gestational sac. Operative hysteroscopy revealed insufficient communication with the left-sided cavity just above the cervical internal os of the uterine septum. After widening the communication, ultrasound-guided D&E was successfully performed.]]>
Abortion, Induced ; Abortion, Missed ; Dilatation ; Female ; Gestational Sac ; Humans ; Hysteroscopy ; Pregnancy Trimester, First ; Pregnancy ; Ultrasonography ; Uterus

OBJECTIVE: This study was conducted to determine the effectiveness and safety of medical treatment with sublingual misoprostol (MS) in the 1st trimester miscarriage under the approval by Health Insurance Review and Assessment Service (HIRA) for off-label usage by the single medical center in Korea. METHODS: A retrospective cohort study was performed in one institution between April 2013 and June 2016. Ninety-one patients diagnosed with miscarriage before 14 weeks of gestation and wanted to try medical treatment were included. A detailed ultrasound scan was performed to confirm the diagnosis. Patients took 600 microgram (mcg) of MS sublingually at initial dose, and repeated the same dose 4–6 hours apart. Successful medical abortion was defined as spontaneous expulsion of gestational products (including gestational sac, embryo, fetus, and placenta). If gestational products were not expelled, surgical evacuation was performed at least 24 hours later from the initial dose. Information about side effects was obtained by medical records. RESULTS: About two-thirds of patients had a successful outcome. The median interval time from pill to expulsion was 18 hours in the successful medical treatment group. There was no serious systemic side effect or massive vaginal bleeding. Presence or absence of vaginal spotting before diagnosis of miscarriage, uterine leiomyomas, subchorionic hematoma, or distorted shape of gestational sac on ultrasound scan were not statistically different between the two groups. CONCLUSION: Medical treatment with sublingual MS can be a proper option for the 1st trimester miscarriage, especially for the patient who want to avoid surgical procedure. We can reduce the unnecessary sedation or surgical intervention in the patients with the 1st trimester miscarriage.
Abortion, Incomplete ; Abortion, Missed ; Abortion, Spontaneous* ; Administration, Sublingual ; Cohort Studies ; Diagnosis ; Embryonic Structures ; Female ; Fetus ; Gestational Sac ; Hematoma ; Humans ; Insurance, Health ; Korea* ; Leiomyoma ; Medical Records ; Metrorrhagia ; Misoprostol* ; Off-Label Use* ; Pregnancy ; Retrospective Studies ; Ultrasonography ; Uterine Hemorrhage

OBJECTIVE: To examine the therapeutic outcomes of methotrexate (MTX) in the treatment of unruptured interstitial pregnancy. METHODS: We reviewed the medical records of patients who were diagnosed with interstitial pregnancy and received MTX as first-line treatment between January 2003 and July 2014 at CHA Gangnam Medical Center. The treatment success rates and subsequent pregnancy outcomes were examined. RESULTS: Ninety-seven patients were diagnosed with interstitial pregnancy between January 2003 and July 2014. Of them, 38 initially received MTX treatment. The diagnosis was made at a median of 6+3 weeks (5+0 to 11+3 weeks). Thirty patients received a systemic MTX injection, while the other 8 received a local MTX injection. Systemic treatment composed of an 8-day alternating MTX regimen, single-dose regimen, or high-dose regimen (100 mg/m2 + 200 mg/m2 intravenously over 12 hours). The local injection consisted of a direct MTX injection into the gestational sac with or without systemic MTX injection. Twenty-one patients (55.3%) were successfully treated with MTX. However, MTX therapy failed in 17 patients (44.7%), who required surgery. Mode of MTX treatment was the only predictive variable of MTX treatment success (P=0.039). Treatment success was seen in 7 of 8 patients (87.5%) in the local MTX group vs. 14 of 30 patients (46.7%) in the systemic MTX group. After treatment, 13 patients attempted a successive pregnancy; of them, 10 patients had a confirmed clinical pregnancy and healthy live birth. CONCLUSION: Combined MTX treatment including a local injection might be an initial approach to the treatment of interstitial pregnancy.
Diagnosis ; Female ; Gestational Sac ; Humans ; Live Birth ; Medical Records ; Methotrexate* ; Pregnancy ; Pregnancy Complications ; Pregnancy Outcome ; Pregnancy, Interstitial*

