[Case of recurring tubal pregnancy occurring in the remnant of a resected tube].
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Heterotopic pregnancy is the simultaneous occurrence of intrauterine and ectopic pregnancy. This situation is very rare (1:30 000 pregnancies), while recently, with the development of assisted reproductive techniques, the incidence has increased to 1:100 - 1:500 pregnancies. The aim of the study is to present the situation of coexistence of intrauterine pregnancy and ruptured tubal pregnancy.The case concerns a 32-year-old patient in the 12th week of the second pregnancy in whom the only risk factor was the state after Caesarean section and thus possible intraperitoneal adhesions. The ultrasound revealed normal intrauterine pregnancy and a very large amount of free fluid in the smaller pelvis. After immediate surgical intervention, a ruptured right tubal pregnancy was found. Right fallopian tube was removed. After the operation, the patient with the preserved intrauterine pregnancy was discharged from the ward. Further intrauterine pregnancy was normal. Delivery by Caesarean section.Conclusions: The described case indicates that the existence of intrauterine pregnancy does not exclude the existence of ectopic pregnancy and emphasizes the great importance of correctly and accurately carried out ultrasound examination in the first trimester of pregnancy along with appendicitis assessment. Early diagnosis of heterotopic pregnancy reduces the risk of complications.
Heterotopic pregnancy
Fallopian tube
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Background: Postpartum hemorrhage (PPH) is considered the most common cause of mortality in cesarean section (CS), and vaginal deliveries and to intercept the uterine bleeding and atony in CS there is need for oxytocin.Objective: This study aimed to reduce the incidence of primary postpartum hemorrhage after cesarean section (CS) by using either intravenous oxytocin or intrauterine misoprostol.Patients and methods: This study was conducted on 76 cases full term pregnant female patients with no risk factors for postpartum hemorrhage.They were admitted for elective caesarean section at Zagazig University Hospital.They were divided into two groups regarding the protocol of treatment, oxytocin group (A) was given oxytocin 10 IU in 250 ml of normal saline solution intravenous over 10 minutes directly after delivery of the fetus.Group (B) included 38 cases that were administered 400 mcg misoprostol intrauterine after delivery of placenta.Results: There was statistically significant variation between the groups of the present study concerning blood loss with higher blood loss either intraoperative, postoperative and overall blood loss in intrauterine misoprostol group than in intravenous oxytocin group.There was a significant difference between the two studied groups concerning side effects of drugs with higher shivering among intrauterine misoprostol group, while headache, and vomiting were reported in the group of oxytocin.Conclusion: Intravenous oxytocin infusion considered more potential than intrauterine misoprostol in blood loss reduction in CS.
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What are the pregnancy outcomes for women with a twin pregnancy that is reduced to a singleton pregnancy?Fetal reduction of a twin pregnancy significantly improves gestational age at birth and neonatal birthweight, however at an increased risk of pregnancy loss and preterm delivery.Women with a multiple pregnancy are at increased risk for preterm delivery. Fetal reduction can be considered in these women.Retrospective cohort study of 118 women with a twin pregnancy reduced to a singleton pregnancy between 2000 and 2010.We compared the outcome of pregnancy in consecutive women with a dichorionic twin pregnancy that was reduced to a singleton pregnancy to that of women with a dichorionic twin pregnancy that was managed expectantly and women with a primary singleton pregnancy. Reductions were performed between 10-23(6/7) weeks' gestation by intracardiac or intrathoracic injection of potassium chloride, mostly for congenital anomalies. We compared median gestational age, pregnancy loss <24 weeks, preterm delivery <32 weeks, neonatal birthweight and perinatal deaths.We studied 118 women with a twin pregnancy that was reduced to a singleton, 818 women with an ongoing dichorionic twin pregnancy and 611 women with a primary singleton pregnancy. Loss of the entire pregnancy <24 weeks and preterm delivery occurred significantly more in the reduction group compared with the ongoing twin group (11.9 versus 3.1% <24 weeks, P< 0.001 and 18.6 versus 11.5% <32 weeks, respectively, P < 0.001). In the reduction group, the percentage of women without any surviving child was significantly higher compared with the ongoing twin and primary singleton group (14.4, 3.4 and 0.7%, respectively, P < 0.001). Median gestational age was 38.9 weeks (interquartile range (IQR) 34.7-40.3) for reduced pregnancies, 37.1 weeks (IQR 35.3-38.1) for ongoing twin pregnancies and 40.1 (IQR 39.1-40.9) for primary singletons (P < 0.001 for all comparisons).The main limitations of the study were its retrospective character, and the fact that indications for reduction were heterogeneous.In women with a dichorionic twin pregnancy fetal reduction increases median gestational age only at considerable risk of complete early pregnancy loss.The study was not funded. None of the authors has conflicts of interest.
