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Heterotopic Cervical Pregnancy
Elmer ress Case Report J Clin Gynecol Obstet. 2015;4(4):307-311 Heterotopic Cervical Pregnancy Mathangi Thangavelua, b, Ravinder Kalkata Abstract tenderness or cervical excitation. Initial hormonal investiga- tions showed BHCG levels were raised to 17,276 IU and ini- We report a rare case of heterotopic cervical pregnancy, which posed tial ultrasound was suggestive of minimal retained products diagnostic challenge. With increasing IVF treatment and raising ce- of conception (Fig. 1). However, a repeat BHCG showed an sarean section rate, there is increasing incidence for non-tubal hetero- increasing trend reaching up to 29,971 IU in 96 h. A repeat topic pregnancy. We have discussed the clinical course of our case, transvaginal scan showed the endometrial cavity had mixed diagnosis and management of cervical pregnancy and some good echoes and multiple cystic spaces, largest measuring 6 × 7 × medical practices to avoid missing atypical presentations of ectopic 8 mm with color flow suggesting a possible molar pregnancy pregnancy. (Fig. 2). Bilateral ovarian cysts were present in both adnexa. Laparoscopy and dilatation and curettage were arranged Keywords: Cervical pregnancy; Heterotopic; Ectopic in view of high BHCG levels and no clear evidence of intrau- terine pregnancy. Laparoscopy was negative for tubal ectopic pregnancy and dilatation and curettage was performed. Post- operatively BHCG levels were monitored to ensure its levels were declining. The levels initially dropped to 2,611 IU from Introduction 29,971 IU in a week after D&C. However, the subsequent BHCG levels doubled to 4,207 IU 2 weeks after D&C. With We report an extremely rare case of spontaneous heterotopic the knowledge of earlier scan findings, raising BHCG levels cervical pregnancy who needed multiple investigations before raised the concern of persistent trophoblastic disease. -
Successful Treatment of Cervical Ectopic Pregnancy with Multi Dose
Case Report iMedPub Journals Gynaecology & Obstetrics Case report 2020 www.imedpub.com ISSN 2471-8165 Vol.6 No.2:14 DOI: 10.36648/2471-8165.6.2.94 Successful Treatment of Cervical Ectopic Iqbal S1*, Iqbal J2, Nowshad N1 and Pregnancy with Multi Dose Methotrexate Mohammad K1 Therapy 1 Department of Obstetrics and Gynecology, Latifa Hospital, Dubai Health Authority Jaddaf, Dubai, UAE 2 Department of Medical Education, Dubai Abstract Medical University, Dubai, UAE Cervical ectopic pregnancies account for less than 1% of all pregnancies. Earlier, it was associated with significant hemorrhage and was treated presumptively with hysterectomy. With the advent of enhanced ultrasound techniques, early *Corresponding author: Iqbal S detection of these pregnancies has led to the development of more effective conservative management. We present a case of a cervical ectopic pregnancy successfully treated with multi-dose Methotrexate therapy. [email protected] A 37-year-old lady, G3P0+2, pregnant for 9 weeks and 4 days, presented with bleeding per vagina, mild lower abdomen and back pain. Serum Beta-hCG done Department of Obstetrics and Gynecology, 5 days ago was 950 mIU/mL. She was diagnosed as ectopic cervical pregnancy Latifa Hospital, Dubai Health Authority by clinical examination which was confirmed by transvaginal ultrasonography Jaddaf, Dubai, UAE. and subsequently managed by Methotrexate (MTX) Hybrid double dose protocol. Due to rising Beta-hCG and continuous bleeding, it was modified to Multi dose Tel: 971569400124 Methotrexate Therapy. Thereafter, the patient was asymptomatic with falling beta-hCG and she was put on a weekly follow up in the clinic. Keywords: Ectopic pregnancy; Cervical pregnancy; Methrotrexate; Gynaecology Citation: Iqbal S, Iqbal J, Nowshad N, Mohammad K (2020) Successful Treatment of Cervical Ectopic Pregnancy with Multi Received: March 31, 2020; Accepted: May 02, 2020; Published: May 06, 2020 Dose Methotrexate Therapy. -
Case Reports 95
