Endovaginal color Doppler sonographic evaluation of ectopic pregnancy in women after in vitro fertilization and embryo transfer

Vourtsi, A.; Antoniou, Aris; Stefanopoulos, T.; Kapetanakis, E.; Vlahos, Lambros

doi:10.1007/s003300050819

Cited by 5 publications

(4 citation statements)

References 13 publications

(12 reference statements)

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“…[6–8] Most infertility specialists perform the scan at 5 weeks of pregnancy when the β-hCG level is 1000 mIU/ml or more.…”

Section: Diagnosismentioning

confidence: 99%

Ectopic pregnancy after infertility treatment

Patil¹

2012

J Hum Reprod Sci

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Early pregnancy complications are more common in women who conceive after infertility treatment. Most of these occur before 12 weeks of gestation and include miscarriage, vaginal bleeding, intrauterine hematoma, vanishing twin, and ectopic pregnancy (EP). The incidence of EPs following infertility treatment is much higher compared with that in spontaneous pregnancies. The occurrence of an EP is very distressing to an infertile couple, who has lots of hopes pinned on the treatment outcome, especially because of the cost incurred and the physical and mental trauma both have gone through during the treatment process. The association between infertility and EP is complex, as it can be a consequence of infertility as well as a cause. The two principal risk factors for an EP are genital tract infections and tubal surgeries. Though several etiologies are proposed, but patients with tubal factor infertility are at an increased risk of an EP. Earlier diagnosis of EP helps to improve prognosis and optimize subsequent fertility. It is pivotal to evaluate the likelihood of subsequent occurrence of an EP and be too vigilant when treating. The correct choice of the treatment modality should be made to prevent the recurrence. The early prediction of the pregnancy outcome therefore has great importance for both the couple and clinician. Today with the help of sensitive beta human chorionic gonadotropin (β-hCG) assays and transvaginal sonography, one can diagnose an EP prior to symptoms, and conservative treatment for the preservation of the fallopian tube is possible. Conservative management in the form of expectant and medical management should be considered as a first-line treatment modality, provided that the overall clinical picture suggests that it is safe to do so. If not, laparoscopic management of EPs appears to be the favored approach of management as compared to laparotomy.

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“…[6–8] Most infertility specialists perform the scan at 5 weeks of pregnancy when the β-hCG level is 1000 mIU/ml or more.…”

Section: Diagnosismentioning

confidence: 99%

Ectopic pregnancy after infertility treatment

Patil¹

2012

J Hum Reprod Sci

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“…Depending on the number of embryos transferred, a wide variety of possible forms of ectopic and heterotopic pregnancies have been described: bilateral tubal ectopic (Abusheikha et al, 2000), interstitial (Atri et al, 1996) or ovarian heterotopic (Bonatz et al, 1994), triple heterotopic (Bonatz et al, 1994), and bilateral interstitial sextuplet ectopic after bilateral salpingectomy (Adoni et al, 1986). A consensus therefore recommends early (6 -8 weeks) and systematic ultrasound examinations by specialists (Johnson et al, 1998;Strandell et al, 1999;Vourtsi et al, 1999). Systematic examination is needed because pelvic pain is common in assisted reproduction technology, and specialists are required because visualization of the ectopic conceptus is more difficult, and the normal ultrasound indices disappear:…”

Section: Se1mentioning

confidence: 99%

Ectopic pregnancies after infertility treatment: modern diagnosis and therapeutic strategy

Fernandez¹,

Gervaise²

2004

Human Reproduction Update

111

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Ectopic pregnancy (EP) is a major event in a woman's reproductive life. It complicates infertility treatment and must be recognized early to simplify the treatment strategy, which must always be directed towards optimizing subsequent fertility. Epidemiological findings indicate that tubal history and smoking are the principal risk factors of those EP that are considered reproductive (rather than contraceptive) failures. Adding together the attributable risks for EP allows the construction of a risk scale to determine its probability for any given patient. This risk calculation makes it easier to establish a diagnostic strategy that uses abdominal and transvaginal ultrasound and hCG assays. Progesterone assays are useful only for determining the activity of the pregnancy but do not help to identify its site. Conservative treatment is to be preferred unless the EP occurs on a known hydrosalpinx. All the treatment trials and the Cochrane database meta-analysis show that medical treatment with methotrexate, preferably multidose, is equivalent in efficacy to conservative treatment with laparoscopy in the populations studied. Heterotopic pregnancies, which occur most often after assisted reproduction technology (1-3%), should preferably be treated by salpingectomy except in interstitial sites. There is no consensus that IVF is indicated after EP. The patient's age is probably the determining factor: fertility treatment should not be delayed to an age where the results would be altered, especially with the risk of a recurrent EP.

