Uterine artery embolization combined with methotrexate for broad ligament ectopic pregnancy in a 30-year old primigravida

We present the case of 30-year old primigravida female at 11 weeks\u27 gestation who was diagnosed to have ectopic pregnancy on obstetric ultrasound. An MRI pelvis was ordered to assess invasion into the posterior myometrium which confirmed a single right-sided broad ligament-extra uterine pelvic ectopic pregnancy with extrinsic mass effect on the right lower uterine segment without frank myometrial invasion. On an urgent basis, a uterine artery embolization (UAE) was performed by targeting the right femoral artery. Selective catheterization was performed of both uterine arteries and the right side showed a major feeder of the gestational sac. Supplied dose of methotrexate (95mg) was infused in the right uterine artery and both arteries were then embolized by gel foam slurry. Thus, prompt treatment reduced the risk of infertility and saved the patient from obstetrical emergency. Further exploration needs to be done in this field to explore conservative management options to preserve fertility

The radiological presentation of Rasmussen aneurysm secondary to pulmonary tuberculosis and COVID-19: A case report

Rasmussen aneurysm is rare diagnosis occurring in patients with long-standing tuberculosis. TB-COVID-19 co-infection in the context of Rasmussen aneurysm is a rare occurrence, yet new cases are emerging. An elderly male was recently diagnosed with TB-COVID-19 co-infection and presented with sudden onset massive hemoptysis. The patient was diagnosed with Rasmussen aneurysm after being evaluated by computed tomography pulmonary angiogram due to a suggestive clinical presentation. Interventional radiologists planned for embolization of pulmonary artery, with an unidentifiable source. It was suspected that the patient\u27s source of bleeding was hampered due to local tamponade effect or thrombosis of the aneurysm. The patient remained stable after 24 hours on computed tomography pulmonary angiogram. Our case emphasizes the importance of Rasmussen aneurysm as a differential diagnosis when presented with a TB-COVID-19 co-infection and sudden onset of hemoptysis symptomatically and radiologically. The timely diagnosis and management are key to improve mortality

Reference range of Amniotic Fluid Index (AFI) in primigravidae with gestational age from 37 to 42 weeks in a local (Pakistani) population.

Background: Amniotic fluid index (AFI) is a key element in fetal biophysical profile that predicts pregnancy outcome especially near term in primigravidae. The objective of the study was to determine a reference range of AFI in primigravidae of a local population having gestational age from 37 to 42 weeks. Methodology: This study was carried out from January 2019 to December 2019 after approval from Institutional Review Board and Ethical Committee at Shifa International hospital, Islamabad, Pakistan. Applying inclusion and exclusion criteria, a sample of 272 was selected. AFI was calculated for each subject using ultrasound and recorded on a data collection sheet. For the sake of simplicity and clinical relevance, the population was further stratified as term pregnancy (gestational age 37-39 weeks) and postdates pregnancy (40-42 weeks). The reference range of AFI was then calculated using mean ±two standard deviations. Results: The reference range of AFI for gestational age of 37-42 weeks (population as a whole) was 6.8- 17.2 cm. For term pregnancy, it was 7.5- 17.5 cm, and for postdate pregnancy, it was 5.8 to 15.4 cm. Conclusion: The reference range of AFI for gestational age of 37 to 42 weeks in Primigravida women was 6.8 to 17.2 cm. There is a decreasing trend in AFI as pregnancy advances from term to postdate. Keywords:  Amniotic Fluid Index, Gestational age, Primigravida, Reference Range

Uterine artery embolization combined with methotrexate for broad ligament ectopic pregnancy in a 30-year old primigravida

We present the case of 30-year old primigravida female at 11 weeks’ gestation who was diagnosed to have ectopic pregnancy on obstetric ultrasound. An MRI pelvis was ordered to assess invasion into the posterior myometrium which confirmed a single right-sided broad ligament-extra uterine pelvic ectopic pregnancy with extrinsic mass effect on the right lower uterine segment without frank myometrial invasion. On an urgent basis, a uterine artery embolization (UAE) was performed by targeting the right femoral artery. Selective catheterization was performed of both uterine arteries and the right side showed a major feeder of the gestational sac. Supplied dose of methotrexate (95mg) was infused in the right uterine artery and both arteries were then embolized by gel foam slurry. Thus, prompt treatment reduced the risk of infertility and saved the patient from obstetrical emergency. Further exploration needs to be done in this field to explore conservative management options to preserve fertility