Twin Pregnancy
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Objective: Study was done to know the role of USG in first trimester bleeding per vaginum and to correlates the findings with clinical assessment. Material of Method:A hospital based cross sectional study was conducted over a period of 1 year between 1st July 2011 to June 2012 in the Department of Radio-diagnosis.Approved was obtained from the Institutional ethics review committees, AMCH.After clinical correlation patients are subjected to ultrasonography abdomen with full bladder for transabdominal examination.In required cases transvaginal examination in empty bladder was performed.Diagnosis was made by trans abdominal and transvaginal USG by using 3.5 Mhz, and 7.5 Mhz sector transducer respectively.Result: Ultrasound can diagnose viable and nonviable pregnancies accurately four weeks onwards.In our study intact pregnancy was found in 46%, incomplete abortion 24%, missed abortion in 7%, blighted ovum in 9%, complete abortion 2%, molar pregnancy 3%, ectopic pregnancy in 6% cases.Thus incomplete abortion was the commonest cause of vaginal bleeding among non viable pregnancies. Conclusion:In our study ultrasound proved to be more accurate than clinical diagnosis with sensitivity and specificity of 100%.Thus USG has opened new dimension in early pregnancy complication so that specific management can be immediately instituted.
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Vaginal bleeding
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It is customary to consider the various aspects of pregnancy in such arbitrarily drawn periods as the first trimester, the second trimester and the third trimester. I shall follow this course in discussing some of the common conditions which may lead to serious trouble.
THE FIRST TRIMESTER
In the first trimester there are two conditions which stand out clearly and which may lead to serious consequences: (1) pregnancy not within the uterine cavity, but within the fallopian tube; (2) the premature expulsion of an indwelling uterine pregnancy. These may be looked on as two of the most frequent complications of pregnancy in general, the first occurring approximately once in every 300 pregnancies and the latter once in every 4 or 5 pregnancies. Ectopic pregnancy seemingly is intricately bound up in the problem of diagnosis. In perhaps more than 50 per cent of cases, the condition is not initially recognized. IfFallopian tube
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Objective To explore treatment approaches for hypertensive disorders in pregnancy.Methods The study analyzed the past 37 hypertensive disorders in pregnancy cases that received treatment in Yanbian Women and Children's Hospital during the period from Jan 2009 to Jul 31,2010.Results Out of all the 37 cases,gestational hypertension 2 cases,mild preeclampsia 9 cases,severe preeclampsia 24 cases,eclampsia 1 case,after having received anticonvulsant,lowering blood pressure and symptomatic treatments,except for one case of maternal and fetal death,patients of all the rest cases were cured and discharged.Conclusion The treatment of hypertensive disorders in pregnancy should be varied in accordance with patient's condition and the number of gestational weeks.
