Objective: To evaluate fetal anomalies and processes leading to termination of pregnancy in the third trimester. Methods: The study includes all cases who underwent termination of pregnancy after 28 weeks of gestation due to fetal anomalies between 2017 and 2022. Results: Forty four of third trimester terminations were carried out in our clinic due to fetal anomalies incompatible with life or associated with severe sequelae. Structural anomalies including 35 (79.5%) cases were the most common reason of terminations followed by chromosomal or genetic abnormalities in 8 (18.2%) cases and intrauterine cytomegalovirus infection in 1 (2.3%) case. The processes leading to the third trimester termination were evaluated by dividing 44 patients into 5 groups. (1) Delayed diagnosis due to inadequate prenatal care (25 patients, 56.8%); (2) patients diagnosed with late-onset findings (5 patients, 11.4%); (3) patients with abnormal findings in prenatal care or history but delayed diagnosis (5 patients, 11.4%); (4) patients with abnormal findings requiring further evaluation (4 patients, 9.0%); (5) patients with a definitive diagnosis but latency in the decision of family for termination of pregnancy (5 patients, 11.4%). Conclusion: Termination of pregnancy in the third trimester has an important role in countries where unfollowed pregnancies are common and access to health services is poor due to low socio-economic status.
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ctopic pregnancy is defined as the implantation of a fertilized ovum outside the uterine cavity, most common site being the fallopian tube. The incidence of ectopic pregnancy varies between 1% and 2% in the general population, with an estimated 11,000 ectopic pregnancies diagnosed each year. 1-3 It is responsible for 3% to 4% of pregnancy-related deaths. 4,5 A study reported at least 90% of all ectopic pregnancies to occur in the fallopian tube, known as tubal ectopic pregnancy. 6 Tubal ectopic pregnancy is managed surgically via an open or laparoscopic route with salpingectomy or salpingostomy. Salpingectomy has a high success rate and is the preferred treatment modality for a ruptured tubal ectopic pregnancy. It is also effective in patients who are hemodynamically unstable because of uncontrolled bleeding from the ectopic focus. Conservative surgery via salpingostomy is a suitable approach for women whose tubal integrity remains intact. 7,8 Various nonsurgical strategies have also been employed for treating ectopic pregnancy including medical treatment and expectant management. Changing Trend of Tubal Ectopic Pregnancy Management During the Experience of Seven Years A AB BS ST TR RA AC CT T O Ob bj je ec ct ti iv ve e: : Ectopic pregnancy is a condition where a fertilized egg gets implanted outside the uterus. The most common site of attachment is the fallopian tube and the condition is termed tubal ectopic pregnancy. It is considered a gynecologic emergency if it is neglected or overlooked. Technological progress and advances in management modalities have provided clinicians with various treatment options for tubal ectopic pregnancy. In the current study, we analyzed the management trends in tubal ectopic pregnancy including an evaluation of the clinical profile and management modalities of the cases. M Ma at te er ri ia al l a an nd d M Me et th ho od ds s: : The present study is a retrospective observational study that included women with tubal ectopic pregnancy who were admitted to the department of obstetrics and gynecology. The patients were allocated to two groups, namely MTX, and surgical treatment groups. R Re es su ul lt ts s: : Of the 207 women included in the study, 84 and 123 were treated with surgery and MTX, respectively, at the first admission. The most common symptom noted was lower abdominal pain in 182 (87.9%) patients and vaginal bleeding was present in 171 (82%) women. The most common ultrasonographic finding was adnexal mass in 156 (75%) women. We performed salpingectomy in 67 (56%) and salpingostomy in 52 (44%) cases that were finally surgically treated (n=119). Our trend analysis reported a significant and quadratic increasing trend for salpingectomy (χ 2 =5.539, degrees of freedom [d f ]=1, p=0.02) from 2009 to 2015. There was a significantly increasing linear trend in the MTX treatment group, whereas the surgery group presented a significant decreasing linear trend (χ 2 =18.56, d f =1, p=0.001). C Co on nc cl lu us si io on n: : The present study observed a downward change in the mana...
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