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Uncommon Ectopic Pregnancies—Challenges in the Management

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Abstract

Background

The risk factors for ectopic pregnancy are on the rise. Despite the progress (availability of serum βhCG, 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.

Objective

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.

Patients and Methods

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.

Results

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.

Conclusion

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.

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Acknowledgments

The authors express their sincere gratitude to Sir, Sabaratnam Arulkumaran, Prof. Emeritus, St George’s University, London, Past President FIGO, BMA and RCOG, for his valuable guidance while writing this manuscript. We sincerely thank Prof. C.N. Purandare, Past President, FIGO, FOGSI and Dean ICOG for all his valuable guidance in writing the article. I thank Md Jakir Hossain for his assistance in manuscript and photographic presentation.

Funding

No funding was received.

Author information

Authors and Affiliations

  1. Dept. OB-GYN, Agartala Govt. Medical College and GB Pant Hospital, Agartala, Tripura, India

    Hiralal Konar (MBBS, MD, DNB, MNAMS, FACS (US), FRCOG (Lond)

  2. Department of OB-GYN, SDU, Academy of Higher Education and Medical Research, Bangaluru, Karnataka, India

    Lisley Konar (MBBS, Resident (1st.Yr.M S)

  3. Department of OB-GYN, SDU Medical College, Bangaluru, Karnataka, India

    Chandrachur Konar (MS, DNB)

  4. Department of OB-GYN, Dinajpur Medical College, Raianj, West Bengal, India

    Arindam Halder (MBBS, MS, Associate Professor)

  5. Department of OB-GYN, N.R.S. Medical College and Hospital, Calcutta, India

    Arindam Saha (MD, R.M.O cum Clinical Tutor)

  6. Divine Nursing Home, Calcutta, India

    J. Khamaru (MD, R.M.O cum Clinical Tutor)

  7. P13, CIT Road, Kolkata, West Bengal, 700014, India

    Hiralal Konar (MBBS, MD, DNB, MNAMS, FACS (US), FRCOG (Lond)

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  1. Hiralal Konar
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  2. Lisley Konar
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  3. Chandrachur Konar
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  4. Arindam Halder
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Corresponding author

Correspondence to Hiralal Konar.

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Conflict of interest

The authors declare they have no conflict of interest.

Ethical approval

Ethical approval was taken from institutional ethics committee.

Ethical Standards

All procedures followed were in accordance with the ethical standards of the responsible committee on the human participants (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008.

Informed Consent

Informed and written consent was obtained from all the eligible women. Additional informed consent was obtained from all individual participants.

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Dr. Hiralal Konar, MBBS, MD, DNB, MNAMS, FACS (US), FRCOG (Lond), Prof and Head, Dept. OB-GYN: Agartala Govt. Medical College and GB Pant Hospital, Agartala,Tripura, India; Dr. Lisley Konar, MBBS, Resident (1st.Yr.M S), Dept OB-GYN, SDU, Academy of Higher Education and Medical Research, Karnataka, India; Dr. Chandrachur Konar, MS, DNB, Assistant Professor, Dept. OB-GYN. SDU Medical College, Karnataka, India; Dr Arindam Halder MBBS, MS, Associate Professor, Dept. OB-GYN, Dinajpur Medical College, West Bengal, India; Dr. Arindam Saha, MD, R.M.O cum Clinical Tutor, Dept. OB-GYN; N.R.S. Medical College, Calcutta, India; Dr. J. Khamaru, MD,Consultant Sonologist, Divine Nursingh Home, Calcutta, India.

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Konar, H., Konar, L., Konar, C. et al. Uncommon Ectopic Pregnancies—Challenges in the Management. J Obstet Gynecol India 72 (Suppl 1), 224–234 (2022). https://doi.org/10.1007/s13224-021-01605-8

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  • DOI: https://doi.org/10.1007/s13224-021-01605-8

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