Project description:Ectopic pregnancy is a life- and fertility-threatening condition that is commonly seen in Canadian emergency departments. Increases in the availability and use of hormonal markers, coupled with advances in formal and emergency ultrasonography have changed the diagnostic approach to the patient in the emergency department with first-trimester bleeding or pain. Ultrasonography should be the initial investigation for symptomatic women in their first trimester; when the results are indeterminate, the serum beta human chorionic gonadotropin (beta-hCG) concentration should be measured. Serial measurement of beta-hCG and progesterone concentrations may be useful when the diagnosis remains unclear. Advances in surgical and medical therapy for ectopic pregnancy have allowed the proliferation of minimally invasive or noninvasive treatment. Guidelines for laparoscopy and for methotrexate therapy are provided.
Project description:We present a rare case of cesarean scar ectopic pregnancy as diagnosed by transvaginal ultrasonography. Cases such as this are rare, but they are becoming more commonly detected with the growing frequency of cesarean sections, improving technology, and provider proficiency with point-of-care ultrasound. Quick identification of this dangerous diagnosis can be life saving for the patient, as the outcomes of ruptured cesarean ectopic pregnancy may include significant hemorrhage, uterine rupture, and possibly maternal death.
Project description:BackgroundCesarean scar ectopic pregnancies are increasing in frequency, due to rise in cesarean deliveries. They should be managed early in pregnancy, preferably by surgical excision, failing which they may rupture, or later develop into morbidly adherent placenta.MethodsThis is a series of five cases described to explain the instrumentations and techniques in the laparoscopic excision of cesarean scar ectopic pregnancies. Written consent was taken from the patients.ResultsAll five patients underwent successful laparoscopic excision. Follow-up period was uneventful.ConclusionLaparoscopic excision of cesarean scar ectopic is a technically demanding procedure, but with excellent results. All gynecologists should be familiar with this technique due to the increasing incidence of cesarean scar ectopic gestations.
Project description:AudienceThis simulation is intended for all levels of emergency medicine residents.IntroductionSyncope and near-syncope are very common presenting complaints to the emergency department.1 There are several causes of syncope ranging from benign to life threatening. It is imperative that the emergency physician is able to evaluate and treat patients with undifferentiated syncope even with limited information. Approximately half of syncope cases can be differentiated by the presentation and clinical context.1 In addition to a thorough history, an electrocardiogram (ECG) should be obtained on all patients presenting with syncope or near-syncope since it is non-invasive and cost effective in assessing cardiac causes of syncope. In this particular simulation, the cause of syncope is due to a hemorrhagic shock from a ruptured ectopic pregnancy.Educational objectivesAt the conclusion of this simulation, the learner will be able to:Review the initial management of syncopeUtilize laboratory and imaging techniques to diagnose a ruptured ectopic pregnancy.Demonstrate the ability to resuscitate and disposition an unstable ruptured ectopic pregnancy.Educational methodsThis simulation case was designed as a medium-to-high fidelity simulation scenario. It could also be altered and utilized as a practice oral board exam case.Research methodsThe quality of the simulation and educational content was evaluated by debriefing and verbal feedback that was obtained immediately after the case. Additionally, a survey was emailed to participants and observers of the case to provide qualitative feedback.ResultsPost-simulation feedback from learners and observers was positive. Everyone present for the simulation felt that it was realistic and provided a unique opportunity to practice resuscitation skills.DiscussionSyncope and near-syncope are common presentations to the emergency department with multiple etiologies that range from cardiac, neurologic, neurocardiogenic, and orthostatic to unknown. It is crucial that we diagnose and treat life-threatening causes of syncope rapidly and with limited information. In this case, the cause of syncope due to a ruptured ectopic pregnancy should be rapidly diagnosed with a thorough history and exam, urine pregnancy test, and a bedside abdominal ultrasound. Once the urine pregnancy test was resulted, ectopic pregnancy was the top differential diagnosis for each learner that participated. Initially, most learners only performed a transabdominal pelvic ultrasound of the pelvis, which is normal in the case. One learner performed a rapid ultrasound for shock and hypotension (RUSH) exam and was able to find free fluid in the right upper quadrant. Overall, this case and the debriefing topics were effective for learners at all levels.TopicsEctopic pregnancy, obstetrical emergencies, ultrasound, resuscitation.
