DIAGNOSTIC DILEMMA AND THERAPEUTIC CHALLENGES IN MANAGING RARE CASES OF ECTOPIC PREGNANCIES.
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Abstract
: to highlight the difficulties and challenges faced in the management of rare cases of ectopic pregnancy and find the most effective management in our setup.
We present case series of rare cases of ectopic pregnancies managed in SOHAR Hospital. Incidence of rare site was 3.2%.
Introduction
Ectopic Pregnancy (EP) is defined as the implantation of the fertilized egg occurs outside the uterine cavity. Reported incidence is approximately 2% of all pregnancies. (1) The fallopian tube is the most common location, accounting for more than 90% of cases. (2) However implantation in the rare sites such as in abdomen (1%), cervix (1%), ovary (1-3%) and caesarean scar (1-3%) can occur and often results in greater morbidity because of delayed diagnosis and treatment. (2)
We performed 3-year retrospective audit within our department from 09/6/2021-09/06/2024 to review the management outcome of ectopic pregnancy.
408 cases of ectopic pregnancies were managed during this period. Among them 80% were in fallopian tube, remaining were PUL 17% (71/408), scar 0.98% (4/408), cornual 0.73% (3/408), heterotopic 0.49% (2/408), ovarian 0.24% (1/408), Interstitial 0.24% (1/408). Secondary abdominal ectopic was 0.49% (2/408).
As the number of cases of rare presentation of ectopic are very less, most of the gynecologists have either none or limited experience of managing such cases. Therefore, it is important to share our experience of managing these atypical cases and discuss the challenges and ways to deal more effectively and efficiently to minimize maternal morbidity and mortality due to ectopic pregnancy in unusual sites.
References
2. 2.Bouyer J, Coste J, Fernandez H, Pouly JL, Job-Spira N. Sites of ectopic pregnancy: a 10 year population-based study of 1800 cases. Hum Reprod 2002;17:3224-30(Level 11-3)
3. 3.Grimes HG, Nosal RA, Gallagher JC. Ovarian pregnancy: a series of 24 cases. Obstet Gynecol 1983;61:174–80.
4. 4.Raziel A, Schachter M, Mordechai E, et al. Ovarian pregnancy-a 12-year experience of 19 cases in one institution. Eur J Obstet Gynecol Reprod Biol 2004;114:92–6.
5. 5.Shiau CS, Hsieh CL, Chang MY. Primary ovarian pregnancy. Int J Gynaecol Obstet 2007;96:127.
6. 6.Tinelli A, Hudelist G, Malvasi A, et al. Laparoscopic management of ovarian pregnancy. JSLS 2008;12:169–72
7. 7.Spigelberg O. Casusistik der ovarialschwangerschaft. Arch Gynecol.1878;13:73(Google Scholar)
8. 8.Joseph Rj, Irvine LM. Ovarian ectopic pregnancy: aetiology, diagnosis and challenges in surgical management. J Obstet Gynaecol 2012;32;472-4
9. 9.Diagnosis and Management of Ectopic Pregnancy.Green Top Guideline No.21.RCOG/AEPU joint Guideline /November 2022
10. 10.Qian ZD, Guo QY, Huang LL. Identifying risk factors for recurrent caesarean scar pregnancy: a case control study. Fertil Steril 2014;102;129-134.e1
11. 11.Timor-Tritch IE, Monteagudo A. Unforseen consequences of the increasing rate of caesarean delivery: early placenta accrete and caesarean scar pregnancy. A review. Am J Obstet Gynecol 2012;207:14-29
12. 12.Peng KW, Lei Z, Xiao TH,J ia FG, Zhong WX, Gao Y,et al. First trimester caesarean scar ectopic pregnancy evaluation using MRI. Clin Radiol 2014;69:123-9
13. 13.Larsen JV, Solomon MH. Pregnancy in a uterine scar sacculus-an usual cause of postabortal hemorrhage. S Afr Med J 1978;53:142-3
14. 14.Seow KM, Huang LW, Lin YH, Lin MY, Tsai YL, Hwang JL. Caesarean scar pregnancy: Issues in management. Ultrasound Obstet Gynecol 2004;23:247-53.
