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Hard Cases for Critics of Abortion
Published in Christopher Kaczor, The Ethics of Abortion, 2023
In an ectopic pregnancy, the human embryo does not implant in the uterus but rather elsewhere in the woman's body, usually in the fallopian tube. The frequency of ectopic pregnancy has increased some 600% in the last two decades (Diamond 1999, p. 5). When the human embryo implants in the fallopian tube (or even more rarely, elsewhere), the pathology can lead to profuse bleeding and loss of both maternal and embryonic human life. Ectopic pregnancy may be treated in different ways, including salpingectomy (removal of the tube with embryo), salpingostomy (removal of embryo alone), and by use of methotrexate. Although there is an ongoing discussion of treatment options, especially the use of methotrexate, each of these options has been defended as permissible in accord with double-effect reasoning by scholars who accept that every human being is a person.
Pelvic Inflammatory Disease: An Underestimated Serious Health Problem
Published in Botros Rizk, A. Mostafa Borahay, Abdel Maguid Ramzy, Clinical Diagnosis and Management of Gynecologic Emergencies, 2020
For proper eradication of PID, collaboration with other health care providers may be helpful. Nurses should teach young females about PID and the nature of the infection, which is usually sexually acquired. Nurses also should teach girls and women about the short- and long-term sequelae of PID. Safe and unsafe sexual practices should be clearly explained to clients. Nurses should help patients distinguish between normal and abnormal vaginal discharge. Promotion of annual screening for chlamydia and gonorrhea, especially in women under age 25, in women over age 25 if they have multiple partners or a new sexual partner, and in pregnant women [49], is essential. Testing for STIs before entering into a new sexual relationship and treating any STIs found are also helpful. Highlighting the deleterious sequelae of PID, including infertility and inability to have a baby in the future, is an important warning. Women should be educated about the signs and symptoms of ectopic pregnancy, especially abdominal pain and vaginal bleeding, which can be fatal if not recognized and treated promptly.
DRCPG MCQs for Circuit A Answers
Published in Una F. Coales, DRCOG: Practice MCQs and OSCEs: How to Pass First Time three Complete MCQ Practice Exams (180 MCQs) Three Complete OSCE Practice Papers (60 Questions) Detailed Answers and Tips, 2020
An ectopic pregnancy is one that occurs outside the uterine cavity. The majority occur in the Fallopian tube. Isthmial pregnancies may rupture between 4 and 8 weeks as the wall of the medial two-thirds of the tube cannot stretch. Ampullary pregnancies may rupture between 8 and 12 weeks as the muscle wall of the lateral one-third of the tube is lax. It occurs in 1 in 200 pregnancies and is associated with salpingitis, tubal surgery, IUD, etc. It may present with shoulder tip pain due to diaphragmatic irritation from accumulated blood. The abdominal pain may be bilateral or unilateral. Classically, the patient will have sudden, severe lower quadrant abdominal pain, a rigid abdomen, a very tender uterus and a boggy adnexal mass.
Serum kisspeptin, to discriminate between ectopic pregnancy, miscarriage and first trimester pregnancy
Published in Journal of Obstetrics and Gynaecology, 2022
Semra Yuksel, Fatma Ketenci Gencer
Ectopic pregnancy affects 2% of all clinical pregnancies and seen mostly in women aged between 35 and 44 years (Cagnacci et al. 1999; Marion and Meeks 2012). The symptoms mostly occur at early weeks of gestation (6–8 weeks). Patients with ectopic pregnancy mainly complain about vaginal bleeding and abdominal pain especially when the location of pregnancy presents at the tuba. Uterine bleeding in patients with ectopic pregnancy usually occurs as miscarriage or abortus imminens of early gestation. In case of hCG levels below 1500–2000 IU/mL, it is hard to make differential diagnosis in a short time period between ectopic pregnancy and miscarriage or early pregnancy. Consecutive serum hCG measurements after transvaginal ultrasound (TVUS) are often required for confirming the diagnosis. Slower doubling times of hCG may both occur in miscarriage and ectopic pregnancy. Hence, the patients usually wait for definite diagnosis at a certain time when the gestational week is early (4–6 weeks) in routine gynaecologic practice.
Combined analysis of human chorionic gonadotrophin concentrations at different time points after frozen-thawed blastocyst transfer can improve our ability to predict the pregnancy outcomes of single gestations
Published in Journal of Obstetrics and Gynaecology, 2022
Yun Ren, Hongzhen Li, Qiao Jie, Zhen Xiaoying, Rong Li, Hai-Yan Wang
This was a retrospective study conducted in a single university-affiliated IVF centre. The inclusion criteria for patients were as follows: women aged ≤44 years, non-donor cycles with one or two frozen-thawed blastocysts transferred in natural or hormone replacement (HRT) cycles, with only one gestational sac inside the uterus confirmed by ultrasound examination undertaken 30 days after ET. Initial HCG levels were determined on days 12 or 14 after ET. Secondary HCG levels were determined on days 19 or 21 after ET. All HCG measurements were performed at the laboratory based in our centre. Patients who underwent biochemical pregnancy loss, ectopic pregnancies, multiple gestations (including vanish twin syndrome), and pregnancies achieved by preimplantation genetic diagnosis, were excluded from analysis. Women with a history of recurrent spontaneous abortion were also excluded. Pregnancy was defined as a rise in HCG above 30 IU/L. Biochemical pregnancy loss was diagnosed if no sign of pregnancy was evident on ultrasound examination. Ectopic pregnancy was diagnosed by transvaginal ultrasound and/or laparoscopy. Early miscarriage was defined as pregnancy loss after ultrasonic demonstration of a foetal gestational sac and abortion prior to 12 weeks of gestation. Ongoing pregnancy was defined as one that proceeded beyond 12 weeks of gestation. All study parameters were extracted from a computerised database held by the IVF centre in our hospital, and from patients’ files. We acquired a range of data, including baseline patient demographics and characteristics, serum HCG levels, ultrasound findings, and pregnancy outcomes.
Extratubal secondary trophoblastic implants (ESTI) following laparoscopic bilateral salpingectomy for ectopic pregnancy: problems that have been neglected for a long time
Published in Gynecological Endocrinology, 2022
It should be noted that Robson et al. [17] did not choose direct surgery at first, but MTX im, unfortunately, 2 days later the patient hemoglobin dropped, emergency laparoscopy was adopted. ESTI can secrete active β-HCG, implant, and erode peritoneum, omentum, and blood vessels, which lead to acute lower abdominal pain and severe hemorrhagic shock. The authors thought that an initial dose of MTX following salpingectomy or salpingotomy for EP where rupture or spillage of trophoblastic tissue was a high risk, which could be considered after re-operation. In our clinical practices, salpingectomy is cleaner treatment for ectopic pregnancy. So, we could not use MTX directly, because we do not know where the localization of trophoblastic tissue. Pregnancy of unknown location is a transient state in the diagnostic process, leading to a final diagnosis of viable or nonviable intrauterine pregnancy, ectopic pregnancy, or persistent pregnancy of unknown location (high), which is strongly recommended in the guidelines classification [18]. At the same time, imaging diagnostic examinations are limited for ESTI. Our patient has been removed bilateral tubes due to ectopic pregnancy twice. Therefore, diagnosis laparoscopy is needed for biopsy identification what cause this clinical problem.