Subsequent pregnancy outcomes among women with tubal ectopic pregnancy treated with methotrexate.

Lay summary: An ectopic pregnancy occurs when an embryo implants outside of the uterus, usually in a fallopian tube. When detected early, treatment is often with a medication called methotrexate. When methotrexate does not work, surgery is required. A recent clinical trial of ectopic pregnancy treatment (called GEM3) found that adding a drug called gefitinib to methotrexate did not reduce the need for surgery. We have used data from the GEM3 trial, combined with data collected 12 months after the trial finished, to investigate post-methotrexate pregnancy outcomes. We found no difference in pregnancy rates, pregnancy loss rates and recurrent ectopic pregnancy rates between those treated medically only and those who subsequently also needed surgery. The surgical technique used also did not affect pregnancy rates. This research provides reassurance that women with ectopic pregnancies treated medically who need surgery have similar post-treatment pregnancy outcomes to those treated successfully medically.

The impact of COVID-19 on the assessment and management of ectopic pregnancies.

Lay Summary: During the COVID-19 pandemic, the public delayed seeking medical help, which may have affected the impact of having an ectopic pregnancy. An ectopic pregnancy is when pregnancy tissue grows outside its normal position in the womb, and it can be life-threatening. It can be treated by non-surgical or surgical options, and any delay in seeking help can reduce the options for treatment and increase the need for more urgent management. We wanted to assess whether there were differences in the presentation and management of ectopic pregnancies in a major teaching hospital between 2019 (pre-COVID-19) and 2021 (COVID-19 period). We found that the pandemic did not cause a delay in seeking medical help or cause worse outcomes. In fact, immediate surgical treatment and time in the hospital were less during COVID-19, perhaps because of a desire to avoid admission to hospital. One outcome of COVID-19 is reassurance that we can safely use more non-surgical treatments for ectopic pregnancies.

A case of feline ectopic abdominal fetuses secondary to trauma.

A multiparous adult cat with a history of prior trauma but no presenting clinical signs was admitted for routine ovariohysterectomy. Uterine abnormalities indicative of trauma were found in addition to 2 ectopic fetuses wrapped in omentum. The ovariohysterectomy was completed and the ectopic fetuses were removed. Recovery was uneventful.

Cas de fœtus abdominaux ectopiques félins secondaires à un traumatisme. Une chatte adulte multipare ayant une anamnèse de traumatismes antérieurs mais ne présentant aucun signe clinique a été admise pour une ovario-hystérectomie de routine. Des anomalies utérines indiquant un traumatisme ont été trouvées en plus de deux fœtus ectopiques enveloppés dans l'omentum. L'ovario-hystérectomie a été réalisée et les fœtus ectopiques ont été enlevés. Le rétablissement s'est effectué normalement.(Traduit par Isabelle Vallières).

Ectopic pregnancy with associated gestational choriocarcinoma in a California sea lion (Zalophus californianus).

A wild-born, captive-reared, 14 yr old, primiparous female California sea lion Zalophus californianus presented for anorexia of 14 d duration and abdominal distention. Routine complete blood cell count revealed leukocytosis with a neutrophilia, and serum chemistry revealed hypoalbumenemia and hyponatremia. Treatment with broad spectrum antibiotics and non-steroidal anti-inflammatories were started, but the animal continued to decline. Abdominal radiographs revealed a mature mineralized fetal skull and spine in the caudal abdomen and abdominal ultrasound revealed ascites but could not confirm the fetus. The patient was taken to surgery where a full term fetus was found outside of the uterus but within the fetal membranes, representing a secondary ectopic pregnancy. The patient passed away during surgery and was taken to necropsy. Gross necropsy revealed a diffuse peritonitis with yellow deposits over the serosal surfaces of the abdominal organs. The uterus appeared intact grossly and the ovaries appeared abnormal. The mesenteric, renal, and sub-lumbar nodes were enlarged and edematous. Histopathology revealed choriocarcinoma in the right uterine horn with evidence of chronic uterine rupture and protrusion of the placental tissue into the abdomen. The choriocarcinoma had metastasized locally as well as to the liver, spleen and lung. Choriocarcinoma is a highly malignant trophoblastic neoplasm that is rare in domestic animals. This case represents, to the authors' knowledge, the first report of gestational choriocarcinoma causing secondary ectopic pregnancy in a California sea lion and presents questions regarding pregnancy monitoring and management in a population of captive, minimally trained California sea lions.

Multiple extrauterine pregnancy with early and near full-term mummified fetuses in a New Zealand white rabbit (Oryctolagus cuniculus).

Extrauterine pregnancy (EP) is infrequent in mammalian species and occurs when fertilized ova implant and develop outside the uterus. A common outcome is abdominal pregnancy resulting in mummified fetuses (lithopedia). Here we describe an unusual case of abdominal pregnancy with early and near full-term lithopedia. Macroscopic findings supported the diagnosis of lithopedia with distinct age differences and facilitated further characterization of primary ectopia and risk factors leading to this occurrence.

Ectopic pregnancy through a caesarean scar in a ewe.