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Objective To investigate application value of hysteroscopic tubal catheterization liquid instillation treatment following conservative management and reproductive status of women with tubal pregnancy.Methods 70 women with tubal pregnancy admitted to Jiangin Municipal People's Hospital over a period from October 2004 to October 2006 who desired childbearing were selected.35 women with tubal pregnancy received hysteroscopic tubal catheterization liquid instillation treatment(as observation group)at 2~6 months after conservative management and other 35 women with tubal pregnancy received routine tubal patent treatment by liquid instillation(as control group) after conservative management at same time.The therapeutic effects in the two groups were observed and compared.Results ① Of 35 women with tubal pregnancy in the observation group,17 women(48.5%) had a intrauterine pregnancy,5 women(14.2%) had a recurrent tubal pregnancy,and 13 women(37.1%) had no pregnancy.Of other 35 women with tubal pregnancy in the control group,9 women(25.7%) had a intrauterine pregnancy,8 women(22.9%) had a recurrent tubal pregnancy,and 18 women(51.4%) had no pregnancy.Significant difference was found in intrauterine pregnancy rate between the two groups(χ2=9.67,P0.05).While in recurrent tubal pregnancy no significant difference was found between the two groups(χ2=2.20,P0.05);② In intrauterine pregnancy rate between patent two lateral tubes subgroup(75.0%) and patent one lateral tube subgroup(34.8%),there was a significant difference(χ2=5.11,P0.05).Conclusion The intrauterine pregnancy rate after conservative management of tubal pregnancy depends on tubal patent extent.Wile hysteroscopic tubal catheterization liquid instillation treatment after conservative management of tubal pregnancy can judge patent status for the tubes and improve intrauterine pregnancy rate,but it can not decrease recurrent tubal pregnancy rate.
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Women with dichorionic twin pregnancies can be faced with difficult decisions in the setting of 1 abnormal fetus, caused by hereditary disease, or a chromosomal or structural abnormality. Selective feticide is sometimes presented as an option for these women. This technique has been shown to allow a pregnancy to progress and result in the birth of at least 1 healthy fetus. In this retrospective, multicenter (10 perinatal centers) cohort study that spanned 10 years (2000–2010), the authors examined records of 118 women with dichorionic twin reduced to singleton pregnancy (study group) and compared their pregnancy outcomes to those of women with either ongoing dichorionic twin pregnancy (611 women) or primary singleton pregnancy (818 women). The authors hoped to assess the course of pregnancy for women in the study group and evaluate suitability of fetal reduction, especially if performed for the purpose of improving outcome. In this study, fetal reduction was completed via transabdominal, intracardiac, or intrathoracic injection of potassium chloride between 100/7 and 236/7 weeks’ gestation. Outcomes examined were gestational age at delivery, delivery at less than 24 weeks, delivery at less than 32 weeks, neonatal birth weight, and perinatal death. Results show that after reduction 11.9% of the study group lost their entire pregnancy prior to 24 weeks’ gestation, compared with 3.1% of women with ongoing dichorionic pregnancy and 0.7% of women with singleton pregnancy (P < 0.001); 18.6% of women in the study group also delivered before 32 weeks’ gestation, compared with 11.5% women with ongoing twin pregnancy and 1% women with singleton pregnancy (P < 0.001). Median neonatal birth weight was 3125 g, compared with 2578 g in ongoing twin pregnancy and 3450 in primary single pregnancy (P = 0.001). In terms of perinatal death, 85.6% of intended fetuses survived in the study group, compared with 94% to 99.3% in the control groups. Another way to view this result is that 14.4% of women in the study group were without any surviving child, versus 3.4% in the ongoing twin pregnancy and 0.7% in the singleton group (P < 0.001). Overall, fetal reduction resulted in a significant 2-week prolongation of pregnancy (38.9 vs 37.1 weeks), but not to the level of a primary singleton pregnancy (40.1 weeks). In addition, women with dichorionic twin pregnancy who underwent fetal reduction had a higher chance of delivering prematurely than did those with ongoing twin pregnancy, without any lowered risk of perinatal mortality. The authors thus do not advise fetal reduction of a dichorionic twin pregnancy to improve obstetric outcome.
Twin Pregnancy
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