Stable patients with bleeding who have pain or a pregnancy of six weeks gestation or more or a pregnancy of uncertain gestation should be referred immediately to an early pregnancy assessment (EPA) service, or out-of-hours gynaecology service if the EPA service is not available. ![]() Women who are haemodynamically unstable, or in whom there is significant concern about the degree of pain or bleeding, should be referred directly to A&E, irrespective of the result of the pregnancy test. Signs of suspected ectopic pregnancy include pelvic, abdominal, adnexal or cervical motion tenderness, rebound tenderness and abdominal distension. A positive diagnosis of a urinary tract infection or gastroenteritis does not exclude an ectopic pregnancy. The most common symptoms of ectopic pregnancy are pelvic or abdominal pain, amenorrhoea, missed period or abnormal period and vaginal bleeding. When the tube ruptures, the woman will quickly become unwell and haemodynamically unstable because of rapid intra- abdominal blood loss. Symptoms and signs appear when the tube starts to tear. NICE recommends a low threshold for offering a pregnancy test to women of childbearing age when they attend the surgery. However, a third of women with an ectopic pregnancy have no known risk factors. Risk factors are previous ectopic pregnancy, PID, endometriosis, previous pelvic surgery, the presence of a coil and infertility. Rarely an ectopic pregnancy can be found in the ovary, a caesarean section scar, the abdomen or the cervix. ![]() The most common site of localisation of an ectopic pregnancy is the fallopian tube. Further research focusing on more homogenous population may help in better characterizingĭiagnosis and treatment of ectopic pregnancy. These are consistent with known risk factors for ectopic pregnancy following IVF. Our systematic review has revealed several trends in reported cases of abdominal ectopic pregnancy after IVF including tubal factor infertility, history of tubal ectopic and tubal surgery, higher number of embryos transferred, and fresh embryo transfers. Heterotopic abdominal pregnancy occurred in 46Â % of cases while 54Â % were abdominal ectopic pregnancies. Transfer of two embryos or more (79Â %) and fresh embryo transfer (71Â %) were reported in the majority of cases. A history of tubal surgery was identified in 50Â % of cases, 32Â % cases having had bilateral salpingectomy. A history of ectopic pregnancy was identified in 39Â % of cases. Infertility causes included tubal factor (46Â %), endometriosis (14Â %), male factor (14Â %), pelvic adhesive disease (7Â %), structural/DES exposure (7Â %), and unexplained infertility (14Â %). ![]() Patients' ages ranged from 23 to 38 (Mean 33.2, S.D. We performed a systematic literature search to identify case reports of abdominal or heterotopic abdominal ectopic pregnancies after IVF. We present a case of a 30Â year-old woman who had an abdominal ectopic pregnancy following IVF and elective single embryo transfer, which was diagnosed and managed by laparoscopy. While risk factors for ectopic pregnancy after IVF have been studied, very little is known about risk factors specific for abdominal ectopic pregnancy. Abdominal ectopic pregnancy is a rare yet clinically significant form of ectopic pregnancy due to potentially high maternal morbidity. Yoder, Nicole Tal, Reshef Martin, J RyanĮctopic pregnancy is the leading cause of maternal morbidity and mortality during the first trimester and the incidence increases dramatically with assisted-reproductive technology (ART), occurring in approximately 1.5-2.1Â % of patients undergoing in-vitro fertilization (IVF). ![]() We present an interesting case of secondary implantation of a tubal ectopic pregnancy to highlight the appendix as a possible secondary implantation site after a tubal ectopic pregnancy.Ībdominal ectopic pregnancy after in vitro fertilization and single embryo transfer: a case report and systematic review. Abdominal pregnancies are rare, and secondary implantation of tubal ectopic pregnancies is the most common cause of abdominal gestations. Laparoscopic management of tubal pregnancies is now the standard form of treatment where this technology is available. In developing countries, the case fatality rate varies from 3% to 27%. Nama, Vivek Gyampoh, Bright Karoshi, Mahantesh McRae, Reynold Opemuyi, IsaacĪlthough the case fatality rate for ectopic pregnancies has decreased to 0.08% in industrialized countries, it still represents 3.8% of maternal mortality in the United States alone. Const CHARSET_LOWER = "abcdefghijklmnopqrstuvwxyz" Ĭonst CHARSET_UPPER = "ABCDEFGHIJKLMNOPQRSTUVWXYZ" Ĭonst CHARSET_ALPHA = CHARSET_LOWER + CHARSET_UPPER Ĭonst CHARSET_ALNUM = CHARSET_ALPHA + CHARSET_NUM Ĭonst CHARSET_ALNUM_SANE = CHARSET_ALNUM.Secondary abdominal appendicular ectopic pregnancy.
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