Viable pregnancy on mirena,how to get pregnant using the withdrawal method,can u still get pregnant from pulling out,how to cook baby carrots sweet - 2016 Feature

The fertilised egg, now known as an embryo, develops in the fallopian tube for the first three days, then travels down into the uterus.
Bilateral ectopic pregnancies are increasing due to an increase in the incidence of pelvic inflammatory disease and increase in assisted reproductive techniques. A 33-year-old Indian woman presented with ruptured ectopic pregnancy associated with hemoperitoneum for which she underwent a laparotomy. A meticulous surgical technique conserving one fallopian tube resulted in subsequent viable intrauterine pregnancy.
IntroductionIn the past few decades the incidence of unusual presentations of ectopic pregnancies has risen along with an increase in assisted reproductive techniques[1].
Case presentationA 33-year-old Indian woman presented with irregular and scanty bleeding with occasional abdominal pain for 17 days. Picture showing uterus in the middle and two arrows indicating the ectopic pregnancies on both the fallopian tubes. The products from the right tube and cut portion of the left tube with ectopic pregnancy were sent for histopathological examination which showed presence of chorionic villi on both sides and the diagnosis of bilateral ampullary ectopic pregnancy was confirmed (Figures 2 and3).
Section of the left fallopian tube with chorionic villi inside and fibrin deposition around the villi. Serum beta human chorionic gonadotropin (HCG) became undetectable 3 weeks after surgery and the woman was advised to report missed periods or irregular bleeding immediately. ConclusionsThe present case and two other cases of intrauterine conception after bilateral ectopic pregnancies which have been studied show conservation of only a single fallopian tube[12, 13]. ConsentWritten informed consent was obtained from the patient for publication of this case report and accompanying images. Competing interestsThe authors declare that they have no competing interests.Authorsa€™ contributionsGP analyzed and interpreted the patient data regarding diagnosis and contributed in writing the manuscript. Except where otherwise noted, this work is licensed under Creative Commons Attribution-NonCommercial 4.0 International License.
Coexistence of a viable fetus with a hydatidiform mole is a rare condition and the diagnosis is very important because of the risk of developing severe complications in pregnancy.The management of these pregnancies is optional, although accurate and great care is required to find early signs of maternal or fetal complications. Hereby we report a case of dizygotic twin pregnancy with a complete mole and coexisting fetus that resulted in a live neonate. Coexistence of a viable fetus with a hydatidiform mole is a rare condition with an estimated frequency of 1 in 22,000 to 100,000 pregnancies (1, 2).
Since some patients with this type of pregnancy encounter with some infertility problems, they do not desire to finish their pregnancy.
The patient was a 39-year-old woman, gravida 2, para 1 with a normal term male infant delivered by a previous cesarean section 8 years ago.
At this time, the diagnosis of dizygotic twin molar pregnancy was confirmed and the patient was offered the termination of pregnancy due to future problems. According to the gross examination report, the specimen consisted of a placenta 20 A— 15 A— 12 cm in diameter and 315 g weight consisting of two parts. There are two different types of pregnancies that present the coexistence of a living fetus and appearance of a molar placenta.
In most cases when diagnosis was made in early pregnancy, termination of pregnancy was recommended. In a large study by Vaisbuch et al., they reported 130 cases of twins with CHMF (complete hydatidiform mole and coexistent fetus) pregnancy of which 41% were terminated because of the positive probability of serious maternal complications (6). Fetal complications such as spontaneous fetal loss before 24 weeks, intrauterine death and severe PTD before 32 weeks were reported. Recent literature in 2008 reviewed 24 studies that reported 30 cases of CHMF resulting in a live birth documented in detail (8). Therefore, management of molar pregnancy with an alive fetus is optional, although accurate and great care is required to find early signs of maternal or fetal complications and in the presence of a stable pregnancy, normal karyotype and a normal sonogram, it is reasonable to allow the pregnancy to continue. The sperms make their way through the cervix into the uterus and then on to the fallopian tubes. The egg is surrounded by a protective covering called the zona pellucida, which allows only one sperm to penetrate it. The length of the time that a woman's egg can be fertilized by a man's sperm ranges from 12-24 hours.
By the fifth day it will become a blastocyst, a hollow ball of cells surrounding a cyst-like cavity. Spontaneous conception after bilateral tubal ectopic pregnancy is associated with an increased risk of recurrent ectopic pregnancy. There was no history of missed periods and all her previous cycles were regular with normal flow. The postoperative period was uneventful and the patient was discharged on the fifth postoperative day. Although the surgical approach was laparotomy, studies have shown that conservation of future fertility and risk of recurrent ectopic pregnancy are the same in laparoscopy and laparotomy. A copy of the written consent is available for review by the Editor-in-Chief of this journal. The diagnosis of twin pregnancy with a complete hydatidiform mole is very important due to the risk of developing severe complications in pregnancy such as early onset of hypertension and pre-eclampsia (3).

