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Is Still Methotrexate an Option for Extratubarian Ectopic Pregnancies?
Abstracts / Journal of Minimally Invasive Gynecology 17 (2010) S178–S188 Setting: Peking Union Medical College Hospital, Beijing, China. Patients: Ninety-nine patients over sixty years old with stage III or IV prolapse but without stress urinary incontinence (SUI). Interventions: Modified pelvic reconstructive surgery. Intervention: Modified pelvic reconstructive surgery. Measurements and Main Results: No severe intraoperative complications were observed. At one year postoperatively, POP-Q measurements of Ba, Bp, and C were significantly improved from baseline (p\0.001), but 8 patients (8.1%) had recurrence. Significant improvement was noted in QOL scores(PFDI-20 and PFIQ-7). The incidence rate of mesh exposure and de novo incontinence was 2% and 12%, respectively. Conclusion: This new pelvic reconstructive surgery with cheaper vaginal mesh is an economic and efficient method that is more suitable for Chinese old people with severe pelvic organ prolapse. POSTER SESSION–UNLISTED MIG PROCEDURES
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intramuscular methyl ergonovine, uterine massage and rectal misoprostol, requiring placement of a Cook balloon. Adequate placement of the balloon was verifed by sonogram. 30 minutes afte the balloon placenment the patient became unresponsible and hypotensive. a beadside sonogram showed signs of intrabdominal bleeding and the balloon catheter was in the myometrium. Measurements and Main Results: A laparotomy was performed revealing a uterine rupture with the balloon protuding through the rupture, that probably was done while the curettage and allowed the passage of the catheter through that point. Due unable to stop the bleeding and restore the anatomy a subtotal abdominal hysterectomy was performed and 4 units or red blood cells packs were transfused. The patient was discharged 6 days later in excellent conditions. Conclusion: The use of the Cook balloon as a mininal invasive procedure to stop the bleeding in the postabortion period can lead to serious complications like uterine rupture.
631 633 Is Still Methotrexate an Option for Extratubarian Ectopic Pregnancies? Duen˜as-Garcia OF, Young CA, Mikhail M, Bingham J. Obstetrics and Gynecology, Bronx Lebanon Hospital Center, New York City, Bronx, New York Study Objective: Our aim was to report two individual case reports on the rarely occurring and lifethreatening condition of ectopic pregnancy developing in a Caesarean section scar and a cervical ectopic pregnancy in the second trimester. Conclusion: Intramuscular methotrexate is still a good option for extratubarian ectopic pregnancies. Due the rareness of these cases further studies are necessaries to determinate the safeties of the use of methotrexate. Design: Case report. Setting: Communitary teaching hospital. Patients: Case 1: a 27 year old primigravida with a second trimester cervical ectopic pregnancy. Case 2: a 35 year old gravida 4 with history of 3 previous cesarean deliveries. Intervention: The patient in case 1 presented to our emergency room with vaginal bleeding, finding a cervical ectopic pregnancy at 14 weeks, treated with intramuscular methotrexate, uterine artery embolization and finally curettage removing the remaining tissue with no massive bleeding. The second case is a patient with a first trimester heterotopic cesarean scar pregnancy. The patient decided to terminate the pregnancy and intramuscular methotrexate was given up to 3 doses and further follow up showed a total resolution of the ectopic pregnancy. Measurements and Main Results: Serum concentrations of the B-human chorionic gonadotropin were monitored until negative values. In the case number one despite the negative serum concentration of the homone, the patient had a remanent tissue that was removed during the curettage. Both patients did not present any side effects related to the methotrexate, no blood transfussion was required also in any of the patients. Conclusion: Intramuscular methotrexate is still a good option for extratubarian ectopic pregnancies. Due the rareness of these cases further studies are necessaries to determinate the safeties of the use of methotrexate. 632 Uterine Rupture Secondary to the Use a Cook Balloon as Tamponade Duen˜as-Garcia OF, Young CA, Mikhail M. Obstetrics and Gynecology, Bronx Lebanon Hospital, New York, Bronx, New York Study Objective: Demostrate that the use of balloon as tamponades in the postabortion period can lead to serious complications. Design: Case report. Setting: Communitary Teaching hospital. Patients: 38 years old gravida 4 para 3, with a 16 weeks intrauterine fetal death, bleeding and febrile. Intervention: The patient was admitted with the diagnosis of septic abortion. Due minimal cervical dilation a dilation and evacuation procedure was planned and at the end of the procedure the patient had profusse bleeding that did not stop with the use of intravenous oxytocin,
