1/8. Heterotopic pregnancy: discovery of ectopic pregnancy after elective abortion.We report a case of combined intrauterine and tubal pregnancy in a 23-year-old woman. The patient came to the emergency department complaining of lower abdominal pain after having had an elective abortion 2 weeks earlier. Her physician had done pelvic ultrasonography, noting an intrauterine pregnancy before the abortion. Our working diagnosis in the emergency department was retained products of conception versus postabortion endometritis. Pelvic ultrasonography in the emergency department revealed an ectopic pregnancy without evidence of retained products of conception, and the patient had a right salpingotomy with removal of the ectopic fetus without complications.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/8. Ruptured ectopic pregnancy after elective termination of intrauterine pregnancy discovered by use of ultrasonography in the emergency department.The authors report a case of a 27-year-old female who was diagnosed as having a ruptured ectopic pregnancy approximately 12 hours after an elective termination of an intrauterine pregnancy (IUP) was performed. Multiple previous evaluations by an obstetrician for a chief complaint of abdominal pain revealed an IUP but did not disclose the underlying pathology. The ectopic pregnancy was identified by the emergency physician's use of ultrasound in the emergency department.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/8. Bilateral tubal ectopic pregnancy: a tale of caution.diagnosis of ectopic pregnancy continues to be an important challenge facing emergency physicians. The authors present a case of bilateral tubal ectopic pregnancy and discuss its clinical features and diagnostic difficulties. A review of the English-language literature on the subject is discussed. Suggestions are made on ways to increase diagnostic accuracy, reduce complications, and preserve future fertility in this group of patients.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/8. Hemorrhagic shock from a ruptured ectopic pregnancy in a patient with a negative urine pregnancy test result.Ectopic pregnancy has been increasing in frequency over the past 2 decades. The sudden rupture of a fallopian tube caused by ectopic pregnancy can lead to hemorrhagic shock and death if not diagnosed and treated in a timely fashion. The emergency physician is often the health professional that is called on to make the diagnosis and coordinate timely and effective intervention. The first step in the diagnosis of ectopic pregnancy is demonstration of pregnancy by means of a rapidly performed and sensitive qualitative urine test for the beta-subunit of human chorionic gonadotropin (beta-hCG). A negative urine pregnancy test result will generally be used to exclude ectopic pregnancy from further consideration. The following is a report of a patient presenting to an emergency department with hypovolemic shock in conjunction with 2 negative urine beta-hCG analysis results and a quantitative serum beta-hCG level of 7 mIU/mL, a value less than the lower limit of detection for the highly sensitive qualitative urine and serum tests. This case report demonstrates the importance of further consideration of the diagnosis of ectopic pregnancy in the setting of a negative urine pregnancy test result.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/8. risk of surgery after use of potassium chloride for treatment of tubal heterotopic pregnancy.BACKGROUND: Spontaneous heterotopic pregnancies are rare, but with assisted reproductive techniques the incidence may approach 1:100. With the widespread use of transvaginal ultrasonography, physicians have attempted treatment of heterotopic pregnancies with minimally invasive procedures such as transvaginal guided potassium chloride (KCl) injection. However, there are few data on the success of this treatment. CASE: A 30-year-old primigravida presented with a desired pregnancy and was found to have a tubal pregnancy in addition to an intrauterine pregnancy. Ultrasound-guided KCl injection into the heterotopic pregnancy was complicated by abdominal pain, surgical abdomen, and hemoperitoneum requiring salpingectomy. CONCLUSION: A review of the literature revealed that 55% of tubal heterotopic pregnancies treated by KCl injection required subsequent salpingectomy. This raises concerns about the advisability of this treatment.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/8. Ruptured interstitial pregnancy presenting as an intrauterine pregnancy by ultrasound.Interstitial pregnancy is an uncommon subset of ectopic pregnancy in which the conceptum implants in the intrauterine portion of the fallopian tube. These pregnancies tend to progress further before rupture than do other tubal pregnancies and subsequently have greater propensity for massive intra-abdominal bleeding and maternal demise. Abdominal ultrasound can be deceptive in evaluating interstitial ectopic pregnancies. Transvaginal ultrasonography is more sensitive in the diagnosis of early ectopic pregnancy. knowledge of the application and limitations of both transabdominal and transvaginal ultrasound will assist the emergency physician in the timely evaluation of this potentially lethal condition.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/8. Ectopic pregnancy. Six atypical cases.Improved methods for detecting ectopic pregnancy, including pelvic ultrasound and radioimmunoassay of the beta subunit of human chorionic gonadotropin, have increased the physician's ability to make an early and specific diagnosis. An algorithm presented in this article decreases the chance of misdiagnosis and often defines unusual cases that previously may have been overlooked, such as concomitant intrauterine and tubal pregnancy, bilateral tubal pregnancy, and tubal pregnancy years after bilateral tubal ligation. The algorithm, which remains to be validated, is recommended as an additional tool when the clinical situation is equivocal.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/8. Conservative management of interstitial pregnancy.Earlier detection of ectopic pregnancies allows the patient and physician the option of conservative management. Conservative surgical management of ampullary ectopic pregnancies has been well described. Traditional management of interstitial or cornual gestation has been by salpingectomy with or without cornual resection or by hysterectomy. In this paper we present a case report of alternative, less radical surgical management and review the literature on conservative surgical and medical management of interstitial pregnancies.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |