Cases reported "Pregnancy, Ectopic"

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1/33. Heterotopic pregnancy following ovulation stimulation with clomiphene: a report of three cases.

    Heterotopic pregnancy was a medical rarity, prior to the use of ovulation inducing drugs and advent of assisted reproduction technology. Three cases were encountered in the course of clinical practice in a teaching hospital, over a period of six and a half years. Two of them occurred in association with ovulation induction with clomiphene and the third case with no identifiable underlying cause. We postulate dizygotic twinning, highest among the Yoruba race of nigeria as a possible aetiological factor. One of the two cases following clomiphene has been highlighted in more details, together with a review of literature. Diagnosis in all cases was made in retrospect following surgical intervention for the ruptured ectopic components. All the patients presented with persistent pregnancy symptoms, with sonographic confirmation of viable intrauterine fetuses which were carried to term.
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2/33. Ectopic pregnancy: uncommon presentations and difficulty in diagnosis.

    Diagnosis of ectopic pregnancy prior to rupture is an arduous task even with the availability of many new investigative methods and imaging modalities. Above all, a high index of suspicion is necessary when dealing with women who present in early pregnancy with abdominal pain and vaginal bleeding. With the increased use of ovulation induction agents, the probability of heterotropic pregnancy should be kept in mind. The use of transvaginal ultrasonography (TVS) will help in earlier diagnosis because of its advantages over transabdominal ultrasonography (TAS).
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3/33. Combined bilateral ectopic and intrauterine pregnancy following ovulation induction with the low-dose step-up protocol in a patient with polycystic ovary syndrome.

    A woman with polycystic ovary syndrome (PCOS) developed bilateral tubal and an intrauterine pregnancy following ovulation induction with urinary FSH using the low-dose step-up protocol. After a spontaneous miscarriage she was treated by laparoscopic left salpingectomy and right linear salpingotomy.
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4/33. clomiphene citrate-induced simulatneous intra- and extrauterine pregnancy: case report.

    A rare complication of ovulation induction with clomiphene citrate is presented. The importance of keeping in mind such a serious complication is emphasized in order to achieve early diagnosis and appropriate management. In pregnancies following clomiphene treatment, close supervision is imperative as soon as pregnancy is evident.
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5/33. ovarian hyperstimulation syndrome complicated by peritonitis due to perforated appendicitis.

    We describe a case of ovarian hyperstimulation syndrome (OHSS) complicated by peritonitis due to perforated appendicitis. A 29-year-old woman presented with abdominal distension after ovarian stimulation with HMG followed by ovulation induction with HCG. Massive ascites with swollen ovaries was observed on ultrasound, and she was admitted on the diagnosis of OHSS. Daily infusion of serum albumin and low dose dopamine failed to increase her urine output and her abdominal symptoms became increasingly deteriorated after her urine pregnancy test turned out to be positive. paracentesis performed for alleviation of her abdominal distension revealed infected, foul-smelling fluid. An emergency laparotomy was performed, and the definite diagnosis was made as panperitonitis due to perforated appendicitis with right tubal pregnancy. appendectomy, right tubectomy and vigorous irrigation with drainage were performed. The case implies that OHSS might not only mask typical manifestations of appendicitis, but could also compromise concurrent intraperitoneal infection.
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6/33. Inadvertent superovulation and intrauterine insemination during pregnancy: a lesson from an ectopic gestation.

    It is believed that follicular development and ovulation is suppressed during the early period of gestation in humans. In this report, we describe a patient who underwent ovarian hyperstimulation following a "presumed" menstrual bleeding. The case illustrates that the ovaries during early pregnancy seem to respond normally to exogenous gonadotrophin stimulation. Despite ongoing pregnancy, the high plasma concentrations of gonadotrophins have rescued pituitary and ovarian insensitivity. Normal follicular development and even ovulation are allowed to occur. Moreover, it is mandatory to preclude pregnancy before commencing superovulation and assisted reproductive technology.
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7/33. Heterotopic pregnancy: case report.

    Heterotopic pregnancy in a spontaneous cycle is a rare entity with an estimated frequency below one per 30,000 pregnancies. Its incidence evidently has increased in accordance with the widespread use of in vitro fertilization and ovulation induction. We report a case of heterotopic pregnancy in a 40-year-old woman who presented with acute abdominal pain. We also present findings from transvaginal ultrasound imaging.
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8/33. Triplet cervical pregnancy treated with intraamniotic methotrexate.

    BACKGROUND: Multifetal cervical pregnancy is very rare. We are reporting a case of a triplet cervical pregnancy that was treated with direct intraamniotic instillation of methotrexate. CASE: A young multiparous woman was diagnosed as having three gestational sacs in her uterine cervix with embryonic cardiac activity observed within one of the sacs. She became pregnant by natural ovulation and coitus. After initial failure with a single-dose intramuscular injection, the patient was successfully treated with an intra-amniotic methotrexate injection under the guidance of transvaginal ultrasonography. Her reproductive capability was preserved. CONCLUSION: Direct intraamniotic injection can be considered as treatment for multifetal cervical pregnancy.
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9/33. Ovarian ectopic pregnancy after intracytoplasmic sperm injection.

    A ruptured primary ovarian pregnancy occurred following ovulation induction, intracytoplasmic sperm injection (ICSI) and embryo transfer (ET). The exact mechanism of ovarian pregnancy after intracytoplasmic sperm injection is unclear, but, it is possible that there may be an association between blastocyst transfer and ovarian pregnancy in infertile patients who underwent ICSI, prolonged in vitro culture and fifth day embryo transfer at blastocyst stage.
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10/33. Human sperm can fertilize ova inside the Graafian follicles before ovulation.

    OBJECTIVE: To report an incidental finding of fertilization of ova inside the ovarian follicles before ovulation. DESIGN: Case report. SETTING: IVF Center, King Fahd Specialist Hospital, Buraidah, Al-Qassim, saudi arabia. PATIENT(S): One 31-year-old woman with 8 years of primary infertility. INTERVENTION(S): Long-protocol superovulation and ovum pickup (OPU). MAIN OUTCOME MEASURE(S): The retrieved nine oocytes were incubated and followed up closely. RESULT(S): Three hours after OPU and only after decoronization of oocytes, sperm were seen attached to the zonae pellucidae of six mature oocytes. Three of them were showing signs of fertilization (two pronuclei). Neither conventional IVF nor intracytoplasmic sperm injection was done, and we decided to continue incubation and observation of all oocytes. From the nine total oocytes, fertilization was demonstrated in six with attached sperm, of which four divided. On day 2 after OPU, three embryos were transferred into the uterus. CONCLUSION(S): Human sperm can migrate and ascend through the female genital tract to get through the ovarian tissue. Moreover, under certain conditions, it can penetrate the wall of an intact ovarian follicle to reach the ovum and fertilize it just before ovulation.
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