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Introduction: Ectopic pregnancies are a significant cause of morbidity and mortality in the first trimester of pregnancy. Hospital protocols requiring a specific beta-human chorionic gonadotropin (β-hCG) level to qualify for diagnostic testing (pelvic ultrasound) can delay diagnosis and treatment. In this study we sought to determine the relationship between β-hCG level and the size of ectopic pregnancy withassociated outcomes.Methods: We performed a retrospective case review of patients diagnosed with ectopic pregnancy in an urban, academic emergency department specializing in obstetrical care, from January 1, 2015–December 31, 2017. Variables extracted included presentation, treatment, adverse outcomes, and rates of rupture.Results: Weidentified 519 unique ectopic pregnancies. Of those ectopic pregnancies, 22.9% presented with evidence of rupture on ultrasound, and 14.4% showed evidence of hemodynamic instability (pulse >100 beats per minute; systolic blood pressure

Introduction: Heterotopic pregnancy, defined as simultaneous intrauterine and ectopic pregnancy, is a rare and potentially life-threatening condition. The incidence of heterotopic pregnancy has significantly increased in the modern era, primarily due to use of assisted reproductive technology. Heterotopic pregnancy in the absence of risk factors is uncommon. The symptoms of heterotopic pregnancy are similar to those of ectopic pregnancy, primarily abdominal pain and vaginal bleeding.Case Report: We report a case of heterotopic pregnancy occurring in the absence of risk factors and presenting with primary symptoms of chest pain and shortness of breath.Conclusion: While uncommon, heterotopic pregnancy may occur in patients without risk factors and may present with atypical symptoms such as chest pain and shortness of breath.

Pregnancy of unknown location (PUL) is a temporary pathologic or physiologic phenomenon of early pregnancy that requires follow up to determine the final pregnancy outcome. Evidence indicated that PUL patients suffer a remarkably higher rate of adverse pregnancy outcomes, represented by ectopic gestation and early pregnancy loss, than the general population. In the past few decades, discussion about PUL has never stopped, and a variety of markers have been widely investigated for the early and accurate evaluation of PUL, including serum biomarkers, ultrasound imaging features, multivariate analysis, and the diagnosis of ectopic pregnancy based on risk stratification. So far, machine learning (ML) methods represented by M4 and M6 logistic regression have gained a level of recognition and are continually improving. Nevertheless, the heterogeneity of PUL markers, mainly caused by the limited sample size, the differences in population and technical maturity, etc., have hampered the management of PUL. With the advancement of multidisciplinary integration and cutting‐edge technologies (e.g. artificial intelligence, prediction model development, and telemedicine), novel markers, and strategies for the management of PUL are expected to be developed. In this review, we summarize both conventional and novel markers (represented by artificial intelligence) for PUL assessment and management, investigate their advancements, limitations and challenges, and propose insights on future research direction and clinical application. Synopsis: This review summarized the conventional markers (represented by hCG) and modern markers (represented by an AI model) of pregnancy of unknown location. [ABSTRACT FROM AUTHOR]

Background: The pre-treatment characteristics of the patient and ectopic pregnancy to determine the patients who are likely to successfully respond to methotrexate (MTX) therapy remain controversial. This study investigated the outcomes of ectopic pregnancy after one and two MTX doses and their independent predictors. Methods: Retrospective cross-sectional study of women who consented to MTX treatment in 2017-2018 at our institution (N = 317). Of these, patients with Caesarean scar pregnancies were excluded because they require different treatment protocols (n=25). All patients were treated according to our institution's protocol based on international guidelines and standardised across the three hospitals included in the current study. We retrieved patients' demographics, laboratory, ultrasonography, and clinical characteristics from our hospital database. Serum β-human chorionic gonadotropin (β-hCG) was measured using electrochemiluminescence immunoassay; ectopic pregnancy was diagnosed using ultrasonography (transvaginal probe). Results: Two ninety-two patients were included in the current analysis. Age, pre-treatment β-hCG levels, sonographic presence of yolk sac, presence of foetal cardiac activity, and pelvic pain were significantly different between patients with successful and unsuccessful outcomes. Younger age (adjusted odds ratio [aOR] 2.33, 95% confidence interval (CI) 1.16-4.66, p = .017), no pelvic pain (aOR 2.65, 95%CI 1.03-6.83, p = .043), lower initial β-hCG level (aOR 1.32, 95%CI 1.08-1.59, p = .005), and absence of foetal cardiac activity (aOR 12.63; 95% CI 1.04-153.6; p = .047) were independently associated with success. Treatment failure odds were >2 folds higher for each 10-year age increase (p = .017), 32% higher for each 1000 I U/L increase in initial β-hCG level (p = .005), and >2 folds higher in presence of pelvic pain (p = .043). Conclusions: MTX is effective in most patients, averting invasive surgery, which might affect fertility. Pre-treatment β-hCG levels, age, pelvic pain, and foetal cardiac activity was independently associated with outcomes. Research should assess the relationship between the ectopic pregnancy size and treatment outcomes and refine β-hCG titres where treatment would be ineffective. [ABSTRACT FROM AUTHOR]

Background: Ectopic pregnancy (EP) can be treated surgically or nonsurgically. In many countries, methotrexate is frequently used as a first-line medical treatment, and its effect is similar to that of surgery in selected patients. We aimed to investigate national trends in the treatment of EP in Japan. Methods: We conducted a retrospective observational analysis between 2010 and 2020 using a nationwide claims database that included inpatient data. We identified female inpatients with EP aged 15 to 49 years old. We analysed year-to-year treatment trends for EP, as well as year-to-year trends in methotrexate administration, with a focus on the site of the pregnancy. Patients who received methotrexate were divided into two groups: Those with and those without surgery after methotrexate use. We compared the characteristics of these groups and calculated the methotrexate success rate. Results: We identified 53,653 patients with EP. The proportion of patients undergoing surgery increased from 79% in 2010 to 83% in 2020, whereas the proportion of methotrexate therapy decreased from 8.1% in 2010 to 5.1% in 2020. Regarding methotrexate use for the site of the pregnancy, there was a significant downward trend in methotrexate therapy for tubal pregnancies. Notably, the methotrexate success rate was 84% during the study period. Conclusions: Surgery showed an increasing tendency over time, whereas methotrexate therapy showed a decreasing tendency for EP treatment in Japan. The efficacy of methotrexate in Japan was comparable to that observed in other countries. [ABSTRACT FROM AUTHOR]

Objectives: A classification system of ovarian ectopic pregnancies (OEP) could aid in their management. This study aimed to investigate the ultrasound classification and preoperative ultrasound diagnosis of OEP. Methods: This retrospective case series study analyzed the clinical and ultrasound imaging data of 68 pregnant women diagnosed and confirmed with OEP at the Obstetrics and Gynecology Hospital affiliated with Tongji University between January 2015 and March 2023. The study focused on examining the ultrasound characteristics of different types of ovarian pregnancies and the accuracy of preoperative ultrasound diagnoses. Results: The study included 68 patients with a median age of 30 (22‐47) years. There were 43 cases (63.2%) of ruptured OEP and 25 (36.8%) of unruptured OEP. The unruptured cases were subclassified as embryonic sac type (n = 16) and heterogeneous mass type (n = 9). Preoperative ultrasound accurately diagnosed 19 cases (27.9%) of OEP, including 10 (62.50%) of the embryonic sac type, 4 (44.44%) of the heterogeneous mass type, and 5 (11.63%) of the ruptured type. Preoperative ultrasonography showed that embryonic sac type OEP was characterized by an intra‐ovarian cystic structure with a distinctive hyperechoic ring and, in some cases (8 out of 16), the presence of embryonic buds and/or yolk sacs. Ruptured OEP was characterized by mixed masses in the pelvic cavity with minimal or significant free pelvic fluid, an unclear boundary between the mass and the ovary, and limited or no vascularity. Conclusions: Ultrasound may be used to determine the type of OEP preoperatively, with a higher diagnostic yield for the embryonic sac subtype. Preoperative ultrasonographic classification may enhance the preoperative diagnosis of OEP. [ABSTRACT FROM AUTHOR]

