Ectopic Pregnancy

Methotrexate (MTX) is a cornerstone non-surgical therapy for ectopic pregnancy, but its narrow therapeutic window necessitates strict dose verification to prevent toxicity. We report a case of severe MTX intoxication in a 31-year-old woman following salpingostomy, resulting from a dosing error. After receiving an excessive intramuscular dose, the patient developed severe gastrointestinal symptoms and acute kidney injury (AKI). Initial management included prompt leucovorin rescue, urine...

BACKGROUND Cesarean scar pregnancy (CSP), a rare form of ectopic pregnancy, is associated with substantial maternal morbidity and uncertain implications for subsequent pregnancies. This study evaluated the association between prior CSP and adverse obstetric outcomes in subsequent pregnancies; it also explored independent predictors of postpartum hemorrhage (PPH). MATERIAL AND METHODS This retrospective single-center study included 15 439 women with prior cesarean section who delivered at a...

CONCLUSION: Thinner endometrial thickness is associated with an increased risk of ectopic pregnancy in IVF; however, this finding should be interpreted cautiously due to the observational design, potential confounding, and publication bias. Clinically, this may aid in risk stratification but should not be used alone, and further prospective studies are needed to confirm its independent predictive value.

Ectopic pregnancy (EP) remains a major cause of early pregnancy-related morbidity and mortality. It can significantly impact future fertility and is associated with various risk factors. To investigate the incidence, clinical profile, and risk factors of EP among admitted women to the tertiary hospital. A prospective, cross-sectional study was conducted on 393 women with early pregnancy at the Maternity Teaching Hospital, Sulaymaniyah, Iraq from January 2024 to April 2025. Collected data...

Ectopic pregnancy is a serious gynecological emergency that imposes a significant global burden. This research aims to provide an effective reference for future strategic planning in various countries. Ectopic pregnancy data from 1990 to 2021 were analyzed, the autoregressive integrated moving average (ARIMA) and exponential smoothing (ES) models were used to predict future disease burden. Compared with 1990, the number of deaths and disability-adjusted life years (DALYs) increased, while the...

CONCLUSIONS: HSC is a safe, effective fertility-preserving option in hemodynamically stable patients in the management of CSP, with a low risk of complications, including hysterectomy. This procedure can be used alone or in combination with other treatments.

This study aimed to improve the diagnosis and treatment of intramural pregnancy (IMP). A retrospective analysis was conducted of 8 cases of IMP admitted between November 2016 and June 2024. Data on patients' clinical characteristics, diagnosis, treatment, and prognosis were systematically reviewed. All 8 patients experienced IMP following embryo transfer due to tubal factor infertility. Among them, 2 had adenomyosis. All patients had a history of pelvic surgery, including 4 with tubal pregnancy...

RATIONALE: Ectopic gestational trophoblastic disease is an extremely rare subtype of gestational trophoblastic disease, with perimenopausal cases especially scarce and prone to preoperative misdiagnosis as a common ectopic pregnancy, leading to potential delays in proper management.

We present a case of a woman in her 20s with right iliac fossa pain. Initial investigations showed mildly elevated inflammatory markers and serum beta human chorionic gonadotrophin (hCG) <1 mIU/mL. She was taken to theatres as a presumed early appendicitis but found to have haemoperitoneum with a free-floating cystic structure in the pouch of Douglas with intact pelvic organs. This was subsequently confirmed histologically as a gestational sac which had likely been expelled via the abdominal...

CONCLUSIONS: This descriptive synthesis indicates uterine horn communication may be associated with later diagnosis/rupture and reported live births were significantly more frequent in published CHP vs. NCHP cases. However, all comparisons are exploratory and must be interpreted with extreme caution, as data limitations preclude causal inference. Exhaustive imaging and diagnosis are essential to characterize horn type. Surgical termination is advised, but if expectant management is chosen, close...

CONCLUSIONS: Observation until Day 10 in clinically stable patients with suboptimal β-hCG decline between Days 4 and 7 may safely reduce unnecessary interventions. Absolute Day 7 β-hCG levels provide a reliable predictive tool for guiding clinical decisions. Prospective studies are warranted to validate these findings.

CONCLUSIONS: Medical abortion before visible IUP is as effective as standard treatment. Very early medical abortion can be implemented safely and effectively with structured follow-up, allowing for earlier treatment without compromising safety.

