Cases reported "Pregnancy, Ectopic"

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1/20. Pelvic arterial embolization for control of obstetric hemorrhage: a five-year experience.

    OBJECTIVE: Obstetric hemorrhage is a significant cause of maternal morbidity and death. postpartum hemorrhage that cannot be controlled by local measures has traditionally been managed by bilateral uterine artery or hypogastric artery ligation. These techniques have a high failure rate, often resulting in hysterectomy. In contrast, endovascular embolization techniques have a success rate of >90%. An additional benefit of the latter procedure is that fertility is maintained. We report our experience at Stanford University Medical Center in which this technique was used in 6 cases within the past 5 years. STUDY DESIGN: Six women between the ages of 18 and 41 years underwent placement of arterial catheters for emergency (n = 3) or prophylactic (n = 3) control of postpartum bleeding. Specific diagnoses included cervical pregnancy (n = 1), uterine atony (n = 3), and placenta previa and accreta (n = 2). RESULTS: Control of severe or anticipated postpartum hemorrhage was obtained with transcatheter embolization in 4 patients. A fifth patient had balloon occlusion of the uterine artery performed prophylactically, but embolization was not necessary. In a sixth case, bleeding could not be controlled in time, and hysterectomy was performed. The only complication observed with this technique was postpartum fever in 1 patient, which was treated with antibiotics and resolved within 7 days. CONCLUSIONS: uterine artery embolization is a superior first-line alternative to surgery for control of obstetric hemorrhage. Use of transcatheter occlusion balloons before embolization allows timely control of bleeding and permits complete embolization of the uterine arteries and hemostasis. Given the improved ultrasonography techniques, diagnosis of some potential high-risk conditions for postpartum hemorrhage, such as placenta previa or accreta, can be made prenatally. The patient can then be prepared with prophylactic placement of arterial catheters, and rapid occlusion of these vessels can be achieved if necessary.
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ranking = 1
keywords = death
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2/20. Extrauterine pregnancy resulting from early uterine rupture.

    BACKGROUND: Cesarean scar rupture of a gravid uterus in early gestation is rare. CASE: A 38-year-old woman, gravida 4, para 2-0-1-1, presented at 13 weeks' gestation with cramping and spotting. She had a history of two cesareans. Ultrasound and magnetic resonance imaging indicated probable uterine dehiscence and a viable extrauterine pregnancy. After embolization of the uterine arteries with subsequent fetal death, the subject had a hysterectomy. Intraoperatively, she had complete rupture of the lower uterine segment, but the pregnancy was enclosed within scar tissue between the uterus and bladder. Placenta percreta was found by histologic examination. CONCLUSION: Women with histories of cesareans might be at risk of early uterine rupture.
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ranking = 1
keywords = death
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3/20. Transvaginal sonographic diagnosis of live monochorionic twin ectopic pregnancy.

    Ectopic pregnancy is a leading cause of pregnancy-related deaths; its incidence has progressively increased in recent years. Spontaneous twin ectopic pregnancy, however, is extremely rare. Among more than 100 reported cases of twin tubal pregnancies, only 5 cases in which fetal cardiac motion has been visualized in both embryos have been reported. We describe an additional case of a live monochorionic twin ectopic pregnancy in a patient with no predisposing factor. With transabdominal sonography, we initially diagnosed a single ectopic pregnancy, visualized as an ill-defined mass in the left adnexa. However, with transvaginal sonography, we determined the left adnexal mass to contain a single monochorionic gestational sac with 2 embryos, each with cardiac motion. These findings were confirmed with color Doppler sonography and at laparotomy. The introduction of high-resolution transvaginal sonography has resulted in the earlier diagnosis of ectopic pregnancy and has contributed to a recent decrease in the maternal mortality and morbidity associated with this condition.
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ranking = 1
keywords = death
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4/20. Laparoscopic management of cornual pregnancy without sutures.

    INTRODUCTION: Cornual pregnancy is a rare form of ectopic pregnancy. The incidence is reported as 3% of all ectopic pregnancies accounting 20% of deaths due to ectopic pregnancy. When an unruptured cornual pregnancy is diagnosed, there are a variety of management options. Many successful endoscopic management options for cornual pregnancy have been reported. CASE REPORT: In this case, cornual resection was performed. DISCUSSION: The other possible treatment options were reviewed.
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ranking = 1
keywords = death
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5/20. Diagnostic and therapeutic imaging in a case of cervical pregnancy. Clinical aspects and ethical implications.

    A case of a 37-year-old, 8 week pregnant woman come to the emergency service with the diagnosis of cervical pregnancy an metrorrhagia, is reported. Uterine artery embolization was performed to arrest the bleeding. BCF monitoring documented its disappearance after approximately 15 days with progressive decrease in serum beta-hCG levels. Once the death of the fetus was ascertained, placental detachment was facilitated with the administration of methotrexate therapy. In view of the curettage of the uterine cavity a second uterine artery embolization was performed. Twenty days after the diagnosis of abortion, curettage was performed and the patient could be discharged. The combined action of embolization, methotrexate therapy and curettage allowed to preserve the potential fertility of the woman.
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ranking = 1
keywords = death
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6/20. Ectopic pregnancy: symptoms, diagnosis and management.

