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Ectopic Pregnancy

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41. ACOG Practice Bulletin No. 193 Summary: Tubal Ectopic Pregnancy. (PubMed)

ACOG Practice Bulletin No. 193 Summary: Tubal Ectopic Pregnancy. Ectopic pregnancy is defined as a pregnancy that occurs outside of the uterine cavity. The most common site of ectopic pregnancy is the fallopian tube. Most cases of tubal ectopic pregnancy that are detected early can be treated successfully either with minimally invasive surgery or with medical management using methotrexate. However, tubal ectopic pregnancy in an unstable patient is a medical emergency that requires prompt (...) surgical intervention. The purpose of this document is to review information on the current understanding of tubal ectopic pregnancy and to provide guidelines for timely diagnosis and management that are consistent with the best available scientific evidence.

2018 Obstetrics and Gynecology

42. ACOG Practice Bulletin No. 193: Tubal Ectopic Pregnancy. (PubMed)

ACOG Practice Bulletin No. 193: Tubal Ectopic Pregnancy. Ectopic pregnancy is defined as a pregnancy that occurs outside of the uterine cavity. The most common site of ectopic pregnancy is the fallopian tube. Most cases of tubal ectopic pregnancy that are detected early can be treated successfully either with minimally invasive surgery or with medical management using methotrexate. However, tubal ectopic pregnancy in an unstable patient is a medical emergency that requires prompt surgical (...) intervention. The purpose of this document is to review information on the current understanding of tubal ectopic pregnancy and to provide guidelines for timely diagnosis and management that are consistent with the best available scientific evidence.

2018 Obstetrics and Gynecology

43. ACOG Practice Bulletin No. 191 Summary: Tubal Ectopic Pregnancy. (PubMed)

ACOG Practice Bulletin No. 191 Summary: Tubal Ectopic Pregnancy. Ectopic pregnancy is defined as a pregnancy that occurs outside of the uterine cavity. The most common site of ectopic pregnancy is the fallopian tube. Most cases of tubal ectopic pregnancy that are detected early can be treated successfully either with minimally invasive surgery or with medical management using methotrexate. However, tubal ectopic pregnancy in an unstable patient is a medical emergency that requires prompt (...) surgical intervention. The purpose of this document is to review information on the current understanding of tubal ectopic pregnancy and to provide guidelines for timely diagnosis and management that are consistent with the best available scientific evidence.

2018 Obstetrics and Gynecology

44. Cesarean Scar Ectopic Pregnancy: Current Management Strategies. (PubMed)

Cesarean Scar Ectopic Pregnancy: Current Management Strategies. Cesarean scar ectopic pregnancy (CSEP) has a high rate of morbidity with nonspecific signs and symptoms making identification difficult. The criterion-standard treatment of CSEP has been subject to debate.This review defines CSEP, discusses pathogenesis and diagnosis, and compares treatment options and outcomes.A literature review was performed utilizing the term cesarean scar ectopic pregnancy and subsequently selecting only meta (...) treatment with additional medication or surgery. Different surgical methods have been explored including uterine artery embolization; dilation and curettage; surgical removal via vaginal, laparoscopic, or laparotomic approach; and hysterectomy. Each method has various levels of success and depends on surgeon skill and patient presentation.Recent research supports any method that removes the pregnancy and scar to reduce morbidity and promote future fertility. Laparoscopic and transvaginal approaches

2018 Obstetrical & Gynecological Survey

45. The effectiveness of different treatments for cesarean ectopic pregnancy. (PubMed)

The effectiveness of different treatments for cesarean ectopic pregnancy. 29878597 2019 02 08 2019 02 15 1471-0528 125 13 2018 12 BJOG : an international journal of obstetrics and gynaecology BJOG The effectiveness of different treatments for caesarean ectopic pregnancy. 1671 10.1111/1471-0528.15314 Agostini A A Department of Gynaecology and Obstetrics, La Conception Hospital, Marseille, France. Crochet P P Department of Gynaecology and Obstetrics, Arnaud de Villeneuve Hospital, Montpellier (...) , France. eng Journal Article Comment 2018 06 28 England BJOG 100935741 1470-0328 AIM IM BJOG. 2018 Dec;125(13):1663-1670 29697890 Cesarean Section Cicatrix Cohort Studies Female Humans Pregnancy Pregnancy, Ectopic United Kingdom 2018 6 8 6 0 2019 2 9 6 0 2018 6 8 6 0 ppublish 29878597 10.1111/1471-0528.15314

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2018 BJOG

46. Appendiceal Endometriosis and Ectopic Pregnancy Occurring Simultaneously. (PubMed)

Appendiceal Endometriosis and Ectopic Pregnancy Occurring Simultaneously. In the setting of a known ectopic pregnancy, severe abdominal pain with clinical concern for rupture is an indication for emergency surgery. In rare cases, appendiceal pathology may occur simultaneously.A woman with a known ectopic pregnancy presented to the emergency department with a clinical picture consistent with its rupture. At the time of surgery, an appendectomy also was performed owing to concern for concurrent (...) appendicitis; histopathologic examination revealed appendiceal endometriosis.During surgical management of ectopic pregnancy, it is important to undertake a thorough examination of the pelvis, because patients may present with multiple concurrent pathologies. In the setting of an emergency operation, when the diagnosis seems clear, this survey should not be forgotten.

