Konar Hiralal, Konar Lisley, Konar Chandrachur, Halder Arindam, Saha Arindam, Khamaru J
Dept. OB-GYN, Agartala Govt. Medical College and GB Pant Hospital, Agartala, Tripura India.
P13, CIT Road, Kolkata, West Bengal 700014 India.
J Obstet Gynaecol India. 2022 Aug;72(Suppl 1):224-234. doi: 10.1007/s13224-021-01605-8. Epub 2022 Apr 12.
The risk factors for ectopic pregnancy are on the rise. Despite the progress (availability of serum hCG, USG and MRI), there are diagnostic and therapeutic challenges in the management. Up to 50% of ectopic pregnancies go undetected. Furthermore, cases seen as emergency with hemodynamic instability need urgent intervention with simultaneous arrangement of transport, blood transfusion and at times multidisciplinary team involvement. This is more challenging in a setting where resources are limited.
To evaluate the outcome of women presenting with uncommon ectopic pregnancies as life-threatening emergency. Challenges encountered in diagnosis, pre-operative evaluation, decision for surgery and the procedure are presented.
This is a series of twelve cases of uncommon ectopic pregnancies belonging to eight different types. These were managed under the first author during the period 2001 to 2019. Subjects were analyzed retrospectively.
Diagnostic dilemma was faced in majority of the cases even with the use of ultrasonography. All the conceptions were spontaneous. Emergency surgical interventions were made on the basis of clinical evaluation. Five cases presented with massive hemoperitoneum. Blood transfusion was needed in nine cases. There was no mortality. One woman (case 4), with abdominal pregnancy, went home with a live baby, after the second laparotomy.
Uncommon ectopic pregnancies are life-threatening conditions. Clinical acumen and an alert mind are of superior value in diagnosis. Investigations are supportive. Early diagnosis and intervention are lifesaving.
异位妊娠的危险因素正在增加。尽管取得了一些进展（血清人绒毛膜促性腺激素、超声检查和磁共振成像的应用），但在管理方面仍存在诊断和治疗挑战。高达50%的异位妊娠未被发现。此外，以血流动力学不稳定为紧急情况就诊的病例需要紧急干预，同时安排转运、输血，有时还需要多学科团队参与。在资源有限的情况下，这更具挑战性。
评估以危及生命的紧急情况出现的罕见异位妊娠女性的治疗结果。介绍诊断、术前评估、手术决策和手术过程中遇到的挑战。
这是一系列12例属于8种不同类型的罕见异位妊娠病例。这些病例在2001年至2019年期间由第一作者进行管理。对研究对象进行回顾性分析。
即使使用超声检查，大多数病例仍面临诊断困境。所有妊娠均为自然受孕。根据临床评估进行紧急手术干预。5例出现大量腹腔内出血。9例需要输血。无死亡病例。一名腹部妊娠的女性（病例4）在第二次剖腹手术后带着活产婴儿回家。
罕见异位妊娠是危及生命的情况。临床敏锐度和警觉思维在诊断中具有更高价值。检查仅起辅助作用。早期诊断和干预可挽救生命。
