Search

Background: Heterotopic pregnancy has increased in frequency due to the increasing number of assisted reproductive procedures. The diagnosis is difficult even with ultrasonography., Objective: To report the case of a patient with heterotopic pregnancy without a history of in vitro fertilization or fertility treatment., Conclusions: Heterotopic pregnancy is a rarity that requires a high diagnostic suspicion, specialized desk studies and early surgical care to ensure a favorable outcome to the embryo.

We report a case of a 31 years-old female previously treated with laparoscopic salpingectomy due to fimbrial ectopic unruptured pregnancy. After 33 days it was performed a repeated laparoscopy due to persistent b-hCG levels and abdominal pain. During surgical performance there were located three ectopic implantations (one uterine and two peritoneal) of active trophoblastic cells with intermittent bleeding. Fulguration with bipolar current was practiced and administered an intramuscular dose of methotrexate. b-hCG monitoring curve descend until it was negative ten days later. In spite of skillful technique and careful review of pelvic cavity there still are active throphoblastic cells that may cause surgical urgency. Supplementary therapy with a single dose of methotrexate can be an innocuous option.

This article presents a clinical report of a cornual ectopic pregnancy as well as a five-year restrospective review of ectopic gestations at Hospital General de Matamoros Dr. Alfredo Pumarejo L, Tamaulipas, Mexico. The list with histopatological reports was checked up from January 2001 to May 2006. There were 66 results, of which only 31 files were complete. The presentation ages in these patients were between 16 and 39 years old, with a media of 25.6 years old and a mode of 21 years. The circumstances why patients attended to the hospital were: transvaginal bleeding and abdominal pain in 14 cases (45.1%), abdominal pain only in 12 cases (38.7%), and transvaginal bleeding only in five cases (16.2%). The clinical presentation was acute in 19 patients (61.3%), and it was insidious in 12 (38.7%). All women presented menstrual delay. Diagnoses were done by clinical findings in 12 women (38.7%), by clinical findings and ultrasonography in 18 (58.1%), and due to clinical findings and culdocentesis in just one patient (3.2%). Ectopic pregnancy was located in different places on each patient, such as: ampula, 24 cases (77.5%); isthmus, four patients (12.8%); fimbria, one case (3.2%); ovary, one woman (3.2%), and cornual in one patient (3.2%). Twenty-seven cases of broken ectopic pregnancies (87%), were found as transoperative findings, and the other four (13%) were not broken ectopic. There were not demises. Cornual ectopic pregnancy represents 1.5% of the ectopic gestations, as it is reported in the literature.

Report of a case of ectopic pregnancy, treated with oral methotrexate qd. as medical management of tubal pregnancy. We report a succesfully case.

Heterotopic pregnancy (HP) is a very rare pathologic event. The incidence of ectopic pregnancy has increased as the consequence of assisted reproduction and the wider use of ovulation induction agents. The diagnosis of HP is frequently done not as earlier as it should be, and it has serious repercussions. The concept of screening, to find relevant rise factors and the correct diagnosis of HP should be pursued as early as possible. In this report we describe an unusual case of a female patient with therapeutic failure to clomiphene citrate. She was treated with two cycles of combined clomiphene citrate and prednisone, and ovulation induction assent. The after she developed HP. Overall, we conclude that the possible association observed could be an accident. The land of investigation is open, to fill cover. The holes on understanding that we still have.

Ovarian pregnancy is an uncommon presentation of ectopic pregnancy. It's frequency is 0.3-3.0 of all ectopic gestations. Is reported the case of a 33-year old female patient without previous pathology, was admitted because of lower abdominal pain, bloody vaginal discharge, a right adnexal mass, and positive serum pregnancy test. The preoperative diagnosis was tubal ectopic pregnancy. The following case report illustrates the successful application of operative laparoscopy for to treat primary ovarian pregnancy.

Ectopic pregnancy is a frequent clinic entity, with an incidence from 4.5 to 16.8 for 1000 pregnancies. The frequency of ectopic pregnancy has been triplicated in the last years, mainly owed to increase of sexual transmitted diseases, increase in salpinges' surgery and in assisted reproductive medicine. The ectopic pregnancy is also the most frequency cause of maternal death during the first trimester of pregnancy. The frequency of bilateral tubal ectopic pregnancy is extremely rare, it is reported from 1:125 to 1:1580 of all ectopic pregnancies. The first case of bilateral tubal ectopic pregnancy was reported n 1918 by Bledsoe. In Mexico, Molina described the first case in 1993, with conservative laparoscopic treatment. Two clinic cases are presented of bilateral ectopic pregnancy, treated conservatively by laparoscopy. The first one with background of sterility because of anovulation, receiving treatment with menotropins for ovarian hyperstimulation, the other one. In the second case, was a spontaneous pregnancy, in a patient with a history of several pelvic surgeries. In this case a bilateral salpingostomy was realized. In both cases was demonstrated chorionic villi by histopathology. These cases are a model of nature to evaluate the real utility of several diagnostic and therapeutic methods which are available nowadays for the treatment of ectopic pregnancy.

The ectopic pregnancy constitutes a disease that require the most diagnostic accuracy, not only for the biologic importance of its clinical manifestations, but for the sequelae of its treatment too, in relation with the fertility of a patient frequently affected with infertility so far. The increase in its frequency, by multiple factors, including treatment of infertility itself and Assisted Reproduction techniques, make the clinician must be alert and have availability of all diagnostic tools for the establishment of an oportune and conservative treatment, directed to prevent an acute alteration of the hemostasis and a shadowy reproductive future. The present review of the literature about the conservative management of the ectopic pregnancy let us have to know the criteria neccessary for giving the optimum treatment to our patients and offering them a better reproductive future.

We present 3 cases of tubal pregnancy treated with methotrexate. According to the success that we have been obtaining, and the reports of the literature, we propose a local protocol of management of the unruptured tubal pregnancy using a single injection of intratubal methotrexate.

A case reported of simultaneous intrauterine and extrauterine pregnancy, is presented, accompanied by a spontaneous abortion, in the 8th week of gestation, and 3 weeks later, rupture of left tubal pregnancy. Frequency and etiologic factors, as well as diagnostic possibilities are discussed.