Abdominal ectopic pregnancy is an uncommon form of ectopic pregnancy with few cases reported in Nigeria. We present a case report of abdominal ectopic pregnancy with haemoperitoneum in an unbooked multipara at advanced gestational age. She subsequently had an emergency exploratory laparotomy and right salpingectomy. Diagnosis of this condition can be challenging due to non-specific clinical symptoms, while definitive management can also pose a challenge due to the site of placental attachment.

RATIONALE: Ectopic pregnancy (EP) with implantation in the upper abdomen is exceptionally rare. It represents a challenging clinical scenario with very limited evidence confined to case reports. It seriously endangers maternal health and early diagnosis and treatment can significantly improve patient prognosis.

Cesarean scar pregnancy (CSP), a condition characterised by inflammation, occurs in 0.2% of women with a history of cesarean section(s), and is clinically categorised by type 1 and type 2 according to the ultrasound findings. Recent studies reported that systemic inflammation indices derived from routine whole-blood tests may serve as additional clinical predictive markers for early CSP detection, with lymphocyte counts showing a reduction. However, the specific lymphocyte populations...

CONCLUSIONS: This case reaffirms a fundamental clinical principle: any reproductive-age woman with a positive pregnancy test, an empty uterus, and an adnexal mass should be presumed to have an ectopic pregnancy, prompting immediate surgical evaluation. In our patient, this principle alone mandated surgery. The transvaginal ultrasound findings (a yolk sac and a negative "sliding organ sign") did not change the need for surgery, but they provided critical preoperative localization of the...

BACKGROUND: Cervical pregnancy (CP) is a rare ectopic pregnancy associated with life-threatening complications if managed improperly. There is currently no consensus on optimal management, and current evidence is largely limited to case reports. In this study, we retrospectively analyzed the clinical data of 178 patients with CP to evaluate the safety and efficacy of direct surgical treatment versus surgery after pretreatment with UAE or methotrexate (MTX). METHODS: 178 CP patients from three...

Ectopic pregnancy represents a prevalent gynecological emergency with incompletely characterized pathophysiology, creating substantial clinical challenges in timely diagnosis and effective management. The causal interplay between gut microbiota and ectopic pregnancy, particularly through plasma proteomics mediation, remains undefined. We derived Gut microbiota GWAS data (n=412) from the Dutch Microbiome Project meta-analysis and Ectopic pregnancy data from IEU OpenGWAS and FinnGen project. The...

Abdominal pregnancy is a rare form of ectopic pregnancy associated with increased maternal and perinatal risks. In low-resource countries, diagnostic challenges complicate management. Prompt diagnosis requires a high level of suspicion. We report a 34-year-old, G3P1A+1SA, referred as a suspected abdominal pregnancy. Despite several ultrasounds and clinical signs, the diagnosis was delayed until 29 weeks' gestation with a live fetus. She was managed conservatively. A live infant was successfully...

PURPOSE: This study aimed to identify the risk factors and potential prognostic indicators associated with intrauterine pregnancy outcomes following laparoscopic management of heterotopic pregnancies (HPs). METHODS: A retrospective analysis was conducted on 87 patients who underwent assisted reproductive technology (ART) and laparoscopy at our hospital from January 2010 to May 2023. Based on postoperative intrauterine pregnancy outcomes, the patients were classified into a miscarriage group (n =...

CONCLUSIONS: In this cohort, treatment selection was individualized based on clinical evaluation. The surgical approach chosen in practice was strongly aligned with the CSP subtype, with both hysteroscopy and laparoscopy being demonstrated as feasible.

CONCLUSION: EP management, even within a country with a homogeneous healthcare system, may demonstrate considerable heterogeneity, strongly influenced by institutional size. These findings highlight the need for national guidelines to ensure standardized and evidence-based care.

CONCLUSION: The neural network model demonstrated statistically significant superior accuracy and reliability in diagnosing ectopic pregnancy compared to the Naïve Bayes model (McNemar's test, p < 0.001), suggesting the potential of machine learning models, particularly deep learning, to enhance early diagnosis and clinical decision-making.

PURPOSE OF REVIEW: Cesarean scar ectopic pregnancy (CSEP) is an uncommon but increasingly encountered pathology associated with severe maternal morbidity. Rising cesarean delivery rates and improved early pregnancy imaging have led to greater recognition of CSEP, highlighting the need for standardized diagnostic frameworks and evidence-based management strategies.

