Ruptura de embarazo ectópico cornual en segundo trimestre de gestación / No disponible

El embarazo cornual representa el 2-4% de todos los embarazos ectópicos y suele prolongarse hasta el segundo trimestre de gestación, con su posterior ruptura a las 12 semanas o más. En este artículo se presenta el caso de una gestante con amenorrea de 4 meses de evolución, que acudió a urgencias con un cuadro de hemoperitoneo con resultado de ruptura de embarazo ectópico cornual y feto libre en cavidad abdominal (AU)

Cornual pregnancy represents 2-4% of all ectopic pregnancies and usually lasts until the second trimester, rupturing at 12 weeks’ gestation or later. In the present article we report the case of a pregnant woman with onset of amenorrhea 4 months previously who presented to the emergency department with hem peritoneum and ruptured cornual ectopic pregnancy with the fetus floating freely in the abdominal cavity (AU)

Embarazo ectópico ovárico: a propósito de un caso / Ovarian ectopic pregnancy: a case report

La localización ovárica es una forma poco frecuente de embarazo ectópico y supone el 3,3% de todos ellos. Se presenta un caso en una mujer 28 años que consultó por metrorragia y dolor hipogástrico a los 14 días de la retirada de un DIU, con la sospecha diagnóstica de embarazo ectópico. Tras empeorar clínicamente se realiza una laparoscopia en la que se aprecia un embarazo ectópico ovárico izquierdo que confirma la anatomía patológica. Se ha revisado la literatura médica respecto a esta infrecuente localización de la gestación, sobre todo desde el punto de vista del diagnóstico diferencial (AU)

Ovarian pregnancy is an infrequent form of ectopic pregnancy, constituting 3.3% of all ectopic pregnancies. We report the case of a 28-year-old woman who presented with metrorrhagia and hypogastric pain 14 days after removal of an intrauterine device. The initial diagnosis was ectopic pregnancy. Clinical deterioration indicated the need for surgical management. Laparoscopic findings revealed a left ovarian ectopic pregnancy, which was confirmed by pathological study of the specimen. We review the literature on this uncommon localization, with special emphasis on its differential diagnosis (AU)

Tratamiento quirúrgico mediante histerectomía de un embarazo ectópico cervical / Surgical treatment through hystesectomy in cervical ectopic pregnacy

Los embarazos cervicales son una rara forma de embarazo ectópico. El diagnóstico se establece por ecografía, hallazgos analíticos o en estudio histopatológico. Presentamos un caso clínico de una paciente con hemorragia genital que requirió histerectomía para control del sangrado resultando un embarazo ectópico cervical. La pronta identificación de un embarazo ectópico cervical puede ayudar a mejorar la morbilidad y mortalidad de las pacientes (AU)

Cervical pregnancies are a rare form of ectopic pregnancy. Diagnosis is established by ultrasound, biochemical findings and histopathology. We report the case of a patient with hemorrhage, requiring hysterectomy to control the bleeding. Early identification of a cervical ectopic pregnancy can help to prevent significant morbidity and mortality in patients seeking emergency care (AU)

Embarazo ectópico ovárico / Ovarian ectopic pregnancy

El embarazo ectópico se define como todo embarazo implantado fuera de la cavidad endometrial. La localización más frecuente es la tubárica, fundamentalmente en la porción ampular de la trompa, seguida del embarazo ectópico cornual, abdominal, ovárico y cervical. La incidencia del embarazo ectópico ha aumentado en los últimos años, pero la tasa de embarazo ectópico ovárico permanece estable. El diagnóstico se establece de manera similar al embarazo ectópico de otra localización, mediante ecografía y niveles de b-HCG en sangre; el diagnóstico preoperatorio de embarazo ectópico ovárico es más difícil. El tratamiento consiste en la resección del saco gestacional u ooforectomía por vía laparoscópica o el tratamiento con metotrexato en los casos precoces. Se exponen los casos clínicos de tres pacientes que acudieron por dolor abdominal y metrorragia a nuestro hospital; el tratamiento consistió en resección ovárica por laparoscopia y el diagnóstico se confirmó mediante estudio anatomopatológico (AU)

Ectopic pregnancy is defined as a gestation out of the endometrial cavity. The most frecuent implantation is the ampular portion of the tube, next to abdominal, ovarian and cervical location. The incidence of ectopic pregnancy is increasing in the last years, but the frecuency of ovarian pregnancies has remained stable. The clinical diagnosis is based in sonography and serum concentrations of b-HCG. The preoperative diagnosis of ovarian pregnancy is difficult. The treatment is ovarian wedge resection by laparoscopy or medical therapy with methotrexate. We report the management of three patients in our hospital. The clinical symptoms were abdominal pain and menstrual irregularities; the diagnosis was confirmed by histopathological study and the treatment was ovarian wedge resection by laparoscopy (AU)