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“…4 However, this does not constitute a routine investigation and could be limited in high-risk populations [e.g., in vitro fertilization (IVF)-embryo transfer]. The case presented was low risk as not known risk factors were present.…”

Section: Discussionmentioning

confidence: 73%

Laparoscopic Treatment of Heterotopic Pregnancy

Efkarpidis¹,

Alexopoulos²,

Antoniadou³

et al. 2003

Journal of Gynecologic Surgery

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Heterotopic pregnancy poses difficulty for diagnosis and for management. The challenge is to treat the ectopic component without risking the mother and ensuring the intrauterine conception progresses safely to full term. There are no studies comparing the various treatment modalities and their outcomes. The authors present a case of laparoscopic treatment of heterotopic pregnancy and literature review. (J GYNECOL SURG 19:49) CASE REPORTA 32-YEAR-OLD West Indian patient presented at the Early Pregnancy Assessment Unit (EPAU) with a 3-week history of sharp intermittent suprapubic pain and a 5-week history of slight blood loss per vaginam. Her last menstrual period was reported to be 9 weeks earlier. She had a regular 28-day cycle and used condoms for contraception.Her obstetric history included three full-term uncomplicated pregnancies. There was no history of early pregnancy loss or termination of pregnancy. From her past medical history, there were recurrent episodes of genital herpes simplex infection.On examination she looked fit and healthy. Her pulse was 72 beats per minute, regular, and of good volume. Her blood pressure was 120/75 mm Hg and she was apyrexial. The abdomen was soft and nontender with no signs of rebound tenderness or guarding. Pelvic examination revealed a 10-week size anteverted, nontender uterus. Tenderness was elicited on the left adnexa where a 10-cm mass was palpable. Speculum examination did not reveal blood loss at that time.Her hemoglobin was 8.5 g/dL with a white cell count of 8.75 3 10 9 /L and a platelet count of 315 3 10 9 /L. Ultrasound scanning (transvaginal and transabdominal) detected a 10.5 weeks viable intrauterine pregnancy with a regular gestation sac. The crown-rump length (CRL) of the fetus measured 38.9 mm (Fig. 1). Between the left ovary and the uterus a second gestational sac was present containing a 10-week fetus (CRL 33.6) with positive cardiac activity (Fig. 2).The patient was counseled to undergo laparoscopic treatment. Laparoscopy revealed a 6-cm-long distention of the distal portion of the left fallopian tube. There was bleeding from the fimbrial end, but there was no apparent rupture. The right adnexa appeared normal and the uterus was enlarged, compatible with the gestational age. Two chromic catgut endo-loops were applied on the proximal end of the left tube and the tube was dissected with laparoscopic scissors. Attempts to remove the ectopic pregnancy with laparoscopic bag failed due to the size of the dissected tube and a small (4-cm) suprapubic incision was performed to remove it. Postoperative course was complicated by paralytic ileus that was managed conservatively. The patient was discharged on the 5th postoperative day.Histopathologic examination confirmed the presence of tubal pregnancy. The fetal umbilical cord was 5 cm long. No other significant histologic findings were revealed. 49

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Endovaginal color Doppler sonographic evaluation of ectopic pregnancy in women after in vitro fertilization and embryo transfer

Cited by 5 publications

References 13 publications

Ectopic pregnancy after infertility treatment

Ectopic pregnancy after infertility treatment

Ectopic pregnancies after infertility treatment: modern diagnosis and therapeutic strategy

Laparoscopic Treatment of Heterotopic Pregnancy

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