Most IEP do not rupture early in the first trimester. In this case of twin IEP, the vascular mass appeared to be significantly bulging from the uterine horn at 7 weeks ...
24th World Congress on Ultrasound in Obstetrics and Gynecology Most IEP do not rupture early in the first trimester. In this case of twin IEP, the vascular mass appeared to be significantly bulging from the uterine horn at 7 weeks gestation, raising a concern of impending rupture. Non-surgical management using local and systemic methotrexate was successful with complete resolution of the mass without complications.
Supporting information can be found in the online version of this abstract
P26.13 Advances in urine pregnancy testing and implications for clinical problems of early pregnancy F. Ajibade, A. Olumbori, M. Shendy, S. Hirsi-Farah Royal Berkshire Hospital, Reading, United Kingdom Urine pregnancy testing (UPT) is one the common bed side test in gynecology. History made references to urine & sprouting of the seeds as a form of UPT before discovery of HCG. Home UPT kits have 99% accuracy. Most UPT detect HCG at 25iu. Newer UPT can detect HCG in urine before missed period. Advances in UPT lead to development of various types of urine kits; combined LH & HCG UPT, UPT with wide testing range 25-600iu/ml to avoid hook effect.The early problems of pregnancy such as miscarriages, ectopic,molar & multiple pregnancies still persist with possible consequences. We present 3 cases to highlight the problems that can arise with these UPT. A 32 year pt with Hx of PCO confirmed to be 2 weeks pregnant with a qualitative UPT. She collapsed at home with mild abdominal pain and found to have hemoperitonium. Diagnostic laparoscopy revealed ruptured ectopic pregnancy and salpingectomy was done. The 2nd is a 30 year nulliparous pt with hx of PCO collapsed at home. LMP 7 months ago. UPT has been negative as far back to 2 months and 2 weeks before presentation. The UPT was negative 2 times in the hospital. Ultrasound and laparoscopy confirmed hemoperitoneum of 2.5 litres from Rt tubal ectopic.Serum Hcg was 17iu on admission and 4iu post-op. Histology confirmed ectopic pregnancy. The 3rd patient is a 23 year old with hx of Juvenile arthritis & past hx of DVT on methotrexate/ warfarin. She presented with and pain and heavy period. She had negative UPT & rising INR. Treatment with progesterone but her bleeding persisted. Represented with increasing pain and bleeding. UPT remains negative but serum HCG was 236. VE revealed 4-5cm suspected fetal tissue at the cervix. These cases illustrated the short coming of the qualitative UPT. They also highlight further the importance of correlation between LMP & qualitative predictive urine HCG testing which may be a challenging problem in patients with PCO. Ectopic should be considered in women of reproductive age with acute surgical abdomen even with negative UPT. The 3rd case highlighted possibility of effects of drugs like methotrexate of sensitivity of UPT.
Electronic poster abstracts
& Laparoscopic Tx of the co-existing ectopic pgs can provide good outcomes for the intrauterine pregnancies. A 28yrs old lady P0 with 2 years of infertility presented at EPAU clinic at 6 + 4 weeks with painless vaginal bleeding. She conceived after 8th cycle of clomiphene. Past hx of PID & PCO.Pelvic scan at 6 & 7 wks showed viable intrauterine DCDA twin pgs & no other pelvic abnormality. The 3rd scan at 8wks gestation revealed co-existing Rt sided viable ectopic pregnancy with the intrauterine DCDA twin pregnancy and free fluid in POD. Laparoscopy confirmed the Rt ectopic pg with Lt hydrosalpinx, bilateral peri-tubal adhesions & Fitz-Hugh-Curtis syndrome. Rt ectopic was confirmed on histology after salpingectomy She had further episodes of painless vaginal bleeding at 12 & 14 weeks gestation with normal ultrasound findings. She was delivered by Caesarean section at 37 wks. The diagnosis of a heterotopic can easily be missed with potentially catastrophic consequences.The combined risk factors of Hx of PID, tubal disease and ovulation induction with put her at high risk of a heterotopic pregnancy. In this case, the absence of typical features of an ectopic pg as well as the presence of not one but two intrauterine fetal poles gave false reassurance and delayed the diagnosis.This case highlights the need to be vigilant on scanning high risk pt. The presence of non-identical twin pregnancy within the uterus, ectopic pregnancy on the Rt side and hydrosalpinx on the Lt side raised questions about ovum maturation and transport in the tubal pregnancy. It raises the link between ovum maturation and size with tubal passage.
P26.15 Successful conservative management of cornucal pregnancy with ultrasound-guided transabdominal methotrexate injection S. Choi, J. Shin, J. Cheon Catholic University of Korea, Seoul, Republic of Korea Cornual pregnancy is a rare form of tubal pregnancy accounting for approximately 2-4% of tubal pregnancies. Early diagnosis of cornual pregnancies is crucial, as they often remain asymptomatic until rupture occurs and carry a mortality rate as high as 2.5%. Historically, diagnosis of cornual pregnancy was most often made intraoperatively in an emergent fashion, following patient presentation with an acute abdomen and/or shock. This would lead to either an cornual resection or a hysterectomy. With advances in sensitive beta human chorionic gonadotropin (BHCG) assays and ultrasound technologies, earlier diagnosis of cornual pregnancy is being made. Despite these advances, a large portion of cornual pregnancies are treated with cornual resection, even when treated laparoscopically. Removal of the cornual portion of the uterus carries potential complications in subsequent pregnancies including risks of uterine rupture. We report a case of an early diagnosed cornual pregnancy treated with ultrasound guided transabdominal methotrexate injection following failed intramuscular methotrexate administration. The procedure was successful and the patient was followed up until her serum beta hCG level was normalized.
P26.14 Heterotopic triplet pregnancy with intrauterine viable DCDA twins
P26.16 OHSS in a spontaneous pregnancy: a case report
F. Ajibade, U. Okwuosa, D. Erinle, A. Crystal
B. Kubesova, J. Popelka, E. Kucera
Royal Berkshire Hospital, Reading, United Kingdom
3rd Clinic of Gynaecology and Obstetrics, Faculty Hospital Prague, Prague, Czech Republic
The incidence of heterotopic pregnancies (pgs) increases to with fertility Tx.The incidence of triple & higher order heterotopic pgs is not known.Variable combinations of triplet’s heterotopic pg have been reported. The diagnosis & presentation of heterotopic pg remains a challenge. Variable combinations of fetal locations have been reported with triplet heterotopic ectopic including cases of simultaneous tubal, cervical & intrauterine pg. Early intervention
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We present a case of a 33-year old G2 P1, previous pregnancy delivered by CS for breech position, with no history of PCO, thyreopathy, admitted for abdominal pain, nausea in 12th gestational week. Conception was spontaneous with no farmacological ovarian stimulation. The initial TAS and TVUS scan detected one live fetus-CRL 34 mm, both ovaries enlarged /
Ultrasound in Obstetrics & Gynecology 2014; 44 (Suppl. 1): 181–369.