Background Objectives Search Strategy Selection Criteria Data Collection and Analysis Main Results Conclusion Given the high incidence of ectopic pregnancy (EP) in the general population and the high maternal morbidity and mortality rates associated with it, determining risk factors for the occurrence of EP is essential for directing attention and care to risk groups, aiming for early diagnosis, favorable outcomes, and the development of prevention strategies.The aim of this study was to identify risk factors for the occurrence of EP.A systematic review with meta‐analysis was performed on the electronic databases MEDLINE/PubMed, LILACS, The Cochrane Library, and Virtual Health Library (VHL), searching the following terms "Ectopic Pregnancy" or "Ectopic Gestation" and "Risk Factors" or "Predisposing Factors".The inclusion criteria were observational studies published in English and Portuguese. We excluded studies with undefined methodology and those published before the year 2000.The authors independently read the titles, abstracts, and full texts, using pre‐defined inclusion and exclusion criteria, and discussed any differences. Data extraction and assessment of methodological quality were performed by each author in a standardized way. Sixteen risk factors were evaluated. The meta‐analysis calculations were performed using the Reviewer Manager 5.3 software (RevMan 5.3).The study found 715 studies, of which 11 were selected for review. The surveys were conducted between 2003 and 2019 and included 25 051 patients. The study revealed that several factors were strongly associated with the occurrence of EP. These included EP history (OR 9.03; 95% CI: 7.18–11.35; I2 = 67%), pelvic inflammatory disease (OR 4.00; 95% CI: 3.46–4.61; I2 = 0%), infertility (OR 3.70; 95% CI: 3.23–4.23; I2 = 48%), abdominal and pelvic surgeries (OR 5.60; 95% CI: 4.83–6.49; I2 = 81%), and previous tubal ligation (OR 5.59; 95% CI: 2.49–12.55; I2 = 0%). Furthermore, the study showed that advanced maternal age, smoking, number of partners exceeding one, history of spontaneous and induced abortion, previous use of emergency contraception, and intrauterine device, demonstrated a slightly increased risk. Advanced maternal age within the range of 30–34 years (OR 1.13; 95% CI: 1.03–1.24; I1 = 11%) and ≥ 40 years (OR 1.46; 95% CI: 1.19–1.78; I1 = 88%), marital status (OR 1.19; 95% CI: 1.03–1.37; I2 = 88%), and the use of oral contraceptives (OR 0.77; 95% CI: 0.66–0.90; I2 = 86%) were also found to be associated with a slightly increased or decreased risk of EP, respectively. The impact of condom use on the occurrence of EP seems to be very limited (OR 0.93; 95% CI: 0.83–1.05; I2 = 83%).Based on the study findings, it is suggested that the presence of strong risk factors warrants the implementation of a screening policy for EP among these women. [ABSTRACT FROM AUTHOR]

Background: Due to the specific nature of interstitial pregnancy (IP), there are significant risks to both the mother and the foetus in women with a heterotopic interstitial pregnancy (HIP). IP alone has been analysed as a site-specific ectopic pregnancy (EP) in previous studies; however, according to the latest European Society of Human Reproduction and Embryology criteria, IP is classified as a tubal pregnancy. If IP can be classified as a tubal pregnancy, then there is no difference in the effects of these two methods on intrauterine pregnancies (IUPs). Under the premise of timely surgery, disposing of IPs and tubal pregnancy (excluding IPs) should also have no differential effect on IUPs. Methods: Patients with heterotopic fallopian tubal pregnancy (HP-tube) and HIP seen at our hospital from January 2005 to December 2020 were included. All included patients were diagnosed by transvaginal sonography (TVS), and EPs were confirmed by surgery and pathological analysis. The IUP outcomes after surgical treatment of the EPs were compared between the HP-tube group (n = 464) and the HIP group (n = 206). The outcomes of IUPs were evaluated in patients with HIP who underwent either laparoscopy (169 cases) or laparotomy (36 cases). Results: There was no significant difference in postoperative miscarriage (6.90% vs. 6.80%, odds ratio (OR) = 1.859, 95% confidence interval (CI) (0.807–4.279), p = 0.145); early spontaneous miscarriage (19.61% vs. 18.93%, OR = 0.788, 95% CI (0.495–1.255), p = 0.316); or late miscarriage (0.43% vs. 0.49%, OR = 0.823, 95% CI (0.070–9.661), p = 0.877) between the HP-tube group and the HIP group. There was no significant difference between the two groups in terms of preterm birth (7.33% vs. 6.80%, OR = 1.044, 95% CI (0.509–2.139), p = 0.907), live birth rate (71.60% vs. 73.30%, OR = 1.010, 95% CI (0.670–1.530), p = 0.980), or perinatal mortality rate (2.00% vs. 0.65%, OR = 0.580, 95% CI (0.030–3.590), p = 0.620). Compared to laparotomy for HIPs, laparoscopic treatment was associated with similar rates of postoperative miscarriage (5.33% vs. 13.90%, p = 0.076), live birth rate (72.80% vs. 75.00%, p = 0.948), caesarean Sect. (83.90% vs. 77.80%, p = 0.414). Conclusions: After early diagnosis and treatment of EPs, patients in the HP-tube and HIP groups achieved comparable outcomes. Laparotomy and laparoscopy for treating HIPs yielded similar pregnancy outcomes. [ABSTRACT FROM AUTHOR]

Aim Methods Results Conclusions Primary splenic pregnancy is a rare form of extratubal ectopic pregnancy, frequently associated with life‐threatening abdominal bleeding, with only 51 cases reported in the worldwide literature. The aim of this work, through the proposal of its own index case, is to identify the fundamental steps of the diagnostic process, crucial to reduce the mortality rate, while evaluating the available therapeutic options, through a review of the literature, particularly the more conservative ones, to avoid splenectomy.We present the case of a 22‐year‐old woman, showing her diagnostic‐therapeutic pathway. We searched Pubmed and other sources for all publications in English and all available non‐English literature, including historical publications, on this rare topic, to identify the best treatment for these patients. We classified each article by clinical onset, diagnostic and therapeutic strategy, and histological findings, if available.We reviewed all the 43 cases available in the English‐language literature (plus another paper in German), finding that 72.7% of patients presented in an emergency setting. Seventy‐five percent of patients required splenectomy, 6.8% received pharmacological‐only therapy, 11.3% received arterial embolization before definitive treatment. The other ones received non‐radical surgical treatment.Primary splenic pregnancy presents challenging diagnostic and therapeutic features. Treatment options (pharmacological, interventional, and/or surgical) should be tailored based on the clinical presentation and hemodynamic status of the patient. Our work would like to stimulate the validation of evidence‐based therapeutic strategies validated by clinical experience. [ABSTRACT FROM AUTHOR]

Background: Heterotopic pregnancy and amniotic embolism are rare conditions that can be challenging to diagnose. To date, there are no cases of heterotopic pregnancy associated with amniotic embolism described in the literature. Therefore, we report the case of a pancreatic heterotopic pregnancy, which led to amniotic embolism and an unfavorable maternal outcome. Case Presentation: A 20-year-old pregnant woman presented with nausea and abdominal pain refractory to drug treatment. She had an increased lipase of 205 U/L (reference 8 to 78 U/L) and a total abdominal ultrasound with biliary sludge. The pregnant woman had no known risk factors for ectopic and heterotopic pregnancy. The initial diagnostic suspicions were hyperemesis gravidarum or acute pancreatitis. During hospitalization, she fluctuated between periods of clinical improvement and worsening of abdominal pain, but serial laboratory control had a favorable and benign evolution. On the 30th day of hospitalization, the patient developed spontaneous abortion, respiratory failure, and cardiorespiratory arrest. Necropsy showed heterotopic pregnancy in the pancreatic tail, amniotic embolism, and consequent disseminated intravascular coagulation. Conclusion: Obstetricians should suspect heterotopic pregnancy in patients with an acute abdomen. The gold standard diagnostic method for this condition is laparoscopy. In the present case, the authors consider that pancreatic pregnancy allowed the introduction of fetal antigens and amniotic fluid into the maternal bloodstream, leading to amniotic embolism and consequent disseminated intravascular coagulation. [ABSTRACT FROM AUTHOR]

BACKGROUND Medication abortion, with a combination of mifepristone and misoprostol, is highly effective and safe. However, there is insufficient evidence on efficacy and safety at very early gestations before a pregnancy can be visualized with ultrasonography. METHODS We conducted a multicenter, noninferiority, randomized, controlled trial involving women requesting medication abortion at up to 42 days of gestation with an unconfirmed intrauterine pregnancy on ultrasound examination (visualized as an empty cavity or a sac-like structure without a yolk sac or embryonic pole). Participants were randomly assigned to either immediate start of abortion (early-start group) or standard-care treatment delayed until intrauterine pregnancy was confirmed (standard group). The primary outcome was complete abortion. The noninferiority margin was set at 3.0 percentage points for the absolute between-group difference. RESULTS In total, 1504 women were included at 26 sites in nine countries and were randomly assigned to the early-start group (754 participants) or the standard group (750 participants). In an intention-to-treat analysis, a complete abortion occurred in 676 of 710 participants (95.2%) in the early-start group and in 656 of 688 (95.3%) in the standard group; the absolute between-group difference was -0.1 percentage points (95% confidence interval, -2.4 to 2.1). Ectopic pregnancies occurred in 10 of 741 participants (1.3%) in the early-start group and in 6 of 724 (0.8%) in the standard group, with one rupture before diagnosis (early-start group). Serious adverse events occurred in 12 of 737 participants (1.6%) in the early-start group and in 5 of 718 (0.7%) in the standard group (P = 0.10); the majority were uncomplicated hospitalizations for treatment of ectopic pregnancy or incomplete abortion. CONCLUSIONS Medication abortion before confirmed intrauterine pregnancy was noninferior to standard, delayed treatment with respect to complete abortion. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Objectives Search Strategy Selection Criteria Data Collection and Analysis Main Results Conclusions Caesarean scar ectopic pregnancy (CSEP) is associated with significant maternal and foetal morbidity. However, the optimal treatment remains unknown.The aim of this study was to review outcomes reported in studies on CSEP treatment and outcome reporting quality.We reviewed 1270 articles identified through searching PubMed, MEDLINE and Google Scholar from 2014 to 2024 using the search terms ‘caesarean scar ectopic pregnancy and caesarean scar pregnancy’.We included all study types evaluating any form of CSEP treatment, with a sample size of ≥ 50, where diagnosis was described, and the article was in English.Two authors independently reviewed studies and assessed outcome reporting and methodological quality. The relationship between outcome reporting quality and publication year and journal type was assessed with univariate and bivariate models.A total of 108 studies, including 17 941 women, were included. 83% of all studies originated from China. Studies reported on 326 outcomes; blood loss (86%), need for additional intervention (77%) and time for serum hCG to normalise post treatment (69%) were the most common outcomes. A primary outcome was clearly defined in 11 (10%) studies. The median quality of outcome reporting was 3 (IQR 3–4). No relationship was demonstrated between outcome reporting quality and publication year (p = 0.116) or journal type (p = 0.503).This review demonstrates that there is a wide variation in outcomes reported in studies on CSEP treatment. Development and implementation of a core outcome set by international stakeholders which includes patients is urgently needed to enable high‐quality research that is both useful and relevant to patients. [ABSTRACT FROM AUTHOR]

