[Pregnancy of undetermined location: how to find it?] / Grossesse de localisation indéterminée : comment la trouver ?

Early pregnancy is frequently accompanied by abnormal symptoms such as pelvic pain and metrorrhagia. In these situations, it is quite frequent to be unable to identify the pregnancy and in particular its location, even if the pregnancy test is clearly positive. Many clinical, biological and ultrasound approaches have been proposed to try to predict the location and development of the suspected pregnancy, without the individualization of a truly reliable tool. Currently the HCG dosage at 48 heures-interval remains one of the best tools available, but it is challenged by mathematical models such as the M6 model. The M6 model has shown in our experience a very good predictive value with also an ability to reduce the follow-up of patients with low progressive risk, thus allowing a reduction in costs and anxiety for patients and caregivers.

Le début des grossesses est fréquemment accompagné de symptômes anormaux tels que douleurs pelviennes et métrorragies. Dans ces situations, il n'est pas rare de ne pas pouvoir identifier la grossesse et, en particulier, sa localisation même si le test de grossesse est nettement positif. De nombreuses approches clinique, biologique et échographique ont été proposées pour essayer de prédire la localisation et l'évolutivité de la grossesse suspectée, sans individualisation d'un outil vraiment fiable. Actuellement, le dosage de HCG à 48 heures d'intervalle reste un des meilleurs outils disponibles, mais il est concurrencé par des modèles mathématiques comme le M6. Ce dernier a démontré, selon notre expérience, une très bonne valeur prédictive avec aussi une capacité à réduire le suivi des patientes à faible risque évolutif, en permettant ainsi une baisse des coûts et de l'anxiété des patientes et soignants.

Utero-ovarian transposition before pelvic radiation in a patient with rectal cancer: a case report and systemic literature review.

Objective: To describe a case of utero-ovarian transposition (UOT) before pelvic radiation in a patient with rectal cancer and provide a systematic literature review on all reported cases of UOT. Methods: We performed a prospective collection and revision of clinical, intraoperative, and postoperative data from a patient who underwent UOT. In addition, a systematic review of the literature available to date on all cases of UOT was realized, and 14 patients from 10 articles were included. Results: We reported the case of a 28-year-old nulligravida patient who was diagnosed with a low-grade rectal adenocarcinoma and underwent neoadjuvant chemoradiotherapy, followed by transanal total mesorectal excision (TaTME). Before starting neoadjuvant oncological therapies, the patient underwent laparoscopic UOT. The intervention was performed without complications, and the patient received neoadjuvant oncological treatments as planned. TaTME and uterus repositioning were completed six weeks after the end of radiotherapy. No complications were observed during the first 9 postoperative months. Adequate utero-ovarian perfusion was assessed by Doppler ultrasound, cervicovaginal anastomosis appeared to have healed correctly, and the patient experienced menstrual bleeding. Data from the literature review of all reported cases of UOT were presented and discussed. Conclusions: UOT represents a valuable option to preserve fertility in patients requiring pelvic radiotherapy. This study provides additional evidence on the feasibility and safety of performing UOT.