2018 Obstetrics and Gynecology

47. Management of uterine ectopic pregnancy - local versus systemic methotrexate. (PubMed)

Management of uterine ectopic pregnancy - local versus systemic methotrexate. The aim of this study was to compare ultrasound-guided local methotrexate (MTX) vs. systemic methotrexate in uterine ectopic pregnancy regarding the beta human chorionic gonadotropin (hCG) clearance duration.Patients with interstitial pregnancy, cervical pregnancy or cesarean scar pregnancy were included. Methotrexate was administered locally ultrasound-guided (25 mg methotrexate fixed dose) or systemically (...) (intramuscular; 50 mg/m2 body weight). Beta hCG clearance duration in days formed the main outcome measure.Forty-six patients with uterine ectopic pregnancy were included. The mean estimated beta hCG clearance duration was 29.2 days longer in patients with local methotrexate compared with systemic methotrexate (64.7 vs. 31.5 days, respectively; p = 0.026). There was no significant difference between local vs. systemic methotrexate regarding adverse events such as bleeding (p = 0.376), pain (p = 0.146

2018 Acta Obstetricia et Gynecologica Scandinavica

48. Thawed embryo transfer and ectopic pregnancy: a meta-analysis.

Thawed embryo transfer and ectopic pregnancy: a meta-analysis. To examine whether thawed embryo transfers can reduce the rate of EP.The PubMed, EMBASE, Cochrane Library databases and two randomized controlled trials registration centers were thoroughly searched until March 2017. The clinical outcomes of IVF/ICSI cycles were compared between thawed and fresh embryo transfer.Twenty-one articles were included in this meta-analysis. There were 801,464 pregnancies totally (thawed-ET: n = 158,967 (...) , fresh-ET: n = 642,497). The ectopic pregnancy rate was significantly lower in the group of thawed-ET than that in the group of fresh-ET (OR 0.69, 95% CI 0.57-0.82; I2 = 83%). We subdivided the data into subgroups for D3 embryo transfer and D5 embryo transfer. We also found that the ectopic pregnancy rate was significantly lower with thawed-ET on D3 than that with fresh-ET (OR 0.67, 95% CI 0.53-0.85; I2 = 0%). The risk of ectopic pregnancy was significantly decreased with thawed-ET on D5 than

2018 Archives of gynecology and obstetrics

49. Systematic review and meta-analysis of single-dose and non-single-dose methotrexate protocols in the treatment of ectopic pregnancy.

Systematic review and meta-analysis of single-dose and non-single-dose methotrexate protocols in the treatment of ectopic pregnancy. It remains unclear which methotrexate protocol for the treatment of ectopic pregnancy has a higher success rate or a higher adverse effect rate.To compare the treatment success rates and adverse effect rates of single-dose and non-single-dose (two-dose and multi-dose) methotrexate protocols in the treatment of ectopic pregnancy.Various databases including Medline (...) , Embase, and the Cochrane Central Register of Controlled Trials were searched on July 1, 2017, using search terms including "methotrexate" and "pregnancy."Randomized controlled trials comparing different methotrexate protocols for the treatment of ectopic pregnancy were included.Relative risks (RRs) and 95% confidence intervals (CIs) were calculated to compare treatment success rates and adverse effect rates.The single-dose and non-single-dose protocols had similar success rates (RR 1.00, 95% CI 0.96

2018 International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics

50. Diagnostic utility of CT in differentiating between ruptured ovarian corpus luteal cyst and ruptured ectopic pregnancy with hemorrhage (PubMed)

Diagnostic utility of CT in differentiating between ruptured ovarian corpus luteal cyst and ruptured ectopic pregnancy with hemorrhage To evaluate the performance of computed tomography (CT) as a diagnostic aid to differentiate between ruptured ovarian corpus luteal cyst (ROCLC) and ruptured ectopic pregnancy with hemorrhage (REPWH).A total of 36 patients treated at our hospitals for ROCLC and REPWH from June 2014 to August 2017 were included in this study. Based on the diagnosis, the study

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2018 Journal of ovarian research

