnosis and management, with their implications in clinical practice for this condition.

Incidence and outcome of bleeding before the 20th week of pregnancy: prospective study from general practice

1997-07-05

Christopher Everett

To estimate the miscarriage rate in a cohort of pregnant women and the final outcome of pregnancy.Two year prospective community study.Women registered with four semirural practices at one health centre.626 … To estimate the miscarriage rate in a cohort of pregnant women and the final outcome of pregnancy.Two year prospective community study.Women registered with four semirural practices at one health centre.626 pregnant women from a population 21448, 5140 of whom were women aged 15-44 years.Vaginal bleeding and outcome of pregnancy.76 of the 89 women with an unwanted pregnancy requested a termination. In the 550 ongoing pregnancies bleeding occurred before the 20th week in 117 (21%), and 67 (12%) ended in miscarriage. The risk of miscarriage was not significantly increased after a miscarriage in the previous pregnancy (11 (15%) women had miscarriage v 55 (12%) women who had not had miscarriage) who had previously had a live birth). Of the 117 women with bleeding, 64 were not admitted to hospital by the general practitioner; 42 of these women had an ultrasound examination at the health centre and 19 subsequently miscarried at home. In hospital 41 of 46 women who miscarried had evacuation of the uterus.Bleeding occurred in one fifth of recognised pregnancies before the 20th week and over half of these miscarried. Treatment of women with miscarriage at home means current statistics on miscarriage in Britain are missing many cases.

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Single-dose methotrexate: An expanded clinical trial

1993-06-01

Thomas G. Stovall , Frank W. Ling

Incidence of Mullerian defects in fertile and infertile women

1997-07-01

Pedro Acién

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Risk factors for first trimester miscarriage—results from a UK‐population‐based case–control study

2006-12-05

Noreen Maconochie , Pat Doyle , Susan Prior +1 more

The aim of this study was to examine the association between biological, behavioural and lifestyle risk factors and risk of miscarriage.Population-based case-control study.Case-control study nested within a population-based, two-stage postal … The aim of this study was to examine the association between biological, behavioural and lifestyle risk factors and risk of miscarriage.Population-based case-control study.Case-control study nested within a population-based, two-stage postal survey of reproductive histories of women randomly sampled from the UK electoral register.Six hundred and three women aged 18-55 years whose most recent pregnancy had ended in first trimester miscarriage (<13 weeks of gestation; cases) and 6116 women aged 18-55 years whose most recent pregnancy had progressed beyond 12 weeks (controls).Women were questioned about socio-demographic, behavioural and other factors in their most recent pregnancy.First trimester miscarriage.After adjustment for confounding, the following were independently associated with increased risk: high maternal age; previous miscarriage, termination and infertility; assisted conception; low pre-pregnancy body mass index; regular or high alcohol consumption; feeling stressed (including trend with number of stressful or traumatic events); high paternal age and changing partner. Previous live birth, nausea, vitamin supplementation and eating fresh fruits and vegetables daily were associated with reduced risk, as were feeling well enough to fly or to have sex. After adjustment for nausea, we did not confirm an association with caffeine consumption, smoking or moderate or occasional alcohol consumption; nor did we find an association with educational level, socio-economic circumstances or working during pregnancy.The results confirm that advice to encourage a healthy diet, reduce stress and promote emotional wellbeing might help women in early pregnancy (or planning a pregnancy) reduce their risk of miscarriage. Findings of increased risk associated with previous termination, stress, change of partner and low pre-pregnancy weight are noteworthy, and we recommend further work to confirm these findings in other study populations.

The medical management of ectopic pregnancy: a meta-analysis comparing “single dose” and “multidose” regimens

2003-04-01

Kurt T. Barnhart , Gabriella G. Gosman , Rachel K. Ashby +1 more

Medical management of an unruptured ectopic pregnancy with intramuscular methotrexate is common and cost-effective. Two treatment protocols, the “single dose” and the “multidose,” have been advocated and independently reported in … Medical management of an unruptured ectopic pregnancy with intramuscular methotrexate is common and cost-effective. Two treatment protocols, the “single dose” and the “multidose,” have been advocated and independently reported in the medical literature. This analysis systematically compares the success and prevalence of side effects of these two regimens. Published data on women with an ectopic pregnancy medically managed were identified using a MEDLINE search from 1966 to 2001 using key words and review of the references of each manuscript. Studies were selected based on dosing regimen, number of subjects, and study quality. Data regarding outcome, number of doses administered, side effects, and baseline characteristics were extracted. Data were summarized, and the associations of failed management and the presence of side effects with treatment protocol were calculated. Baseline serum chorionic gonadotropin values and the presence of embryonic fetal actively were controlled for with multivariable logistic regression. The overall success rate for women treated with methotrexate for an ectopic pregnancy was 89% (1181 of 1327). The single dose was much more commonly used. The use of single dose was associated with a significantly greater chance of failed medical management than the use of the multidose in both crude (odds ratio [OR] 1.71; 1.04, 2.82) and adjusted analyses (OR 4.74; 1.77, 12.62). The single-dose regimen was associated with fewer side effects (OR 0.44; 0.31, 0.63). Women who experienced side effects were more likely to have successful treatment regardless of regimen. The multidose regimen is more effective than the single-dose regimen.

Predictors of Success of Methotrexate Treatment in Women with Tubal Ectopic Pregnancies

1999-12-23

Gary H. Lipscomb , Marian L. McCord , Thomas G. Stovall +3 more

The use of methotrexate for the treatment of women with tubal ectopic pregnancies is now common practice. However, the clinical and hormonal determinants of the success of this treatment are … The use of methotrexate for the treatment of women with tubal ectopic pregnancies is now common practice. However, the clinical and hormonal determinants of the success of this treatment are not known.

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Ectopic Pregnancy Within a Cesarean Scar: A Review

2002-08-01

Donald L. Fylstra

Implantation of a pregnancy within the scar of a previous cesarean delivery is the rarest of ectopic pregnancy locations. Only 19 cases have been reported in the English medical literature … Implantation of a pregnancy within the scar of a previous cesarean delivery is the rarest of ectopic pregnancy locations. Only 19 cases have been reported in the English medical literature since 1966. If diagnosed early, treatment options are capable of preserving the uterus and subsequent fertility. However, a delay in either diagnosis or treatment can lead to uterine rupture, hysterectomy, and significant maternal morbidity. Although expectant and medical managements have been reported, termination of a cesarean scar pregnancy by laparotomy and hysterotomy, with repair of the accompanying uterine scar dehiscence, may be the best treatment option. Target Audience: Obstetricians & Gynecologists, Family Physicians Learning Objectives: After completion of this article, the reader will be able to define the entity of an ectopic pregnancy within a cesarean delivery scar, to list the ultrasound findings used to make the diagnosis of an ectopic pregnancy within a cesarean delivery scar, and to outline a potential management plan for a patient with an ectopic pregnancy within a cesarean delivery scar.

The history of the diagnosis and treatment of ectopic pregnancy: a medical adventure

1992-01-01

Samuel Lurie

Diagnostic Criteria for Nonviable Pregnancy Early in the First Trimester

2013-10-10

Peter M. Doubilet , Carol B. Benson , T. Bourne +1 more

Determining the viability of a pregnancy is a major challenge, especially with a pregnancy of unknown location. This review provides specific guidance, including stringent criteria for nonviability, that can reduce … Determining the viability of a pregnancy is a major challenge, especially with a pregnancy of unknown location. This review provides specific guidance, including stringent criteria for nonviability, that can reduce the risk of inadvertent harm to a potentially normal pregnancy.