OBJECTIVE: This study aims to investigate whether there are any notable etiologies for repeated biochemical pregnancy (RBP) and, if so, to compare those etiologies associated with repeated spontaneous abortion in infertile couples who have undergone in vitro fertilization (IVF). METHODS: Forty-four infertile couples who underwent IVF and experienced RBP were included in this study. RBP was defined as more than 2 early pregnancy losses that occurred before the detection of a gestational sac, with ectopic pregnancies specifically excluded by serial serum beta human chorionic gonadotropin evaluation. Forty-three infertile couples who underwent IVF and experienced recurrent spontaneous abortion (RSA) were included as a control group. Karyotype analysis, anatomic evaluation of uterus, endocrine and immunological evaluation were performed. In addition, the number of pregnant women confirmed by 12 weeks' gestation was compared between groups. RESULTS: Immunological factors (RSA: 20.9% vs. RBP: 29.5%, P=0.361), diminished ovarian reserve (RSA: 10.9% vs. RBP: 17%, P=0.552), and parental chromosomal abnormalities (RSA: 18.6% vs. RBP: 9.1%, P=0.218) were not different between groups. Additionally, the incidence of uterine factors (RSA: 11.6% vs. RBP: 4.6%, P=0.206), unknown cause (RSA: 48.8% vs. RBP: 54.5%, P=0.161), and the pregnancy outcome identified until 12 weeks' gestation (RSA: 46.5% vs. RBP: 38.6%, P=0.520) did not differ between groups. CONCLUSION: In the present study, the causes of RBP after IVF were similar to those of RSA. Accordingly, we suggest that efforts should be made to define the etiology of RBP, particularly for infertile couples, and that possible management strategies should be offered.
Abortion, Habitual ; Abortion, Spontaneous ; Biochemical Phenomena ; Chorionic Gonadotropin ; Chromosome Aberrations ; Family Characteristics* ; Female ; Fertilization in Vitro* ; Gestational Sac ; Humans ; Immunologic Factors ; In Vitro Techniques* ; Incidence ; Karyotype ; Ovarian Reserve ; Parents ; Pregnancy Outcome ; Pregnancy* ; Pregnancy, Ectopic ; Pregnant Women ; Uterus

OBJECTIVE: To analyze the preoperative diagnostic clues to ovarian pregnancy (OP). METHODS: This study conducted a retrospective chart review of 23 patients with OP and 46 patients with tubal pregnancy (TP) from October 1, 2003 to September 31, 2016 in Hanyang University Hospital. RESULTS: There were no significant differences in demographic and clinical characteristics between the two groups. The presence of an ectopic gestational sac and hemoperitoneum was significantly higher in the TP group (13.0% vs. 95.7%, P=0.000; 13.0% vs. 54.3%, P=0.001, respectively) in preoperative ultrasonogram. The OP group had more ruptured ectopic gestational sacs than the TP group (73.9% vs. 45.7%, P=0.039) in surgical findings. CONCLUSION: For the patients in whom a gestational sac is not detected in the uterus or the fallopian tubes, it is important to be aware of the possibility of OP and rupture of an ovarian gestational sac to promote early diagnosis and surgical intervention.
Early Diagnosis ; Fallopian Tubes ; Female ; Gestational Sac ; Hemoperitoneum ; Humans ; Laparoscopy ; Pregnancy ; Pregnancy, Ovarian* ; Pregnancy, Tubal* ; Retrospective Studies* ; Rupture ; Ultrasonography ; Uterus

This is a case report of a first trimester cesarean scar pregnancy (CSP) evolving into a placenta accreta at term based on the ultrasound imaging. The gestational sac, initially implanted at the site of previous scar, grew into the uterine cavity as the pregnancy progressed and resulted into a viable birth complicated by placenta accreta.
Cesarean scar pregnancy is a rare form of ectopic pregnancy and is associated with increased maternal morbidity and mortality. Thus, early recognition of the salient sonographic findings is crucial because a delay could lead to a life threatening condition. Early diagnosis also gives women the option to choose between expectant management and termination of pregnancy. The exact incidence of CSP has not been determined but its incidence is on the rise in parallel with the high rate of cesarean sections. There are two types of CSP. The first type is due to the implantation of the gestational sac on the scar with progression towards the uterine cavity. In this type expectant management is justifiable since pregnancy may progress into a viable pregnancy. The second type involves growth of gestational tissues towards the bladder and abdominal cavity and is associated with uterine rupture if immediate intervention is not undertaken. In this report, we present a case of a first trimester CSP that was managed expectantly and developed into placenta accreta at term.

Human ; Female ; Adult ; Placenta Accreta ; Pregnancy Trimester, First ; Gestational Sac ; Uterine Rupture ; Pregnancy, Ectopic ; Cesarean Section ; Embryo Implantation

This is a case report of a first trimester cesarean scar pregnancy (CSP) evolving into a placenta accreta at term based on the ultrasound imaging. The gestational sac, initially implanted at the site of previous scar, grew into the uterine cavity as the pregnancy progressed and resulted into a viable birth complicated by placenta accreta.
Cesarean scar pregnancy is a rare form of ectopic pregnancy and is associated with increased maternal morbidity and mortality. Thus, early recognition of the salient sonographic findings is crucial because a delay could lead to a life threatening condition. Early diagnosis also gives women the option to choose between expectant management and termination of pregnancy. The exact incidence of CSP has not been determined but its incidence is on the rise in parallel with the high rate of cesarean sections. There are two types of CSP. The first type is due to the implantation of the gestational sac on the scar with progression towards the uterine cavity. In this type expectant management is justifiable since pregnancy may progress into a viable pregnancy. The second type involves growth of gestational tissues towards the bladder and abdominal cavity and is associated with uterine rupture if immediate intervention is not undertaken. In this report, we present a case of a first trimester CSP that was managed expectantly and developed into placenta accreta at term.

