Live birth after treatment of a spontaneous ovarian heterotopic pregnancy: a case report

We report the case of a healthy 32-year-old woman, gravida 4, para 3, who presented to the emergency room with severe abdominal pain. Two weeks earlier, pelvic ultrasound had revealed a 6-week intrauterine pregnancy. She was hemodynamically stable, but had rebound tenderness on the right iliac fossa. Transvaginal ultrasound revealed an evolutive intrauterine pregnancy with a gestational age (GA) of 8 weeks, with a synchronous evolutive adnexal pregnancy of the same GA and some free fluid in the pouch of Douglas. She underwent an urgent laparoscopy which showed an intact gestational sac containing an embryo on the right ovary associated with mild hemoperitoneum. An ovarian wedge resection was performed to preserve ovarian tissue. The intrauterine pregnancy had no complications and the patient delivered vaginally at term.Heterotopic pregnancy is potentially life-threatening. Despite being extremely rare after natural conception, and even more so in the absence of major risk factors, it should be considered in any pregnant woman with abdominal pain. A high index of suspicion is important for a prompt diagnosis, selection of the appropriate surgical treatment and successful obstetric outcomes.
Source: Case Reports in Womens Health - Category: OBGYN Source Type: research

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Abstract PURPOSE:  The aim of this study was to investigate the association of clinical, laboratory, and ultrasound findings with the surgical diagnosis of adnexal torsion in a retrospective cohort of women operated for suspected torsion during pregnancy. MATERIALS AND METHODS:  A multicenter retrospective study of pregnant women who underwent urgent laparoscopy for suspected adnexal torsion during 2004-2019 in three tertiary medical centers. RESULTS:  Adnexal torsion was found in 143/208 (68.8 %) cases. Women with adnexal torsion had lower parity and lower rates of previous cesarean sec...
Source: Ultraschall in der Medizin - Category: Radiology Authors: Tags: Ultraschall Med Source Type: research
A 30-year-old nulliparous woman presented with light vaginal bleeding, right lower abdominal pain and tenderness, without peritonism. Serum beta human chorionic gonadotrophin (B-hCG) was static at 720-730 IU/mL over 48 hours and the uterus appeared empty on transvaginal ultrasound. Diagnostic laparoscopy was recommended over medical management due to ongoing pain.
Source: The Journal of Minimally Invasive Gynecology - Category: OBGYN Authors: Tags: IMAGES IN Gynecological Surgery Source Type: research
A 30-year-old nulliparous woman presented with light vaginal bleeding and right lower abdominal pain and tenderness, without peritonism. Her serum β human chorionic gonadotrophin (β-hCG) level was static at 720 to 730 IU/mL over 48 hours, and the uterus appeared empty on transvaginal ultrasound. Diagnostic laparoscopy was recommended over medical management owing to ongoing pain.
Source: The Journal of Minimally Invasive Gynecology - Category: OBGYN Authors: Tags: Images in Gyneclogic Surgery Source Type: research
Conclusion: HIFU showed a safe and effective profile as a therapeutic management option for patients with adenomyosis. In comparison with LE, HIFU treatment achieved better postoperative reproductive outcomes. HIFU treatment should be encouraged and implemented in clinical practice. PMID: 32208771 [PubMed - in process]
Source: International Journal of Hyperthermia - Category: Internal Medicine Tags: Int J Hyperthermia Source Type: research
Discussion –— Cesarean scar ectopic pregnancy (CSEP) or Cesarean scar pregnancy (CSP) is a rare form of ectopic pregnancy resulting from implantation of a blastocyst within myometrial scar tissue (old uterine scars) in the anterior lower uterine segment (LUS) at the site of prior Cesarean section.— It is considered amongst the rarest type of ectopic pregnancy, although some do not include it in the category of ectopic pregnancy as implantation occurs within the uterus itself.— Incidence is on rise due to increasing numbers of elective Cesarean sections as well as improved detection with tr...
Source: Sumer's Radiology Site - Category: Radiology Authors: Source Type: blogs
Authors: D'Ambrosio V, Brunelli R, Musacchio L, Del Negro V, Vena F, Boccuzzi G, Boccherini C, Di Donato V, Piccioni MG, Benedetti Panici P, Giancotti A Abstract Adnexal masses are not common in pregnancy. They are often discovered incidentally during routine ultrasound examinations. In general, 24%-40% of the cases are benign tumors; up to 8% are malignant tumors. Adnexal masses are usually asymptomatic, but sometimes can be responsible for abdominal or pelvic pain. Transvaginal and transabdominal ultrasound is essential to define the morphology of pelvic masses and to distinguish between benign and malignant case...
Source: Tumori - Category: Cancer & Oncology Tags: Tumori Source Type: research
Heterotopic pregnancy occurs when a patient has simultaneous intrauterine and ectopic pregnancies. Rates of heterotopic pregnancy have been rising with increased availability and access to in vitro fertilization and other advanced fertility technologies. Symptoms of heterotopic pregnancy are nonspecific, such as vague abdominal pain, so transvaginal ultrasound is a crucial part of the diagnostic process. Laparoscopy is the most commonly performed treatment of the ectopic pregnancy; other options include localized injections of methotrexate and/or potassium chloride. Following definitive termination of the ectopic pregnancy...
Source: Journal of the American Academy of Physician Assistants - Category: Primary Care Tags: Review Article Source Type: research
ConclusionThe additional use of MRI was more accurate than clinical assessment and USS combined. The accurate exclusion of pathology in 11 cases is particularly significant. MRI should be considered in cases of abdomino-pelvic pain in pregnant women.
Source: European Journal of Obstetrics and Gynecology and Reproductive Biology - Category: OBGYN Source Type: research
Prediction of Adnexal Torsion by Ultrasound in Women with Acute Abdominal Pain. Ultraschall Med. 2019 Nov 08;: Authors: Bardin R, Perl N, Mashiach R, Ram E, Orbach-Zinger S, Shmueli A, Wiznitzer A, Hadar E Abstract PURPOSE:  To investigate the accuracy of ultrasound in the diagnosis of adnexal torsion. MATERIALS AND METHODS:  Retrospective cohort analysis of 322 women, presenting to a tertiary medical center with acute abdominal pain, who underwent gynecological examination, sonographic evaluation and laparoscopic surgery, between 2010 and 2016. Findings for adnexal torsi...
Source: Ultraschall in der Medizin - Category: Radiology Authors: Tags: Ultraschall Med Source Type: research
AbstractBackgroundEndometriosis can exert obvious negative effects on women ’s quality of life.Excisional surgery is among the most effective treatments for severe pelvic endometriosis. The prevalence of severe pelvic adhesions following a laparoscopic examination of severe endometriosis varies between 50 and 100%. Temporary intraoperative ovarian suspension is a method for the reduction of adhesions is in the treatment of severe pelvic endometriosis. Given the importance and the prevalence of endometriosis and its complications, we conducted the present study to determine more effective adhesion-reducing methods wit...
Source: Gynecological Surgery - Category: OBGYN Source Type: research
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