15. 15.Jurkovic D, Hillaby K, Woelfer B, Lawrence A, Salim R, Elson CJ. First trimester diagnosis and management of pregnancies implanted into the lower uterine segment Caesarean section scar. Ultrasound Obstet Gynecol 2003;21:220-7
16. 16..Ash A, Smith A. Maxwell. Caesarean scar pregnancy. BJOG 2007;114:253-63
17. 17.Peng KW, Lei Z, Xiao TH,J ia FG, Zhong WX, Gao Y,et al. First trimester caesarean scar ectopic pregnancy evaluation using MRI. Clin Radiol 2014;69:123-9
18. 18.Childs AJ, Royek AB, Leigh TB, Gallup PG. Triplet heterotopic pregnancy after gonadotropin stimulation and intrauterine insemination diagnosed at laparoscopy:a case report. South Med J.2005;98:833-835
19. 19.Childs AJ, Royek AB, Leigh TB, Gallup PG. Triplet heterotopic pregnancy after gonadotropin stimulation and intrauterine insemination diagnosed at laparoscopy:a case report. South Med J.2005;98:833-835
20. 20.H.S.Jeon,H.Shin,I.H.Kim,and D.Y. Chung. “A case of Spontaneous Heterotopic Pregnancy presenting with heart activity of both embryos. ”Korean Journal of Obstetrics & Gynaecology, Vol 55.no 5 pp,339-342,2012.View at publisher.View at Google Scholar.
21. 21.M.Varras , C Akrivis G, Hadjopoulous, and N.Antoniou,”Hetrotopic pregnancy in a natural conception cycle presenting with tubal rupture: a case report and review of literature, “European Journal of Obstetrics Gynecology and Reproductive Biology,vol.106,no.1,pp.79-82,2003.View at Publisher. View at Google Scholar. View at Scopus.
22. 22.S. Shiragur,V.R,M,J,R Doshi, and, S.Kori,” Ruptured cornual ectopic pregnancy at 8 weeks gestation-successful conservative approach:a case report, ”International journal of Reproduction, Contraception, Obstetrics and Gynaecology ,vol 2.no .4,p.671,2013.View at Publisher. view at Google scholar.
23. 23.Andrews J, Farrell S. Spontaneous bilateral tubal pregnancies: A case report. J Obstet Gynaecol can.2008:30:51-54[PubMed][Google Scholar]
24. 24.Edelstein MC, Morgan MA. Bilateral simultaneous tubal pregnancy: Case report and review of literature. Obstet Gynecol Surv.1989;44:250-252
25. 25.Fishback HR. Bilateral simultaneous tubal pregnancy. Am J Obstet Gynecol.1939;37 :1035 [Google Scholar]
26. 26.Foster HM, Lakshin AS, Taylor WF. Bilateral tubal pregnancy with vaginal delivery. Obstet Gynecol.1982 ;60: 644-66[Pubmed][Google Scholar].
27. 27.Tabachnikoff RM, Dada MO, Woods RJ, Rohere D, Myers CP. Bilateral tubal pregnancy. A report of an unusual case .J Reprod Med.1998;43:707-09.[Pubmed][Google Scholar].
28. 28.Norris S. Bilateral simultaneous tubal pregnancy. Can Med Assoc J.1953;68:379-381[PMC free article][Pubmed][Google Search].
29. 29.Andrews J, Farrell. Spontaneous bilateral tubal pregnancies: A case report Obstet Gynecol can.2008;30:51-54 [Pubmed][Google Scholar]
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Dr Samiha Samad
Department of Obstetrics & Gynaecology, Sohar Hospital, Suhar/Oman
