Pharmacological treatment of ectopic pregnancy: Accuracy, safety and cost-effectiveness of day 1-7 ß-hCG measurements.

OBJECTIVE: The aim of the present study was to compare accuracy, safety and cost-effectiveness of three ß-hCG measurements protocols, applied in managing ectopic pregnancies (EP) with methotrexate (MTX): (1) day 1 to 7 ß-hCG levels, (2) day 1 to 4 ß-hCG levels and (3) day 4 to 7 ß-hCG levels. METHODS: Cost-minimization analysis (CMA) based on a retrospective study of patients treated with single-dose MTX for EP, was evaluated at a single institution between January 2001 to May 2021. Successful MTX treatment was defined as no surgical intervention. We evaluated safety by analyzing cases of day 4 interventions and cases of inconsistency between the different protocols. Predicting accuracy was assessed by the area under the receiver operating characteristic (AUC) curve. RESULTS: A total of 229 patients with single dose MTX treatment were included. Overall, 184 (80.3%) patients were treated successfully with a single dose of MTX. For days 1 and 7 the optimal cutoff point was 7% reduction in ß-hCG levels with sensitivity, specificity and PPV of 76.6% (69.9-82.5, 95% CI), 75.5% (60.5-87.1, 95% CI) and 92.8% (88.4-95.6, 95% CI), respectively. There was no significant difference between the protocols' AUC. None of the patients had any change of management during their day 4 visit in our 20 years of records. The cost for each visit day (day 4 and 7) was calculated with a total cost of 251 USD per patient. CONCLUSION: Patients treated with MTX for EP, measurement of day 1 and day 7 ß-hCG serum levels has a cost minimization advantage and is not inferior to the traditional protocol for predictive accuracy and safety.

The Efficacy and Success Rate of Methotrexate in the Management of Ectopic Pregnancy.

Background Ectopic pregnancy is a life-threatening medical condition wherein pregnancy occurs outside the uterus. This study primarily aimed to evaluate the efficacy of methotrexate (MTX) in treating patients diagnosed with early ectopic pregnancy between 2016 and 2021. Second, it aimed to investigate the clinical outcomes of subsequent pregnancies following ectopic pregnancy treatment. Methods A retrospective cohort study was carried out at a tertiary care centre in Jeddah, Saudi Arabia. The sample for this study comprised 59 patients who were diagnosed with ectopic pregnancy and treated with MTX at King Abdulaziz Medical City, Jeddah, between 2016 and 2021. The data were stored in the Microsoft Office Excel format and analyzed using the SPSS software. Results There were 10 reported cases of ruptured ectopic pregnancy; seven of these underwent surgery, while three were successfully treated conservatively using MTX. Success rates of 55.9% and 93.8% were recorded after administering the first and second dose of MTX, respectively, based on beta-human chorionic gonadotrophin (ß-hCG) drop between day 4 and day 7. Among those treated with MTX, 37.3% of the patients reported a successful subsequent pregnancy, of which 54.5% delivered a live, healthy infant and 13.6% had a second ectopic pregnancy. Conclusion MTX proved effective in treating ectopic pregnancy, with a ß-hCG drop of more than 15%. Patients who received a second dose of MTX showed a higher drop in ß-hCG level, indicating greater success as a cumulative effect. The clinical outcome after MTX treatment of ectopic pregnancy was shown to be significant with a p-value <0.05.

Gestación heterotópica abdominal tras fecundación in vitro y transferencia embrionaria. Reporte de un caso y discusión sobre el diagnóstico y manejo / Abdominal heterotopic pregnancy after IVF and embryo transfer. A case report and a review of the diagnosis and management

La coexistencia de una gestación intrauterina y una extrauterina se denomina gestación heterotópica. Es una condición poco frecuente, que ocurre en un 0,001-0,006% de las gestaciones espontáneas y hasta en un 1% de las gestaciones conseguidas mediante técnicas de reproducción asistida.Presentamos un caso de gestación heterotópica con implantación pélvica, una circunstancia extremadamente rara, y discutimos sobre su diagnóstico y su manejo clínico insistiendo en la necesidad de pensar en esta entidad aunque se objetive una gestación intrauterina tras una técnica de reproducción asistida y aunque no existan otros factores de riesgo. Un diagnóstico y tratamiento precoces serán claves para evitar las graves complicaciones asociadas a este tipo de gestación.(AU)

The coexistence of an intrauterine pregnancy and an extra-uterine one is called a heterotopic pregnancy. It is a rare condition that occurs in 0.001-0.006% of spontaneous pregnancies, and in up to 1% of pregnancies achieved through assisted reproduction treatments.The case is presented of a heterotopic pregnancy with pelvic implantation, an extremely uncommon event, followed by a discussion on its diagnosis and clinical management. There must be awareness of this disorder, even if an intra-uterine pregnancy is observed after an assisted reproduction treatment, and although there are no other risk factors.Early diagnosis and treatment is essential to avoid the serious complications associated with this type of pregnancy.(AU)

Maternal health and pregnancy outcome in diagnosed and undiagnosed Marfan syndrome: A registry-based study.

