A 29-year-old Japanese primipara with fetal sacrococcygeal teratoma and hydronephrosis was referred to our department at 22 weeks of gestation. The preload index of the inferior vena cava (PLI) was 0.75 and fetal cardiac failure was suspected at 28 weeks of gestation. The sodium and chloride concentrations and osmolarity of the fetal urine were 96 mEq/L, 81 mEq/L and 204 mOsm/L, respectively, and we predicted a good renal function. Then, a vesico-amniotic shunting operation was performed at 28 weeks of gestation to keep the renal function and PLI decreased 0.41 after this operation. At 30 weeks of gestation, the fetus was delivered by a cesarean section owing to preterm PROM and a huge growing sacrococcygeal teratoma. The baby was female, weighing 2,020 g, and the 1 minute Apgar score was 1. She died almost 7 hours after birth due to respiratory insufficiency. An autopsy confirmed bilateral hydronephrosis, urethral stenosis, sacrococcygeal immature teratoma, and pulmonary hypoplasia. The size of this tumor revealed 80 x 70 x 45 mm in intrapelvic cavity and 130 x 90 x 50 mm out of body, and this tumor was classified as Type II according to the American Academy of Pediatrics Surgery Section classification.
A 36-year-old pregnant woman with a rapidly growing hemangioma in the vagina was treated by transcatheter arterial embolization after delivery. Blood flow characteristics within the tumor were evaluated using transvaginal color Doppler ultrasound both before and after the embolization. The vascular resistance in the tumor vessels within the vaginal hemangioma was observed to be significantly decreased; the tumor reduced in volume following this non-surgical treatment.
The detection of color vascularity by TV-CDU in patients with an ectopic pregnancy is helpful for diagnosis, especially for patients with either a questionable adnexal mass in B-mode images or lower serum β-hCG concentrations.
Ten patients with ovarian bleeding, who were surgically treated, had been preoperatively evaluated using transvaginal color Doppler ultrasound. The blood-flow velocity waveforms of the bleeding also were analyzed. The bleeding artery of the ovary was clearly detected in 9 of 10 (90%) patients by transvaginal color Doppler ultrasound and was later confirmed by either a laparotomy or laparoscopic surgery. Either a corpus luteum cyst or a ruptured corpus luteum was associated with the bleeding in the 9 of the 10 patients. The resistance-index value in each bleeding artery examined in the 9 cases was relatively low, ranging from 0.46 to 0.59 (mean: 0.51). Based on our findings, transvaginal color Doppler ultrasound is useful for preoperatively detecting bleeding arteries in clinically severe cases of ovarian bleeding.
Background: Cervical ectopic pregnancies (cEP) represent less than 1% of all ectopic pregnancies. Diagnosis of cEP is now based upon TVS findings rather than clinical presentation. As a result the vast majority of women presenting with cEP are stable and hazardous surgical intervention can be avoided. We report a series of seven cEP managed conservatively. Methods: A cEP was diagnosed on the following TVS criteria: the cervix was classically barrel-shaped, a gestational sac was present at the level of the uterine arteries, there was an absence of the sliding sign and colour Doppler flow around the sac demonstrated high vascularity. All women diagnosed with cEP had serum hCG levels taken at presentation. All but one woman was managed medically with methotrexate. Results: 7 cEP were diagnosed between 22.04.97 and 15.03.02. The mean gestation at presentation was 56 days (range 42-80 days). The mean hCG at presentation was 8188 IU/L (range 144-20967 IU/L). 4/7 presented with painless vaginal bleeding. 6/7 women were diagnosed with a cEP on the basis of their first ultrasound. 3/7 were successfully treated with a single dose of intramuscular methotrexate (50 mg/m2). 2/7 were given methotrexate 1 mg/kg days 1, 3 and 5 and leucoviron 0.1 mg/kg days 2, 4 and 6 (one was treated successfully whilst the other had a viable cEP and required TVS guided KCL injection into the sac). 1/7 was successfully managed expectantly and 1/7 was lost to follow up. The mean length of stay in hospital was 24 days (range 16-34 days) and the mean follow up time was 74 days (range 34-139 days). On average each woman had 4 ultrasound scans (range 2-8) and 15 serum hCG levels (range 8-23). Conclusion: In our experience, all women with cEPs can and should be managed conservatively. As the incidence of such pregnancies is low, it would be appropriate to refer all such women to a tertiary referral early pregnancy unit.
P04.14 Case presentation of a unilateral live twin tubal ectopic pregnancy
S. L. Lam
KK Women's and Children's Hospital, SingaporeEctopic pregnancies represent a major health risk for women of reproductive age. If not treated properly, they can result in lifethreatening complications. Live twin ectopic gestations are extremely rare. There are more than 100 reported twin tubal pregnancies but only 6 have foetal cardiac motions demonstrated in both embryos. We describe an additional patient with live twin ectopic gestation. A 32 year old Chinese woman presented with amenorrhoea and 3 to 4 days of left iliac fossa pain without any vaginal bleeding. She had a past history of primary subfertility secondary to pelvic inflammatory disease and had therapeutic laparoscopy performed for blocked tubes. An endovaginal ultrasonogram showed no intrauterine gestational sac. A left adnexal ring echogenic mass containing 2 viable foetal poles were identified. These were later confirmed on surgery. Multiple factors are known to contribute to the relative risk of ectopic pregnancy and in this patient, these factors were previous pelvic inflammatory dis...
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