Human ; Female ; Adult ; Placenta Accreta ; Pregnancy Trimester, First ; Gestational Sac ; Uterine Rupture ; Pregnancy, Ectopic ; Cesarean Section ; Embryo Implantation

OBJECTIVES: To identify the clinical factors associated with intrauterine insemination (IUI) success among Filipino couples and incorporate the significant clinical factors in a formula for a prognostic scoring index for the success of IUI.

METHODS: This is a review of cases who consulted for infertility and underwent IUI at a tertiary hospital between January 2007 and December 2014. The variables considered for analysis were female age, duration of infertility, etiology of infertility, method of sperm processing, number of preovulatory follicles, total motile insemination count (TMSC), and sperm motility. The outcome measure was determined either by a positive urine or serum beta HCG or a gestational sac on transvaginal ultrasound. Results from the logistic regression analysis were used to develop prognostic scoring index for IUI success. Computed scores were plotted in a Receiver Operating Characteristic Curve and cut off values were determined.

RESULTS: The overall pregnancy rate in this study was 10.7%. Duration of infertility (OR 10.33, 95% CI 3.488-30.602) and sperm motility (OR 5.30, 95% CI 1.830-15.331) showed the strongest significant association with the occurrence of pregnancy. Odds of pregnancy after IUI are likewise increased in female age of < 32.5 years (OR 2.52, 95% CI 1.704-3.734), swim-up method (OR 2.17, 95% CI 1.383-3.415) and TMSC of ?19.5 million (OR 1.78, 95% CI 1.076-2.954). The odds of successful pregnancy among patients whose duration of infertility is ? 2.5 years and who have a sperm motility count of ? 67.5 are more than thrice (OR 3.13, 95% CI 0.095-0.990), compared to those with duration of infertility of > 2.5 years. The formulated prognostic scoring index for IUI success was 18.6, with specificity of 91.1%, sensitivity of 39.4%.

CONCLUSION: Duration of infertility, female age, sperm motility, TMSC and sperm processing method significantly affect the success of IUI success among Filipino couples studied. Using the formula derived, with a sensitivity of 91% and a sensitivity of 39, couples with a score of ?18.6 are more likely to get pregnant 4 times more than those with a score of less than 18.6.

Human ; Female ; Adult ; Pregnancy ; Sperm Motility ; Pregnancy Rate ; Gestational Sac ; Prognosis ; Infertility, Female ; Spermatozoa ; Fertilization In Vitro ; Insemination

OBJECTIVE: To estimate the failure rate of medical treatment and to identify variables associated with treatment failure in patients with tubal pregnancy and an initial serum level of human chorionic gonadotropin (HCG) over 10,000 IU/L. METHODS: The inclusion criteria were tubal pregnancy diagnosed using ultrasonography, primary treatment of intramuscular methotrexate injection at one of the four institutions between January 2003 and December 2011, a serum HCG level within two days before treatment>10,000 IU/L, and follow-up data to determine treatment success or failure. Exclusion criteria were other primary treatments besides intramuscular methotrexate injection. The clinicopathologic data of 36 patients were collected and analyzed. RESULTS: Medical treatment failed and surgery was performed in 19 (53%) patients. In univariable analysis, age, parity, and size of the gestational sac were associated with treatment failure, but none of the variables were associated with treatment failure in multivariable analysis. The failure rate in the subgroup with age<33 years and size of gestational sac> or =1.1 cm was significantly higher than those of the other subgroups (82% vs. 41% [mean of the other subgroups], respectively). CONCLUSION: Patients with a serum HCG level>10,000 IU/L who received medical treatment had a high failure rate. Among them, patients aged<33 years and with a gestational sac> or =1.1 cm had an extremely high failure rate.
Chorionic Gonadotropin* ; Female ; Follow-Up Studies ; Gestational Sac ; Humans ; Humans* ; Methotrexate* ; Parity ; Pregnancy ; Pregnancy, Tubal* ; Treatment Failure ; Ultrasonography

A broad ligament pregnancy is an extremely rare condition. Diagnosis is often missed and finally made during laparotomy. We present a case which remained undiagnosed throughout her pregnancy till she reached term and unfortunately had intrauterine foetal demise when she reported to our hospital. On clinical suspicion, ultrasound and magnetic resonance imaging evaluation was done which picked up the diagnosis of abdominal pregnancy. On laparotomy a broad ligament pregnancy was found with a rent in the previous Cesarean scar towards the gestational sac in the broad ligament.
Rare Diseases ; Broad Ligament* ; Cicatrix ; Diagnosis ; Female ; Gestational Sac ; Laparotomy ; Magnetic Resonance Imaging ; Pregnancy ; Pregnancy, Abdominal ; Pregnancy, Ectopic* ; Ultrasonography