Successive prenatal examination manifested the patient in good condition without any serious problems for the mother and the fetus.
A 3150 g normal male infant, with an Apgar score of nine and ten at 1 and 5 minutes, respectively, was delivered. One portion with a pink to dark reddish color and spongy consistency resembling a normal placenta and the other part consisted of multiple small vesicles resembling a hydatidiform mole. After cesarean section, the I?-hCG was followed for 1 year finally, returning to the normal level. One of them is a partial hydatidiform mole and the other is a twin pregnancy with a normal fetus which coexists with a complete or partial hydatidiform mole. The maternal complication and the necessity of termination of pregnancy is an important matter in clinical management.
Some previous studies reported a greater risk of PTD in women who had a twin pregnancy with CHMF (50-60%) compared with a singleton molar pregnancy (15%) (3).
The chance of an alive fetus in these cases has been estimated between 29% and 38% (2, 4) and no fetal anomalies have been yet reported. Management of twin pregnancies consisting of a complete hydatidiform mole and normal fetus.
Evaluation of the risk of persistent trophoblastic disease after twin pregnancy with diploid hydatidiform mole and coexisting normal fetus. Twin pregnancy consisting of a complete hydatidiform mole and co-existent fetus: report of two cases and review of literature. Twin pregnancy with complete hydatidiform mole and coexistent fetus: obstetrical and oncological outcomes in a series of 14 cases. Neither the service provider nor the domain owner maintain any relationship with the advertisers.
Once inside the egg, the head of the fertilizing sperm releases its genetic contents, which fuses with the nucleus of the egg.
The blastocyst then breaks free from its shell, or hatches, and it is ready to adhere to the surface of the endometrium. It calls for maximum care to prevent tubal damage when conservative surgery is done on the fallopian tube. A serum beta HCG estimation and a transvaginal ultrasound examination at 5 weeks revealed a single intrauterine pregnancy with good fetal cardiac activity. Many cases are as a result of assisted reproductive techniques.The postulated mechanisms of bilateral ectopic pregnancy include multiple ovulation, transperitoneal migration of trophoblastic tissue from one tube to another or superfetation[4].
The tubal damage may significantly be reduced by ligating the main feeding vessel in the mesosalpinx prior to salpingostomy.
In most cases, termination of pregnancy is recommended when the diagnosis is made in early pregnancy (3).
In the present study, we report a case of dizygotic twin pregnancy with a complete mole and coexistent fetus that resulted in a live neonate.
It seems that the normal placenta and the hydatidiform mole were attached subsequently increasing the gestational age. So, complete remission was diagnosed and the patient has remained clinically well eversince. In these two separate classifications, the genetic content and both maternal and fetal prognoses are completely different. Some studies such as Fishman et al.(4) reported the high frequency (71%) of pregnancy termination because of maternal complications. The recent study by Neimann in 2007 revealed that the risk of PTD after a diploid mole with a viable fetus is similar to that after a singleton molar pregnancy and elective early termination of such pregnancy because of the risk of PTD alone should not be recommended (5).
Cesarean section was reported due to fetal or maternal complications in 14 of 30 cases (46.7%).
In case of trademark issues please contact the domain owner directly (contact information can be found in whois). It begins to secrete human chorionic gonadotrophin (hCG), a hormone that tells the corpus luteum to continue progesterone production. Six months after surgery, she conceived spontaneously and a transvaginal ultrasound examination revealed a 5-weeks live intrauterine pregnancy.
The first baby died 52 days after delivery due to pneumonia and the second child is healthy and 7-years old. There are case reports on bilateral tubal pregnancy diagnosed with a ruptured ectopic on one tube and chronic ectopic on the other[5]. However, assessment of 77 twin pregnancies, comprising a complete hydatidiform mole and a healthy co-twin showed that these pregnancies have a high risk of spontaneous abortion, but about 40% result in livebirth without significantly increasing the risk of persistent gestational trophoblastic disease (4). The next control ultrasound examination showed the normal fetus and the hydatidiform mole clearly (Figure 1C and D).
Sections of molar vesicles revealed edematous villi with marked stromal hydropic changes and cistern formation. The incidence of a dizygotic hydatidiform mole with a viable fetus is very rare and this matter is distinguished from a partial molar pregnancy because there are two separate conceptions; namely, a normal placenta linked to the fetus and a molar gestation. Another study in 2009 which evaluated the registered data of patients from 1999 to 2006 showed the 50% (7 cases in 14) rate of gestational trophoblastic neoplasia (GTN) after CHMF.