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Sites of ectopic pregnancy: a 10 year population-based study of 1800 cases

2002-11-27

Jean Bouyer

BACKGROUND: Several risk factors for ectopic pregnancy (EP) have been identified, but the site of implantation of EP has been little studied. METHODS: A total of 1800 surgically treated EP … BACKGROUND: Several risk factors for ectopic pregnancy (EP) have been identified, but the site of implantation of EP has been little studied. METHODS: A total of 1800 surgically treated EP was registered between January 1992 and December 2001 in the Auvergne EP register and the women concerned were followed up. In this large population-based sample, we studied the distribution of EP sites, immediate complications, determining factors, and subsequent fertility. RESULTS: EP sites were interstitial (2.4%), isthmic (12.0%), ampullary (70.0%), fimbrial (11.1%), ovarian (3.2%) or abdominal (1.3%). No cervical pregnancies were observed. Complications and treatment depended on the site of EP. In multivariate analysis, the only risk factor associated with EP site was current use of an intrauterine device (IUD), which was more frequent in distal EP. The 2 year cumulative rate of subsequent spontaneous intrauterine pregnancy (IUP) increased progressively from interstitial to ovarian EP. Fair concordance (weighted κ = 0.31) was observed between the sites of two successive EP if they were homolateral. CONCLUSION: In addition to providing an accurate description of the sites of implantation of EP, this study shows that current IUD use ‘protects’ against interstitial pregnancies, which are the most difficult to manage. It shows that subsequent fertility tends to be higher in women with distal EP.

Recurrent miscarriage I: definition and epidemiology

1990-09-01

Gordon M. Stirrat

Pregnancy in a Cesarean scar

2000-11-01

Yvan Vial , Patrick Petignat , Patrick Hohlfeld

Current status of surgical and nonsurgical management of ectopic pregnancy

1997-03-01

Mylene Yao , Togas Tulandi

Conception to ongoing pregnancy: the 'black box' of early pregnancy loss

2002-07-01

N.S. Macklon

Even when conditions are optimal, the maximum chance of a clinically recognized pregnancy occurring in a given menstrual cycle is 30-40%. Increasing evidence points to preclinical pregnancy loss rather than … Even when conditions are optimal, the maximum chance of a clinically recognized pregnancy occurring in a given menstrual cycle is 30-40%. Increasing evidence points to preclinical pregnancy loss rather than failure of conception as the principal cause for the relatively low fecundity observed in humans. While sensitive assays for hCG have provided a glimpse of the events occurring between implantation and the missed menstrual period, new cytogenetic techniques have further opened this 'black box', providing novel insights into the causes of early pregnancy wastage. In this article, the evidence and causes of preclinical or 'occult' pregnancy are reviewed, and the implications for the infertile patient are addressed.

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Ultrasound for fetal assessment in early pregnancy

2015-07-14

Melissa Whitworth , Leanne Bricker , C. Mullan

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Cesarean scar pregnancy: issues in management

2004-02-17

Kok‐Min Seow , L.‐W. Huang , Y.‐H. Lin +3 more

Abstract Objective To evaluate our experience with the diagnosis and treatment of Cesarean scar pregnancy. Methods During a 6‐year period, 12 cases of Cesarean scar pregnancy were diagnosed using transvaginal … Abstract Objective To evaluate our experience with the diagnosis and treatment of Cesarean scar pregnancy. Methods During a 6‐year period, 12 cases of Cesarean scar pregnancy were diagnosed using transvaginal color Doppler sonography and treated conservatively to preserve fertility. Incidence, gestational age, sonographic findings, β ‐human chorionic gonadotropin ( β ‐hCG) levels, flow profiles of transvaginal color Doppler ultrasound, and methods of treatment were recorded. Results The incidence of Cesarean scar pregnancy was 1:2216 and its rate was 6.1% in women with an ectopic pregnancy and at least one previous Cesarean section. Gestational age at diagnosis ranged from 5 + 0 to 12 + 4 weeks. The time interval from the last Cesarean section to the diagnosis of Cesarean scar pregnancy ranged from 6 months to 12 years. High‐velocity and low‐impedance subtrophoblastic flow (resistance index, 0.38) persisted until β ‐hCG declined to normal. Patients were treated as follows: transvaginal ultrasound‐guided injection of methotrexate into the embryo or gestational sac ( n = 3), transabdominal ultrasound‐guided injection of methotrexate ( n = 2), transabdominal ultrasound‐guided injection of methotrexate followed by systemic methotrexate administration ( n = 2), systemic methotrexate administration alone ( n = 2), dilatation and curettage ( n = 2), or local resection of the gestation mass ( n = 1). Eleven of the 12 patients preserved their reproductive capacity; the remaining patient, treated by dilatation and curettage, underwent a hysterectomy because of profuse vaginal bleeding. The Cesarean scar mass regressed from 2 months to as long as 1 year after treatment. Uterine rupture occurred in one patient during the following pregnancy at 38 + 3 weeks' gestational age. Conclusion Ultrasound‐guided methotrexate injection emerges as the treatment of choice to terminate Cesarean scar pregnancy. Surgical or invasive techniques, including dilatation and curettage are not recommended for Cesarean scar pregnancy due to high morbidity and poor prognosis. Copyright © 2004 ISUOG. Published by John Wiley & Sons, Ltd.

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Risk Factors for Ectopic Pregnancy: A Comprehensive Analysis Based on a Large Case-Control, Population-based Study in France

2003-01-23

Jean Bouyer

This case-control study was associated with a regional register of ectopic pregnancy between 1993 and 2000 in France. It included 803 cases of ectopic pregnancy and 1,683 deliveries and was … This case-control study was associated with a regional register of ectopic pregnancy between 1993 and 2000 in France. It included 803 cases of ectopic pregnancy and 1,683 deliveries and was powerful enough to investigate all ectopic pregnancy risk factors. The main risk factors were infectious history (adjusted attributable risk = 0.33; adjusted odds ratio for previous pelvic infectious disease = 3.4, 95% percent confidence interval (CI): 2.4, 5.0) and smoking (adjusted attributable risk = 0.35; adjusted odds ratio = 3.9, 95% CI: 2.6, 5.9 for >20 cigarettes/day vs. women who had never smoked). The other risk factors were age (associated per se with a risk of ectopic pregnancy), prior spontaneous abortions, history of infertility, and previous use of an intrauterine device. Prior medical induced abortion was associated with a risk of ectopic pregnancy (adjusted odds ratio = 2.8, 95% CI: 1.1, 7.2); no such association was observed for surgical abortion (adjusted odds ratio = 1.1, 95% CI: 0.8, 1.6). The total attributable risk of all the factors investigated was 0.76. As close associations were found between ectopic pregnancy and infertility and between ectopic pregnancy and spontaneous abortion, further research into ectopic pregnancy should focus on risk factors common to these conditions. In terms of public health, increasing awareness of the effects of smoking may be useful for ectopic pregnancy prevention.

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The diagnosis, treatment, and follow-up of cesarean scar pregnancy

2012-04-16

Ilan E. Timor‐Tritsch , Ana Monteagudo , Rosalba Santos +3 more

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Conservative medical and surgical management of interstitial ectopic pregnancy

1999-08-01

Susie Lau , Togas Tulandi

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Current knowledge of the aetiology of human tubal ectopic pregnancy

2010-01-12

Julie Shaw , Sudhansu K. Dey , Hilary Critchley +1 more

An ectopic pregnancy is a pregnancy which occurs outside of the uterine cavity, and over 98% implant in the Fallopian tube. Tubal ectopic pregnancy remains the most common cause of … An ectopic pregnancy is a pregnancy which occurs outside of the uterine cavity, and over 98% implant in the Fallopian tube. Tubal ectopic pregnancy remains the most common cause of maternal mortality in the first trimester of pregnancy. The epidemiological risk factors for tubal ectopic pregnancy are well established and include: tubal damage as a result of surgery or infection (particularly Chlamydia trachomatis), smoking and in vitro fertilization. This review appraises the data to date researching the aetiology of tubal ectopic pregnancy. Scientific literature was searched for studies investigating the underlying aetiology of tubal ectopic pregnancy. Existing data addressing the underlying cause of tubal ectopic pregnancy are mostly descriptive. There are currently few good animal models of tubal ectopic pregnancy. There are limited data explaining the link between risk factors and tubal implantation. Current evidence supports the hypothesis that tubal ectopic pregnancy is caused by a combination of retention of the embryo within the Fallopian tube due to impaired embryo-tubal transport and alterations in the tubal environment allowing early implantation to occur. Future studies are needed that address the functional consequences of infection and smoking on Fallopian tube physiology. A greater understanding of the aetiology of tubal ectopic pregnancy is critical for the development of improved preventative measures, the advancement of diagnostic screening methods and the development of novel treatments.

