Intraperitoneally Retained Contraceptive Device After Uterine Perforation: A Case Report.

A 29-year-old parous woman with a history of a T-shaped copper intrauterine device (IUD) insertion presented 8 months later with a complaint of the contraceptive device being missing. Computed tomography with contrast turned out to be superior to the combined abdominal and pelvic X-ray and transvaginal ultrasound in providing the detailed extrauterine location of the device between the urinary bladder and uterus. A laparoscopy was successful in the atraumatic freeing of the IUD from omental and bladder adhesions, and in its final removal.

Efficacy of ferric carboxy maltose in treatment of iron deficiency/iron deficiency anaemia during pregnancy.

Introduction: To evaluate the efficacy of ferric carboxy maltose (FCM) in the treatment of iron deficiency/iron deficiency anaemia (ID/IDA) during pregnancy. Material and methods: Pregnant women ≥ 20 years old diagnosed with ID (serum ferritin < 15 µg/l) and moderate IDA were included in this study for correction of their ID/IDA. The participants received an FCM infusion for correction of their ID/IDA. The pre-treatment ferritin, haemoglobin (Hb), and red blood cell (RBC) indices were compared with the 6- and 12-week post-treatment values to evaluate the efficacy of FCM in the treatment of ID/IDA during pregnancy. Results: The pre-treatment ferritin and Hb significantly increased from 10.3 ±2.3 µg/l and 7.99 ±0.6 g/dl, respectively, to 139.5 ±1.9 and 14.04 ±0.45, respectively, 6-weeks after FCM infusion (p = 0.02 and 0.001, respectively), and to 128.9 ±1.7 and 13.02 ±0.5, respectively, 12-weeks after FCM infusion (p = 0.0008 and 0.02, respectively). In addition, the pre-treatment RBCs mean corpuscular volume and RBCs mean corpuscular haemoglobin (MCH) significantly increased from 72.02 ±3.5 fl and 23.9 ±1.9 pg, respectively, to 90.6 ± 2.8 fl and 29.98 ±1.5 pg, respectively, 6 weeks after FCM infusion (p = 0.01 and p = 0.007, respectively), and to 89.5 ±2.9 fl and 30.2 ±1.5 pg, respectively, 12 weeks after FCM infusion (p = 0.02 and 0.007 respectively). Conclusions: The ferric carboxy maltose was safe and effective for the treatment of ID/IDA during pregnancy within 6 weeks. The serum ferritin and Hb levels and the RBC indices remained significantly high 12 weeks after FCM infusion compared to the pre-treatment values.

Treatment of left tubal pregnancy with foetal cardiac activity using a two-dose methotrexate regimen.

The incidence of ectopic pregnancy (EP) is about 1.3-2.4%. Approximately 6% of maternal deaths in the first trimester occur following ruptured EP. A 35-year-old lady, G4, P3, pregnant 7 weeks + 2 days, presented with left iliac pain, after positive pregnancy test, and ß-human chorionic gonadotropin (ß-hCG) 3614 mIU/ml. The transvaginal sonography showed an empty uterus, with a well-defined left adnexal echogenic structure measuring 38×32 mm (left adnexal gestational sac - GS) with foetal pole (bagel sign). The colour Doppler examination showed foetal cardiac activity with circumferential Doppler flow around the GS (ring of fire). She was diagnosed as left undisturbed tubal pregnancy with foetal cardiac activity. She refused the option of laparoscopic surgery. Therefore, she was counselled for medical treatment using methotrexate (MTX). She was also informed that the MTX treatment may fail due to the presence of foetal cardiac activity, and she may need more than one MTX dose. She received the first MTX dose at an initial ß-hCG 3614 mIU/ml. The fourth day ß-hCG after the first MTX dose was 5421 mIU/ml, while the seventh day ß-hCG was 5055 mIU/ml [< 15% decrease of ß-hCG (6.75%)]; therefore, she was given a second MTX dose. The fourth day ß-hCG after the second MTX dose was 3851 mIU/ml, while the seventh day ß-hCG was 2218 mIU/ml [> 15% decrease of ß-hCG (42.4%)]; therefore, she was discharged home for follow-up in the outpatient department. This report represents the treatment of left undisturbed tubal pregnancy with foetal cardiac activity using a two-dose MTX regimen.

Undisturbed tubal pregnancies with positive fetal heart treated medically: Case study.

The incidence of ectopic pregnancy (EP) is 1.3-2.4%. Suspicion of EP starts after a positive serum pregnancy test and failure to visualize the intrauterine gestational sac (GS) by transvaginal sonography (TVS). About 88% of tubal EPs are diagnosed by absent intrauterine GS and the presence of an adnexal mass during TVS. Medical treatment of EP using methotrexate (MTX) is cost-effective with a similar success rate to surgical treatment. The presence of fetal heart beats, ß-human chorionic gonadotropin >5000 mIU/mL, and EP size >4 cm are relative contraindications for using MTX in the treatment of EP.