In Marfan syndrome (MFS), pregnancy is considered as high risk due to the deficiency of fibrillin in the connective tissue and increased risk of aortic dissection. The objective was to demonstrate the consequences on maternal health, in women with diagnosed and undiagnosed MFS at the time of pregnancy and childbirth. By using national health care registries, we identified all pregnancy related outcomes, from women with MFS (n = 183) and an age-matched background population (n = 18,300). We found 91 pregnancies during follow-up. Significantly fewer women with MFS gave birth, compared to the background population. No women with known MFS had a pregnancy related aortic dissection but complications related to the cervix were increased (HR:19.8 [95% CI:2.2-177.5]). Fifty women with MFS were undiagnosed at the time of their first pregnancy and/or childbirth. Among these, there were more birth canal related complications HR:27.2 (95% CI: 2.3-315.0), preeclampsia (HR:2.25 [95% CI: 1.11-4.60]), fetal deaths (HR:12.3 [95% CI: 1.51-99.8]), and all delivery-related dissections came from this subgroup. In conclusion, undiagnosed women with MFS experienced more pregnancy and childbirth related complications including fetal death, birth canal issues, preeclampsia, and aortic disease, which emphasizes the need for an early MFS diagnosis and special care during pregnancy and childbirth.

Fertility after Endoscopic Surgery for Ectopic Pregnancy Management in Point "G" Teaching Hospital, Bamako-Mali.

Endoscopic surgery of ectopic pregnancy is actually the gold standard for the management of fallopian tubal diseases. A survey was conducted to evaluate fertility in patients who underwent endoscopic management for ectopic pregnancy. A retrospective study was conducted at the department of general and endoscopic surgery of the Point "G" teaching hospital, in Bamako, Mali, from January 1st 2007 to December 31, 2016. Forty-eight (48) patients who underwent endoscopic management of tubal ectopic pregnancy and who have been followed up for fertility were included in this study. Statistical tests used were X2 or Fisher test and their confident interval, p <1 % has been considered as statistically significant. The therapeutic score of Pouly was less than 4 in 25.0% (n = 12). The return to fertility was observed among 48.0% of patients (n = 23). The chance of conception was less than 80.0% after the fourth postoperative year (p=0.001). The outcome of pregnancies has been seventeen full-term pregnancies, three ectopic pregnancies and three miscarriages. The occurrence of pregnancy after endoscopic management indicated for ectopic pregnancy is possible. However, many factors can influence the future conception.

[Ectopic pregnancy on tubal obstruction by bilharzia eggs at Meaux medical center (France)]. / Grossesse extra uterine et bilharziose genitale au centre hospitalier de Meaux (France).

Bilharzia is the world's second parasitic endemic and its genito-urinary lesions are well described. Ectopic pregnancies on tubal obstruction by bilharzia eggs are reported in African populations. Through a case of clinical observation we report an exceptional case of tubal erythema tubal bilharziasis in a French woman of origin but particularly affectionate by the African woman Africa south of the sahara. where she carries out humanitarian activities in countries in conflits (Democratic Republic Of Congo, Ivory Coast, and Mali).

La bilharziose est la seconde endémie parasitaire mondiale et ses atteintes génito-urinaires sont bien décrites. Les grossesses ectopiques sur salpingite bilharziennes ont rapportées dans les populations Africaines. Nous vous rapportons un cas exceptionnel. de grossesse extra-utérine sur bilharziose tubaire chez une française d'origine mais particulièrement affectionnée par l'Afrique au sud du saharienne où elle mène des activités humanitaires dans les pays Africains en conflits armées (République Démocratique Congo, Côte d'Ivoire, et Mali).

Levonorgestrel only emergency contraceptive use and risk of ectopic pregnancy in Eldoret Kenya: a case-control study.

INTRODUCTION: ectopic pregnancy is one of the causes of maternal morbidity and mortality in sub-Saharan Africa. Levonorgestrel (LNG) only emergency contraceptive pill is a well-established emergency contraceptive pill that is administered within 72 hours after unprotected intercourse. This study aimed at determining whether or not there is a significant association between levonorgestrel emergency contraceptive use and the occurrence of ectopic pregnancy. METHODS: case-control (1:3) study among 79 women with ectopic pregnancy (cases) matched against 237 women without (controls) at Moi Teaching and Referral Hospital in Eldoret, Kenya; Sociodemographic and clinical data were collected using a questionnaire. Association between ectopic pregnancy and LNG-EC was assessed using Pearson chi-square test. The relationship between outcome and exposure (while adjusting for confounders) was assessed using logistic regression model. RESULTS: The mean age was 27.15 years. Both cases and controls were similar by age (p = 0.990), educational level (p = 0.850), marital status (p = 0.559), employment status (p = 0.186) and parity (p = 0.999). Seventy-eight (24.7%) participants had a history of miscarriage. A higher proportion of the cases had history of using LNG-EC compared to the controls (32.9% vs. 7.2%, p < 0.001). The use of LNG-EC portended more than nine times increased odds of ectopic pregnancy compared to other contraceptive methods {OR = 9.34 (95% CI: 3.9 - 16.0)}. CONCLUSION: levonorgestrel only emergency contraceptive use was associated with ectopic pregnancy. One of the limitations of this study is that we could not control for all confounders of ectopic pregnancy.