r- CASE REPORTS 95 CASE REPORTS Past & family history were not contributory. General physical examination revealed no abnor mality. On abdominal examination- abdomen was overdistended, presenting part could not be made out, however there was suspicion of breech ABilA SINGH • NEERJA SETIII presentation. Fetal heart was not localised, mod erate uterine contractions were present. On per NEERA AGARWAL • K MISRA vaginum examination- cervix was fully effaced and 5 em dilated, soft irregular presenting part INTRODUCTION was felt high up at brim and liquor was blood 1 / Sacroccocygeal teratoma is a potentially stained. 2 2 hours later the patient delivered a 28 malignant congenital tumour. The incidence re weeks size still born female fetus weighing 850 ported in India is 1 in 30,000-40,000 live births. grns by breech. There was no PPH. Placenta These tumours present either as obstructed labour or dystocia. The case is reported because of its rare occurence. CASE REPORT Mrs. K. 22 year old unhooked, primigravida was admitted to G.T.B. Hospital with 7 months amenorrhoea and labour pains for 3 hours. Her antenatal period was uneventfull with no history of drug intake. Menstrual Cycles were regular. 'Dtpt. of 06Jt<t antf qynu, antf 'Patfw. ~cctp tttf for 'Pu6lication on 2216/ 91 fig. 1 96 JOURNAL OF OBSTETRICS AND GYNAECOLOGY weighed 120 gm. There was no gmss abnormal AIIMS as she was Rb -ve. She bad a diagnostic ity detected in the placenta. laparoscopy one year back at a private hospital Examination of the fetus showed a bilobed where a bicornuate uterus was diagnosed and massofl5x 17 cmarisingfromtbesacrococcygeal excision of complete longitudinal vaginal sep region with partial rupture of one lobe, cut tum was done. -
A Case of Cervical Ectopic Pregnancy JAHANARA BEGUM1, SHAMSUNNAHAR BEGUM (HENA)2, ROWSHAN ARA3, SHAMIM FATEMA NARGIS4
Bangladesh J Obstet Gynaecol, 2012; Vol. 27(1) : 31-35 A Case of Cervical Ectopic Pregnancy JAHANARA BEGUM1, SHAMSUNNAHAR BEGUM (HENA)2, ROWSHAN ARA3, SHAMIM FATEMA NARGIS4 Abstract: Cervical ectopic pregnancy is the implantation of a pregnancy in the endocervix1. Such pregnancy typically aborts within the first trimester, if it is implanted closer to the uterine cavity called cervico isthmic pregnancy it may continue longer2. Cervical pregnancy accounts for less than 1% of all ectopic pregnancies, with an estimated incidence of one in 2500 to one in 180003-5. Though the pregnancy in this area is uncommon but possibly life threatening condition due to risk of severe hemorrhage and may need hysterectomy. Early detection and conservative approach of treatment limit the morbidity and preserve fertility. A 26 years lady diagnosed as a case of cervical ectopic pregnancy and managed conservatively successfully with adjunctive techniques like cervical artery ligation and cervical temponade to control haemorrhage. The case is reported here for its relative rarity. Key Words: Cervical Ectopic, Intractable bleeding, Cervical artery ligation, cervical temponade. Introduction: and duration. She was married for 5 years, having In ectopic pregnancy the fertilized ovum becomes no issue and no history of MR or D and C. She had implanted in a site other than normal uterine cavity. It is no relevant family history. On general examination the consequence of an abnormal implantation of the she was mildly anaemic, normotensive. On per blastocyst. Worldwide incidence of ectopic pregnancy abdominal examination nothing abnormal was is 3-4% but the incidence is rising. In some studies the detected. -
Sexual and Reproductive Health
Sexual and Reproductive Health Guide for the Care of the Most Relevant Obstetric Emergencies Guide for the Care of the Most Relevant Obstetric Emergencies Fescina R*, De Mucio B*, Ortiz El**, Jarquin D**. *Latin American Center for Perinatology Women and Reproductive Health **Latin American Federation of Societies of Obstetrics and Gynecology Scientific Publication CLAP/WR N° 1594-02 Latin American Center for Perinatology Women and Reproductive Health CLAP/ WR Sexual and Reproductive Health Cataloguing-in-Publication Data Fescina R, De Mucio B, Ortiz E, Jarquin D. Guide for the care of the most relevant obstetric emergencies. Montevideo: CLAP/WR; 2013. (CLAP/WR. Scientific Publication; 1594-02) ISBN: 1. Maternal Mortality - Prevention 2. Pregnancy Complications 3. Placenta Previa 4. Pre-Eclampsia 5. Pregnancy Complications, Infectious 6. Eclampsia 7. Postnatal care 8. Postpartum Hemorrhage 9. Pregnancy, High-Risk 10.Pregnancy, Ectopic I. CLAP/WR II.Title The Pan American Health Organization welcomes requests for permission to reproduce or translate its publications, in part or in full. Applications and inquiries should be addressed to Editorial Services, Area of Knowledge Management and Communications (KMC), Pan American Health Organization, Washington, D.C., U.S.A. The Latin American Center for Perinatology, Women and Reproductive Health (CLAP/WR), Area of Family and Community Health, Pan American Health Organization, will be glad to provide the latest information on any changes made to the text, plans for new editions, and reprints and translations already available. © Pan American Health Organization, 2013 All rights reserved. Publications of the Pan American Health Organization enjoy copyright protection in accordance with the provisions of Protocol 2 of the Universal Copyright Convention. -