BACKGROUND This report describes the rare occurrence of a unilateral live tubal twin ectopic pregnancy, diagnosed by transvaginal ultrasound and confirmed surgically. This case is presented to emphasize diagnostic and management challenges. CASE REPORT A 29-year-old primigravid woman at 5 weeks and 6 days by last menstrual period was referred with a suspected pregnancy of unknown location. She was asymptomatic, and vital signs were within normal limits. Her medical history was unremarkable...

CONCLUSION: Surgical excision of uterine scar lesions, laparoscopic or ultrasound-guided curettage, and interventional embolization combined with perfusion chemotherapy, especially when integrated with adjunctive therapies, represent safe and effective approaches for the management of CSP.

Cervical insufficiency is rarely observed during the first trimester of pregnancy. Its diagnosis during early pregnancy is challenging; however, it may be suspected by carefully evaluating the implantation site in combination with obstetric history, serial ultrasound assessments of cervical length, and inflammatory markers. Nevertheless, the optimal management strategy remains unclear. Herein, we report a case of cervical insufficiency resulting from a previous cervical ectopic pregnancy...

CONCLUSION: Implementation of the M6NP model or NICE guidelines would result in up to 10-12% theoretical cost reduction compared with current practice; patient safety must remain a key consideration in PUL management.

CONCLUSIONS: MTX is an effective, safe, fertility-sparing option for IP, achieving high resolution rates across protocols. Local administration and 1 mg/kg regimens may reduce failure. Multicenter studies are needed for standardized guidelines.

CONCLUSIONS: Morphological defect severity, short interpregnancy interval, and low early-pregnancy hormone levels were associated with CSP risk in women with CSD. The model may support early risk stratification and clinical management.

CONCLUSION: Splenic pregnancy is difficult to diagnose owing to the lack of typical clinical manifestations. Expanded ultrasound scanning or computed tomography/magnetic resonance imaging can help to detect ectopic pregnancy lesions, and laparoscopic exploration can be performed when necessary in patients who cannot be definitively diagnosed.

CONCLUSIONS: In this cohort, vNOTES demonstrated shorter operative times, reduced insufflation pressures, and enhanced postoperative recovery compared with conventional laparoscopy. The results indicate that vNOTES could serve as a promising surgical alternative for selected patients presenting with ruptured ectopic pregnancy. Future multicenter investigations involving larger populations and extended follow-up periods-including assessments of fertility and quality of life-will be crucial to...

CONCLUSION: Despite high risks associated with continuing a CSP pregnancy, outcomes can be favorable when management is carefully planned and individualized. Given the increasing prevalence of ART, clinicians should remain aware of the risk of CSP in patients with prior cesarean delivery and focus on early recognition, comprehensive imaging evaluation, and personalized management strategies to ensure optimal maternal and neonatal outcomes.

CONCLUSION: This study identifies three key predictors of ectopic pregnancy in younger PCOS (<35 year) patients undergoing ART: IVF cycle number, endometrial thickness, and frozen embryo transfer. The developed nomogram provides a validated assessment tool, particularly for younger patients. These findings highlight the need for personalized risk stratification and further research into underlying mechanism.

CONCLUSIONS: In IMP, Pelvic fluid and larger gestational mass size were independent predictors of uterine rupture. Both cohorts offer favorable reproductive outcomes when timely diagnosis and individualized management are provided.

Objective: To present a rare case of partial molar pregnancy implanted in a previous cesarean section scar and summarize the literature. Case report: A 33-year-old woman (gravida 5, two prior cesarean deliveries, two spontaneous abortions) presented with vaginal spotting and lower abdominal pain at 6 weeks of gestation. Transvaginal ultrasonography revealed a 28 × 19 mm gestational sac at the cesarean scar site, containing a 4mm fetus with positive cardiac activity. Vacuum curettage was...

CONCLUSIONS: vNOTES salpingectomy for ectopic pregnancy appears to be a safe and feasible procedure, with high levels of patient satisfaction and low pain scores. The heterogeneity of data of the control groups is acknowledged and patients undergoing vNOTES versus conventional laparoscopic salpingectomy had reductions in length of stay but similar duration of surgery, while vNOTES salpingectomy versus laparoendoscopic single-site surgery incurred similar duration of surgery and length of stay....