However, in our study cesarean section was performed because of the previous history of cesarean section in this patient.
During the trip, sperm prepare themselves to meet the egg by subtle alterations of their heads and movement patterns. She has a history of a intrauterine copper contraceptive device insertion 10 months after her second delivery, which was removed 8 months before her presenting symptoms. The criteria for diagnosis of bilateral ectopic pregnancy were first suggested by Fishback and later revised by Norris who stated that microscopic demonstration of chorionic villi in each tube was sufficient for the diagnosis[6].The preoperative diagnosis of bilateral ectopic pregnancy remains a challenge.
Successive ultrasound examination at 13-week gestation demonstrated a live fetus with a marginal placenta previa.
In this rare entity, fetuses are chrosomally normal and potentially viable with an increased risk for hemorrhage and medical complications as well as the development of persistent gestational trophoblastic tumor. Six of these patients were treated by single-agent chemotherapy and only one needed multi-agent chemotherapy (7).
Serum beta HCG estimation is not reliable as the values will be elevated more than that of a single ectopic. The patient reported spotting from the first weeks of pregnancy until the end of pregnancy. Although the data of both studies come through oncologic reports and not exactly through gynecologic and obstetrics reports (5). Sperm can remain viable in the cervical mucus for 48-72 hours or more around the time leading up to ovulation.
There was no history suggestive of pelvic inflammatory disease, previous laparotomy or intake of fertility-enhancing drugs.On examination, the patient was pale, although her vitals were stable.
Detection with ultrasound scan is difficult and only very few cases have been diagnosed preoperatively by ultrasound[7].There are very few case reports in the literature on medical management of bilateral ectopic pregnancies. However, one report showed successful treatment of bilateral ectopics by two consecutive methotrexate injections into the gestational sac under vaginal ultrasonographic guidance[8].
Meanwhile, multiple small vesicles were reported by the sonologist at the anterior side of the uterus which were separated from the normal placenta (Figure 1A). A pelvic examination revealed mild bleeding per vagina, a normal-sized uterus and left forniceal tenderness. Another report shows failure of single dose methotrexate given for a single ectopic pregnancy which was later diagnosed to be a bilateral ectopic pregnancy[9]. In the next sonographic evaluation (18-20 weeks), a live fetus with a normal placenta was reported again in which a separated area of multiple small vesicles was seen. There is also a report on failed conservative management for suspected single ectopic pregnancy which on laparotomy was found to be a bilateral tubal ectopic pregnancy[10].During surgery for ectopic pregnancy, inspection of both tubes, ovaries and peritoneal cavity should be done.
First, it could be diagnosed as dizygotic twin pregnancy consisting of a normal fetus and a mole (Figure 1B).
With the clinical suspicion of ectopic pregnancy, an emergency ultrasound examination was performed which showed an empty normal-sized uterus and a gestational sac of 5A—4cm with a fetal pole having cardiac activity in the left fallopian tube. There are reports of failure to identify one of the bilateral ectopic pregnancies and the patient presenting a few days after surgery with acute abdominal pain[11]. There was also a moderate amount of fluid in the pouch of Douglas.In view of hemoperitoneum, an emergency laparotomy was done with informed consent. Management options should be discussed with the patient and relatives because of increased risk of recurrent ectopic pregnancy and future infertility.The fallopian tube derives its blood supply from branches of uterine and ovarian arteries. On opening, there was about 300mL of blood in the peritoneal cavity and the ampullary region of the left tube was distended with a 5A—4cm mass.
With an ectopic gestation in the tube, prominent blood vessels are seen in the mesosalpinx supplying the site of the ectopic pregnancy. Ligation of the main vessel of supply before removal of the products of conception by salpingostomy helps in decreasing bleeding from the site of the ectopic pregnancy. It reduces the use of cautery with less damage to the fallopian tubes.Only two previous reported cases of intrauterine conception following surgery done for bilateral ectopic pregnancy were retrieved after an extensive database search[12, 13].
With these findings, a bilateral ampullary pregnancy with features of tubal abortion on the left fallopian tube was diagnosed (Figure 1).
They were similar to the present case discussed, in that only one tube was conserved during surgery.
The intraoperative findings were explained to the womana€™s husband and the possibilities of salpingectomy or salpingostomy were discussed.
After bilateral spontaneous ectopics, there is a higher risk for heterotopic pregnancies as the patient has twin proneness[14].Bilateral ectopic pregnancies are being managed in different ways. Because the left tube was extensively damaged by the ectopic gestation and hematoma, salpingectomy was done. A linear salpingostomy was performed on her right fallopian tube after ligating the feeding vessel on the mesosalpinx 1cm below the ampullary ectopic pregnancy to control bleeding.

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