Statistical Analysis Plan
Cover Page for Statistical Analysis Plan Sponsor name: Novo Nordisk A/S NCT number NCT03061214 Sponsor trial ID: NN9535-4114 Official title of study: SUSTAINTM CHINA - Efficacy and safety of semaglutide once-weekly versus sitagliptin once-daily as add-on to metformin in subjects with type 2 diabetes Document date: 22 August 2019 Semaglutide s.c (Ozempic®) Date: 22 August 2019 Novo Nordisk Trial ID: NN9535-4114 Version: 1.0 CONFIDENTIAL Clinical Trial Report Status: Final Appendix 16.1.9 16.1.9 Documentation of statistical methods List of contents Statistical analysis plan...................................................................................................................... /LQN Statistical documentation................................................................................................................... /LQN Redacted VWDWLVWLFDODQDO\VLVSODQ Includes redaction of personal identifiable information only. Statistical Analysis Plan Date: 28 May 2019 Novo Nordisk Trial ID: NN9535-4114 Version: 1.0 CONFIDENTIAL UTN:U1111-1149-0432 Status: Final EudraCT No.:NA Page: 1 of 30 Statistical Analysis Plan Trial ID: NN9535-4114 Efficacy and safety of semaglutide once-weekly versus sitagliptin once-daily as add-on to metformin in subjects with type 2 diabetes Author Biostatistics Semaglutide s.c. This confidential document is the property of Novo Nordisk. No unpublished information contained herein may be disclosed without prior written approval from Novo Nordisk. Access to this document must be restricted to relevant parties.This -
Board-Review-Series-Obstetrics-Gynecology-Pearls.Pdf
ObstetricsandGynecology BOARDREVIEW Third Edition Stephen G. Somkuti, MD, PhD Associate Professor Department of Obstetrics and Gynecology and Reproductive Sciences Temple University School of Medicine School Philadelphia, Pennsylvania Director, The Toll Center for Reproductive Sciences Division of Reproductive Endocrinology Department of Obstetrics and Gynecology Abington Memorial Hospital Abington Reproductive Medicine Abington, Pennsylvania New York Chicago San Francisco Lisbon London Madrid Mexico City Milan New Delhi San Juan Seoul Singapore Sydney Toronto Copyright © 2008 by the McGraw-Hill Companies, Inc. All rights reserved. Manufactured in the United States of America. Except as permitted under the United States Copyright Act of 1976, no part of this publication may be reproduced or distributed in any form or by any means, or stored in a database or retrieval system, without the prior written permission of the publisher. 0-07-164298-6 The material in this eBook also appears in the print version of this title: 0-07-149703-X. All trademarks are trademarks of their respective owners. Rather than put a trademark symbol after every occurrence of a trademarked name, we use names in an editorial fashion only, and to the benefit of the trademark owner, with no intention of infringement of the trademark. Where such designations appear in this book, they have been printed with initial caps. McGraw-Hill eBooks are available at special quantity discounts to use as premiums and sales promotions, or for use in corporate training programs. For more information, please contact George Hoare, Special Sales, at [email protected] or (212) 904-4069. TERMS OF USE This is a copyrighted work and The McGraw-Hill Companies, Inc. -
Ovarian Fibrothecoma - a Diagnostic Dilemma