Clinical features of extra-uterine pregnancy in Cameroon: a review of 148 cases at the Yaounde Central Hospital.

BACKGROUND: Extra-uterine pregnancy (EUP) is frequent in Cameroon but little is known about its clinical features. OBJECTIVE: To describe the epidemiological, diagnostic, therapeutic and prognostic features of extra-uterine EUPs at the Yaounde Central Hospital in Cameroon. METHODS: We carried out a cross-sectional study from the 1 st of January 2015 till January 31 st 2016 at the maternity of the Yaounde Central Hospital. All patients admitted for EUP were included. Data was analysed with Epi info 3.5.4 and SPSS 2.0. RESULTS: In this study, EUPs were diagnosed between 7 and 11 weeks of amenorrhoea including 148 cases (3.14%) out of 4707 deliveries.The mean age of patients was 28.54 ± 5.85 years and participants were mainly single (80.4%), self-employed (48.7%) and for most living in town (80.4%). Half of the patients (50.0%) had history of sexually transmitted infections and 56.8% have had a voluntary abortion. Male condom was the most frequently used contraceptive (54.7%) and EUP was iterative in 8.8% of cases. Most EUPs were ruptured (85%) and some presented haemorrhagic shock (67.5%) with nearly all (93.7%) requiring management by laprotomic salpingectomy. Death occurred in 1.3% (2/148) of cases. CONCLUSION: In Yaounde - Cameroon, diagnosis and medical care of EUP takes place with a cosiderable delay leading to high risk complications. Salpingectomy via laparotomy remains the mainstay for management of EUP.

Term Live Secondary Abdominal Pregnancy: A Case Report.

Term, live abdominal pregnancy secondary to rupture of a uterine rudimentary horn is a rare condition. Pregnancies conceived in the rudimentary horn of the uterus usually rupture during early gestation and present as a catastrophic event. However, rarely, after rupture of the uterine horn the foetus may continue to grow in the abdominal cavity and reach term gestation. A primigravida with a term pregnancy was referred to our centre for caesarean section with ultrasonography findings of transverse lie and placenta previa. During surgery, a live baby was extracted from the abdominal cavity, revealing a bicornuate uterus with rupture of the rudimentary horn. The early peroperative diagnosis and prompt control of the bleeding with excision of the rudimentary horn and transfusion of multiple blood products saved the patient's life. The case is presented for its rarity and to highlight the importance of a high index of suspicion in cases presenting with abnormal foetal presentation.

Term Live Secondary Abdominal Pregnancy: A Case Report

Term, live abdominal pregnancy secondary to rupture of a uterine rudimentary horn is a rare condition. Pregnancies conceived in the rudimentary horn of the uterus usually rupture during early gestation and present as a catastrophic event. However, rarely, after rupture of the uterine horn the foetus may continue to grow in the abdominal cavity and reach term gestation. A primigravida with a term pregnancy was referred to our centre for caesarean section with ultrasonography findings of transverse lie and placenta previa. During surgery, a live baby was extracted from the abdominal cavity, revealing a bicornuate uterus with rupture of the rudimentary horn. The early peroperative diagnosis and prompt control of the bleeding with excision of the rudimentary horn and transfusion of multiple blood products saved the patient’s life. The case is presented for its rarity and to highlight the importance of a high index of suspicion in cases presenting with abnormal foetal presentation.

Ovarian pregnancy: uncommon mode of presentation.

Ovarian pregnancy is very rare, and its incidence is 1 in 3000 live births. In this condition, common risk factors for ectopic pregnancy not usually found. It usually occurs in fertile women and more commonly with in-situ intrauterine device (IUD). Preoperative diagnosis is always not possible although the patient commonly presents with abdomen-pelvic pain, per vaginal bleeding and hypovolemic shock. High degree of suspicion with estimation of serum beta HCG, transvaginal ultrasonography by an experienced sonologist and laparoscopy is required for confirming the diagnosis. Though, the usual treatment is surgery, it can be managed by medical methods only in hemodynamically stable patients. In this case report, we describe the unusual mode of clinical presentation in an elderly woman with ovarian pregnancy.