Abdominal pregnancy during the COVID‐19 pandemic

Damiani, Gianluca Raffaello; Biffi, Anna; Boca, Gregorio Del; Arezzo, Francesca

doi:10.1002/ijgo.13271

Cited by 4 publications

(3 citation statements)

References 4 publications

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“…Among sites fallopian tube is the most common accounting for the 98% of cases [1]. Abdominal EPs can arise in almost every organ, from most frequent to least implant site: uterine pouches, omentum, appendix, liver, spleen, retroperitoneum and abdominal wall [3,16]. In addition, to this physician should always contemplate risk of uterine cervical pregnancy in a woman in the first trimester of pregnancy that shows pain and great vaginal blood discharge.…”

Section: Symptoms and Signs Of Ectopic Pregnancymentioning

confidence: 99%

Ectopic Pregnancy: An Overview

Gennaro¹,

Damiani²,

Muzzupapa³

et al. 2022

Clin. Exp. Obstet. Gynecol.

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Objectives: Purpose of this narrative review is to compare, the latest findings about ectopic pregnancy (EP) reporting pathogenetic hypothesis, common and uncommon symptoms, diagnostic work-up, treatment alternatives. EP is a pathological condition characterized by an abnormal blastocyst implant at any site apart from uterine cavity. Dealing with pathogenesis we can recognize many factors: hormonal imbalance, post infective or mechanical induced defects of the tube, assisted reproduction techniques. This condition has aroused interest for its capacity to evolve instantly in a life-threatening condition, needing an early diagnosis and an urgent surgical solution. Mechanism: A comprehensive literature research of recent articles has been performed. Researches for relevant data were conducted utilizing multiple databases, including PubMed, SCOPUS and Ovid. Searches included combinations of the key terms: tubal pregnancy, cervical pregnancy, cesarean scar pregnancy, 'twin and ectopic pregnancy', 'twin and tubal pregnancy', 'twin heterotopic pregnancy', 'laparoscopy and twin pregnancy', 'laparoscopy and tubal pregnancy', 'surgery and pregnancy', 'surgery and ectopic', 'surgery and twin tubal pregnancy', "methotrexate and twin pregnancy 'cornual pregnancy' ". Findings in brief: EP is frequently located in the salpinges but may also occur in many other sites like uterine horns, cervix, ovaries, cesarean scar or in splanchnic organs. Typical signs and symptoms of EP usually consist of pelvic pain, vaginal bleeding or sudden amenorrhea. Beta-human chorionic gonadotropin (b-hCG) dosages are fundamental tools for diagnosis of the early pregnancy whether is normal or not, always considering tubal pregnancy a possible event. Imaging diagnostic tools are described in our review, Ultrasound, Magnetic resonance imaging (MRI), Computed Tomography (CT) are the main options. When the serum b-hCG is positive but at ultrasound examination of pregnancy cannot be found, physician must define this condition as a pregnancy of unknown location (PUL). In this literature-based review we found three therapeutic solutions: expectant, medical or surgical management. Expectant strategy consists of strictly monitoring b-hCG values with no pharmacological or surgical intervention. Methotrexate administration following therapeutic schemes is a cost-effective solution and keeps patient away from surgical risks. Surgery maintains a key role in treatment choice considering that is the only one available in emergency scenario. Conclusions: EP is a diagnostic challenge for the physician, therapy choice is a careful and difficult decision that must be always individualized to ensure patient life uppermost and also future fertility desire.

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Section: Symptoms and Signs Of Ectopic Pregnancymentioning

confidence: 99%

Ectopic Pregnancy: An Overview

Gennaro¹,

Damiani²,

Muzzupapa³

et al. 2022

Clin. Exp. Obstet. Gynecol.

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“…Eculizumab therapy has also been associated with improved survival in both clinical settings [7]. Sometimes it may be challenging to distinguish between pregnancy complications like preeclampsia, HELLP syndrome with COVID-19 related to clinical findings and increased rates of pregnancy complications and cesarean section were observed [10,11]. Recent studies evidenced higher pregnancy complication rate, erythrocyte sedimentation rate, C-reactive protein, procalcitonin, ferritin, D-dimer, lactate dehydrogenase, IFN γ, and IL-6 values (p < 0.05) in COVID-19 pregnancy.…”

Section: Discussionmentioning

confidence: 99%

Management of atypical Hemolytic-Uremic Syndrome in gravida with SARS-COVID-2 infection

Damiani¹,

Pellegrino²,

Villa³

et al. 2022

Ital J Gynaecol Obstet

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Background. Coronavirus disease is a highly contagious infection that can be deadly and is caused by the severe acute respiratory syndrome SARS-CoV-2.The current literature indicates that pregnancy may worsen the course of COVID-19 infection compared to non pregnant women at the same age. Atypical hemolytic uremic syndrome (aHUS) is a complement-mediated disorder, characterized by microangiopathic hemolysis, thrombocytopenia, and renal failure. Case presentation. A case of a gravida at 20 weeks of gestation with worsening clinical conditions due to aHUS, and SARS-COV-2 infection was managed. Continuous renal replacement therapies with transfusion of plasma was started. Diagnosis comprised atypical HELLP presentation with progressive reduction of PLT levels versus other thrombotic microangiopathy. Conclusions. The lack of anti-ADAMTS 13 antibodies allowed to make the diagnosis of Hemolytic-Uremic Syndrome (HUS). The patient started therapy with Eculizumab 900 mg that was administered one time every 7 days. The patient resumed spontaneous urination after one day of therapy. Renal failure persisted after 5 days with creatinine levels at 7.9 mg/dL and azotemia at 126 mg/dL. It is challenging to predict the impact of immune-mediated therapies on pregnant women. Furthermore, additional data about the immunomodulatory changes in COVID-19 patients during pregnancy may reveal pathophysiological events behind this deadly disease.

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“…Two layers continuous barbed suture or even single layer multiple sutures are used for myometrial reconstruction. [ 28 30 32 33 34 ]…”

Section: S Urgical M Anagementmentioning

confidence: 99%

Cornual Pregnancy

Gaetani,

Di Gennaro,

Vimercati

et al. 2023

Gynecology and Minimally Invasive Therapy

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Cornual pregnancy (CP) is a subtype of ectopic pregnancy that is implanted in the interstitial segment of the fallopian tube which is defined as the tubal section crossing uterine muscular tissue. Widely recognized risk factors for CP are endometriosis, uterine leiomyomata, or pelvic inflammatory disease; all these diseases can cause tubal anatomic changes and consequently alter embryo physiological implant process. Many treatment options are available for this condition each one must be tailored according to patient and operating scenario. The incidence of uterine ruptures in the scarred uterus appears to be low, but the fear of it remains and therefore medical treatment might be favored over cornual wedge resection. The actual risk of uterine rupture after medical treatment is unknown. Multiple testing strategies exist to diagnose CP, but caution needs to be used to avoid a false diagnosis.

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Abdominal pregnancy during the COVID‐19 pandemic

Abstract: Description of the emergency approach used for management of an abdominal pregnancy during the COVID‐19 pandemic.

Cited by 4 publications

References 4 publications

Ectopic Pregnancy: An Overview

Ectopic Pregnancy: An Overview

Management of atypical Hemolytic-Uremic Syndrome in gravida with SARS-COVID-2 infection

Cornual Pregnancy

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