Ectopic pregnancy affects ~ 2% of pregnancies annually in the United States, with no current treatments allowing for the continuation of the pregnancy. Thus, this study sought to initiate an investigation into the potential design of a surgical technique, in an animal model, that could serve as a foundation for future research into the potential of relocating an ectopic embryo into the uterus at the human level. Female Long-Evans rats were randomly assigned to one of two groups: Embryo Relocation (ER; n = 12; underwent embryo relocation surgery) and Normal Pregnancy (NP; n = 12; carried a normal pregnancy; no surgery). Eight rats/group were allowed to carry their pregnancy to term and deliver, while four had their uteri collected at the end of gestation. Briefly, for the ER group, a uterine horn containing 1–2 embryos was translocated to the contralateral horn, which had been incised and cleared of its contents, prior to being wrapped around the relocated horn. Rat weight, food consumption and vaginal impedance of the mothers were measured throughout the experiment. Ultrasounds were performed and fetal heart rates measured on day 20–21 of gestation. Additionally, rat weight of all offspring was measured at adulthood. Our findings indicate that, in the ER group, 15/15 (100%) of the relocated embryos had detectable heart rates at the end of gestation (within the normal range), 14/15 (93%) were delivered vaginally, and 12/14 (86%) survived until adulthood. A significant decrease in rat weight and food consumption was observed only on the day following surgery. Fertility, as measured by vaginal impedance, was minimally impacted by surgery. Moreover, there was no significant difference between groups in average body weight of offspring at adulthood. Histological analysis indicated a thicker placenta in the ER group, attributable to the fetal part of the placenta, potentially indicating compensatory mechanisms. Our findings reflect a successful transuterine embryo relocation followed by vaginal birth and survival of offspring to adulthood, in a rat model. Such findings lay the foundation for future preclinical research in higher animals, with potential implications on a procedure relevant to human ectopic embryo relocation. [ABSTRACT FROM AUTHOR]

To report the New England Trophoblastic Disease Center (NETDC) experience with atypical placental site nodules (APSN). The NETDC registry was reviewed from 2005 to 2022 and clinical data abstracted. Expert pathologists in GTD reviewed available slides with concurrent immunohistochemical analysis. Targeted deep sequencing was performed for four cases. Among 35 cases of APSN identified, 29 had clinical and demographic data available. Abnormal uterine bleeding (59.3%) was the most common presenting symptom. Most women (79.3%) had an antecedent live birth. Two cases were incidentally diagnosed after hysterectomy for other indications, and one case lost to follow-up. Among the remaining 26 cases, 11 (42.3%) opted for hysterectomy and 15 for re-sampling (57.7%), among whom 3 later underwent hysterectomy for persistent APSN. Subsequent obstetrical outcomes included 3 spontaneous abortions, 1 therapeutic abortion, 1 ectopic pregnancy, 2 cesarean sections, 1 cesarean hysterectomy, and 1 spontaneous vaginal delivery. Subsequent pathology was available for 26 cases: 4 epithelioid trophoblastic tumors (15.4%), 9 APSN (34.6%), 3 PSN (11.5%), and 10 without abnormalities (38.4%). Histopathologic characteristics of APSN included moderate to severe cytologic atypia, median Ki-67 proliferation index of 8%, and typical immunohistochemical profiles (diffuse or multifocal positivity for p63 and GATA-3 and absent or focal CD146). No histopathologic feature predicted ETT. Among 4 sequenced cases, no recurrent genomic features were identified. APSN is a rare form of gestational trophoblastic proliferation with uncertain malignant potential. While normal obstetric outcomes are possible, the persistence rate is high, and definitive management remains hysterectomy. • The rate of subsequent epithelioid trophoblastic tumor following an atypical placental site nodule was 15.4%. • No single clinical or histologic feature correlated with the development of malignancy. • Among cases desiring fertility preservation, the subsequent live birth rate was 26.7%. [ABSTRACT FROM AUTHOR]

Gynecological emergencies can often present with a myriad of non-specific signs and symptoms, posing a diagnostic challenge to the clinician. They can be grossly divided into uterine or adnexal pathologies. Uterine pathologies can be secondary to intracavitary accumulation of blood [like in patients with transverse vaginal septum, Robert's uterus, accessory and cavitated uterine mass, unicornuate uterus with contralateral non-communicating functional horn], bleeding per vaginum [like in patients with retained products of conception, enhanced myometrial vascularity], pyometra [secondary to pelvic inflammatory disease, cervical obstruction secondary to benign and malignant causes] or complications of fibroids [like red degeneration, torsion of subserosal fibroid]. The adnexal pathologies can range from ectopic pregnancy in a urine pregnancy test (UPT) positive patient to haemorrhagic ovarian cyst, ovarian torsion, ruptured dermoid cyst and tubo-ovarian abscess in a UPT negative patient. Multimodality imaging including ultrasound (USG), computed tomography (CT) scan and magnetic resonance imaging (MRI) can narrow down the differentials and help in formulating an accurate diagnosis. The objective of this article is to familiarize the readers with multimodality imaging findings in common as well as uncommon acute gynecological emergencies and provide an algorithmic imaging approach for acute gynecological emergencies. USG is typically used as the first line diagnostic modality in diagnosis of acute gynecological emergencies. CT scan & MRI are helpful as a problem-solving tool in acute gynecological emergencies when USG findings are indeterminate. [ABSTRACT FROM AUTHOR]

Objective: To investigate the systemic immune‐inflammation index (SII) and neutrophil‐to‐lymphocyte ratio (NLR) in predicting a successful methotrexate response in tubal ectopic pregnancy (TEP). Methods: Women treated for TEP at a tertiary hospital between 2017 and 2021 were retrospectively reviewed. A total of 502 (100%) eligible patients who received methotrexate were included and divided into two groups based on whether or not they were successfully treated with methotrexate alone. Inflammatory parameters derived from the patients' hemograms at hospital admission were compared. Results: In total, 434 (86.4%) patients were successfully treated with methotrexate alone (Group 1), while 68 (13.6%) patients underwent surgery after methotrexate failure (Group 2). Median neutrophil count, NLR, platelet‐to‐lymphocyte ratio, monocyte‐to‐lymphocyte ratio, SII, largest ectopic mass diameter, and β‐human chorionic gonadotropin (β‐hCG) were significantly lower, whereas median lymphocyte and platelet counts were significantly higher in Group 1. According to the receiver operating characteristic analysis performed for the discriminatory power of NLR, β‐hCG, and SII for methotrexate response, the area under the curve values were 0.742, 0.730, and 0.699, respectively. Conclusion: Low NLR and SII are associated with methotrexate success and could be used to refine decision making regarding β‐hCG for predicting successful response to methotrexate in patients with TEP. Synopsis: Neutrophil‐to‐lymphocyte ratio and systemic immune‐inflammation index at hospital admission can be used as biomarkers to predict methotrexate success in tubal ectopic pregnancy. [ABSTRACT FROM AUTHOR]

Introduction: To compare the 2-year reproductive outcomes of tubal ectopic pregnancies (EP) treated with surgery, methotrexate (MTX) or expectant management. Materials and methods: This case–control study was conducted retrospectively at the Obstetrics-Gynecology and Perinatology Clinics of Etlik Zubeyde Hanim Women's Health Education and Training Hospital. 985 of 1156 patients, who were managed between January 2015 and December 2019 for a tubal EP, tried to conceive in 2 years after treatment: 366 patients underwent surgical treatment; 549 patients were treated with MTX, and 70 patients had expectant management. Clinical data and fertility outcomes were retrieved by medical and hospital records. We compared the three groups based on the 2-year reproductive outcomes of three treatment modalities of tubal EP. Results: There was a significant difference in the frequency of no pregnancy in patients who underwent surgery compared to patients who received expectant management and MTX therapy (p < 0.001). The frequency of no pregnancy was higher in patients who underwent surgery. There was no significant difference between expectant management and MTX therapy (p = 0.411). In the reproductive outcomes of patients who underwent surgery, the incidence of viable pregnancies was statistically lower than in the group treated with expectant management and MTX therapy (p = 0.003). Conclusions: Patients with an EP often have a future desire to have children, the treatment options are also important. The earlier the diagnosis is made, the more likely it is that expectant management or MTX treatment will be considered. With these two treatment methods, the likelihood of having a child in the future is higher than with surgical treatment. [ABSTRACT FROM AUTHOR]

