A 10-year retrospective cohort study of non-tubal ectopic pregnancy management outcomes in an Australian tertiary centre.

Introduction: Non-tubal ectopic pregnancy (NTEP) is a rare but significant early pregnancy complication which can result in maternal morbidity and mortality. There is however a lack of evidence-based guidelines for the management of NTEP. Purpose: To evaluate the success rates of expectant, medical and surgical management in the treatment of NTEP at our tertiary centre. Methods: Retrospective cohort study from 2010 to 2020. All NTEP were classified by ectopic sites. Primary management was classified by expectant, medical [systemic methotrexate (Sys-MTX) and/or local ultrasound-guided injection of MTX and/or KCl intra-sac (L-MTX, L-MTX/KCl)] or surgical. Primary management was considered successful if no change in intervention was required. Treatment complications were compared. Results: Twenty-four NTEP were identified, which included 14 interstitial pregnancies (IP), 9 caesarean scar pregnancies (CSP) and 1 ovarian pregnancy (OP), which gave NTEP an incidence of 7.12% among all EP (4.15% for IP, 2.67% for CSP and 0.30% for OP). The success of primary surgical management was 100% (7/7), primary medical management was 76.9% (10/13) and primary expectant management was 33.3% (1/3). Primary medical management had a non-statistically significant greater mean time to serum ß-human Chorionic Gonadotrophin <5 IU/L, mean length of hospitalisation, mean number of follow-up visits and hospital re-presentation/readmissions compared to primary surgical management. There was no other difference in complication rates between the treatment management groups. Conclusion: Surgery remains the most effective way to manage NTEP. However, medical management can be a safe and effective alternative option in carefully selected cases.

Awareness and utilisation of advanced gynaecological ultrasound in the preoperative work-up of women planning surgery for endometriosis: A survey of RANZCOG fellows and trainees.

BACKGROUND: Endometriosis-specific (advanced gynaecological) ultrasound is recommended as part of preoperative work-up of women with suspected endometriosis. AIM: To evaluate the awareness and utilisation of advanced gynaecological ultrasound in the preoperative work-up of women with suspected endometriosis among active RANZCOG (Royal Australian and New Zealand College of Obstetricians and Gynaecologists) fellows and trainees. MATERIALS AND METHODS: Anonymous online survey invitations were emailed to all active RANZCOG fellows in Australia and New Zealand. Descriptive analysis of responses and multivariate analysis where appropriate were performed. P < 0.05 was considered statistically significant. RESULTS: A 17% (437/2567) survey response rate and 93% (409/437) completion rate were recorded; 59% (248/421) of respondents identified as generalists, whereas 15% (63/421) identified as advanced laparoscopic surgeons. Routine pelvic ultrasound (88.9%, 361/406) was the most common imaging modality requested by respondents; 32% (128/405) of respondents would also always request advanced gynaecology ultrasound. Respondents' self-reported practice type was significantly associated with utilisation of advanced gynaecological ultrasound (P = 0.03); 79.6% (348/437) agreed with our proposed definition of advanced gynaecological ultrasound for endometriosis. A major limitation to the utilisation of advanced gynaecological ultrasound for endometriosis was the lack of local expertise (63.8%, 233/356). CONCLUSION: The utilisation of advanced gynaecological ultrasound for endometriosis is significantly influenced by respondents' self-reported practice type and limited by the lack of local expertise.

Diagnostic Accuracy and Reproducibility of Predicting Cul-de-Sac Obliteration by General Gynaecologists and Minimally Invasive Gynaecologic Surgeons.

OBJECTIVE: Knowledge of rectouterine cul-de-sac state and consistent classification among surgeons are important in the surgical management of women with endometriosis. The objective of this study was to determine the diagnostic accuracy and interobserver and intraobserver agreement among general gynaecologists (GGs) and minimally invasive gynaecologic surgeons (MIGSs) in the prediction of cul-de-sac obliteration at off-line analysis of laparoscopic videos. METHODS: Five GGs and five MIGSs viewed 33 prerecorded laparoscopic video sets off-line to determine cul-de-sac obliteration state (non-obliterated, partially obliterated, or completely obliterated) on two occasions (at least 7days apart). Diagnostic accuracy and interobserver and intraobserver agreement were evaluated. RESULTS: The interobserver agreements for all 10 observers for the description of cul-de-sac state ranged from fair to substantial agreement, with moderate overall agreement. MIGSs had slightly higher within-group interobserver agreement compared with GGs. MIGSs achieved overall almost perfect intraobserver agreement compared with substantial agreement for GGs. The accuracy, sensitivity, specificity, positive predictive value, and negative predictive value for MIGSs classifying the cul-de-sac state were 83.9%, 88.5%, 88.5%, 89.2%, 92.0%, and 84.7%, respectively, whereas for GGs, they were 79.1%, 79.4%, 88.1%, 89.9%, and 76.1%, respectively. CONCLUSION: Diagnostic accuracy and interobserver and intraobserver agreement for cul-de-sac obliteration state classification is acceptable in both groups. MIGSs had greater diagnostic accuracy and exhibited high interobserver and intraobserver agreement, a finding suggesting that their advanced training makes them more reliable in cul-de-sac obliteration assessment. Partial cul-de-sac obliteration was the most commonly incorrectly diagnosed state, thus implying that partial obliteration is not well understood.

Central airway obstruction caused by adenoid cystic carcinoma in pregnancy: a case report and review of the literature.

Malignancy complicates one in a thousand pregnancies. The most frequently diagnosed of these are breast, cervical, melanoma, ovarian, and haematological neoplasms. Tumours of respiratory origin are very uncommon during pregnancy. We present a case of tracheal adenoid cystic carcinoma (ACC), a rare type of primary airway tumour, diagnosed in a pregnant woman. To our knowledge, this is the third reported case of tracheal ACC complicating pregnancy. We discuss potential barriers to timely diagnosis of malignancies during pregnancy and consider optimal management strategies, taking into account the potential harm to the mother and foetus in a field with a limited evidence base.