Cervical ectopic pregnancy is one of the rarest forms of ectopic pregnancy. We present a single center case series of 10 cases of cervical ectopic pregnancy, where 3 patients underwent small-caliber hysteroscopy as a single treatment method.This was a ...

Background and Objectives: Inherited thrombophilia (IT) increases the risk of adverse pregnancy outcomes, but the benefit of low-molecular-weight heparin (LMWH) prophylaxis remains debated. This study aimed evaluate the effect of LMWH by analyzing outcomes in women with IT who received LMWH versus those who did not and also compare pregnancy complication rates before and after inherited thrombophilia diagnosis. Materials and Methods: We conducted a retrospective case–control study including 276 pregnant women with inherited thrombophilia and prior pregnancy complications and 276 healthy pregnant controls on delivery. The main outcome was the incidence of complications: preterm rupture of membranes, oligohydramnios, fetal growth restriction, preterm delivery, stillbirth, HELLP syndrome, gestational hypertension, deep vein thrombosis, and recurrent pregnancy loss. The effect of LMWH was assessed by comparing complication rates among inherited thrombophilia patients who received therapy versus those who did not. Results: Women with IT were older, had higher BMI, delivered earlier, and had neonates with lower birth weight compared to controls. In current pregnancies, LMWH was associated with reduced rates of preterm delivery, fetal growth restriction, gestational hypertension, and recurrent pregnancy loss, especially in factor V Leiden carriers. LMWH had little effect on low-risk genotypes and was not independently associated with outcome reduction. Conclusions: LMWH prophylaxis should be reserved for high-risk women with IT. Routine use in all IT pregnancies is not justified and may cause unnecessary risks and costs. Early screening, risk stratification, and individualized care are essential to optimize outcomes.

Epitheliod trophoblastic tumor (ETT) account for only 1–2% of all the cases of gestational trophoblastic neoplasia (GTN), with a reported mortality rate of 10–24%. ETT is derived from chorionic type intermediate trophoblastic cells, which appears to be the reason for the only slightly elevated βhCG levels in these patients. We present a case of a 42-year-old patient who was admitted to the clinic eight months after Caesarean delivery, for irregular vaginal bleed with normal values of beta-human chorionic gonadotropin (βhCG). A 6 × 5 cm hematoma was evacuated from the isthmic uterine segment during the operation, and the histopathological exam of the tissue surrounding the hematoma revealed ETT. There were no metastatic lesions on the thoracal, abdominal, and pelvic CT. The second ultrasonographic exam revealed tumefaction of 5 cm at the site from the previous surgical procedure. Color Doppler imaging revealed no central nor peripheral blood flow. The patient underwent a total abdominal hysterectomy with bilateral adnexectomy without adjuvant chemotherapy. This appears to be one of the shortest intervals from the anteceded gestational event until the diagnosis of this tumor, along with the absence of the significant ultrasonographic feature of the ETT-peripheral Doppler signal pattern. We underline that, even with normal values of βhCG, irregular vaginal bleeding following the antecedent gestational event should always arouse suspicion of GTN.

In relation to the most commonly described ampullary ectopic pregnancies in contemporary gynecological practice, rare localizations of ectopic pregnancies represent a diagnostic and therapeutic challenge whose clinical significance far exceeds their frequency. In contrast to tubal ectopic pregnancy, these implantation localizations are characterized by specific anatomical relationships and early trophoblastic invasion into highly vascularized tissues, which is why classical diagnostic algorithms and therapeutic patterns are often not applicable in clinical practice. Clinical uncertainty is further increased by the fact that a large proportion of these pregnancies in early gestation cannot be precisely mapped and initially present as pregnancies of unknown location. This narrative review integrates contemporary evidence and guidelines of relevant professional societies with the aim of highlighting patterns of diagnostic errors, systemic weaknesses of existing approaches, and key points for safe clinical decision-making. Special emphasis is placed on the role of disciplined transvaginal ultrasound evaluation, terminological precision, and timely recognition of high-risk and nonspecific implantations. Analysis of the available literature indicates that therapeutic decisions must be individualized and guided by the implantation site and assessment of hemorrhagic risk, rather than gestational age or absolute β-hCG values. Understanding these principles represents the basis for reducing serious complications and for the development of future diagnostic and therapeutic algorithms, thereby improving treatment outcomes.

Introduction. Adnexal torsion is a serious complication in pregnancy that can lead to ovarian ischemia and necrosis. This retrospective study aimed to provide clinically driven guidelines for treatment of adnexal torsion during pregnancy. Case report. We analyzed data from 10 patients who underwent surgery for adnexal torsion between 2018 and 2023. The most common symptoms were pelvic pain, nausea, and vomiting. Laparoscopy and laparotomy were equally performed, with the choice depending on factors like trimester and tumor size. Unfortunately, adnexectomy was the most common surgery due to delayed presentation and advanced necrosis. Despite this, pregnancy outcomes were favorable, with most patients delivering live babies. Discussion. The most frequent adnexal tumor in pregnancy is the corpus luteum cyst. Several studies suggest laparoscopic management of adnexal torsion in pregnancy with excellent maternal and fetal outcomes. Both delayed diagnosis and intervention can lead to adnexal necrosis and hence increase the risk of miscarriage and maternal morbidity Conclusion. Expectant management is not recommended. Due to the increased risk of miscarriage and maternal morbidity, laparoscopy (detorsion and cystectomy) is the safest and most effective type of surgery in the first trimester. Laparotomy might be more appropriate in the third or late second trimester or with a very large adnexal mass.

Introduction: Inherited thrombophilia (IT) presents genetic conditions associated with the risk of deep vascular thrombosis (DVT) and obstetric complications (OC) such as preeclampsia (PE), fetal growth restriction (FGR), stillbirth and placental abruption (PA). The aim of our study was to evaluate the frequency of OC and oxidative stress (OS) in women with IT during pregnancies with and without low molecular weight therapy (LMWH), compared to women with healthy pregnancies. Material and methods: We evaluated 60 pregnant women with IT diagnosed before ongoing pregnancy based on previous DVT or OC (study group) and 60 healthy pregnant women (control group). Blood samples were collected before delivery, along with placental tissue from all subjects, to determine the activity of CAT, GPX, GH, SH, GR, CuZnSOD, and MnSOD enzymes. Results: After the introduction of LMWH therapy, the total number of OC decreased significantly in women with IT. Analyzing the association between OC and different kinds of IT, we found significant association only between Factor V Leiden mutation and Protein C deficiency with GH/PE. Levels of SH are higher in IT; CAT, GPH and GR are three times more active in patients with IT with LMWH therapy compared to control group. Conclusion: Values of OS parameters in pregnant women with IT during delivery may confirm increased OS in those patients indicating that introduction of antioxidant therapy may be advisable.