A rare case of bilateral spontaneous tubal ectopic pregnancy

A 30 year old woman with 40 days amenorrhoea presented with complains of pain in lower abdomen and blackish discharge per vaginum for 2 days. After investigations and ultrasound, she was diagnosed to have ruptured left tubal ectopic pregnancy. On exploratory laparotomy, patient had ruptured left tubal ectopic pregnancy and unruptured ampullary right tubal ectopic. After appropriate counseling salpingectomy was done on left side and removal of intact ectopic sac by salpingotomy followed by recanalization was done for right tube. Histopathology proved presence of bilateral ectopic pregnancy. Hysterosalpingography done 3 months later confirmed patency of right fallopian tube thus giving hope of natural conception. Spontaneous bilateral ectopic pregnancy is an extremely rare condition which most of the times is not diagnosed preoperatively. Conservative management is possible in a few cases after proper counseling

Safety and efficacy of simultaneous use of Mifepristone and Misoprostol in second trimester termination of pregnancy

Background: Combination of Mifepristone and Misoprostol has been successfully used for termination of pregnancy up to 63 days however no specific protocol is available for use in termination of pregnancy in second trimester. There are various regimens regarding optimal dose of Mifepristone and Misoprostol to be used in second trimester termination of pregnancy. Most of the regimens have a 24 to 48 hr. interval in administering the two drugs.Methods: This is a non-randomized prospective single arm interventional study approved by ethical committee of our institution and carried out over a period of 2 years from January 2013 to December 2014.This trial was also registered under Clinical Trial Registry Of India CTRI/2013/03/003488.152 healthy women who wanted to undergo second trimester termination of pregnancy were included in the study after applying inclusion and exclusion criteria. All women received T Mifepristone 200mg orally along with T Misoprostol 400mcg placed vaginally in the posterior fornix. T Misoprostol 200 mcg was placed vaginally every 4hrs till good uterine contractions were established. The end point of the study was complete abortion with expulsion of placenta. The induction abortion interval was noted. Women were observed for complications and women needing additional intervention to complete the abortion process were also noted.Results: The mean induction abortion interval was 783.17 minutes (13 hrs.) in our study which was comparable to similar study by Chai J et al in which induction-to-abortion interval was 10 hours 96% of women aborted in 24 hrs. and 100% in 32 hrs. in our study. 81% had no complications and 17% had minor complications which were managed by medicines alone.Conclusions: Simultaneous use of Mifepristone and misoprostol is both safe and effective in termination of pregnancy in second trimester