Purpose: Ectopic pregnancies with implantation in the upper abdomen are exceptionally rare. Here we provide a systematic review of hepatic ectopic pregnancies and the corresponding management strategies. Furthermore, this report details a case of ectopic hepatic pregnancy, successfully treated with primary methotrexate (MTX) followed by a two-staged robotic-assisted resection. Methods: Two independent investigators performed a systematic review using the online search engine PubMed and MEDLINE database. The search utilized the following terms: 'Hepatic Ectopic Pregnancy,' 'Hepatic Extrauterine Pregnancy,' 'Hepatic Abdominal Pregnancy,' and 'Ectopic Liver Pregnancy.' Cross-referencing was employed to identify possible additional publications. Findings: Forty-seven case reports on hepatic pregnancies were identified. Of these, 40 provided manuscripts in the English language. Most patients with hepatic pregnancy presented with mild to moderate abdominal pain, while only a minority exhibited signs of hemodynamically relevant intraperitoneal hemorrhage. Most cases were managed through open surgical removal, although in recent years, there has been an increase in laparoscopically managed cases. Conservative approaches using methotrexate are seldom employed. Conclusion: Hepatic pregnancies present a rare and challenging clinical scenario. Until now, these cases have usually been treated primarily with open explorative surgery. As reported in this case, primary conservative treatment approaches with MTX before surgery hold promise as a strategy to reduce surgery-related bleeding and morbidity, particularly for asymptomatic or oligosymptomatic patients. [ABSTRACT FROM AUTHOR]

Ectopic pregnancy is a serious condition that can have significant morbidity and mortality. This review highlights the pearls and pitfalls of ectopic pregnancy, including presentation, diagnosis, and management in the emergency department (ED) based on current evidence. Ectopic pregnancy is a pregnancy that implants outside the normal uterine cavity. It most commonly presents with vaginal bleeding, abdominal or pelvic pain, and amenorrhea. Risk factors for ectopic pregnancy include abnormalities of the fallopian tube, prior ectopic pregnancy, and age over 35 years, but a significant number of patients with confirmed ectopic pregnancy will not have an identifiable risk factor. In patients with suspected ectopic pregnancy, evaluation includes quantitative serum hCG, blood type, and ultrasound. Ultrasound is necessary regardless of the hCG level. If the patient is hemodynamically unstable, resuscitation with blood products and early consultation of obstetrics/gynecology is necessary. Patients with confirmed ectopic pregnancy but who are otherwise stable may be managed medically or surgically. If a yolk sac or fetal pole is not seen in the uterus on ultrasound, this is considered a pregnancy of unknown location (PUL), which may represent an early, failed, or ectopic pregnancy. Stable patients with a PUL who can reliably follow up are managed with close specialist follow up and repeat 48 h HCG level. These patients need to have an hCG level repeated every 48 h until diagnosed with a viable pregnancy, failed pregnancy, or ectopic pregnancy. Knowledge of the latest advances in managing ectopic pregnancy will help clinicians more quickly and accurately diagnose patients presenting with this potentially fatal condition. [ABSTRACT FROM AUTHOR]

Aim: Most patients with ectopic pregnancies experience a high level of psychological distress for various reasons. The psychological state and needs of patients with recurrent ectopic pregnancies need to be seriously addressed. However, psychological distress in patients with recurrent ectopic pregnancy has not been widely studied. The purpose of this study is to investigate and understand the prevalence and factors influencing psychological distress in patients with recurrent ectopic pregnancies. Design: A cross‐sectional study. Methods: This study follows the STROBE guidelines. The Kessler Psychological Distress Scale (K10) was utilised to assess the level of psychological stress in patients. The Kruskal–Wallis test or Mann–Whitney U test was used to compare the factors influencing psychological stress in patients with different conditions. Results: A total of 134 patients with recurrent ectopic pregnancies completed the survey, and most patients experienced moderate‐to‐severe psychological distress. The psychological distress experienced by patients with recurrent ectopic pregnancies is complex and dynamic, influenced by various factors. Among them, the main factors affecting the psychological distress of patients were age, education level, number of children, number of abortions, medical insurance and economic pressure (p < 0.05). Conclusion: This study suggests that the psychological distress experienced by patients with recurrent ectopic pregnancies is universal and cannot be ignored. It is necessary to pay attention to the psychological needs of patients with recurrent ectopic pregnancies and carry out scientific and effective psychological care management. [ABSTRACT FROM AUTHOR]

Background and Objectives: Caesarean scar pregnancy (CSP) is a rare form of ectopic pregnancy in which the early pregnancy implants at the site of the uterine scar. Methotrexate (MTX) in lower doses can be used to treat CSPs. However, MTX administration is associated with a spectrum of side effects that include hematological toxicities. This case report presents a CSP treated with an intragestational injection of MTX and subsequently developed pancytopenia. Materials and Methods: A 23-year-old woman at six weeks and six days of pregnancy was referred as a potential case of CSP. After establishing the diagnosis, she was treated with a transvaginal ultrasound-guided intragestational administration of 80 mg MTX (adjusted to 50 mg/m2 body surface area) under sedation. Results: On day four after the MTX injection, she developed oral ulcers, fever, and pruritic phlyctenular maculopapular rash. Subsequently, the patient developed febrile neutropenia and was admitted to the Intensive Care Unit. On day six, a subsequent exacerbation of the rash was observed with the formation of blisters and purplish spots with concurrent odynophagia and sialorrhea. Ultimately, the patient developed pancytopenia due to bone marrow suppression. Fifteen days after MTX administration, the patient recovered and was discharged from the hospital hemodynamically stable, afebrile, with dropping β-hcg levels, and in good clinical condition. Conclusions: Although methotrexate administration is the preferred option for the treatment of cesarean scar pregnancies, clinicians should be aware of the fact that its use entails potential risks, even when it is used locally. To our knowledge, this case is the first description of pancytopenia due to bone marrow suppression following a single low dose of intragestational methotrexate injection. [ABSTRACT FROM AUTHOR]

Background: Lithopaedion, or "stone baby," represents an exceptionally rare clinical phenomenon with fewer than 350 documented cases existing in the medical literature. This condition arises when an advanced extrauterine pregnancy ceases its developmental trajectory and undergoes a lithification process, potentially resulting in a calcified mass with fetal‐like morphology. Typically, lithopaedions remain asymptomatic for decades, but may occasionally elicit acute symptoms necessitating medical intervention. However, predominantly, these entities are incidental findings discovered during radiological examinations or autopsies. Results: In this article, we present a comprehensive overview of 25 lithopaedion cases, including unreported cases from several European medical museums. When feasible, additional radiological imaging was conducted to enhance diagnostic clarity. Furthermore, this article situates lithopaedions within a broader historical perspective and a detailed etiopathogenetic framework, elucidating the physiological and pathological mechanisms contributing to their formation. The phenomenon of lithopaedion is a testimony to the complex and often enigmatic nature of the human body. Conclusions: By compiling and scrutinizing a substantial number of cases, this review offers valuable insights into the clinical implications of lithopaedions. Furthermore, it highlights the necessity for ongoing research and meticulous documentation of rare medical conditions like this, in order to contribute to a deeper understanding of extraordinary phenomena. [ABSTRACT FROM AUTHOR]

The proper evaluation of abortion specimens and placentas from stillbirth and post-partum cases is important for adequate clinical care of post-abortion and post-partum patients. The following topics will be reviewed: (1) the importance of evaluation of both fetal and placental tissue in first trimester abortions to confirm an intrauterine pregnancy versus an ectopic pregnancy; (2) the clinical history associated with an abortion specimen or retained products of conception (POC) influences how the pathologist should triage the specimen; (3) the criteria for diagnosis of a molar pregnancy, which is critical for clinicians to know which patients need follow-up; (4) the utility of genetic studies for both diagnosis and appropriate follow-up of the patient; and (5) the pathologic evaluation of specimens from patients with post-partum hemorrhage for placenta accreta spectrum and subinvolution of maternal vessels. [ABSTRACT FROM AUTHOR]

Background: Early pregnancy loss (EPL) can have profound implications for physical and psychological health. In the UK, significant variation in service provision exists for women affected by EPL. There is very little guidance on what hospital-based follow-up support services should entail, and how these can be implemented and integrated into current care provision to meet the needs of women who experience EPL. This service evaluation (SE) reports on an Early Pregnancy Loss Support Clinic (EPLSC) in an inner-city Hospital Trust. Methods: This SE gathered both quantitative and qualitative feedback from women to assess the value of a locally implemented Early Pregnancy Loss Support Clinic (EPLSC). Quantitative feedback was collected using the Short Assessment of Patient Satisfaction (SAPS) questionnaire and the Visual Anxiety Scale (VAS-A), both administered to women attending the EPLSC. Qualitative feedback was collected through semi-structured interviews and focused on four pre-determined themes based on EPL literature - physical health, mental health, role of the bereavement midwife and overall service user experience. Quantitative feedback was summarised using descriptive statistics, while qualitative feedback was analysed using framework analysis. Results: A total of 127 women were invited to the EPLSC, with 110 (87%) attending, and 17 (13%) not attending their appointment. SAPS scores ranged from 21 to 28, indicating that women were either satisfied or very satisfied with the care they received at the EPLSC. Results from VAS-A scores showed that 76 (69%) women reported a decrease in anxiety immediately after attending the EPLSC, compared to 8 (7%) who reported no change or a small increase in anxiety. Qualitative findings highlighted women’s concerns around future fertility, the importance of emotional support and the value of connecting with the bereavement midwife. Conclusion: An EPLSC that focuses on providing emotional support and reassurance, particularly regarding future fertility, is important to women. Further rigorous evaluation of national disparities in EPL follow-up is urgently needed to assess the gaps in clinical care delivery. [ABSTRACT FROM AUTHOR]