    Ectopic pregnancy is the third biggest killer of pregnant women in the UK. Misdiagnosis and delay in treatment remain common problems, which feature in the Department of health's last two confidential inquiries into maternal death. This article outlines the symptoms and management of ectopic pregnancy as well as high-lighting its psychological and physical effects.
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ranking = 2188.342061573
keywords = maternal death, death
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7/20. Intravenous methotrexate for treatment of interstitial pregnancy: a case report.

    BACKGROUND: Ectopic pregnancy is the leading cause of first-trimester maternal death, accounting for 9% of pregnancy-related deaths. Interstitial (cornual) pregnancies represent 6% of all ectopics but account for a disproportionately higher mortality rate. Surgical management has been the treatment of choice for interstitial pregnancies. A very limited number of articles pre have explored the use of intravenous methotrexate to treat cornual pregnancy as a possible conservative first-line therapy in selected, hemodynamically stable patients. CASE: A patient with a confirmed interstitial pregnancy was treated with intravenous methotrexate. The patient's beta-hCG levels decreased to zero within 9 weeks. CONCLUSION: Intravenous methotrexate was used successfully in the treatment of an interstitial pregnancy without complications.
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ranking = 2189.342061573
keywords = maternal death, death
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8/20. Sudden death: ectopic pregnancy mortality.

    OBJECTIVE: To describe the trends in ectopic pregnancy mortality in michigan from 1985 through 1999 and compare to those of previous time periods. methods: We reviewed all cases of maternal mortality from ectopic pregnancy in michigan from 1985 through 1999. We extracted data from death certificates, hospital inpatient and emergency department records, medical examiner autopsy reports, and reviews by the michigan maternal mortality Study. The health Data Development Section of the michigan Department of Community health provided data on live births and maternal deaths RESULTS: Of the 268 pregnancy-related deaths, 16 (6%) were caused by complications of ectopic pregnancy. Mean age at death was 27 ( /- 6) years. Thirteen deaths were to African-American women and 3 were to white women (P < .01). African-American women had an ectopic mortality ratio 18 times higher than white women (3.25/100,000 live births, compared with 0.18/100,000) Three cases of pregnancy-related death due to complications of ectopic pregnancy were considered preventable, and 2 others were of unknown preventability. CONCLUSION: Ectopic pregnancy treatment has changed in the last 20 years coincident with a decrease in maternal mortality from ectopic pregnancy. Sudden death was the presenting scenario in 75% of nonpreventable ectopic deaths, an increase from previous analyses. A large racial disparity is apparent. Ideally, pregnancy care should start as soon as possible after the first missed menses; however, systemwide changes are needed to create a new norm promoting early access to pregnancy care and promoting education and testing to rule out pregnancy abnormalities. LEVEL OF EVIDENCE: II-2
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ranking = 2199.342061573
keywords = maternal death, death
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9/20. Medical and psychological management of recurrent abortion, history of postneonatal death, ectopic pregnancy and infertility: successful implementation of IVF for multifactorial reproductive dysfunction. A case report.

    The medical and psychological treatment for a 37-year-old Caucasian G6 P1051 woman who presented for evaluation of secondary infertility and recurrent pregnancy loss is described. Although one living child had been conceived without medical assistance, that delivery preceded the present evaluation by ten years and involved a different partner. With the current husband, the patient had two miscarriages and a left ectopic pregnancy. The couple had attempted controlled ovarian hyperstimulation and in vitro fertilization (IVF) elsewhere, but the cycle was cancelled due to poor follicular response. About one year before consultation at our institution, the couple established a pregnancy although the infant was born at 24 weeks with a cardiac anomaly, living only 40 days. Additionally, a persistent cervical lesion required cone biopsy before any fertility treatment could resume. andrology evaluation found the husband's sperm dna fragmentation index to be 48.6%. This constellation of stressors represented substantial emotional issues and psychological therapy/counseling was recommended. After obtaining psychological clearance, the couple underwent IVF and 16 oocytes were retrieved. Four embryos were transferred, and a healthy male infant was delivered at term. Although multifactorial infertility can be associated with very poor reproductive outcomes, the advanced reproductive technologies merit consideration during management of complex clinical challenges. Standard IVF strategies can be optimized by inclusion of thorough psychological assessment and counseling.
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ranking = 4
keywords = death
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10/20. A cautionary tale: fatal outcome of methotrexate therapy given for management of ectopic pregnancy.

    BACKGROUND: Medical therapy with methotrexate is a standard practice for the commonly encountered problem of ectopic pregnancy. methotrexate is excreted predominantly by the kidney and should be used with extreme caution in renal insufficiency. All physicians who administer methotrexate must understand its mechanism of action, distribution, and elimination to minimize potential risks to the patient. CASE: A young, dialysis-dependent woman received a standard dose of methotrexate for an ectopic pregnancy. Prolonged methotrexate exposure resulted. The consequences-pancytopenia, desquamation, acute respiratory distress syndrome, and profound bowel ischemia-ultimately led to her death. CONCLUSION: methotrexate, even at extremely low doses, can be fatal in patients with renal insufficiency. Alternative means of therapy should be sought for women with ectopic pregnancy and renal failure.
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ranking = 1
keywords = death
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