CASE HISTORY: A routine ultrasonographic examination for pregnancy diagnosis in a 3-year-old ewe revealed a normal embryo located in the uterine cavity and an abnormal mass located in the abdomen. At the time of examination, the ewe was 4.5 months pregnant, but 10 months previously she had undergone a caesarean section due to dystocia. CLINICAL FINDINGS: The abnormal mass (12 cm × 8 cm) was located outside the uterine cavity; it was anechoic at the periphery, and in the centre there was an echogenic embryo-like structure. Exploratory laparotomy was performed, which revealed an ectopic pregnancy through the caesarean scar. TREATMENT: The ectopic foetus was excised and the caesarean scar was repaired. The ewe made a complete recovery and the intrauterine pregnancy was completed to full-term, resulting in the birth of a healthy female lamb 35 days after the removal of the ectopic foetus. CLINICAL RELEVANCE: Ectopic pregnancies have previously been described in ewes. As far as the authors are aware, this is the first report of an ectopic pregnancy through a caesarean scar in sheep or any other farm animal species.

Ectopic pregnancy in an apparently healthy bitch.

This case describes an extrauterine fetus that was discovered in an apparently healthy bitch 5 mo after whelping. The extrauterine fetus was surgically removed, and the bitch made a complete recovery. The topic of canine ectopic pregnancy is discussed, and a review of previously reported cases is presented.

A case report of an ectopic fetus in a cat.

An ectopic fetus was discovered in an 18-month-old uniparous queen that was admitted for an elective ovariectomy. Six months prior she had delivered three healthy kittens. During the preoperative examination, a mass similar in size to a full-term fetus was detected in the abdominal cavity. Ultrasound examination revealed the mass to be an ectopic fetus in the mid-abdominal region. A mummified fetus was removed by laparotomy. No rupture of the uterine wall was visible, but a small necrotic area was present on the left uterine horn, adjacent to the very proximal portion of the uterine horn. The fetus, which was fully developed and covered by a thin membrane, was carefully dissected. Histological examination did not enable us to definitively prove the extra-uterine development of the fetus; however, the ectopic development of the conceptus secondarily expelled into the peritoneal cavity could be assumed.

Dystocia caused by ectopic pregnancy in a guinea pig (Cavia porcellus).

Dystocia is a common problem in guinea pigs, usually associated with complete fusion of the public symphysis. In this article, a less common problem, ectopic pregnancy, is described.

Clinical management of pregnancy in cats.

Average gestation length in domestic cats is 65.6 days, with a range of 52-74 days. Average reported litter size is 4.0 kittens per litter; litter size is not correlated with number of matings in a given estrus. Superfecundation is common in domestic cats; superfetation never has been definitively proven to occur. Eclampsia may occur during pregnancy in queens, with non-specific clinical signs. Ectopic pregnancy and uterine torsion have been reported. Pregnancy loss may be due to infectious causes, including bacteria, viruses or protozoa, or non-infectious causes, such as hypoluteoidism and chromosome errors.

Ectopic pregnancy in animals and humans.

Ectopic pregnancy denotes a pregnancy occurring elsewhere than in the cavity of the uterus. This pathology has been recognised for years and it causes numerous maternal deaths during the first trimester of pregnancy. While this condition is well-known in humans, it is rarely diagnosed in animals. However, the causes and mechanisms leading to an ectopic implantation of the ovum are not always clearly defined in humans or animals. Two types of ectopic pregnancy are mainly recognized: (1) tubal pregnancy occurs when an oocyte is fertilized and then remains in the oviduct and (2) abdominal pregnancy occurs when the gestation develops in the peritoneal cavity. The latter may be subdivided into two subtypes: the primary form, when a fertilized oocyte enters the peritoneal cavity and becomes attached to the mesentery or abdominal viscera, and the secondary form, which follows the rupture of an oviduct or the uterus after the fetus has been implanted, and the fetus is expelled into the peritoneal cavity. Cornual, ovarian and cervical ectopic locations are less frequent. Several differences exist in ectopic pregnancies between human beings and animal species. While abdominal pregnancy has been described in both human and animal species, tubal ectopic pregnancies would appear to be restricted to primates. Other than anecdotal cases, this pathological condition does not occur in laboratory, domestic or farm animals. Several factors are described as being the cause of these differences.

Surgical resolution of an ectopic pregnancy in a captive gerenuk (Litocranius walleri walleri).

A full-term ectopic pregnancy was diagnosed in a multiparous, captive gerenuk (Litocranius walleri walleri) following prolonged gestation without parturition. Until 213 days of gestation, fetal viability was determined by transabdominal ultrasound of fetal heartbeat, physical palpation, and visual observations of fetal movements. Survey abdominal radiographs obtained at day 229 of gestation revealed a fully mineralized fetal skeleton in an inappropriate position for parturition. Surgical exploration revealed a full-term, nonviable, male calf contained within fetal membranes attached to the omentum. Histologic examination of the fetal membranes identified lesions compatible with placenta-cotyledon separation occurring prior to surgical removal. No congenital fetal abnormalities or infectious processes were identified. Visual observation of the reproductive tract at the time of surgery revealed no abnormalities or evidence of concurrent pregnancy.

[Simulation of an extrauterine pregnancy by a fatty tissue tumor in a Galloway cow]. / Vortäuschung einer Extrauteringravidität durch einen Fettgewebstumor bei einer Gallowaykuh.

In an eight-year old Galloway cow, an ectopic pregnancy with mummification of the fetus which had been assumed because of history and clinical examination of the animal was diagnosed as a "tumor of the adipose tissue" (steatitis) following exploratory laparotomy. Possible problems of obesity in cows of extensively kept breeds are discussed.