Background: Cesarean scar pregnancy (CSP), the incidence of which is increasing, can lead to life-threatening consequences. In this study, it was aimed to compare the results of two different ultrasound-assisted suction curettage (SC) approaches that we applied to endogenous type CSPs in different time periods. Methods: Patients who were diagnosed with CSP and treated with SC in the early pregnancy service between January 2012 and March 2019 were included in the study. While classical SC was applied until December 2016, patients were treated with SC modified by us after this date. Demographic characteristics, preoperative clinical findings, intraoperative characteristics and postoperative short-term follow-up of these two groups of patients belonging to different time periods were compared. Results: 34 patients were treated with classic SC (Group 1) and 32 patients with modified SC (Group 2). The amount of decrease in Hemoglobin values measured at the sixth hour postoperatively compared to the preoperative period was found to be less in group 2 (1.01 ± 0.67 g/dl) than in group 1 (1.39 ± 0.85 g/dl) (p = 0.042). The treatment failure rate was found to be lower in group 2 (p = 0.028). According to the results of multiple logistic regression analysis of significant factors associated with treatment outcome, myometrial thickness measurement and the largest gestational diameter measurement were found to be significant independent factors. Conclusion: In CSP cases, SC procedure with abdominal ultrasonography is an effective and reliable approach. At the beginning of this surgical procedure, if the gestational sac is removed from the uterine wall with the curettage cannula before suction, the success of the procedure will increase even more. [ABSTRACT FROM AUTHOR]

Ectopic pregnancy (EP), which complicates 2% of all pregnancies, can be treated with either methotrexate (MTX) or surgery. While most cases can be managed with a single dose of MTX, the success rate has declined in recent years. One theoretical explanation for this decline might be related to smoking, as studies of patients with rheumatoid arthritis who smoke have demonstrated an inadequate response to MTX treatment. This study aims to identify risk factors for single‐dose MTX treatment failure, with a focus on smoking status. We conducted a retrospective cohort study of patients diagnosed with EP and treated with single‐dose MTX at a single institution between January 2001 and May 2021. The primary outcome was the incidence of failed MTX treatment, defined as the need for additional surgical intervention. Logistic regression was used to adjust the results and calculate the odds ratio (OR). The final analysis included 299 patients. Overall, 209 (69.9%) patients were treated successfully with a single dose of MTX, while 79 patients (26.4%) required further surgical intervention. A day 1 β‐hCG level >1500 mIU/mL and smoking were independently associated with MTX treatment failure, with an OR of 2.69 (95% confidence interval [CI] 1.41–5.13) and 2.58 (95% CI 1.16–5.75), respectively. Smoking and an initial β‐hCG level above 1500 mIU/mL might reduce the success rate of single‐dose MTX treatment for EP. Future studies should prospectively investigate alternative treatment protocols for patients with risk factors for medical treatment failure. [ABSTRACT FROM AUTHOR]

Background: Choriocarcinoma is an aggressively invasive neoplasm, characterized by its rapid proliferation and propensity for metastasis to distant organs via hematogenous dissemination. Lungs (80%), vagina (30%), pelvis (20%), liver (10%), and brain (10%) are the most frequently metastasized organs. Renal metastases are very rare. The clinical manifestations of choriocarcinoma varies depending on the site of disease, making diagnosis challenging. In this report, we provide a clinical case of choriocarcinoma with metastases to the renal and pulmonary systems, displaying symptoms akin to those observed in ectopic pregnancy. Case presentation: A 27-year-old female, G2P1, with a previous history of full-term pregnancy in 2018, presented to the hospital with the onset of vaginal bleeding and accompanying abdominal aches. Investigations uncovered a left adnexal mass with a human chorionic gonadotropin (hCG) level of 77,4 mIU/mL and a left pulmonary nodule measuring 31 mm x 21 mm. Laparoscopy was performed due to the high suspicion of an ectopic pregnancy. However, no visible villi were identified during the surgery, and postoperative blood hCG levels continued to rise. A diagnostic curettage also failed to reveal any villi, maintaining the suspicion of a persistent ectopic pregnancy. Following two ineffective courses of methotrexate therapy, the patient was referred to our facility. Prior to her referral, an ultrasound had indicated a mass in the right kidney. However, upon arrival at our hospital, subsequent ultrasonography failed to detect any renal masses. Despite two months of outpatient monitoring, there was a sudden and significant increase in her serum hCG levels. An emergency laparoscopy was performed, revealing no pregnancy-related lesion. After surgery, the patient's hCG levels dropped dramatically to less than one-tenth of the original amount. Multisite enhanced computed tomography(CT)revealed suspicious lesions in both the renal and pulmonary regions. Upon thorough multidisciplinary consultation, a diagnosis of choriocarcinoma was entertained. Consequently, the patient successfully underwent eight cycles of chemotherapy and has remained recurrence-free for the past year. Conclusions: This case underscores the potential for choriocarcinoma in women of reproductive age who exhibit radiological signs of renal masses. Early and accurate diagnosis, followed by prompt intervention, is essential to prevent needless surgery procedures. [ABSTRACT FROM AUTHOR]

Chronic recurrent multifocal osteomyelitis (CRMO) is a rare, non-infectious inflammatory disease with a prevalence of 1 to 2/106, causing multiple lytic bone lesions. There are no established protocols for treating CRMO; thus, current practice is largely empirical. Data on the use of zoledronic acid (ZA) in juvenile CRMO are scarce. A 12-year-old male child with a history of multiple aseptic osteomylitis, affecting the chest wall, right ankle, and wrist, had no fever. Cultures and a bone biopsy ruled out infection or malignancy. The patient's condition stayed stable while taking naproxen (20 mg/kg/day) and methotrexate (10 mg/week) for 1.5 years until he experienced right elbow pain, swelling, no overlying skin erythema, and a restricted range of motion. The laboratory tests all came back normal, including white blood cell (WBC) count, erythrocyte sedimentation rate, C-reactive protein, and immunoglobin assays. The magnetic resonance imaging showed a focal lesion in the medial humeral condyle with increased signal intensity on T2 and short tau inversion recovery, mild joint effusion, and no cortical break. Thus, intravenous ZA infusion commenced at 0.0125 mg/kg initially, followed by 0.025 mg/kg 3 months later, with a marked improvement in the patient's clinical symptoms and radiological findings. Non-steroidal anti-inflammatory drugs and methotrexate were initially effective in treating our patient's condition, but a recurrence necessitated treatment modification. To the best of our knowledge, this case is the first documented instance of the use of ZA in CRMO in Iraq and Arab nations. [ABSTRACT FROM AUTHOR]

The Canadian Medical Association Journal article delves into the diagnosis and management of early pregnancy loss, emphasizing the significance of empathetic communication and supportive follow-up to address the psychological impact on patients. It outlines risk factors, symptoms, diagnosis, and management options, stressing the need for personalized care and informed decision-making. The document also provides resources for patients and underscores the importance of compassionate support during this challenging period, while highlighting the role of Early Pregnancy Assessment Clinics in enhancing patient outcomes and satisfaction. [Extracted from the article]

Background: Recurrent heterotopic pregnancy is a serious and rare pregnancy complication that occurs after in vitro fertilization and embryo transfer, posing a great threat to the safety of the mother and intrauterine fetus. We report a case of recurrent heterotopic pregnancy after in vitro fertilization and embryo transfer. We also reviewed the literature to explore the causes, diagnosis, treatment, and prevention of recurrent heterotopic pregnancy. Case Report: A 32-year-old woman with tubal factor infertility underwent in vitro fertilization and embryo transfer. Oocyte extraction was performed twice, while embryo transfer was performed 4 times, with 2 embryos transferred each time. No pregnancies occurred during the 2 fresh embryo transfer cycles; however, heterotopic pregnancies occurred during both frozen-thawed embryo transfer cycles. Ultrasonography detected only the first heterotopic pregnancy, at 6 weeks after embryo transfer. As the intrauterine embryo had stopped developing, laparoscopically monitored dilatation and curettage and removal of the affected fallopian tubes were performed. The second heterotopic pregnancy was detected 3 weeks after embryo transfer, guided by the ultrasound examination conducted earlier. After timely surgical treatment, a live birth occurred. Conclusions: This case and review of the literature elucidates the importance of considering the possibility of a heterotopic pregnancy during ultrasound examinations, especially in patients who utilized assisted reproductive technology to transfer multiple embryos. [ABSTRACT FROM AUTHOR]