Obstetrics & Gynecology International Journal Case Report Open Access Ovarian fibrothecoma - a diagnostic dilemma Abstract Volume 10 Issue 3 - 2019 Background: The presentation of ovarian fibrothecoma is highly deceptive and it may Nikita Kumari,1 Bindu Bajaj2 be undiagnosed till histopathology reveals the actual diagnosis. Hence, the clinician 1 must be aware of such cases which may present as a diagnostic dilemma. Attending Consultant at Sitaram Bhartia Institute of Science and Research, Ex Senior Resident at VMMC and Safdarjung Introduction: Ovarian fibrothecomas are rare ovarian neoplasm. We report a case Hospital, India where clinical presentation was highly deceptive and suggestive of malignant tumor. 2Associate Professor at VMMC and Safdarjung Hospital, New However, ascitic fluid cytology revealed absent malignant cells. On histopathological Delhi, India examination, it was diagnosed as benign fibrothecoma with cystic changes. Postoperative follow-up for about six months was uneventful. Correspondence: Nikita Kumari, Attending Consultant at Sitaram Bhartia Institute of Science and Research, Ex Senior Case: A 45 year old female presented with large abdominal lump of 20 weeks size Resident at VMMC and Safdarjung Hospital, New Delhi, India, Tel associated with pain abdomen. She was admitted for management and evaluation. 9654251653, Email Hematological and biochemical parameters were normal. USG revealed a large multilocular, predominantly cystic lesion 20.9x9.6x11.4 cm in pelvis. CECT revealed Received: May 27, 2019 | Published: June 13, 2019 ovarian cystadenocarcinoma left ovary with locoregional mass effect, mild ascites and suspicious metastasis to internal iliac lymph nodes. Hence panhysterectomy and omentectomy was performed as radiological and preoperative clinical diagnosis was malignant ovarian tumor. On gross examination, a well encapsulated, multinodular cystic tumor of left ovary about 17x14x7 cm was identified. -
Ectopic Pregnancy
Ectopic pregnancy Reviewed By Peter Chen MD, Department of Obstetrics & Gynecology, University of Pennsylvania Medical «more » Definition An ectopic pregnancy is an abnormal pregnancy that occurs outside the womb (uterus). The baby cannot survive. Alternative Names Tubal pregnancy; Cervical pregnancy; Abdominal pregnancy Causes, incidence, and risk factors An ectopic pregnancy occurs when the baby starts to develop outside the womb (uterus). The most common site for an ectopic pregnancy is within one of the tubes through which the egg passes from the ovary to the uterus (fallopian tube). However, in rare cases, ectopic pregnancies can occur in the ovary, stomach area, or cervix. An ectopic pregnancy is usually caused by a condition that blocks or slows the movement of a fertilized egg through the fallopian tube to the uterus. This may be caused by a physical blockage in the tube. Most cases are a result of scarring caused by: y Past ectopic pregnancy y Past infection in the fallopian tubes y Surgery of the fallopian tubes Up to 50% of women who have ectopic pregnancies have had swelling (inflammation) of the fallopian tubes (salpingitis) or pelvic inflammatory disease (PID). Some ectopic pregnancies can be due to: y Birth defects of the fallopian tubes y Complications of a ruptured appendix y Endometriosis y Scarring caused by previous pelvic surgery In a few cases, the cause is unknown. Sometimes, a woman will become pregnant after having her tubes tied (tubal sterilization). Ectopic pregnancies are more likely to occur 2 or more years after the procedure, rather than right after it. In the first year after sterilization, only about 6% of pregnancies will be ectopic, but most pregnancies that occur 2 - 3 years after tubal sterilization will be ectopic. -
Complications of Pregnancy, Childbirth and the Puerperium Diagnosis Codes
Complications of Pregnancy, Childbirth and the Puerperium Diagnosis Codes 10058006 Miscarriage with amniotic fluid embolism (disorder) SNOMEDCT 10217006 Third degree perineal laceration (disorder) SNOMEDCT 102872000 Pregnancy on oral contraceptive (finding) SNOMEDCT 102873005 Pregnancy on intrauterine device (finding) SNOMEDCT 102875003 Surrogate pregnancy (finding) SNOMEDCT 102876002 Multigravida (finding) SNOMEDCT 106004004 Hemorrhagic complication of pregnancy (disorder) SNOMEDCT 106007006 Maternal AND/OR fetal condition affecting labor AND/OR delivery SNOMEDCT (disorder) 106008001 Delivery AND/OR maternal condition affecting management (disorder) SNOMEDCT 106009009 Fetal condition affecting obstetrical care of mother (disorder) SNOMEDCT 106010004 Pelvic dystocia AND/OR uterine disorder (disorder) SNOMEDCT 10853001 Obstetrical complication of general anesthesia (disorder) SNOMEDCT 111451002 Obstetrical injury to pelvic organ (disorder) SNOMEDCT 111452009 Postpartum afibrinogenemia with hemorrhage (disorder) SNOMEDCT 111453004 Retained placenta, without hemorrhage (disorder) SNOMEDCT 111454005 Retained portions of placenta AND/OR membranes without SNOMEDCT hemorrhage (disorder) 111458008 Postpartum venous thrombosis (disorder) SNOMEDCT 11209007 Cord entanglement without compression (disorder) SNOMEDCT 1125006 Sepsis during labor (disorder) SNOMEDCT 11454006 Failed attempted abortion with amniotic fluid embolism (disorder) SNOMEDCT 11687002 Gestational diabetes mellitus (disorder) SNOMEDCT 11942004 Perineal laceration involving pelvic -