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An ectopic pregnancy developing in a previous caesarian section scar

1997-02-01

Pierre‐Arnaud Godin , S. Bassil , Jacques Donnez

Interstitial line: sonographic finding in interstitial (cornual) ectopic pregnancy.

1993-10-01

T E Ackerman , C S Levi , S M Dashefsky +2 more

To evaluate the relationship of the endometrial canal and decidua vera to the interstitial gestational sac and to determine if this relationship can be used to increase the predictive value … To evaluate the relationship of the endometrial canal and decidua vera to the interstitial gestational sac and to determine if this relationship can be used to increase the predictive value of ultrasound (US) in the diagnosis of interstitial ectopic pregnancy.The US findings in 12 patients with interstitial ectopic pregnancy were reviewed. Radiologists also reviewed the cases of 40 patients with various diagnoses to assess the accuracy of the interstitial line sign.US showed a definite gestational sac in four of the 12 patients (33%); the rest had a heterogeneous mass in the cornual region. Thinning of the myometrial mantle was seen in these four patients. The gestational sac appeared eccentric in three of these but in only three of 12 (25%) overall. The endometrial canal or interstitial portion of the tube was identified in 11 of 12 patients (92%). The interstitial line had better sensitivity (80%) and specificity (98%) than eccentric gestational sac location (sensitivity, 40%; specificity, 88%) and myometrial thinning (sensitivity, 40%; specificity, 93%) for the diagnosis of interstitial ectopic pregnancy.The interstitial line sign is a useful diagnostic sign of interstitial ectopic pregnancy.

FETAL LOSS AFTER IMPLANTATION

1980-09-01

John F. Miller , Elizabeth Williamson , J. Glue +3 more

Pregnancy of unknown location: a consensus statement of nomenclature, definitions, and outcome

2010-10-15

Kurt T. Barnhart , Norah M. van Mello , T. Bourne +7 more

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Unforeseen consequences of the increasing rate of cesarean deliveries: early placenta accreta and cesarean scar pregnancy. A review

2012-03-10

Ilan E. Timor‐Tritsch , Ana Monteagudo

Cesarean scar pregnancy: a systematic review of treatment studies

2016-01-18

Kathrine Birch Petersen , Elise Hoffmann , Christian Rifbjerg Larsen +1 more

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Early embryonic mortality in women

1982-10-01

D.K. Edmonds , K.S. Lindsay , John F. Miller +2 more

Heterotopic pregnancy after ovulation induction and assisted reproductive technologies: a literature review from 1971 to 1993

1996-07-01

Edward E. Wallach , J. Tal , Sami Haddad +2 more

Ectopic Pregnancy

2009-07-22

Kurt T. Barnhart

A healthy 29-year-old woman who has been trying to conceive presents with vaginal spotting for the past 5 days and intermittent crampy abdominal pain in her left lower quadrant for … A healthy 29-year-old woman who has been trying to conceive presents with vaginal spotting for the past 5 days and intermittent crampy abdominal pain in her left lower quadrant for the past 3 days. Her last menstrual period was 6 weeks and 2 days before presentation. She has had a spontaneous vaginal delivery and an anembryonic gestation treated by dilation and curettage. How should this patient be evaluated and treated?

Association Between MRI Exposure During Pregnancy and Fetal and Childhood Outcomes

2016-09-06

Joel G. Ray , Marian J. Vermeulen , Aditya Bharatha +2 more

<h3>Importance</h3> Fetal safety of magnetic resonance imaging (MRI) during the first trimester of pregnancy or with gadolinium enhancement at any time of pregnancy is unknown. <h3>Objective</h3> To evaluate the long-term … <h3>Importance</h3> Fetal safety of magnetic resonance imaging (MRI) during the first trimester of pregnancy or with gadolinium enhancement at any time of pregnancy is unknown. <h3>Objective</h3> To evaluate the long-term safety after exposure to MRI in the first trimester of pregnancy or to gadolinium at any time during pregnancy. <h3>Design, Setting, and Participants</h3> Universal health care databases in the province of Ontario, Canada, were used to identify all births of more than 20 weeks, from 2003-2015. <h3>Exposures</h3> Magnetic resonance imaging exposure in the first trimester of pregnancy, or gadolinium MRI exposure at any time in pregnancy. <h3>Main Outcomes and Measures</h3> For first-trimester MRI exposure, the risk of stillbirth or neonatal death within 28 days of birth and any congenital anomaly, neoplasm, and hearing or vision loss was evaluated from birth to age 4 years. For gadolinium-enhanced MRI in pregnancy, connective tissue or skin disease resembling nephrogenic systemic fibrosis (NSF-like) and a broader set of rheumatological, inflammatory, or infiltrative skin conditions from birth were identified. <h3>Results</h3> Of 1 424 105 deliveries (48% girls; mean gestational age, 39 weeks), the overall rate of MRI was 3.97 per 1000 pregnancies. Comparing first-trimester MRI (n = 1737) to no MRI (n = 1 418 451), there were 19 stillbirths or deaths vs 9844 in the unexposed cohort (adjusted relative risk [RR], 1.68; 95% CI, 0.97 to 2.90) for an adjusted risk difference of 4.7 per 1000 person-years (95% CI, −1.6 to 11.0). The risk was also not significantly higher for congenital anomalies, neoplasm, or vision or hearing loss. Comparing gadolinium MRI (n = 397) with no MRI (n = 1 418 451), the hazard ratio for NSF-like outcomes was not statistically significant. The broader outcome of any rheumatological, inflammatory, or infiltrative skin condition occurred in 123 vs 384 180 births (adjusted HR, 1.36; 95% CI, 1.09 to 1.69) for an adjusted risk difference of 45.3 per 1000 person-years (95% CI, 11.3 to 86.8). Stillbirths and neonatal deaths occurred among 7 MRI-exposed vs 9844 unexposed pregnancies (adjusted RR, 3.70; 95% CI, 1.55 to 8.85) for an adjusted risk difference of 47.5 per 1000 pregnancies (95% CI, 9.7 to 138.2). <h3>Conclusions and Relevance</h3> Exposure to MRI during the first trimester of pregnancy compared with nonexposure was not associated with increased risk of harm to the fetus or in early childhood. Gadolinium MRI at any time during pregnancy was associated with an increased risk of a broad set of rheumatological, inflammatory, or infiltrative skin conditions and for stillbirth or neonatal death. The study may not have been able to detect rare adverse outcomes.