Introduction: Cesarean scar ectopic pregnancy (CSEP) is a rare gynecological disorder that occurs at a rate of approximately 0.05% of pregnancies and less than 0.2% of cesarean scars. The ultimate goal in the management of CSEP cases is to remove pregnancy and reduce morbidity while preserving fertility. This case report highlights the successful application of a conservative laparoscopic approach in managing a 14‐week viable CSEP. Case Presentation: A 35‐year‐old multiparous woman (G8P5A2L5) with five previous cesarean sections and five normal healthy children presented to the clinic with a viable CSEP of 14 weeks of gestation as revealed by abdominal and transvaginal ultrasound examination. The decision for a conservative laparoscopic approach was made in light of the patient's desire to preserve fertility. Intervention and outcome: The laparoscopic procedure included the following steps: extensive dissection of adhesions between the bladder and the uterus; identification of the ectopic pregnancy at the level of the lower segment; extraction of the product of conception in an endobag; and suturing of the lower segment defect. The successful execution of these steps resulted in the removal of the ectopic pregnancy while addressing associated structural concerns. This approach allowed for mitigating morbidity and, importantly, preserving the patient's fertility. Conclusion: This case highlights the importance of a conservative laparoscopic approach for CSEP in the second trimester. Imaging techniques play a pivotal role in accurate diagnosis, with minimally invasive technologies offering effective solutions. Individualized, patient‐centered approaches are necessary to prioritize clinical outcomes and patient preferences. [ABSTRACT FROM AUTHOR]

Background: Ectopic pregnancy is the leading cause of direct maternal deaths. Ectopic pregnancy and corpus luteum cyst are two most common differential diagnoses in a patient with urine pregnancy test (UPT) positive and no sonographic evidence of intrauterine pregnancy. Internal echotexture and color Doppler features of the cyst wall are also considered in an attempt to differentiate the tubal ring of an ectopic pregnancy from that of a corpus luteum. Aims and Objectives: The aim of this study was to diagnose the presence of ectopic pregnancy and to differentiate ectopic pregnancy from corpus luteum cyst using grayscale ultrasound and color Doppler findings. Materials and Methods: The prospective study was conducted in 46 patients who were referred to the Department of Radiodiagnosis in R.L Jalappa Hospital with UPT positive and clinical features suggestive of ectopic pregnancy. Results: Out of 46 patients, 33 were diagnosed with ectopic pregnancy and 13 with corpus luteum cyst. Ectopic pregnancies had thicker walls as compared to corpus luteum cysts. Most of the ectopic pregnancies had hyperechoic walls as compared to ovaries (63.6%) and endometrium (60.6%). Free fluid with echoes was seen in the pelvis in 59.4% ectopic pregnancies whereas most of the corpus luteum cysts (69.2%) had no free fluid. Most of the corpus luteum cysts (61.5%) had clear internal echotexture whereas ectopic pregnancies were mostly lacy or solid. Yolk sac was seen exclusively in ectopic pregnancy (30.3%). RI 0.7 was found to be highly specific for diagnosing ectopic pregnancy. Conclusion: Significant ultrasound parameters that aid in differentiating between the two include the thickness of the mass's wall, the wall's echogenicity in relation to the ovary and endometrium, the internal echotexture of the cystic mass, the presence of the yolk sac, and the presence of free fluid with echoes. It was shown that RI 0.7 has a very good specificity in identifying ectopic pregnancy. [ABSTRACT FROM AUTHOR]

Background: Ectopic Pregnancy is defined as pregnancy that occurs outside normal uterine cavity in an aberrant site. In developing countries like India, late presentations with tubal rupture and haemodynamic instability, causes maternal morbidity and mortality. Aims and Objectives: To determine the incidence, risk factors, clinical features, associated with ectopic pregnancy in a tertiary care hospital and interventions for early diagnosis and conservative management. Materials and Methods: In this Time bound, Observational descriptive study with Longitudinal design conducted at Dept of G&O, R. G. Kar Medical College and Hospital, between March 2021 to August 2022. 138 participants, suspected to have ectopic pregnancy were enrolled for the study and detailed history taking and physical examination was done. Basic investigations including CBC, ABO &RH typing, UPT and USG were done. Post-op HPE reports were collected and final diagnosis was made. Results: 63.8% of the study population belonged to 21 to 30 years of age. 63.7% patients presented with >5 wks. - 8 wks. of amenorrhoea.18.1% of the study population were sterilized. The most common risk factor and clinical symptom was h/o Previous C-section (31.8%) and abdominal pain present in 131(94.9%),44 (31.9%) participants had all the three classical symptoms with 100 % specificity. Forniceal fullness/tenderness was the most specific examination finding. The most common USG finding was Adnexal mass with empty Uterine cavity with Free fluid (49.2%). Most of the patients were managed with Partial Salpingectomy (30.4%). The final diagnosis of ectopic was made in 129 patients, which was confirmed by HPE reports in 124 patients. 5 patients underwent medical treatment. Conclusion: Early diagnosis before rupture and referral are the key factor in reducing the maternal morbidity and mortality. [ABSTRACT FROM AUTHOR]

Background: Abortion service as medical healthcare facility is an essential service a women needs. The objective of this study was to observe maternal outcome of supervised and unsupervised medical abortion in first trimester of pregnancy. Methods: A case control study was done with two groups of patients in their first trimester in a tertiary care hospital (SMGS) during a period of 1 year from July 2022 to July 2023.Case group includes 30 patients presenting to emergency department with history of unsupervised abortion pill intake. Control group consists of 30 patients presenting to OPD want abortion pill under supervision. The main outcome variables were comparison of success rate, complications like heavy bleeding, fever, shock, requirement of blood transfusion and interventions required in terms of medical management, surgical evacuations and Laparotomy. Results: In our study, the success rate achieved in terms of complete abortion was 76.7% in supervised group and 13.3% in unsupervised group. The complication rate was 23.3% in supervised group in contrast to 93.3% in the unsupervised group. 43.3% patients in unsupervised group required blood transfusion which was 10% in supervised group. 83.3% in the supervised group did not require intervention. In the unsupervised group 20% required medical management, 70% required surgical evacuations and 10 % had to undergo Laparotomy for ectopic pregnancy. Conclusion: In this study, we conclude that first trimester medical abortion under supervision is more effective and safe as compared to unsupervised medical abortion. Thus we recommend to curb the practice of over the counter sale of medical abortion pills. [ABSTRACT FROM AUTHOR]

The word “abortion” pervades public discourse in the wake of Dobbs v. Jackson Women’s Health Organization. But do people know what it means? Not only do law and medicine define it differently, but state legislatures have codified wildly different definitions of abortion across jurisdictions. This Article exposes inherent ambiguities at the boundaries of the term, particularly as it intersects with other categories of reproductive health care often viewed as separate, like pregnancy loss and ectopic pregnancy. By juxtaposing statutory text with real people’s experiences of being denied care in states with abortion bans, this Article reveals how those ambiguities cause tragic results. This Article’s analysis also tracks how antiabortion legislatures have responded to the tragedies of their own making by changing the definition of abortion. Thirteen abortion-hostile states have changed the definition of abortion since Dobbs, eleven of which have added at least one definitional exclusion, most commonly for ectopic pregnancy, miscarriage, or molar pregnancy. States that have expanded abortion rights, on the other hand, have moved in the opposite direction, broadening their abortion definitions as they expand reproductive rights. The findings from this Article have a variety of normative implications. First, they demonstrate that “abortion” is an ambiguous term that lacks a fixed meaning. Given that many abortion bans and the long-unenforced Comstock Act leave the term undefined, courts will need to consider canons of construction, context, and history to resolve the term’s ambiguity. Second, the findings strongly support the conclusion that state abortion definitions and ban exceptions are unconstitutionally vague. This analysis cuts against a predominate antiabortion narrative that the laws are clear, yet doctors are willfully or unintentionally misinterpreting them. Finally, the findings underscore how Dobbs created an unworkable framework that moved the complicated experience of pregnancy from the medical to the legal domain, strengthening calls to overturn the decision. [ABSTRACT FROM AUTHOR]

Objective: To study the clinical profile and management outcomes of non-tubal ectopic pregnancy at a tertiary care hospital in the United Arab Emirates (UAE). Methods: Case files of non-tubal ectopic pregnancy (NTEP) patients from October 2017 to October 2020 presented to Alqasmi Women and Children’s Hospital, Sharjah, were included in the study. The data was extracted from available medical records. Results: A total of 30 confirmed cases of NTEP were identified with the following break-up: caesarean scar ectopic pregnancy (n=14; 46.7%), cornual pregnancy (n=11; 36.7%), cervical pregnancy (n=3; 10%) and ovarian pregnancy n=2; 6.7%). Abdominal pain was the most common presenting symptom, present in 23 (76.7% patients) followed by vaginal bleeding in 17 (56.7%) patients. Ten women were managed medically, ten required surgical treatment, and eight were managed with combined medical and surgical treatments; Two patients were managed expectantly. Patients in each treatment strategy did well and there were no deaths. One patient in the medical treatment group developed complications after one month and underwent subtotal hysterectomy. Conclusion: Patients with NTEP were presented with varying symptoms and signs depending upon the location of NTEP. The different currently available management options for NTEP seem to be effective and safe when carefully selected based on the clinical merits of each case. [ABSTRACT FROM AUTHOR]