CONCLUSIONS: Our data suggested that elevated levels of CELSR1 expression in tubal pregnancy promoted epithelial cell invasion and migration, and altered ciliary function, thus contributing to the disease process.

Splenic ectopic pregnancy is a rare and life-threatening condition, with no prior studies exploring its immune microenvironment. We analyzed immune cell alterations in splenic ectopic pregnancy and the potential role of macrophages in pregnancy using immunohistochemical staining, transcriptomic profiling, and histological analysis. Our findings suggest that M2 macrophages may play a crucial role in maintaining successful pregnancy. The biological effects of macrophages on trophoblast cells were...

CONCLUSION: Integrated approaches combining molecular diagnostics, imaging, and targeted therapies are essential to bridge laboratory research and clinical practice. Standardized diagnostic criteria, validated biomarkers, and improved reproductive health equity are critical to reducing the global burden of salpingitis.

CONCLUSION: CSP may represent an early phenotype within the PAS. Standardized terminology, early first-trimester screening and risk-based management strategies are essential to reduce maternal morbidity and optimize reproductive outcomes. Multicenter prospective studies are needed to guide evidence-based prevention and treatment strategies.

CONCLUSION: This case highlights the diagnostic complexity of abdominal pregnancy in low-resource environments, especially when presenting with atypical gastrointestinal symptoms. It underscores the importance of high clinical suspicion, detailed ultrasonographic assessment, and multidisciplinary preparedness in achieving favorable maternal outcomes. Early recognition and appropriate surgical intervention remain key to reducing morbidity and mortality in these rare but high-risk pregnancies.

BACKGROUND: Assisted hatching (AH) influences embryo implantation, whereas ectopic pregnancy (EP) is embryo ectopic implantation and AH may influence EP. Patients with EP history are at higher risk of EP resulting from IVF/ICSI (IVF-EP), and this is associated with the number of previous EP. However, the effect of laser-AH on IVF-EP in patients with EP history has not been studied so far, so we investigated the effect and considered possible different effects in populations with different...

RATIONALE: Primary abdominal pregnancy, though a variant of extrauterine gestation, is exceedingly rare in clinical practice and is associated with a disproportionately high maternal mortality rate, necessitating vigilant diagnostic approaches and prompt therapeutic interventions.

CONCLUSIONS: The most common presenting symptom was abdominal pain in patients in the age group of 31-35 years. Most patient presented with ruptured ectopics.

BACKGROUND: Cervical pregnancy (CP) is a rare but life-threatening ectopic gestation with high risk of catastrophic hemorrhage during evacuation. Uterine artery embolization (UAE) combined with dilation and curettage (D&C) has been proposed as a fertility-sparing approach, but its comparative effectiveness against D&C alone remains insufficiently evaluated across multidimensional outcomes. METHODS: This retrospective cohort study included 67 women with first-trimester CP diagnosed between...

An ectopic pregnancy in a retroperitoneal location is an extremely rare and life-threatening situation. Here, we present a case report of a nulliparous woman in her 30s who presented with rising β-human chorionic gonadotropin (hCG) titre after embryo transfer but with no pregnancy detected on transvaginal scan. She was referred to us after two negative laparoscopies done outside and finally an MRI revealing a retroperitoneal pregnancy embedded close to the aorta near the origin of the left renal...

CONCLUSION: Cesarean scar ectopic pregnancy is an emerging, potentially life-threatening complication in low-resource settings, where limited diagnostic capacity and low clinical suspicion often impede timely diagnosis and management. The avoidance of blind uterine evacuation until cesarean scar ectopic pregnancy is excluded, the adoption of lesion-tailored treatment strategies, and the strengthening of targeted clinical training and diagnostic access are critical to improve maternal health...

Abdominal ectopic pregnancy is a rare and life-threatening condition, often misdiagnosed due to its nonspecific clinical presentation and imaging challenges. We present a case of a 20-year-old primigravida at 39+6 weeks of gestation that was initially misdiagnosed as complete placenta previa with transverse lie and was only identified as abdominal ectopic pregnancy intraoperatively. An emergency cesarean section was planned for suspected placenta previa, during which an intact amniotic sac was...

CONCLUSIONS: Prior TB is independently associated with compromised ART success in normo-responders through residual reproductive dysfunction, with young patients experiencing heightened ectopic pregnancy risk.