51. Comparison of Four Methods of Treating Ectopic Pregnancy: A Retrospective Cohort Study (PubMed)

Comparison of Four Methods of Treating Ectopic Pregnancy: A Retrospective Cohort Study To compare the results of expectant management, single and multidose methotrexate (MTX) and surgical management of ectopic pregnancy (EP).In this retrospective cohort study, the original files of 233 patients who were treated for EP between May 2009 and December 2016 were analyzed. The patients were assigned to the following groups based on the applied treatment methods: Group 1, expectant management (n = 24 (...) ), Group 2, single-dose MTX (n = 144), Group 3, multiple-dose MTX (n = 25), and Group 4, surgical intervention (n = 40). The following parameters were recorded and assessed: sociodemographic characteristics, pelvic ultrasonography findings (gestational sac, ectopic mass appearance, positive fetal cardiac activity), serum beta-human chorionic gonadotropin (β-hCG) levels on Day 0, Day 4, and Day 7, and surgical procedures in women that underwent surgical interventions.The sociodemographic characteristics

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2018 Geburtshilfe Und Frauenheilkunde

52. Acute intestinal obstruction due to extrinsic compression by previa myoma and ectopic pregnancy: a case report (PubMed)

Acute intestinal obstruction due to extrinsic compression by previa myoma and ectopic pregnancy: a case report Acute intestinal obstruction during pregnancy is a rare digestive surgical emergency with significant maternal and fetal mortality. Diagnosis is difficult, often delaying the management. Here, we report an exceptional association of mechanical acute intestinal obstruction due to compression by previa uterine leiomyoma, and a ruptured ectopic pregnancy.This is the case report of a 43 (...) an empty rectum, and the mass was perceptible in Douglas's pouch. At the vaginal examination, we found the same mass and a finger holster was clean. The diagnosis of intestinal occlusion by a tumor was retained. The laparotomy revealed a distended intestine, a ruptured right tubal ectopic pregnancy and a polymyomatous uterus. The most massive previa leiomyoma was adhering and compressing the rectal and sigmoidal hinge. A total hysterectomy was performed and histopathological examination of specimens

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2018 Journal of medical case reports

53. Vinorelbine Potently Induces Placental Cell Death, Does Not Harm Fertility and is a Potential Treatment for Ectopic Pregnancy (PubMed)

Vinorelbine Potently Induces Placental Cell Death, Does Not Harm Fertility and is a Potential Treatment for Ectopic Pregnancy Ectopic pregnancies complicate 1-2 pregnancies and are a leading cause of maternal death. An effective oral drug therapy that replaces surgery might make its treatment safer, cheaper, simpler and therefore more widely accessible. The only current medical treatment offered to women is intramuscular methotrexate, but this only reliably resolves smaller ectopic pregnancies (...) . As such, many ectopic pregnancies require surgical excision. We show that vinorelbine, an orally available chemotherapeutic agent, potently induced placental cell death but did not harm fertility in mice. Vinorelbine was 100-1000 times more potent than methotrexate in inducing placental cell death in vitro, and more potent than combination methotrexate and gefitinib (another proposed treatment for ectopic pregnancy being evaluated in phase III trials). Mechanistically, it caused microtubule condensation

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2018 EBioMedicine

54. Successful Management of Cervical Ectopic Pregnancy with Bilateral Uterine Artery Embolization and Methotrexate (PubMed)

Successful Management of Cervical Ectopic Pregnancy with Bilateral Uterine Artery Embolization and Methotrexate Cervical ectopic pregnancy (CEP) is a rare form of ectopic pregnancy. Cases diagnosed early in pregnancy can be managed medically, but more advanced pregnancies often require hysterectomy. Uterine artery embolization (UAE) is a novel approach to CEP for those who wish to preserve fertility. Here we present the case of a 44-year-old female with a 2-week history of vaginal bleeding

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2018 Case Reports in Emergency Medicine

55. Ruptured caesarean scar ectopic pregnancy: a diagnostic dilemma in a resource-limited setting (PubMed)

Ruptured caesarean scar ectopic pregnancy: a diagnostic dilemma in a resource-limited setting Caesarean scar pregnancy (CSP) remains a very rare form of ectopic pregnancy associated with serious life threatening obstetric complications and even death in case of late diagnosis and treatment.We report a case of a ruptured caesarean scar pregnancy in a 29 year-old gravida 5, para 3 with a past obstetric history of two consecutive caesarean sections done 9 and 5 years ago respectively. The patient (...) presented with intermittent lower abdominal pains on a 20 weeks gestation associated with mild epigastralgia and 2 previous episodes of mild pervaginal bleeding (2 and 1 months ago respectively before consultation) managed with injectable progesterone. Her evolution 4 h later was marked by an increase in the intensity of the abdominal pain, an unmeasurable blood pressure and a feeble pulse. Immediate paracentesis revealed 10 cc of fresh non coagulating blood. The diagnosis of ruptured ectopic pregnancy