Ectopic pregnancy (EP) is the leading cause of maternal morbidity and mortality in the first trimester. Using an untargeted metabolomic approach, we sought to identify putative plasma biomarkers using tandem liquid chromatography–mass spectrometry for the detection of tubal EP. This case-control study included the prospective recruitment of 50 tubal EP cases and 50 early intrauterine pregnancy controls. To avoid over-fitting, logistic regression models were developed in a randomly selected discovery group (30 cases vs. 30 controls) and validated in the test group (20 cases vs. 20 controls). In total, 585 mass spectral features were detected, of which 221 molecular features were significantly altered in EP plasma (p < 0.05). Molecular networking and metabolite identification was employed using the Global Natural Products Social Molecular Networking (GNPS) database, which identified 97 metabolites at a high confidence level. Top significant metabolites include subclasses of sphingolipids, carnitines, glycerophosphocholines, and tryptophan metabolism. The top regression model, consisting of D-erythro-sphingosine and oleoyl-carnitine, was validated in a test group and achieved an area under receiving operating curve (AUC) (95% CI) = 0.962 (0.910–1) with a sensitivity of 100% and specificity of 95.9%. Metabolite alterations indicate alterations related to inflammation and abnormal placentation in EP. The validation of these metabolite biomarkers in the future could potentially result in improved early diagnosis. [ABSTRACT FROM AUTHOR]

STUDY QUESTION What is the risk of an undetected natural conception pregnancy during luteal phase ovarian stimulation, and how does it impact the pregnancy's course? SUMMARY ANSWER The risk for an undetected, natural conception pregnancy in luteal phase ovarian stimulation is low and it appears that ovarian stimulation is unlikely to harm the pregnancy. WHAT IS KNOWN ALREADY Random start ovarian stimulation appears to be similarly effective as early follicular stimulation start; and it allows ovarian stimulation to be started independent of the cycle day and throughout the cycle, in accordance with the patients' and clinics' schedule as long as there is no intention of a fresh embryo transfer in the same cycle. Starting ovarian stimulation in the luteal phase bears the possibility of an—at the timepoint of stimulation start—undetected, natural conception pregnancy that has already occurred. There is scarce data on the incidence of this event as well as on the possible implications of ovarian stimulation on the course of an existing pregnancy. STUDY DESIGN, SIZE, DURATION This retrospective observational study, performed between June 2017 and January 2024, analyzed luteal phase stimulations, in which a natural conception pregnancy was detected during the ovarian stimulation treatment for IVF/ICSI. Luteal phase stimulation was defined as ovarian stimulation started after ovulation and before the next expected menstrual bleeding, with a serum progesterone (P4) level of >1.5 ng/ml on the day of stimulation start or 1 day before. PARTICIPANTS/MATERIALS, SETTING, METHODS Women who underwent a luteal phase ovarian stimulation in a tertiary referral ART center. MAIN RESULTS AND THE ROLE OF CHANCE A total of 488 luteal phase stimulation cycles were included in the analysis. Luteal phase stimulation was only started after a negative serum hCG measurement on the day or 1 day before commencement of ovarian stimulation. Ten patients (2.1%) had an undetected natural conception pregnancy at the time of luteal phase stimulation start. Eight of these patients underwent an ovarian stimulation in a GnRH-antagonist protocol and two in a progestin-primed stimulation protocol (PPOS). Recombinant FSH was used as stimulation medication for all patients, the patients with a PPOS protocol received additional recombinant LH. One pregnancy (0.2%) was detected after the oocyte retrieval, the other nine pregnancies were detected either due to persistent high serum progesterone levels or due to an increasing progesterone level after an initial decrease before oocyte retrieval. In the cycles with an undetected natural conception pregnancy, the median number of stimulation days was 8 days (range: 6–11 days) and median serum hCG at detection of pregnancy was 59 IU hCG (range: 14.91–183.1). From 10 patients with a pregnancy, three patients delivered a healthy baby, two patients had ongoing pregnancies at the time of summarizing the data, three patients had biochemical pregnancies (patient age: 30, 39, and 42 years), one patient had an ectopic pregnancy which required a salpingectomy, and one patient (age: 34 years) had an early pregnancy loss. LIMITATIONS, REASONS FOR CAUTION The retrospective study design and the small sample size can limit the accuracy of the estimates. WIDER IMPLICATIONS OF THE FINDINGS Overall, there is a small risk of undetected natural conception pregnancies when luteal phase stimulation is undertaken. It appears that there are no adverse effects through either direct effect on the embryo or indirectly through a detrimental effect on the corpus luteum function on the pregnancy in our cohort. STUDY FUNDING/COMPETING INTEREST(S) This study did not receive funding. The authors declare that there is no conflict of interest. TRIAL REGISTRATION NUMBER N/A. [ABSTRACT FROM AUTHOR]

Objective: A pregnancy at the utero‐tubal junction is a rare type of ectopic pregnancy and is associated with high maternal morbidity if it remains undetected. In the present study we discuss four cases of ectopic pregnancies at the utero‐tubal junction which caused diagnostic and management dilemmas. Methods: Four cases of early pregnancies with the gestational sac (G‐sac) implanted near the utero‐tubal junction are described. In case 1 this was suspected after a failed attempt at dilatation and curettage at our hospital, cases 2 and 3 presented with amenorrhea and pain abdomen and case 4 was diagnosed on first pregnancy documentation scan after frozen embryo transfer. Results: As initial two‐dimensional (2D) transvaginal scan (TVS) failed to diagnose the exact location of the G‐sac, three‐dimensional (3D) TVS helped to localize the exact location of pregnancy and subsequent individualized management. Case 1 had a partial intramural ectopic pregnancy managed by laparotomy and removal of the ectopic sac. The second and third cases were eccentric uterine pregnancies. The fourth was an interstitial ectopic pregnancy managed by a laparoscopic loop and stitch technique. Conclusion: This case series describes the role of 3D TVS for the evaluation of pregnancies implanted at the utero‐tubal junction and individual management of eccentric intrauterine, interstitial ectopic and intramural ectopic pregnancies. A diagnostic algorithm for such types of cases and management options is discussed. Synopsis: Four cases of pregnancies at the utero‐tubal junction along with diagnostic dilemmas, role of three‐dimensional ultrasound (3D USG) in diagnosis and management algorithm are described. [ABSTRACT FROM AUTHOR]

Introduction: Contrast‐enhanced computed tomography (CECT) is an emergent diagnostic imaging modality to identify the bleeding site and survey the abdominal cavity. The diagnostic utility of CECT for ectopic pregnancy (EP) has not been well‐investigated. The objective of this study was to evaluate the characteristics of CECT findings in patients with EP and extract specific findings that could contribute to the identification of implantation sites. Method: We conducted a retrospective study, reviewing suspected EP cases between April 2015 and March 2018 in our hospital. Clinical symptoms, blood test results, transvaginal sonography findings, and surgical and pathologic findings from the medical records were assessed. CECT images were evaluated by a certified radiologist and gynecologist retrospectively in consensus. The following were selected as positive findings for specific determination of the ectopic implantation site: the ectopic gestational sac, lateralization of the hemoperitoneum around the adnexa on either side, and extravascular leakage of the contrast agent outside the uterine cavity. Results: CECT was performed in 41 women with an EP. The ectopic implantation site was detectable on CECT in 90.2% (37/41), whereas it was noted in 70.0% (32/41) on transvaginal ultrasonography (TVS). Of nine patients with an EP with an undetectable implantation site on TVS, six were positive for the specific determination of the ectopic implantation site on CECT. Conclusion: CECT has the potential to predict ectopic implantation sites with high‐level sensitivity. As CECT is an urgent diagnostic imaging tool to be used in an emergent setting, it may be a good option for EP diagnosis when the availability of magnetic resonance imaging is limited. Synopsis: Contrast‐enhanced computed tomography has the potential to predict ectopic implantation sites and is a useful imaging tool in emergency situations. [ABSTRACT FROM AUTHOR]

An estimated 7.7 million Venezuelans have fled a severe humanitarian crisis in their country, most (70%) to other middle-income host countries in the same Andean region. Migration-related exposures during periconception and other critical gestational periods can adversely impact maternal-perinatal outcomes. Emerging evidence suggests that Venezuelan refugee and migrant women (VRMW) who migrate to Andean host countries are at-risk for delivering preterm and low birthweight infants and for Cesarean-sections. However, relatively few studies have examined obstetrical complications that could contribute to these or other short- and longer-term health outcomes of VRMW and/or their offspring. Our exploratory study analyzed four recent years of national hospital discharge data (2018–2021) from Ecuador to compare the primary discharge diagnoses of VRMW (n = 29,005) and Ecuadorian nationals (n = 1,136,796) for ICD-10 O code obstetrical complications related to or aggravated by pregnancy, childbirth, or the puerperium. Our findings indicated that VRMW were hospitalized for 0.5 days longer than Ecuadorian reference group women and they had higher adjusted odds (aOR) for a primary discharge diagnosis for obstetrical complications including preeclampsia (aOR:1.62, 95% CI:1.55,1.69), preterm labor (aOR:1.20, 95% CI:1.11,1.31), premature rupture of membranes (aOR: 1.72, 95% CI:1.63,1.83), oligohydraminos (aOR:1.24, 95% CI:1.12,1.36), obstructed labor (aOR: 1.39, 95% CI:1.31,1.47), perineal lacerations/other obstetric trauma (aOR:1.76, 95% CI:1.63, 1.91), STIs (aOR:2.59, 95% CI:1.29,2.92), anemia (aOR:1.33, 95% CI:1.24,1.42), and ectopic pregnancy (aOR:1.16 95% CI:1.04,1.28). They had similar aOR for diagnosed gestational diabetes and spontaneous abortion (SAB) compared to the reference group but a reduced aOR for genitourinary infections (aOR:0.79, 95% CI:0.74,0.84) and early pregnancy hemorrhage not ending in SAB (aOR:0.43, 95% CI:0.36,0.51). Our findings underscore the vulnerability of VRMW for a number of potentially serious obstetrical complications with the potential to adversely impact the short- and longer-term health of mothers and their offspring. Future studies should collect more detailed information on the migration status, experiences, and exposures of MRMW that influence their risk for obstetrical complications. These are needed to expand our findings to better understand why they have excess risk for these and to inform social and public health policies, programs and targeted interventions aimed at reducing the risk of this vulnerable refugee and migrant group. [ABSTRACT FROM AUTHOR]