Evaluation of Single Mini-Incision Laparotomic Myomectomy Miyamoto Y,1 Hiraike O,1 Hiraike H,2 Ikezuki Y,2 Aisaka K.2 1Obstetrics and Gynecology, University of Tokyo, Tokyo, Tokyo, Japan; 2Obstetrics and Gynecology, Hamada Hospital, Tokyo, Tokyo, Tokyo, Japan Study Objective: To evaluate the benefit of the single mini-laparotomy (MIL) for treatment of leiomyoma and future pregnancy. Design: Retrospective analysis of 103 cases of leiomyoma who had taken the operations by the MIL method. Setting: Hamada Hospital, Tokyo. Patients: One hundred and three cases of the multiple leiomyoma (ages 2543 yrs, maximum diameters of myoma 12-20cm) were subjected under the enough informed consent. All of the subjects were suffering from infertility. Intervention: Myomectomy by the single lower abdominal transverse mini-laparotomy (4-5cm). The surgical knots were made by both hands tightly. Measurements and Main Results: The operation time was 98.5+/-33.2min (49-154min), the blood loss during the operation was 376.4+/-192.0g (80950g), and the weight of the fibroid was 396.4+/-219.9g (94-1080g). All of the patients recovered from the invasion of the operation within a few days, and there were no severe complications. Thirty-four cases had conceived within three years after the operation and delivered by cesarean section. No complications (such as the uterine rupture) were observed during their pregnancy courses. Conclusion: The surgical knots by using both hands are effective and safety method to repair the uterine wall for the future pregnancy. Myomectomy by the single mini-laparotomy is safe and effective treatment in the patients of multiple leiomyoma who are wishing to conceive.
634 Spontaneous Rupture of Uterine Artery in Puerperium: A Case Managed by Selective Coil Embolization of Internal Iliac Artery Thakur M,1 Kumar S,1 Asaad R,1 Seman SJ.2 1Department of Obstetrics and Gynecology, Wayne State University/ Detroit Medical Center, Detroit, Michigan; 2Department of Surgery (Trauma Surgery), Sinai-Grace Hospital, Detroit, Michigan Study Objective: To present a case of spontaneous rupture of uterine artery in puerperium and discuss its management. Design: Case report. Setting: University Teaching Hospital. Patients: 39 years old G3P2002 who had a vaginal delivery. Intervention: Ultrasound, exploratory laparotomy, selective coil embolisation of internal iliac artery. Measurements and Main Results: A 39 yo G3P2002 had a vaginal delivery following induction of labor at 38 weeks for chronic hypertension and superimposed pre-eclampsia. She had high blood pressures intrapartum requiring IV labetalol and received IV Magnesium sulphate for seizure prophylaxis. The delivery was complicated by
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intramuscular methyl ergonovine, uterine massage and rectal misoprostol, requiring placement of a Cook balloon. Adequate placement of the balloon was verifed by sonogram. 30 minutes afte the balloon placenment the patient became unresponsible and hypotensive. a beadside sonogram showed signs of intrabdominal bleeding and the balloon catheter was in the myometrium. Measurements and Main Results: A laparotomy was performed revealing a uterine rupture with the balloon protuding through the rupture, that probably was done while the curettage and allowed the passage of the catheter through that point. Due unable to stop the bleeding and restore the anatomy a subtotal abdominal hysterectomy was performed and 4 units or red blood cells packs were transfused. The patient was discharged 6 days later in excellent conditions. Conclusion: The use of the Cook balloon as a mininal invasive procedure to stop the bleeding in the postabortion period can lead to serious complications like uterine rupture.
631 633 Is Still Methotrexate an Option for Extratubarian Ectopic Pregnancies? Duen˜as-Garcia OF, Young CA, Mikhail M, Bingham J. Obstetrics and Gynecology, Bronx Lebanon Hospital Center, New York City, Bronx, New York Study Objective: Our aim was to report two individual case reports on the rarely occurring and lifethreatening condition of ectopic pregnancy developing in a Caesarean section scar and a cervical ectopic pregnancy in the second trimester. Conclusion: Intramuscular methotrexate is still a good option for extratubarian ectopic pregnancies. Due the rareness of these cases further studies are necessaries to determinate the safeties of the use of methotrexate. Design: Case report. Setting: Communitary teaching hospital. Patients: Case 1: a 27 year old primigravida with a second trimester cervical ectopic pregnancy. Case 2: a 35 year old gravida 4 with history of 3 previous cesarean deliveries. Intervention: The patient in case 1 presented to our emergency room with vaginal bleeding, finding a cervical ectopic pregnancy at 14 weeks, treated with intramuscular methotrexate, uterine artery embolization and finally curettage removing the remaining tissue with no massive bleeding. The second case is a patient with a first trimester heterotopic cesarean scar pregnancy. The patient decided to terminate the pregnancy and intramuscular methotrexate was given up to 3 doses and further follow up showed a total resolution of the ectopic pregnancy. Measurements and Main Results: Serum concentrations of the B-human chorionic gonadotropin were monitored until negative values. In the case number one despite the negative serum concentration of the homone, the patient had a remanent tissue that was removed during the curettage. Both patients did not present any side effects related to the methotrexate, no blood transfussion was required also in any of the patients. Conclusion: Intramuscular methotrexate is still a good option for extratubarian ectopic pregnancies. Due the rareness of these cases further studies are necessaries to determinate the safeties of the use of methotrexate. 632 Uterine Rupture Secondary to the Use a Cook Balloon as Tamponade Duen˜as-Garcia OF, Young CA, Mikhail M. Obstetrics and Gynecology, Bronx Lebanon Hospital, New York, Bronx, New York Study Objective: Demostrate that the use of balloon as tamponades in the postabortion period can lead to serious complications. Design: Case report. Setting: Communitary Teaching hospital. Patients: 38 years old gravida 4 para 3, with a 16 weeks intrauterine fetal death, bleeding and febrile. Intervention: The patient was admitted with the diagnosis of septic abortion. Due minimal cervical dilation a dilation and evacuation procedure was planned and at the end of the procedure the patient had profusse bleeding that did not stop with the use of intravenous oxytocin,
Evaluation of Single Mini-Incision Laparotomic Myomectomy Miyamoto Y,1 Hiraike O,1 Hiraike H,2 Ikezuki Y,2 Aisaka K.2 1Obstetrics and Gynecology, University of Tokyo, Tokyo, Tokyo, Japan; 2Obstetrics and Gynecology, Hamada Hospital, Tokyo, Tokyo, Tokyo, Japan Study Objective: To evaluate the benefit of the single mini-laparotomy (MIL) for treatment of leiomyoma and future pregnancy. Design: Retrospective analysis of 103 cases of leiomyoma who had taken the operations by the MIL method. Setting: Hamada Hospital, Tokyo. Patients: One hundred and three cases of the multiple leiomyoma (ages 2543 yrs, maximum diameters of myoma 12-20cm) were subjected under the enough informed consent. All of the subjects were suffering from infertility. Intervention: Myomectomy by the single lower abdominal transverse mini-laparotomy (4-5cm). The surgical knots were made by both hands tightly. Measurements and Main Results: The operation time was 98.5+/-33.2min (49-154min), the blood loss during the operation was 376.4+/-192.0g (80950g), and the weight of the fibroid was 396.4+/-219.9g (94-1080g). All of the patients recovered from the invasion of the operation within a few days, and there were no severe complications. Thirty-four cases had conceived within three years after the operation and delivered by cesarean section. No complications (such as the uterine rupture) were observed during their pregnancy courses. Conclusion: The surgical knots by using both hands are effective and safety method to repair the uterine wall for the future pregnancy. Myomectomy by the single mini-laparotomy is safe and effective treatment in the patients of multiple leiomyoma who are wishing to conceive.
634 Spontaneous Rupture of Uterine Artery in Puerperium: A Case Managed by Selective Coil Embolization of Internal Iliac Artery Thakur M,1 Kumar S,1 Asaad R,1 Seman SJ.2 1Department of Obstetrics and Gynecology, Wayne State University/ Detroit Medical Center, Detroit, Michigan; 2Department of Surgery (Trauma Surgery), Sinai-Grace Hospital, Detroit, Michigan Study Objective: To present a case of spontaneous rupture of uterine artery in puerperium and discuss its management. Design: Case report. Setting: University Teaching Hospital. Patients: 39 years old G3P2002 who had a vaginal delivery. Intervention: Ultrasound, exploratory laparotomy, selective coil embolisation of internal iliac artery. Measurements and Main Results: A 39 yo G3P2002 had a vaginal delivery following induction of labor at 38 weeks for chronic hypertension and superimposed pre-eclampsia. She had high blood pressures intrapartum requiring IV labetalol and received IV Magnesium sulphate for seizure prophylaxis. The delivery was complicated by