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Role of maternal age and pregnancy history in risk of miscarriage: prospective register based study

2019-03-20

Maria C. Magnus , Allen J. Wilcox , Nils‐Halvdan Morken +2 more

Abstract Objectives To estimate the burden of miscarriage in the Norwegian population and to evaluate the associations with maternal age and pregnancy history. Design Prospective register based study. Setting Medical … Abstract Objectives To estimate the burden of miscarriage in the Norwegian population and to evaluate the associations with maternal age and pregnancy history. Design Prospective register based study. Setting Medical Birth Register of Norway, the Norwegian Patient Register, and the induced abortion register. Participants All Norwegian women that were pregnant between 2009-13. Main outcome measure Risk of miscarriage according to the woman’s age and pregnancy history estimated by logistic regression. Results There were 421 201 pregnancies during the study period. The risk of miscarriage was lowest in women aged 25-29 (10%), and rose rapidly after age 30, reaching 53% in women aged 45 and over. There was a strong recurrence risk of miscarriage, with age adjusted odds ratios of 1.54 (95% confidence interval 1.48 to 1.60) after one miscarriage, 2.21 (2.03 to 2.41) after two, and 3.97 (3.29 to 4.78) after three consecutive miscarriages. The risk of miscarriage was modestly increased if the previous birth ended in a preterm delivery (adjusted odds ratio 1.22, 95% confidence interval 1.12 to 1.29), stillbirth (1.30, 1.11 to 1.53), caesarean section (1.16, 1.12 to 1.21), or if the woman had gestational diabetes in the previous pregnancy (1.19, 1.05 to 1.36). The risk of miscarriage was slightly higher in women who themselves had been small for gestational age (1.08, 1.04 to 1.13). Conclusions The risk of miscarriage varies greatly with maternal age, shows a strong pattern of recurrence, and is also increased after some adverse pregnancy outcomes. Miscarriage and other pregnancy complications might share underlying causes, which could be biological conditions or unmeasured common risk factors.

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Indicators of socioeconomic position (part 2)

2006-01-13

Bruna Galobardes

Abstract This is the second part of a glossary on indicators of socioeconomic position used in health research (the first part was published in the January issue of the journal). … Abstract This is the second part of a glossary on indicators of socioeconomic position used in health research (the first part was published in the January issue of the journal). socioeconomic positionglossary

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Ectopic pregnancy

2005-08-01

Cindy Farquhar

Recurrent miscarriage

2006-08-01

Raj Rai , Lesley Regan

ACOG Practice Bulletin No. 200: Early Pregnancy Loss

2018-08-30

Early pregnancy loss, or loss of an intrauterine pregnancy within the first trimester, is encountered commonly in clinical practice. Obstetricians and gynecologists should understand the use of various diagnostic tools … Early pregnancy loss, or loss of an intrauterine pregnancy within the first trimester, is encountered commonly in clinical practice. Obstetricians and gynecologists should understand the use of various diagnostic tools to differentiate between viable and nonviable pregnancies and offer the full range of therapeutic options to patients, including expectant, medical, and surgical management. The purpose of this Practice Bulletin is to review diagnostic approaches and describe options for the management of early pregnancy loss.

Committee Opinion No 700: Methods for Estimating the Due Date

2017-04-22

Accurate dating of pregnancy is important to improve outcomes and is a research and public health imperative. As soon as data from the last menstrual period, the first accurate ultrasound … Accurate dating of pregnancy is important to improve outcomes and is a research and public health imperative. As soon as data from the last menstrual period, the first accurate ultrasound examination, or both are obtained, the gestational age and the estimated due date (EDD) should be determined, discussed with the patient, and documented clearly in the medical record. Subsequent changes to the EDD should be reserved for rare circumstances, discussed with the patient, and documented clearly in the medical record. A pregnancy without an ultrasound examination that confirms or revises the EDD before 22 0/7 weeks of gestational age should be considered suboptimally dated. When determined from the methods outlined in this document for estimating the due date, gestational age at delivery represents the best obstetric estimate for the purpose of clinical care and should be recorded on the birth certificate. For the purposes of research and surveillance, the best obstetric estimate, rather than estimates based on the last menstrual period alone, should be used as the measure for gestational age.

Localization of a contraceptive implant using a silicon chip-based handheld ultrasound device

2025-06-24

Ruben Plöger , Eckhard Binder , Brigitte Strizek +2 more | Archives of Gynecology and Obstetrics

Etonogestrel contraceptive implants (Implanon/Nexplanon) are a highly effective form of long-acting reversible contraception. Removal is typically straightforward when the implant is palpable in the upper arm. However, it can become … Etonogestrel contraceptive implants (Implanon/Nexplanon) are a highly effective form of long-acting reversible contraception. Removal is typically straightforward when the implant is palpable in the upper arm. However, it can become challenging if the implant cannot be located by palpation due to deep placement, weight gain, or migration. Ultrasound is the recommended first-line imaging modality to localize non-palpable implants. Standard cart-based ultrasound devices may not be readily available in all settings (e.g., outpatient clinics, operating rooms, or resource-limited regions). A new generation of handheld ultrasound devices based on silicon chip technology has recently emerged, offering high-resolution imaging in a handheld, point-of-care format. These devices have the potential to facilitate rapid bedside localization of implants. We present the first case of localizing a non-palpable Implanon NXT® (68 mg etonogestrel) rod using a silicon chip-based handheld ultrasound device (Butterfly iQ). A 27-year-old woman with a non-palpable upper arm implant underwent sequential scanning with the handheld ultrasound device connected to a smartphone and with a standard piezoelectric ultrasound device for comparison. The handheld ultrasound readily identified the implant as an echogenic focus in the arm, enabling marking of the location for removal. A confirmatory scan with a standard ultrasound unit likewise visualized the implant. Guided by these imaging findings, a small incision was made directly over the implant site and the rod was removed successfully under local anesthesia. This case demonstrates that a semiconductor-based handheld ultrasound can reliably detect a non-palpable contraceptive implant, yielding sonographic images comparable to a standard piezoelectic ultrasound device. The successful localization and removal of the implant using the portable device suggests that this new ultrasound technology can be a valuable tool in obstetric and gynecologic practice for managing challenging implant cases. Its portability and ease of use at the point of care may improve access to timely implant removal in clinic settings, operating theaters, and remote or underserved areas. Wider adoption of this technology, alongside formal studies validating its accuracy, could enhance clinical workflows for contraceptive implant management.

A five-year review of ectopic pregnancy at university of Maiduguri teaching hospital: Randomised controlled study

2025-06-24

Onah Livinus Nnanyereugo , Maduka Chike Joachim , Ifeanyi Anthony Ezugwu | Magna Scientia Advanced Research and Reviews

Back ground: Ectopic pregnancy continues to be a life-threatening gynaecological emergency in our environment. Objective: This is to determine the epidemiology, risk factors, mode of presentation and management of cases, … Back ground: Ectopic pregnancy continues to be a life-threatening gynaecological emergency in our environment. Objective: This is to determine the epidemiology, risk factors, mode of presentation and management of cases, managed in this centre over a five years period. Materials and Methods: This is a retrospective study of cases of ectopic pregnancies managed in the gyneacological unit of UMTH Maiduguri from 1st January 2012 to 31st December 2016. Result: During the period, there were a total of 15,163 deliveries and 3,181 gynaecological admissions in the centre. One hundred and two patients had ectopic pregnancy accounting for 0.7% of all deliveries and 3.2% of all gynaecological admissions. Majority of the patient (47.0%) were between 25-29 years of age, 39.8% attended secondary education and 94.0% were married. Most of the patient (68.7%) were Para 1 to 4. The duration of amenorrhoea ranged between 5-16 weeks and 44.6% of the patient had a period of amenorrhoea of 7-9 weeks. The two most common risk factors in the review were previous abortion (37.3%) and pelvic inflammatory disease (27.7%) but 20.5% of patient did not have any identifiable risk factors. Lower abdominal pain (85.5%) was the commonest symptoms and lower abdominal tenderness (80.7%) was the commonest signs. In 67.1% of the patient, the implantation site was in the ampulla and 59.8% of the patient had ruptured ectopic pregnancy. All the patients were managed by laparatomy and the 30.1% of the patient that were transfused, were given homologous blood. Conclusion: The rate of ectopic pregnancy in our centre is relatively low. Most of the patients presented with ruptured ectopic pregnancy, hence making tubal conservative treatment inapplicable. Emphasis should be on prevention of common risk factors in our environment, early detection and prompt intervention of ectopic pregnancies so as to give patients opportunities for tubal conservative treatment.