Successful Treatment of a Cervical Ectopic Pregnancy with Single-Dose Methotrexate Therapy
Successful treatment of a cervical ectopic pregnancy with single-dose methotrexate therapy Abstract Ectopic pregnancies implanted in the cervix account for less than one percent of all extra-uterine pregnancies. Due to the rare incidence of cervical ectopic pregnancies, there are no established guidelines for medical versus surgical management. We report a case of a cervical ectopic pregnancy with a fetal heartbeat successfully treated with single-dose methotrexate therapy. Keywords cervical ectopic pregnancy, methotrexate, pregnancy Introduction An ectopic pregnancy is a pregnancy that is implanted outside of the uterus, most commonly within the fallopian tube, but can occur in other rare sites such as the cervical canal. Cervical ectopic pregnancies occur in 1 in 9000 pregnancies.1,2 An ectopic pregnancy implanted in the cervical canal is considered a non-viable gestation with high risk for maternal morbidity and mortality. Prior reports describe multi-dose methotrexate therapy for an embryo with no fetal pole, and direct potassium chloride (KCL) injection into the gestational sac if a heartbeat is present.3 We report a case of a cervical ectopic pregnancy with a fetal heartbeat successfully treated with single-dose methotrexate therapy. Case Description A 22-year-old gravida 2 para 0 at 6 weeks and 5 days gestational age by the last menstrual period presented to the emergency room with heavy vaginal bleeding. A previous dating and viability transvaginal ultrasound at her OB/GYN’s office was suspicious for a cervical ectopic pregnancy. She reported no previous medical conditions. The patient’s obstetric history was significant for a previous dilation and curettage at 7 weeks and 3 days gestation due to a spontaneous abortion. -
1 Copy Number Aberrations in Benign Serous Ovarian Tumors: a Case for Reclassification?
Author Manuscript Published OnlineFirst on October 5, 2011; DOI: 10.1158/1078-0432.CCR-11-2080 Author manuscripts have been peer reviewed and accepted for publication but have not yet been edited. Copy number aberrations in benign serous ovarian tumors: a case for reclassification? Sally M. Hunter1, Michael S. Anglesio2, Raghwa Sharma3, C. Blake Gilks2,5, Nataliya Melnyk2, Yoke-Eng Chiew4,7, Anna deFazio for the Australian Ovarian Cancer Study Group1, Teri A. Longacre6, Anna deFazio4,7, David G. Huntsman2,5, *Kylie L. Gorringe1, *Ian G. Campbell1. 1Centre for Cancer Genomics and Predictive Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia. 2The Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada. 3Anatomical Pathology, University of Sydney and University of Western Sydney at Westmead Hospital, Australia. 4Department of Gynaecological Oncology, Westmead Hospital, Westmead, Australia. 5Genetic Pathology Evaluation Centre of the Prostate Research Centre and Department of Pathology, Vancouver General Hospital and University of British Columbia, Vancouver BC, Canada. 6Stanford University School of Medicine, Stanford, CA 94305, United States. 7Westmead Institute for Cancer Research, University of Sydney at Westmead Millennium Institute, Westmead Hospital, Westmead, Australia. *Co-senior authors Running title: Copy number aberrations in benign serous ovarian tumors Keywords: ovarian, fibroma, serous, benign, borderline. Financial support: This work was supported by a grant (ID 628630) from the National Health and Medical Research Council of Australia (NHMRC). The AOCS was supported by the U.S. Army Medical Research and Materiel Command under DAMD17-01-1-0729, The Cancer Council Tasmania and The Cancer Foundation of Western Australia and the National Health and Medical Research Council of Australia (NHMRC).