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2018 BMC research notes

56. Diagnosis and surgical therapy of the retroperitoneal ectopic pregnancy: A case report (PubMed)

Diagnosis and surgical therapy of the retroperitoneal ectopic pregnancy: A case report Retroperitoneal ectopic pregnancy (REP) is a rare type of gestation that is difficult to diagnose and treat. To date, only several published cases are available and no specific guideline has been developed to manage this disease. As the lesions are located closely to the large retroperitoneal blood vessels, surgical resection of the gestational tissue might incur risks such as associated hemorrhage, injury (...) of blood vessels or nerves. On the other hand, the therapeutic effect of conservative treatment using methotrexate is not satisfactory.A case of retroperitoneal ectopic pregnancy which was diagnosed in the PLA general hospital was reported here. A 34-year-old woman, gravida 2, parturition 0, was admitted via the emergency department on July 7, 2015 with the main complaint of missed period for 52 days and bellyache for 16 h.The mechanisms of retroperitoneal embryo migration and related literatures

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2018 International journal of surgery case reports

57. Ruptured ectopic pregnancy following a cycle of freeze-all in vitro fertilization: A case report (PubMed)

Ruptured ectopic pregnancy following a cycle of freeze-all in vitro fertilization: A case report Patients undergoing assisted reproduction are advised to abstain from intercourse to prevent the possibility of multiple pregnancy. If patients do not follow this advice, multiple dizygotic pregnancy or even a heterotopic pregnancy can result. We report the case of a 28-year-old nulliparous female with unexplained infertility who underwent freeze-all vaginal oocyte retrieval. Twenty-one days later (...) she presented with vaginal bleeding (similar to menstruation) and right lower-quadrant pain. The results of ultrasound scanning and a laboratory work-up were consistent with an ectopic pregnancy. She underwent laparoscopic right salpingectomy for a tubal ectopic pregnancy. We recommend sexual abstinence during assisted reproduction to lower the risk of multiple pregnancy and especially of heterotopic pregnancy.

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2018 Case Reports in Women's Health

58. Gefitinib and Methotrexate to Treat Ectopic Pregnancies with a Pre-Treatment Serum hCG 1000–10,000 IU/L: Phase II Open Label, Single Arm Multi-Centre Trial (PubMed)

Gefitinib and Methotrexate to Treat Ectopic Pregnancies with a Pre-Treatment Serum hCG 1000–10,000 IU/L: Phase II Open Label, Single Arm Multi-Centre Trial Ectopic pregnancies are a leading cause of maternal mortality. Most are treated surgically. We evaluated the efficacy and safety of combining oral gefitinib (epidermal growth factor receptor inhibitor) with methotrexate to treat larger ectopic pregnancies.We performed a phase II, single arm, open label study across four hospitals (...) in Edinburgh and Melbourne. We recruited women with a stable tubal ectopic pregnancy and a pre-treatment serum hCG between 1000 and 10,000 IU/L. We administered intramuscular methotrexate (50 mg/m2) once, and oral gefitinib (250 mg) for seven days. The primary outcome was the percentage successfully treated without needing surgery. To show the treatment is at least 70% effective, 28 participants were required, and 24 or more successfully treated without surgery. Secondary outcomes were safety, tolerability

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2018 EBioMedicine

59. Myomectomy scar ectopic pregnancy following a cryopreserved embryo transfer (PubMed)

Myomectomy scar ectopic pregnancy following a cryopreserved embryo transfer A 40 year old woman with a history of a myomectomy visited the Department of Obstetrics and Gynecology, Niigata University Medical and Dental Hospital, Niigata, Japan, following 2 years of infertility. Magnetic resonance imaging detected an abnormal endometrial-like pseudo-cavity. A hysterosalpingography also revealed an abnormal accumulation of contrast medium at the myometrial scar site. A transvaginal ultrasound (...) transvaginal ultrasonography.A subserosal uterine pregnancy is a rare form of intramural pregnancy, which is a rare subtype of an ectopic pregnancy, which could occur at the myomectomy site, especially after an embryo transfer. It is believed that this rare ectopic pregnancy resulted from embryo implantation under the serosa through a micro-sinus tract that was a site of suture failure of the myomectomy scar and was partially affected by the embryo transfer. Clinicians should consider the possibility

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2018 Reproductive Medicine and Biology

60. An audit of the management of ectopic pregnancies in a district hospital, Gauteng, South Africa (PubMed)

An audit of the management of ectopic pregnancies in a district hospital, Gauteng, South Africa  Ectopic pregnancy (EP) is a life-threatening condition; at Odi Hospital, approximately 7-10 EPs are managed weekly. Our study is the first to assess the management of this life-threatening condition at Odi Hospital. This study aimed to determine the incidence of EP and to assess the profile of women who presented with EP at Odi District Hospital from 01 January 2010 to 31 December 2014. The study

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2018 African journal of primary health care & family medicine

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