Ruptured Ectopic Pregnancy with Levonorgestrel Implant : A Contraceptive Failure and Life-threatening Case

2025-06-24

Erics Efrany , Ketut Mira Yoga Pratiwi , I Gede Mahendra Adiguna Dira +2 more | Eduvest - Journal Of Universal Studies

Levonorgestrel implant is the most used in Indonesia, it is free provided by BKKBN. Levonorgestrel implant provides 99.95% of effectiveness. However, it could not prevent pregnancy absolutely including ectopic pregnancy. … Levonorgestrel implant is the most used in Indonesia, it is free provided by BKKBN. Levonorgestrel implant provides 99.95% of effectiveness. However, it could not prevent pregnancy absolutely including ectopic pregnancy. Ectopic pregnancy is a life threatening condition that is oftenly ignored by the patient and sometimes misdiagnosed. The incidence of ectopic pregnancy is very low, particularly in implant contraceptive users. Despite this fact, little is known about mechanism of implant failure including its correlation to ectopic pregnancy, and studies are limited. This case report presented a levonorgestrel implant contraceptive failure result in ectopic pregnancy. A 21-years-old woman P1001 was provided with levonorgestrel implant seventh month before admission. Patient was presented to emergency department after suffering from severe lower abdominal pain. She was diagnosed with ruptured ectopic pregnancy and underwent exploratory laparotomy. Her ruptured right fallopian tube was ligated and partially removed. Histopathological examination supported the diagnosis, chorionic villi lined with syncytiotrophoblast and cytotrophoblast cells in right fallopian tube tissue were found. The levonorgestrel implant was removed and she was scheduled for next contraceptive counseling. This case report emphasizes the fact that low incidence of contraceptive implant failure, does not rule out the possibility of ectopic pregnancy. Several hypotheses have been proposed as the cause of ectopic pregnancy. Further research is necessary to determine definitive etiology in ectopic pregnancy with levonorgestrel implant contraceptive failure.

Retroperitoneal ectopic pregnancy: A case report

2025-06-24

Trieu Quoc Tinh , Pham Thu Huyen , Le Thanh Dung +4 more | Radiology Case Reports

Complications for Ballerine pearl spiral

2025-06-23

Christina Damsted Petersen , Susanne Neergaard Poll | Ugeskrift for Læger

The Ballerine copper intrauterine device (IUD) has been used worldwide since 2014 and in Denmark since 2020. There is limited documentation for its effectiveness and possible risks and complications. In … The Ballerine copper intrauterine device (IUD) has been used worldwide since 2014 and in Denmark since 2020. There is limited documentation for its effectiveness and possible risks and complications. In this case report, two women, one 22-year-old (multipara) and the other 24-year-old (nullipara), both experienced extrauterine displacement and perforation. In both cases, the IUD needed removal surgically. Clinical experience with the insertion of an IUD as well as the need for detailed information on possible complications is advised. Further studies on the Ballerine cobber IUD are warranted.

A Case Report of Chronic Ectopic Pregnancy: A Silent Entity With a Surgical Diagnosis

2025-06-23

Rashid Sadek Azar , Norma Patricia Juan Vázquez , Ereldi García González +2 more | Cureus

Hysteroscopic resection of a cervical ectopic pregnancy. Case report.

2025-06-21

Karla Castellanos , Mariana Luna , Roberto Ceballos +3 more | International Journal of Medical Science and Clinical Research Studies

Introduction: Cervical ectopic pregnancy (CEP) is a rare form of ectopic pregnancy, accounting for less than 1% of all ectopic pregnancies, with an estimated incidence of 1 in 9,000 pregnancies. … Introduction: Cervical ectopic pregnancy (CEP) is a rare form of ectopic pregnancy, accounting for less than 1% of all ectopic pregnancies, with an estimated incidence of 1 in 9,000 pregnancies. Historically, the management of CEP has involved hysterectomy due to the high risk of uncontrolled hemorrhage. However, advancements in early diagnosis through high-resolution ultrasound and serum beta-human chorionic gonadotropin (β-hCG) quantification have allowed for the exploration of conservative management approaches aimed at preserving fertility. Case Presentation: We present the case of a 25-year-old female, with no significant gynecological or obstetric history, who presented to the emergency department with vaginal bleeding. Ultrasound examination revealed a gestational sac located in the endocervical region, without a visible embryo, and β-hCG levels were 4,436 mUI/mL. Medical management with methotrexate was initiated according to a multiple-dose regimen, supplemented with folinic acid, but did not result in adequate resolution. Given the persistent rise in β-hCG levels (8,225 mUI/mL), surgical intervention via hysteroscopy was performed. Under regional anesthesia, hysteroscopic resection of the gestational sac was successfully completed using bipolar energy, achieving effective hemostasis with minimal blood loss (50 mL). The patient had an uneventful recovery and was discharged after 72 hours. Follow-up at three weeks post-procedure showed a decrease in β-hCG to undetectable levels (2.3 mUI/mL). Conclusion: Hysteroscopic resection is a safe and effective conservative treatment option for cervical ectopic pregnancy, minimizing surgical morbidity, preserving fertility, and avoiding radical interventions. However, this approach requires specialized expertise and careful patient selection. Standardized clinical protocols are needed to optimize outcomes and reduce complications.

Midwifery Care for Over 35 Years Multigravida Mothers with Premature Rupture of Membranes at the Age of a Term Pregnancy

2025-06-21

Erica Diana Putri , Finta Isti Kundarti , Ririn Indriani +1 more | Health and Technology Journal (HTechJ)

Premature rupture of membranes (PROM) is a condition of rupture of the amniotic membrane after 37 weeks of gestation but before labor begins, which can increase the risk of intraamniotic … Premature rupture of membranes (PROM) is a condition of rupture of the amniotic membrane after 37 weeks of gestation but before labor begins, which can increase the risk of intraamniotic infection, preterm labor, and operative measures such as cesarean section. This study aims to provide midwifery care for a case of PROM in a multigravida mother aged >35 years with a term pregnancy. This study used a case study design with an in-depth approach to the subject, Mrs. LN, age 40 years, G4P3003, gestational age 37 weeks, who came with complaints of discharge from the birth canal without adequate contractions. Data was collected through interviews, observation, physical examination, and documentation study. Examination using the Leopold palpation method, vaginal toucher, and examination with red litmus paper, which turns purple, indicating the presence of amniotic fluid. The diagnosis was the first stage of the labor latent phase with PROM. Obstetric interventions were carried out through observation, education, and referral to the hospital due to indications for postpartum MOW contraception. The study results showed that the mother and baby were born in good health, and the postpartum contraception plan could be implemented. This study emphasizes the importance of early detection of PROM and collaborative management in supporting maternal and infant safety.

A case report of secondary ectopic pregnancy on the hepatic diaphragmatic surface originating from tubal abortion detected by the second laparoscopy after primary salpingectomy

2025-06-20

Ting Liang , Ming Yang , Hongying Li +3 more | Medicine

Ectopic pregnancies tend to occur in the fallopian tubes. Secondary abdominal pregnancies (SAP) are much rarer. Laparoscopic salpingectomy is a commonly performed radical surgery. However, even if a patient has … Ectopic pregnancies tend to occur in the fallopian tubes. Secondary abdominal pregnancies (SAP) are much rarer. Laparoscopic salpingectomy is a commonly performed radical surgery. However, even if a patient has undergone radical surgery, we cannot take it lightly. We report a relatively rare case here: an SAP on the hepatic diaphragmatic surface originating from a tubal abortion detected by a 2nd laparoscopy after primary salpingectomy. The patient was admitted to the local hospital for "ectopic pregnancy" half a month ago and underwent laparoscopic left salpingectomy and right tubal ligation 45 days later. But her values of beta-human chorionic gonadotropin (β-hCG) continued to rise and she experienced pain in the right shoulder, right subclavian, and right lower abdominal (Murphy sign) after the 1st surgery. The final diagnosis was secondary ectopic pregnancy at the hepatic phrenic surface. Half a month after the 1st operation, the patient underwent a laparoscopic examination in our hospital. After the 2nd operation, her β-hCG value decreased to normal and menstruation resumed. In the face of ectopic pregnancy, we need to continue to monitor the β-hCG value. SAP may occur even if it is relatively rare. Pay attention to the collection of symptoms and signs of patients to reduce missed diagnoses. It is vital for physicians to control the timing of surgery. Sometimes, it is necessary to emphasize the importance of comprehensive exploration and rapid pathological examination during the operation.