Purpose: This study was presented to investigate the clinical–pathological characteristics of gestational trophoblastic neoplasia (GTN) following non-molar pregnancy and differentiated with ectopic pregnancy (EP). Methods: The clinical data of 83 patients who were admitted for suspected GTN after non-molar pregnancy at the Women's Hospital School of Medicine Zhejiang University from January 2015 to September 2022 were selected for analysis. Results: In total, 41 cases were confirmed non-molar GTN, including 31 choriocarcinoma, 9 PSTT (placental site trophoblastic tumor), and 1 ETT (epithelioid trophoblastic tumor), while 42 cases were confirmed EP. Compared with ectopic pregnancy, non-molar GTN patients had lower levels of serum progesterone compared with EP (3.81 nmol/L vs 17.70 nmol/L, P = 0.001). Based on the ultrasound, the thickness of the endometrium was thinner in patients with non-molar GTN compared with EP (0.565 cm vs 0.70 cm, P = 0.018). By histopathologic examination, the endothelium of non-molar GTN showed less decidual-like changes compared with EP (64.3% vs 14.6%, P = 0.001). Conclusion: A combination of serum progesterone levels, endometrium thickness, and histopathologic features of the endometrium can help to differentiate non-molar GTN and EP. Surgeries including hysteroscopy with curettage and/or laparoscopy are needed. [ABSTRACT FROM AUTHOR]

Early diagnosis of an abdominal pregnancy is difficult since it is associated with a wide range of signs and symptoms. However, ultrasound is the most effective method for diagnosing an abdominal ectopic pregnancy. We present a case of advanced abdominal ectopic pregnancy, which progressed to the second trimester and ended up with fetal death. Despite having repeated ultrasound scanning, the diagnosis was missed. This case report emphasizes the need for a high index of suspicion and correlation of the patient's signs and symptoms with ultrasound findings to make an early diagnosis of abdominal ectopic pregnancy. [ABSTRACT FROM AUTHOR]

The relationship between the intake of artificial sweetener (AS) and adverse pregnancy outcomes is under-researched, and existing studies yield inconsistent conclusions. A Mendelian randomization (MR) approach was employed to investigate the causal relationship between the intake of AS and adverse pregnancy outcomes. Instrumental variables related to the exposure phenotype were selected for analysis. The analysis was conducted using genome-wide association study summary data from public datasets. The inverse variance weighted, MR-Egger, weighted median, simple mode, and weighted mode methods were used to evaluate the causal relationship between exposure and outcomes. Sensitivity analysis and multivariable Mendelian randomization enrolling body mass index, type 2 diabetes mellitus, and fasting glucose were employed to further validate the consistency and robustness of the results. In univariable MR, the intake of AS added to tea was associated with an increased risk of ectopic pregnancy [OR = 1.821 (1.118–2.967), p = 0.016]. In multivariable MR adjusting for body mass index and type 2 diabetes mellitus, the intake of AS added to cereal was linked to a reduced risk of ectopic pregnancy [OR = 0.361 (0.145–0.895), p = 0.028] and premature rupture of membranes [OR = 0.116 (0.019–0.704), p = 0.019], while the intake of artificial sweetener added to coffee was associated with an increased risk of placenta previa [OR = 1.617 (1.042–2.510), p = 0.032]. No causal relationship was identified between the intake of artificial sweetener and other adverse pregnancy outcomes. The consumption of artificial sweetener during pregnancy warrants careful consideration. [ABSTRACT FROM AUTHOR]

Background: Methotrexate (MTX) is used in clinical practice as a medical treatment option in patients with early pregnancy complications like ectopic pregnancy. Aims: To review systemic MTX therapy use in the first trimester of pregnancy in our hospital and to examine subsequent clinical outcomes. Methods: Retrospective review of all women treated with systemic MTX in early pregnancy identified from electronic prescription records from 1 January 2018 to 31 December 2020 at Cork University Maternity Hospital, Ireland. Relevant data was transcribed from electronic health records. Results: Indications for treatment were tubal ectopic pregnancy (70%, n = 51), persistent pregnancy of unknown location (22%, n = 16) and caesarean scar pregnancy (7%, n = 5). Treatment was successful in 88% (n = 44) of tubal ectopic pregnancies with 73% (n = 37) and 14% (n = 7) of women receiving a single dose and repeated doses, respectively. Only 8% (n = 4) of tubal ectopic pregnancies required emergency surgery for subsequent tubal rupture. In 93% (n = 15) of cases of persistent pregnancy of unknown location, treatment was successful with one patient requiring uterine evacuation. Women with caesarean scar pregnancy were treated with combined MTX and uterine evacuation without complication. Conclusions: The efficacy of medical treatment with systemic MTX for confirmed tubal ectopic pregnancy in our hospital is in line with national and international standards. Careful consideration should be given to treating caesarean scar pregnancy and persistent pregnancy of unknown location with systemic MTX. Systemic MTX use guided by clinicians specialised in early pregnancy complications and safe medication practices may improve treatment success and reduce adverse events. [ABSTRACT FROM AUTHOR]

A case of secondary infertility with multisystem involvement is being presented herewith. Secondary infertility indicates previous pregnancy but failure to conceive subsequently. Numbers of secondary infertility are growing day by day. Many factors like age, unwholesome lifestyle, disturbed schedule, diet, stress is accountable for it. Due to involvement of these all factors sometimes a female may expose to multiple metabolic disorders resulting into infertility. Aim: To study the outcome of Ayurvedic treatment in management of secondary infertility. Objective: To access the role of Ayurvedic management in secondary infertility. Methodology: It is a single case study of secondary infertility due to multiple metabolic disorders. Case description: A female aged 31years, had pain during menstruation and regular cycles with history of left tube removal due to ectopic pregnancy visited for wants to conceive. She had history of treatment at various private centers and had multisystem metabolic disorders. She was advised Ayurvedic oral medications along with yogabasti. Outcome: After Ayurveda interventions she conceived. Conclusion: Ayurvedic management by improving the health and reproductive ability of a woman may help to conceive. The probable mechanism for the efficacy of multidrug therapy in multisystem disorders gives ray of hope to numerous. [ABSTRACT FROM AUTHOR]

Ectopic pregnancy (EP) is diagnosed based on laboratory values and ultrasonography (US) findings. Evaluation for suspected EP should begin with a quantitative measurement of the serum β-human chorionic gonadotropin levels and transvaginal US. MR imaging is not preferentially performed in the evaluation of EP; however, if the findings of transvaginal US are uncertain, MR imaging can be used, as it has the advantages of superior soft-tissue contrast resolution and a wide scanning range. Identifying the exact location of implantation transfer using MR imaging can help in the diagnosis and establishment of treatment strategies for ectopic pregnancies, including laparoscopy. In particular, as the incidence of heterotopic pregnancy has increased with the recent increase in use of assisted reproductive technology, the scope of application of MR imaging is expected to expand further. This pictorial essay describes the various manifestations of EP and related conditions on MR imaging and US. Familiarity with the clinical setting and the US and MR imaging features of EP and associated conditions can lead to a more accurate diagnosis and treatment.

Abstract Objective This study explored the effectiveness of combining problem-based learning (PBL) and case-based learning (CBL) in the clinical teaching of ectopic pregnancy. Methods: Fifth-year students majoring in clinical medicine were recruited from the Department of Gynecology at the Hengyang Central Hospital and Hainan General Hospital between September 2023 and June 2024. The students were randomly assigned to either the combined PBL-CBL or the traditional group. At the end of the class, both groups of students were required to complete a post-class quiz and an anonymous questionnaire. Results The basic knowledge score in the combined PBL-CBL group was significantly higher than that in the traditional group (42.6 ± 3.6 vs 35.0 ± 2.3, p = 0.000). Similarly, the case analysis score was higher in the combined PBL-CBL group than that in the traditional group (37.1 ± 6.2 versus 33.8 ± 5.7, p = 0.013). The scores for learning motivation, understanding, student–teacher interaction, communication skills, clinical thinking skills, self-learning skills, knowledge absorption, and satisfaction with the course in the combined PBL-CBL group were significantly higher than those in the traditional group (p