Background: An ectopic pregnancy (EP) occurs when a fertilized ovum implants outside the normal uterine cavity 1. Ectopic pregnancy (EP) is a condition presenting as a major health problem for women of childbearing age.2 The incidence of EP varies with the population, but it has been accounted for 1-2% of all reported pregnancies. EP is one of the few medical conditions that can be managed expectantly, medically or surgically. Surgical methods are still the mainstay in the management of EP, and in developed societies, laparoscopic surgery is currently the gold standard.Methods: This is a retrospective observational study conducted in a tertiary care centre in Mumbai from November 2016 to November 2017. All patients diagnosed with ectopic pregnancy (by clinical examination, USG and/or B hCG) were included in the study. The aims and objectives of the study were to determine the demographic distribution, risk factors, clinical features, treatment modalities and complications in patients presenting with EP.Results: The incidence of ectopic pregnancies in one year was 1.17%. The commonest age of presentation of EP was between 35-40 years, most of the patients were Gravida 4 (28.57%). Majority of patients presented at a gestational age between 6-8 weeks. Most patients (64.28%) were found to have ruptured ectopic. 28.57% patients had a previous history of abortion. 14.28% of each EP were cornual and heterotopic as found intra-operatively. There was 1 interstitial and 1 scar ectopic pregnancy. The most common associated risk factor in these patients were a history of some form of pelvic surgeries in the past. Most of these patients presented with pain abdomen and were found to be anaemic and with a shock index (SBP/HR) of > 0.8. 64.28% of cases were diagnosed by combination of TVS and serum BhCG levels. Two cases were managed medically, and obstetric hysterectomy was needed in the patient with ruptured scar ectopic gestation.Conclusions: Ectopic pregnancy has a rising incidence in today’s world. With the use of better diagnostic modalities, ectopic pregnancies can be detected early and treated appropriately. However, as a silent disease, it presents with subtle signs and symptoms and hence can be easily misdiagnosed. Also, because of its subtle presentations, patients often present late in the course of the disease, wherein management of the condition can be sometimes life - saving. But once diagnosed accurately, it needs prompt treatment. Treatment however is easy and patients respond wonderfully with both medical and surgical management.
An ectopic pregnancy is the development of an embryo outside the uterus, a major cause of maternal morbidity and mortality. Heterotopic pregnancy is when an intrauterine implanted embryo develops simultaneously along with an extra uterine implantation. With rising incidence of assisted reproductive technology (ART), incidence of ectopic pregnancy is on a rise. We report a case of an elderly patient, conceived by in vitro fertilization and embryo transfer (IVF-ET), who had a catastrophe of events following conception, where she had an intrauterine twin gestation and an ectopic gestation in the left fallopian tube. She presented with vomiting and on ultrasound scan, we found a twin intra uterine gestation, with demise of one twin with no sign of ectopic implantation. Initially we decided to continue pregnancy. However, she had persistent spotting per vagina, and on a repeat ultrasound scan there was intrauterine demise of the other foetus also. Her uterus was then evacuated under anaesthesia. Post operatively, she became hemodynamic ally unstable and ultrasound was inconclusive of the cause. So, we subjected her to an MRI which showed a left adnexal ruptured ectopic pregnancy with hemoperitoneum. She was immediately taken up for exploratory laparotomy and left salpingectomy was done hemoperitoneum evacuated. Due to timely intervention and use of advanced techniques for diagnosis, she recovered successfully. Thus, heterotopic pregnancy can be a rare, life threatening complication of IVF, a vigilant eye and not shying away from the use of novel and advanced techniques for diagnosis, can help in early diagnosis and timely intervention and thus prove to be lifesaving.
Incidence of incisional hernia in pregnancy is rare and is mainly managed conservatively. An ideal technique for repairing incisional hernia in pregnant patients has yet to be established, but it is clear that each case must be dealt with on an individual basis. It is essential for surgeons to consider the length of the surgery, the presence of contamination, the age of the fetus, the size of the defect, and the chances of recurrence before selecting which technique to employ when repairing abdominal wall hernia in pregnancy. We report a case of term pregnancy in a third gravida, aged 30 years with previous two vaginal deliveries with incisional hernia with overlying hyperpigmented lax skin patch. Incisional hernia developed as a complication because of the previous surgical history of open appendectomy 10 years back which was complicated in the post-operative period, 22 days later leading to an emergency laparotomy in view of intestinal obstruction. Caesarean section was done with simultaneous repair of the incisional hernia with nonabsorbable sutures. The post-operative recovery was uneventful.
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