Assessing the risk of ectopic pregnancy following euploid frozen embryo transfer: a retrospective cohort study

2025-06-20

A Salame , Barbara Lawrenz , Erkan Kalafat +4 more | Journal of Assisted Reproduction and Genetics

A Rare Case of Lithopaedion: A Calcified Legacy of Chronic Tubal Ectopic Pregnancy

2025-06-19

Sandra Venkat | International Journal of Contemporary Medicine

IntroductionLithopaedion, or “stone baby,” is an extremely rare complication of abdominal or tubal ectopic pregnancy where the fetus dies and undergoes calcification instead of resorption. Fewer than 300 cases have … IntroductionLithopaedion, or “stone baby,” is an extremely rare complication of abdominal or tubal ectopic pregnancy where the fetus dies and undergoes calcification instead of resorption. Fewer than 300 cases have been reported worldwide, making it a medical rarity. This case underscores the importance of early diagnosis and complete management of ectopic pregnancies, particularly in low-resource settings where incomplete abortions or delayed care may lead to such unusual outcomes. It enriches the global literature by documenting a rare pathology and reinforcing vigilance in chronic pelvic pain and abnormal bleeding in reproductive-age women.Patient Concerns and Clinical FindingsChief Complaints:⦁ Intermittent abdominal pain for 3 years⦁ Spotting per vaginam for 1.5 monthsClinical Examination:⦁ Mild tenderness in the lower abdomen⦁ No palpable mass on abdominal or bimanual examinationImaging Findings:⦁ Ultrasound and CT Abdomen: Revealed a mummified, crumpled fetal skeleton in the left adnexa, separate from the ovary⦁ MRI: Confirmed a calcified fetal structure with skeletal elements consistent with a chronic tubal ectopic pregnancy of approximately 21 weeks gestational ageDiagnosis, Interventions, and OutcomesFinal Diagnosis:⦁ Lithopaedion secondary to chronic left tubal ectopic pregnancyManagement:⦁ Surgical removal of the calcified mass via laparotomy⦁ Histopathological confirmation of calcified fetal tissues⦁ Postoperative recovery was uneventfulOutcome:⦁ The patient had symptomatic relief from abdominal pain and no further spotting⦁ Counseling provided regarding early antenatal care in future pregnancies Conclusion and Key Takeaways⦁ Lithopaedion is a preventable complication of untreated or partially treated ectopic pregnancies.⦁ In women presenting with chronic abdominal pain and abnormal bleeding, especially with a remote history of missed pregnancy or incomplete abortion, rare pathologies like lithopaedion should be considered.⦁ Imaging modalities like CT and MRI are essential in confirming the diagnosis.⦁ This case emphasizes the critical role of early diagnosis and complete evacuation in ectopic pregnancies to prevent severe complications such as lithopaedion.

Ruptured Cornual Ectopic Pregnancy Mimics as Acute Retention of Urine: A Case Report

2025-06-19

K Guruparan , R Hemabala | Cureus

A Rare Case of Lithopaedion: A Calcified Legacy of Chronic Tubal Ectopic Pregnancy

2025-06-19

Sandra Venkat | International Journal of Contemporary Medicine

IntroductionLithopaedion, or “stone baby,” is an extremely rare complication of abdominal or tubal ectopic pregnancy where the fetus dies and undergoes calcification instead of resorption. Fewer than 300 cases have … IntroductionLithopaedion, or “stone baby,” is an extremely rare complication of abdominal or tubal ectopic pregnancy where the fetus dies and undergoes calcification instead of resorption. Fewer than 300 cases have been reported worldwide, making it a medical rarity. This case underscores the importance of early diagnosis and complete management of ectopic pregnancies, particularly in low-resource settings where incomplete abortions or delayed care may lead to such unusual outcomes. It enriches the global literature by documenting a rare pathology and reinforcing vigilance in chronic pelvic pain and abnormal bleeding in reproductive-age women.Patient Concerns and Clinical FindingsChief Complaints:Intermittent abdominal pain for 3 yearsSpotting per vaginam for 1.5 monthsClinical Examination:Mild tenderness in the lower abdomenNo palpable mass on abdominal or bimanual examinationImaging Findings:Ultrasound and CT Abdomen: Revealed a mummified, crumpled fetal skeleton in the left adnexa, separate from the ovaryMRI: Confirmed a calcified fetal structure with skeletal elements consistent with a chronic tubal ectopic pregnancy of approximately 21 weeks gestational ageDiagnosis, Interventions, and OutcomesFinal Diagnosis:Lithopaedion secondary to chronic left tubal ectopic pregnancyManagement:Surgical removal of the calcified mass via laparotomyHistopathological confirmation of calcified fetal tissuesPostoperative recovery was uneventfulOutcome:The patient had symptomatic relief from abdominal pain and no further spottingCounseling provided regarding early antenatal care in future pregnancies Conclusion and Key TakeawaysLithopaedion is a preventable complication of untreated or partially treated ectopic pregnancies.In women presenting with chronic abdominal pain and abnormal bleeding, especially with a remote history of missed pregnancy or incomplete abortion, rare pathologies like lithopaedion should be considered.Imaging modalities like CT and MRI are essential in confirming the diagnosis.This case emphasizes the critical role of early diagnosis and complete evacuation in ectopic pregnancies to prevent severe complications such as lithopaedion.

A clinical dilemma for fertility preservation in a woman with unilateral salpingectomy followed by contralateral ruptured ectopic pregnancy. A case report

2025-06-18

Constantin Mukeba Mpoyi , Emmanuel Mashyaka , Halima Mbwambo +2 more | International Journal of Surgery Case Reports

An ectopic pregnancy (EP) occurs when the blastocyst implants outside the endometrial lining of the uterine cavity. The loss of fertility poses a dilemma in the radical treatment of ruptured … An ectopic pregnancy (EP) occurs when the blastocyst implants outside the endometrial lining of the uterine cavity. The loss of fertility poses a dilemma in the radical treatment of ruptured ectopic pregnancy. This case report is presented in line with the SCARE criteria. A 36-year-old woman, G3P1 + 1 L1, at 8 weeks of gestation, presented with lower abdominal pain that was localized in the left iliac region. The pain was not associated with per vaginal spotting or bleeding. Pelvic ultrasonography revealed a significant fluid collection in the pouch of Douglas. A left salpingectomy was performed. A history of one ectopic pregnancy increases the risk of a subsequent EP by approximately 10 %, while having more than one previous ectopic pregnancy raises the risk to around 25 %. In communities where reproduction is believed to be an essence of womanhood, the loss of fertility carries serious socio-cultural consequences. These include not only external stigma but also internalized self-stigma that presents a significant dilemma when considering definitive treatment for a recurrent contralateral ruptured EP in a patient with a prior salpingectomy, particularly in low-resource settings, where IVF-ET and egg/embryo freezing are costly or unavailable. Surgical management of recurrent EP does not significantly impact the outcomes of IVF-ET. A patient who refuses salpingectomy after a recurrent ruptured EP faces a dilemma between preserving autonomy and preventing potentially life-threatening complications. A comprehensive approach should include discussions about alternative fertility options, patient education, psychological support, and ensuring that all decisions are fully informed.

