Management of non-tubal ectopic pregnancies: rural tertiary care centre experience

Non-tubal ectopic pregnancies are rare but potentially life-threatening conditions. Nearly 95% of ectopic pregnancies are implanted in the various segments of fallopian tube. The remaining 5% implant in non-tubal sites like ovary, cervix, rudimentary horn, cesarean scar, abdominal and even heterotopic. Seven patients with non-tubal ectopic pregnancy at rural tertiary institute at Dr. RPGMC Tanda, from February 2020 to January 2021 were included in the study. Demographic details, symptoms, beta human chorionic gonadotrophin (?-hCG) levels, ultrasound findings, management and treatment outcomes were presented. Medical treatment and surgical procedure, alone or combined, resulted in effective treatment in women with early diagnosis of non-tubal ectopic pregnancy and two patients had live birth (heterotopic and abdominal pregnancy). In our study, we report two cases of ovarian pregnancy, one case of rudimentary horn successfully managed surgically, one case of LSCS scar pregnancy managed medically with methotrexate followed by suction and evacuation, one case of cervical pregnancy managed by D&C, one case of heterotopic pregnancy managed surgically and abdominal pregnancy managed surgically. In this paper we report a single centre experience in the management of non-tubal ectopic pregnancy Early diagnosis of ectopic pregnancy especially non tubal ectopic, requires a high index of suspicion and availability of point of care, transvaginal USG. Accurate diagnosis and timely intervention will help reduce maternal morbidity, mortality and preserve future fertility.

Myomectomy during cesarean section: is it a contraindication these days?

Myomectomy during the cesarean section is a debatable procedure because of raised risk of associated uncontrollable hemorrhage and postoperative morbidity. 38 years, elderly primigravida, who conceived after primary infertility with large leiomyoma in the lower uterine segment, underwent myomectomy during the cesarean section. Her intra-operative hemorrhage was within normal limits and post-partum period was uneventful. Conclusion of this study is Safety and feasibility of myomectomy along with cesarean largely depends upon the case selection, experience of the obstetrician and backup ICU and transfusion facilities.

Mesenteric Leiomyosarcoma Mistaken as Subserosal Fibroid: A Rare Case Report.

Mesenteric leiomyosarcoma is a rare entity. It is usually seen in middle-aged individuals. The tumor usually remains asymptomatic for longer duration until it acquires a big size. Surgical removal is the main modality of treatment. Common symptoms of the patients are usually pain or distension abdomen. Pre-operative diagnosis is usually difficult. Ultrasonography and computed tomography scan can help in the diagnosis. In this case, the tumor was mistaken for subserosal fibroid but intraoperatively turned out a mesenteric mass with retroperitoneal extension. On histopathological examination, it was a leiomyosarcoma. Reoccurrence can occur. Early diagnosis and wide surgical resection can improve the prognosis of the patient.