Gestación gemelar ectópica / Twin ectopic pregnancy

Presentamos el caso de una mujer con esterilidad primaria, que consiguió un embarazo tras técnicas de reproducción. Se verificó una gestación ectópica doble por ecografía, que requirió cirugía

We present the case of a woman with primary infertility, who became pregnant after assisted reproduction techniques. A twin ectopic pregnancy was confirmed by transvaginal ultrasound and surgery was required

Gestación ectópica: evolución diagnóstica y terapéutica en la última década / Ectopic pregnancy: changes in diagnosis and treatment in the last

El embarazo ectópico representa la implantación de una gestación fuera de la cavidad uterina. Esta situación patológica se conoce desde el siglo xvii, y presenta una incidencia aproximada de 11-18 casos por cada 1.000 partos. Sin lugar a dudas, esta implantación gestacional patológica representa una de las complicaciones más graves del embarazo, y su incidencia se ha visto incrementada notoriamente en los últimos 20 años. En el presente artículo revisamos la evolución en nuestro centro de esta enfermedad (AU)

Ectopic pregnancy consists of implantation of an embryo outside the uterine cavity. This abnormality has been known since the seventeenth century and the incidence is approximately 11-18 cases per 1,000 deliveries. Ectopic pregnancy is undoubtedly one of the most dangerous complications in pregnancy, and its incidence has risen markedly in the last 20 years. The present study reviews changes in the incidence, etiologic factors, diagnosis and treatment of this complication in our center (AU)

Dolor axilar como forma de presentación del embarazo ectópico / Underarm pain as presentation form ofectopic pregnancy

El embarazo ectópico es una patología grave cuya incidencia está aumentando en los últimos años debido a las técnicas para el tratamiento de la infertilidad. Puede llegar a ser la primera causa de muerte entre las gestantes. Se presenta el caso de una paciente de 27 años, vista en la sala de urgencias de un hospital comarcal por presentar dolor torácico irradiado a axila derecha de cuatro días de evolución. En la anamnesis destaca el ser portadora de prótesis mamarias y una escasa metrorragia, desconociendo su situación gestacional. La inexistencia de un síntoma guía claro y la poca especificidad de las pruebas complementarias (eco-transvaginal y fracción-β de la gonadotropina coriónica humana) obliga a los médicos de urgencias a sospechar el embarazo ectópico en mujeres con dolor abdominal y/o torácico

Ectopic pregnancy must be considered in all cases of vaginal bleeding in early pregnancy, as it is by far most lethal condition to be considered. Its incidence is particularly high in patients who have undergone infertility treatment. The case report of a 27-year-old female seen in the Emergency Department with chest, abdominal, and right shoulder pain of four days duration is presented. Standing out in the anamnesis are the following: she had a breast prosthesis and mild vaginal bleeding. Her gestational situation was unknown. The non-existence of a clear guiding symptoms and little specificity of the complementary tests (echo-transvaginal and β fraction of the human chorionic gonadotropin) led the Emergency care physicians to suspect ectopic pregnancy in women having abdominal and/or thoracic pain

Gestación heterotópica espontánea / Spontaneous heterotopic pregnancy

No disponible

Embarazo ectópico bilateral espontáneo / Spontaneous bilateral ectopic pregnancy

El embarazo ectópico bilateral espontáneo es una entidad rara y difícil de diagnosticar preoperatoriamente. Se presenta un caso diagnosticado por ecografía transvaginal en una paciente sin factores de riesgo. Se realizó salpinguectomía izquierda y salpingostomía lineal derecha por laparoscopia. Este caso es ilustrativo de la importancia del examen cuidadoso de ambos anejos cuando se lleva a cabo el examen ecográfico o la cirugía

Spontaneous bilateral ectopic pregnancy is a rare event and is difficult to diagnose preoperatively. We report a case diagnosed by transvaginal ultrasonography in a patient without risk factors. Laparoscopic left salpingectomy and right linear salpingostomy were performed. This case illustrates the importance of carefully examining both adnexa when ultrasound examination or surgery are performed

Failure to diagnose: ectopic pregnancy.

Case histories are based on actual medical negligence claims, however certain facts have been omitted or changed by the author to ensure the anonymity of the parties involved. Medical negligence claims alleging 'failure to diagnose' are a common cause of claims and complaints against general practitioners. This article outlines strategies to minimise the possibility of an adverse patient outcome arising out of a delay in diagnosis of ectopic pregnancy.