Caesarean Scar Pregnancy Presenting With Septic Shock and Multiorgan Dysfunction in a High-Risk Cardiac Patient: A Case Report

2025-06-18

S. Patil , Vidya Jadhav | Cureus

Value of performing initial transvaginal sonography on day 21 after embryo transfer for early diagnosis of ectopic pregnancy: A retrospective cohort study

2025-06-18

Jingwen Lang , Xiuxian Zhu , Yonglun Fu | International Journal of Gynecology & Obstetrics

Evaluation of hemogram parameters in the diagnosis of ectopic pregnancy, early pregnancy loss and threatened miscarriage

2025-06-18

İsa Temur | Journal of Medicine and Palliative Care

Aims: In present study, it aimed to analyse the importance and potential use of inflammatory blood parameters in the prediction of threatened miscarriage (TM), early pregnancy loss (EPL) and ectopic … Aims: In present study, it aimed to analyse the importance and potential use of inflammatory blood parameters in the prediction of threatened miscarriage (TM), early pregnancy loss (EPL) and ectopic pregnancy (EP). Methods: Between October 2021 and 2023, the demographic data and obstetric histories of a total of 300 patients (n=100 for each group) diagnosed with TM, EPL, and EP at a single center, as well as 100 healthy women with a first-trimester intrauterine pregnancy, were analyzed. Complete blood count data obtained from these participants included. In statistical analyses, the significance level was set at p

Ectopic Pregnancy with Lithopedion Formation: Case Report

2025-06-18

Seif Nuru , Simon Mrema , Denis Katyali +3 more | Clinical Reviews & Cases

Lithopedion is a rare obstetric complication, corresponding to an ectopic pregnancy (usually abdominal in location) that progresses beyond the first trimester to fetal death and calcification. We report a case … Lithopedion is a rare obstetric complication, corresponding to an ectopic pregnancy (usually abdominal in location) that progresses beyond the first trimester to fetal death and calcification. We report a case of a 30-year-old woman who was referred to our facility complaining of abdominal swelling and heaviness for 3 years which was preceded by a history of positive urine pregnancy test. CT scan of abdomen and pelvis showed calcified intra-abdominal (omental) mass which was confirmed a lithopedion by laparotomy with excision.

Cervical heterotopic pregnancy: a rare occurrence

2025-06-17

Vinutha M. Sharma , Parag Hitnalikar , Sandhya Babu | International Journal of Reproduction Contraception Obstetrics and Gynecology

Ectopic pregnancy is one of the leading causes of first-trimester gestation-related mortality. Cervical ectopic is a rare entity (less than 1% of all ectopic cases), heterotopic cervical pregnancy is a … Ectopic pregnancy is one of the leading causes of first-trimester gestation-related mortality. Cervical ectopic is a rare entity (less than 1% of all ectopic cases), heterotopic cervical pregnancy is a much rarer occurrence. Cervical pregnancy is highly dangerous and demands immediate termination of pregnancy as the chances of haemorrhage are too high, leading to maternal mortality. Although there are various approaches to terminate cervical pregnancy, it is challenging when accompanied by a live intrauterine pregnancy. Ultrasound-guided transcervical aspiration of the products of conception is the most suitable option in these cases. Here we describe a case of cervical heterotopic pregnancy, which we successfully and safely terminated using the above approach.

The Development of an Ultrasound-Based Scoring System for the Prediction of Interstitial Pregnancy

2025-06-14

Yun Ji Jung , Hyun‐Soo Zhang , Eun Jin Lee +4 more | Journal of Clinical Medicine

Background/Objectives: Diagnosing interstitial pregnancy (IP) using ultrasonography can be challenging, as it is often mistaken for eccentrically located intrauterine pregnancy (IUP). In this retrospective cohort study, we aimed to develop … Background/Objectives: Diagnosing interstitial pregnancy (IP) using ultrasonography can be challenging, as it is often mistaken for eccentrically located intrauterine pregnancy (IUP). In this retrospective cohort study, we aimed to develop a predictive scoring model using multiple clinical factors to enhance the diagnosis of IP and facilitate timely interventions in suspected cases. Methods: We enrolled 63 pregnant women with a diagnosis of suspected IP who visited a single tertiary center between January 2006 and December 2023. Data on the clinical risk factors, symptoms, laboratory test results, and ultrasound findings were analyzed. A statistical predictive score was developed using logistic regression analysis with feature selection based on the least absolute shrinkage and selection operator to optimize the predictive accuracy and clinical applicability. Results: From a total of 12 factors, a scoring model was constructed from the three most prominent factors-ultrasound findings showing no surrounding endometrium, myometrial thinning of less than 5 mm, and vaginal bleeding-all of which demonstrated high feature importance. This predictive score identified IP with a negative predictive value of 0.950 in the low-risk group and a positive predictive value of 1.000 in the high-risk group, whereas the overall area under the curve was 0.998 (95% confidence interval, 0.992-1.000). Conclusions: The statistically derived predictive model--ultrasound showing no surrounding endometrium and myometrial thinning < 5 mm combined with vaginal bleeding--demonstrated high accuracy and practical applicability for IP diagnosis, providing a robust tool to enhance clinical decision-making and optimize routine management strategies for IP.

Clinical Profiles and Post-Surgical Outcomes of Ectopic Pregnancy: Experience of 60 Cases in Bangladesh

2025-06-14

Nahida Naznin , Farzana Sharmin , Saima Siraji +1 more | Journal of Current and Advance Medical Research

Background: Ectopic pregnancy is a significant cause of morbidity in reproductive-age women. Objective: The purpose of the present study was to assess the various clinical presentations and outcomes of ectopic … Background: Ectopic pregnancy is a significant cause of morbidity in reproductive-age women. Objective: The purpose of the present study was to assess the various clinical presentations and outcomes of ectopic pregnancy. Methodology: This prospective cohort study was conducted among patients admitted to Maternal and Child Health Training Institute, Azimpur, Dhaka, Bangladesh from January 2022 to December 2023 for a period of two years. It involved the clinical evaluation of ectopic pregnancy cases, focusing on sociodemographic characteristics, clinical presentations, risk factors, examination findings, intraoperative observations, and the management provided to the patients. Results: Most of the 60 patients were aged 26 to 30 years (51.7%), with a mean age of 28.17±4.39 years. All patients had a history of amenorrhea, and the most common symptom was abdominal pain (93.3%). Syncopal attacks occurred in 48.3% of cases, and 38.3% had per vaginal bleeding. The primary risk factor was a history of previous abortions or menstrual regulation (48.3%), followed by pelvic infections (28.3%) and previous D&C (16.7%). The ampulla was the most common site for ectopic pregnancies (88.3%), with 65% of ectopic sacs in the fallopian tube and 35% ovarian. Most patients underwent salpingectomy (71.7%) and were managed by laparotomy (85%). A majority (88.3%) had a hospital stay of less than 7 days. Conclusion: In conclusion, prior abortions are a more significant etiological factor for ectopic pregnancy compared to previous pelvic infections. Journal of Current and Advance Medical Research, January 2024;11(1):22-27

Retroperitoneal Ectopic Pregnancy

2025-06-13

Qingfa Song , Dan Li | iRadiology

Tubal Ectopic Pregnancy: From Diagnosis to Treatment

2025-06-13

Dimitrios Papageorgiou , Ioakeim Sapantzoglou , Ioannis Prokopakis +1 more | Biomedicines

The most frequent form of ectopic pregnancy, known as tubal pregnancy, leads to a dangerous situation where the fertilized ovum implants inside a fallopian tube, which can result in tubal … The most frequent form of ectopic pregnancy, known as tubal pregnancy, leads to a dangerous situation where the fertilized ovum implants inside a fallopian tube, which can result in tubal rupture and severe bleeding. The purpose of this narrative review is to evaluate all existing data regarding epidemiology, risk factors, pathophysiology, clinical presentation, diagnosis, and management of tubal ectopic pregnancy in order to provide a comprehensive understanding of this common yet difficult clinical condition. Prior ectopic pregnancy, together with tubal pathology and assisted reproduction, represent the main risk factors for this condition. The diagnosis relies on serial β-hCG tests combined with transvaginal ultrasonography, but laparoscopy serves as the diagnostic tool for cases with uncertain results. The treatment plan depends on the fallopian tube integrity, along with the patient's hemodynamic condition. Patients with unruptured pregnancies who are hemodynamically stable receive methotrexate treatment as the preferred option, but surgical intervention with salpingectomy or salpingostomy becomes necessary in case of tubal rupture or when medical treatment fails. The development of laparoscopic procedures has led to better results and improved possibilities for fertility preservation. The psychological effects on patients require both counseling and follow-up care. Early detection, along with personalized management, helps decrease maternal complications and optimize reproductive outcomes.