Project description:Cervical ectopic pregnancy (CP) is a rare condition with an incidence of less than 0.1% of all ectopic pregnancies. It is associated with a high morbidity and mortality potential. Timely intervention is required to preserve fertility and avoid the need for a hysterectomy. A case of CP is reported and the challenges in the diagnosis and management are discussed.
Project description:Human endometrium undergoes modifications in preparation for embryonic implantation. This study investigated in vivo the endocrine effects of pregnancy on the endometrium, using the model of ectopic pregnancy. Endometrial biopsies from 9 subjects with ectopic pregnancy (Preg) were compared with 8 and 6 samples of mid and late secretory endometrium, respectively. After hybridizing with Affymetrix HGU133 Plus 2 chips, data were analyzed using GeneSpring GX and Ingenuity Pathways Analysis. From 54,675 genes, 3021 genes were significantly differentiated when mid-secretory endometrium was compared with the Preg (Volcano plot; P < .05, >or=2-fold change).The complement and coagulation cascade, phospholid degradation, glycosphingolipid biosynthesis (globoseries), retinol metabolism, antigen presentation pathway, glycosphingolipid biosynthesis, and O-glycan biosynthesis were main significant canonical pathways found in Preg samples. Validation was done with reverse transcriptase polymerase chain reaction. In conclusion, the ectopic embryo has a significant impact, by an endocrine mechanism, on endometrium, when compared with the window of implantation.
Project description:Lay summaryAn ectopic pregnancy occurs when an embryo implants outside of the uterus, usually in a fallopian tube. When detected early, treatment is often with a medication called methotrexate. When methotrexate does not work, surgery is required. A recent clinical trial of ectopic pregnancy treatment (called GEM3) found that adding a drug called gefitinib to methotrexate did not reduce the need for surgery. We have used data from the GEM3 trial, combined with data collected 12 months after the trial finished, to investigate post-methotrexate pregnancy outcomes. We found no difference in pregnancy rates, pregnancy loss rates and recurrent ectopic pregnancy rates between those treated medically only and those who subsequently also needed surgery. The surgical technique used also did not affect pregnancy rates. This research provides reassurance that women with ectopic pregnancies treated medically who need surgery have similar post-treatment pregnancy outcomes to those treated successfully medically.
Project description:Cesarean scar ectopic pregnancies are a rare form of extrauterine pregnancies, yet their incidence is increasing given the rise in cesarean deliveries. Similar to other ectopic pregnancies, cesarean scar ectopic pregnancies pose a great risk for maternal hemorrhage and ultimately maternal mortality. This study presents the case of a cesarean scar ectopic pregnancy in a patient with 3 prior cesarean deliveries. Here, we highlight the importance of early diagnosis and treatment of cesarean scar ectopic pregnancies.
Project description:Ectopic pregnancy (EP) is associated with high maternal morbidity and mortality. Ultrasonography is the only dependable diagnostic tool for confirming an ectopic pregnancy. In view of inadequate early detection methods, women suffer from a high-life risk due to the severity of EP. Early detection of EP using pathological/molecular markers will possibly improve clinical diagnosis and patient management. Salivary proteins contain potential biomarkers for diagnosing and detecting various physiological and/or pathological conditions. Therefore, the present investigation was designed to explore the salivary proteome with special reference to EP. Gel-based protein separation was performed on saliva, followed by identification of proteins using Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS). Totally, 326 proteins were identified in the salivary samples, among which 101 were found to be specific for ruptured ectopic pregnancy (EPR). Reactome analysis revealed innate immune system, neutrophil degranulation, cell surface interactions at the vascular wall, and FCERI-mediated NF-kB activation as the major pathways to which the salivary proteins identified during EPR are associated. Glutathione-S-transferase omega-1 (GSTO1) is specific for EPR and has been reported as a candidate biomarker in the serum of EPR patients. Therefore, saliva would be a potential source of diagnostic non-invasive protein biomarker(s) for EP. Intensive investigation on the salivary proteins specific to EP can potentially lead to setting up of a panel of candidate biomarkers and developing a non-invasive protein-based diagnostic kit.