Embarazo ectópico tubárico gemelar unilateral derecho: informe de un caso / Right tubal unilateral twins ectopic pregnancy: a case report

Se presenta un caso de embarazo ectópico tubárico gemelar unilateral derecho en una mujer de 27 años de edad y con antecedentes ginecológicos de uso de dispositivo intraut erino, píldoras contraceptivas, interrupciones de embarazo del primer trimestre, embarazo ectópico tubárico izquierdo y trastornos menstruales. Es valorada de urgencia en el cuerpo de guardia por referir amenorrea no confiable de aproximadamente 10 semana s, pérdidas genitales oscuras, tipo mancha, y dolor en bajo vientre que se irradiaba al miembro inferior izquierdo. Como dato positivo al ex amen físico presentaba útero aumentado de tamaño y anejo derecho engrosado. El ultrasonido informa una imagen compleja anexial derecha que impresiona como embarazo gemelar ectópico. Se interviene quirúrgicamente de urgencia. El estudio anatomopatológico confirma el diagnóstico(AU)

Cost-effectiveness of presumptively medically treating women at risk for ectopic pregnancy compared with first performing a dilatation and curettage.

OBJECTIVE: To compare the cost and complication rate of two alternative strategies for the diagnosis and medical management of ectopic pregnancy when ultrasound is nondiagnostic. DESIGN: A decision tree was constructed to compare [1] dilatation and curettage (D&C) followed by treatment of all ectopic pregnancies with methotrexate versus [2] empiric treatment of all patients with possible ectopic pregnancies with methotrexate without D&C. SETTING: University setting. PATIENT(S): Ten thousand hypothetical women with nonviable pregnancies and a known incidence of ectopic pregnancy were entered into a computer model. MAIN OUTCOME MEASURE(S): The two approaches were compared with respect to the number of missed ectopic pregnancies, complications, procedures performed, admissions to the hospital, and cost. RESULT(S): The D&C group had 1% more failed managements of ectopic pregnancies and 13.4% fewer patients with a miscarriage undergo a second treatment for resolution. The D&C group had 13.7% fewer complications including 6.3% fewer hospitalizations. D&C costs $173 to $223 more than empiric use of methotrexate per patient. CONCLUSION(S): Empirically treating women at risk for ectopic pregnancy with methotrexate does not reduce complications or save money. In the absence of such savings, the desire to make an accurate and definitive diagnosis, allowing objective prognosis on future fertility and risk of repeat ectopic pregnancy, supports the need to distinguish a miscarriage from ectopic pregnancy before treatment with methotrexate.

Parasitación retroperitoneal por un organismo vermiforme en una paciente africana / Retroperitoneal parasitation by a vermiform organism in a patient from Africa

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Primary omental pregnancy: case report.

Omental pregnancy is a very rare form of ectopic pregnancy. Here we presented a case of primary omental pregnancy diagnosed at surgical exploration. A 28 year old woman submitted with severe abdominal pain, without any delay of menstruation. History of the patient revealed no use of contraceptive method. There was no gestational sac in the endometrial cavity and no tubal ring in the adnexa, but free peritoneal fluid in the pouch of Douglas was detected at ultrasonography. Laparotomy was done according to pre-operative diagnosis of ruptured tubal pregnancy. Bilateral tubes and ovaries were intact; omental pregnancy was detected and partial omentectomy was performed. Although 16 cases of omental pregnancy (mostly secondary) were reported in the literature, herein we describe a primary omental pregnancy without adnexial involvement.

Ruptured ectopic pregnancy presenting as an irreducible inguinal hernia.

An inguinal hernia that suddenly becomes irreducible may be secondary to a variety of other underlying conditions which can occasionally mislead the attending surgeon. Benign, inflammatory or neoplastic processes, as well as surgical emergencies such as intraperitoneal or retroperitoneal haemorrhage, have all been previously reported to mimic an inguinal hernia that suddenly becomes irreducible with or without clinical features of strangulation. We add an additional interesting presentation to this list in the form of a ruptured ectopic pregnancy, which is the first such case reported in the literature. A swelling in the groin may be much more complicated than it seems on superficial consideration and good clinical acumen is constantly required in managing such cases if a satisfactory outcome without any morbidity is to be expected.

Characterizing ectopic pregnancies that rupture despite treatment with methotrexate.

OBJECTIVE: To identify risk factors for tubal rupture among ectopic pregnancies treated with methotrexate (MTX). DESIGN: Retrospective case-control analysis. SETTING: An urban medical center. PATIENT(S): Eighty-one women diagnosed with an ectopic gestation treated with MTX: 19 patients experienced subsequent tubal rupture, and 62 patients experienced ectopic resolution. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Predictive variables including serial human chorionic gonadotropin (hCG) values. RESULT(S): The hCG incremental rate before as well as after MTX administration was positively associated with tubal rupture. HCG values prior to ectopic diagnosis that increased at least 66% over 48 hours and rising hCG values after treatment with methotrexate were independent predictors of tubal rupture. A disproportionate number (47%) of ectopic pregnancies that ruptured were located in the tubal isthmus. CONCLUSION(S): The hCG incremental rate both before and after MTX represents an independent risk factor for subsequent tubal rupture. Concentrations of hCG before ectopic diagnosis that increased at least 66% over 48 hours, or persistently rising hCG concentrations after treatment with MTX, may lower the threshold for surgical intervention. Implantation site may represent an unidentifiable risk factor for tubal rupture.