Abdominal ectopic pregnancy-fetal MR

2025-06-13

Ashesh Ranchod | Radiopaedia.org

Heterotopic pregnancy after natural conception

2025-06-09

Lars L. Andersen , Malin Nylander , Marlene Mohr | Ugeskrift for Læger

Heterotopic pregnancy is defined as a simultaneously intra- and extrauterine pregnancy. The condition is exceedingly rare, with an estimated incidence of one in 30,000 though more frequent in the presence … Heterotopic pregnancy is defined as a simultaneously intra- and extrauterine pregnancy. The condition is exceedingly rare, with an estimated incidence of one in 30,000 though more frequent in the presence of risk factors. In this case report, a 29-year-old woman, nine weeks pregnant, presented in the emergency department with lower abdominal pain worsening throughout the day. Ultrasound showed an intrauterine pregnancy and excess fluid in the pelvis. Laparoscopy revealed a tubal pregnancy and a salpingectomy was performed. The patient was discharged the following day with ongoing intrauterine pregnancy.

Interpregnancy interval and risk of recurrence following tubal ectopic pregnancy: retrospective cohort study from <scp>UK</scp> tertiary center

2025-06-05

W. M. Dooley , J. Farren , Lucrezia De Braud +4 more | Ultrasound in Obstetrics and Gynecology

ABSTRACT Objective To assess the effect of interpregnancy interval on the odds of recurrence of tubal ectopic pregnancy (TEP) following expectant or surgical management. Methods This was a retrospective cohort … ABSTRACT Objective To assess the effect of interpregnancy interval on the odds of recurrence of tubal ectopic pregnancy (TEP) following expectant or surgical management. Methods This was a retrospective cohort study conducted at a tertiary early pregnancy unit (EPU) in London, UK. Patients diagnosed with TEP following spontaneous conception, who had expectant or surgical management and who attended the EPU between December 2008 and January 2021 were included. Univariate and multivariate regression analyses were conducted to explore the association between the odds of recurrence of ectopic pregnancy and various factors, including maternal history, interpregnancy interval and management method of the index TEP, and analyses were adjusted for confounders. The main outcome measure was the odds of recurrence of extrauterine ectopic pregnancy in women presenting with a subsequent pregnancy. Results A total of 1386 women with TEP were included, of whom 626 (45.2%) presented with a subsequent pregnancy. Fifty‐nine of these women were excluded, as their subsequent pregnancy was conceived via in‐vitro fertilization. From the remaining 567 women, 59 (10.4%) were diagnosed with recurrent extrauterine ectopic pregnancy. An interpregnancy interval of 6–18 months was associated with four times the odds of recurrence compared with an interval of ≤ 3 months (odds ratio (OR), 4.05 (95% CI, 1.37–12.03)). Women with two or more previous TEPs had more than three times the odds of recurrence compared to those with one previous TEP (OR, 3.27 (95% CI, 1.13–9.42)). Surgical management of the index TEP was associated with similar odds of recurrence as expectant management (OR, 1.26 (95% CI, 0.72–2.20)). Conclusions Rapid conception after TEP is associated with low odds of recurrence. Therefore, purposeful delay to conception after TEP, including those managed expectantly, should not be recommended. Women with conception delay or a history of more than one ectopic pregnancy are at high risk of recurrent extrauterine ectopic pregnancy. © 2025 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Magnitude of ectopic pregnancy, management methods, and its associated factors among pregnant women attending Ambo University Referral Hospital in Oromia Regional State, Ethiopia: A seven years retrospective institutional based cross-sectional study

2025-06-05

N. Gizaw , M Mariam , Motuma Gutu Fayera | PLOS Global Public Health

Background Ectopic pregnancy is the implantation of a blastocyst outside of the endometrial lining of the uterus. Ectopic pregnancy can take several forms, including ovarian, abdominal, and tubal. The most … Background Ectopic pregnancy is the implantation of a blastocyst outside of the endometrial lining of the uterus. Ectopic pregnancy can take several forms, including ovarian, abdominal, and tubal. The most prevalent place for ectopic pregnancy is the fallopian tube, which accounts for over 97.7% of all ectopic gestations. The ampulla accounts for around 80% of tubal pregnancy, followed by the isthmus (12%), fimbria (5%). Ectopic pregnancy is diagnosed with the classic triad of amenorrhea, abdominal pain, vaginal bleeding, and a positive pregnancy test. Objective This study aimed to assess the magnitude of ectopic pregnancy, its management outcome, and associated factors among pregnant women attending Ambo University Referral Hospital in the Oromia Region, Ethiopia, in 2024. Methods A seven-year retrospective cross-sectional study, from February 2018 to April 2024, was conducted at the Ambo University Referral Hospital, which is located in Ambo town, Ethiopia. Data concerning all pregnant mothers who were admitted and managed for ectopic pregnancy were extracted from the medical records of patients and the operation book by a trained data collector through Kobo Toolbox electronic data collection software. The collected data was checked first for its completeness, and it was exported into SPSS version 26 software for data analysis. Then Descriptive statistics were employed for summarizing the data, and bivariate and multivariate logistic regression analyses were used to identify the independent effect of the predictor variable on the outcome variable. Results From February 2018 to April 2024, there were 17,687 total pregnancies, 6,249 gynecologic admissions, and 182 cases of ectopic pregnancies at Ambo University Referral Hospital. A total of 173 patients with ectopic pregnancy were included in the data analysis. The magnitude of ectopic pregnancy was 0.98% among the total pregnancies and accounted for 2.77% of all gynecological admissions during the study period. Most of the patients, 81 (46.8%), were in the 25–29 years age group, with a mean age of 27.16 ± SD 4.77 years. Mothers who had a previous history of abortion, a history of pelvic inflammatory disease, a history of ectopic pregnancy, or a history of tubal surgery had a statistically significant association with ectopic pregnancy. The majority of the patients were married, 98 (56.6%), and urban residents, 121 (69.9%). The majority of ectopic pregnancies occurred on the right side of the fallopian tube 144 (83.24%). Among the majority of ectopic pregnancies, 159 (61.3%) were tubal ampullary ectopic pregnancies. Conclusion and recommendation The major risk factors identified in this study were previous abortion, pelvic inflammatory disease, a previous history of ectopic pregnancy, and previous tubal surgery. The magnitude of the ectopic pregnancy in this study was 0.98%, which is similar to the global range. The majority of ectopic pregnancies occurred on the right side of the fallopian tube 144 (83.24%) and 160 (92.49%) were ruptured. Further research is needed to assess why ectopic pregnancy is most common in the right fallopian tube .

Reevaluating PoCUS in RPOC diagnosis: Overlooked sonographic findings and the potential role of high-frequency transducers

2025-06-01

Ali Çelik | The American Journal of Emergency Medicine

Ectopic pregnancy in the spleen: Report of a rare case

2025-06-01

Jie Yan , Yaxin Guo , Chong Gao +1 more | Asian Journal of Surgery

Cesarean scar ectopic pregnancy - a case series

2025-06-01

Basanta Manjari Hota , Naimisha Movva , Swathi Pandirla | The New Indian Journal of OBGYN