Ectopic pregnancy: role of laparoscopic treatment.

Ectopic pregnancy is a common condition with the immediate risk of life-threatening hemorrhage and subsequent risks of infertility and recurrence. Despite remarkable advances in diagnosis and treatment, ectopic pregnancies account for 9% of all maternal deaths. Early diagnosis has led to the development of innovative surgical and nonsurgical options. The choice of treatment, including expectant, medical, and surgical approaches, depends on ectopic location, symptoms, gestational age, and future fertility desires. Goals are to make the diagnosis of ectopic pregnancy early and provide the most effective and least invasive procedure while sparing future fertility when desired.

Comparison of 3- and 2-dimensional sonographic techniques for counting ovarian follicles.

OBJECTIVE: The purpose of this study was to compare 3-dimensional (3D) and 2-dimensional (2D) ovarian follicle counts and 3D counts using stored volumes between experienced and inexperienced operators. METHODS: Follicles larger than 5 mm were counted on 1 randomly selected ovary. Two-dimensional follicle counts were compared with stored 3D volumes by the same experienced operator (registered diagnostic medical sonographer [RDMS]). Counts using 3D stored data were compared between the experienced operator and inexperienced operator (principal investigator [PI]). The mean difference in follicle counts was computed, and a 1-sample Student t test was performed to test the hypothesis that the mean of the differences was 0. Comparison of the 2 methods and observers by Bland-Altman plots was used to determine any systematic differences based on the total number of follicles per selected ovary. RESULTS: Mean differences differed from 0 (P < .005) for all 3 comparisons: 2D RDMS versus 3D RDMS, 2D RDMS versus 3D PI, and 3D RDMS versus 3D PI. For the comparison of 2D versus 3D counts done by the RDMS, 5 ovaries (10%) had a difference of more than 5 follicles counted; for the 2D RDMS versus 3D PI, 11 ovaries (22%) had a difference of more than 5 follicles; for the 3D RDMS versus 3D PI, 8 ovaries (16%) had a difference of more than 5 follicles. Mean differences in counts ranged 0.29 to 1.04 for ovaries with 10 or fewer follicles compared with 3.94 to 9.00 for ovaries with more than 10 follicles. CONCLUSIONS: Follicle counts using 3D volumes were similar to 2D counts, and 3D follicle counts done by an inexperienced operator were similar to counts done by an experienced sonographer.

Mini-cornual excision: a simple stepwise laparoscopic technique for the treatment of cornual pregnancy.

Cornual pregnancy often poses a diagnostic and therapeutic challenge, with a significant risk for morbidity and mortality. Traditional treatment for cornual pregnancy has been through laparotomy, wedge resection, or hysterectomy. Early diagnosis is now possible through transvaginal ultrasonography and highly-sensitive beta-human chorionic gonadotropin assays. Consequently, several less-invasive therapies and techniques have been introduced over the last 2 decades. We present a simple, stepwise laparoscopic technique for the definitive, minimally-invasive excision of cornual pregnancy, along with a review of the pertinent literature.