Background: Ectopic pregnancy after hysterectomy is a rare event. To date there are 73 defi nitive cases of post-hysterectomy ectopic pregnancy. The fi rst case was reported by Wendler in 1895.Case: A 31 year old P2G4 (one miscarriage) presented with a history of severe lower abdominal pain of three days duration. She previously had a subtotal hysterectomy four years prior her current presentation for a septic miscarriage with multiple organ dysfunction. She had a background history of being HIV reactive on antiretroviral therapy initiated two days before her presentation. Her CD4 count was 54 cells/uL, negative cryptococcal latex test. She was fi rst diagnosed with HIV in 2015, however had not been on antiretroviral therapy since then. On clinical examination she was hemodynamically stable, normal blood pressure and pulse, afebrile and no stigmata of AIDS. She had an acute abdomen and on pelvic examination a cervical stump was palpable with no blood from the cervical os. Her haemoglobin was 13.4g/dl. Urine pregnancy test was positive. Her quantitative beta-HCG of 3979 IU/L. Pelvic ultrasound showed fl uid collection in the pelvis, no defi nite masses seen, no uterus seen and ovaries could also not be visualised. Abdominal ultrasound did not show any abnormalities in the rest of the abdomen. The patient was counselled for surgery. Preparation with multidisciplinary consultation was done. Intraoperatively, 100ml haemoperitoneum was found. There were dense pelvic adhesions. Adhesiolysis was done and a bleeding right fallopian tube ampullary pregnancy was found. The right ovary was grossly normal. The contralateral adnexa could not be identifi ed. A right salpingectomy was done. Total blood loss was 100ml. She recovered well post operatively and was discharged three days later to continue her antiretroviral therapy.Discussion: A rare case of tubal ectopic pregnancy after hysterectomy is presented. Access to the peritoneal cavity and fallopian tube through the cervical canal, we postulated as the mechanism in this case. Ectopic pregnancies after hysterectomy are classifi ed into early and late. The former being associated with a pregnancy (or viable gametes) that was present at the time of hysterectomy. These present soon after the hysterectomy. The latter present long after the hysterectomy. Conception can occur after hysterectomy through access via a prolapsed fallopian tube, a fi stula or defect in the vault. Cervical stump pregnancy is also described. Surgical intervention is the most common intervention described amongst the case reports.Conclusion: Pregnancy after a hysterectomy is a rare possibility with possible adverse outcomes. Clinicians must have a strong index of suspicion for a possible ectopic pregnancy in patients that present with abdominal pain after hysterectomy.
New scientific and technological discoveries in all spheres of Medicine continuously challenge the boundaries of healthcare. To this end, the discipline is considered progressive and accomplished. The birth of this heavily professionalized discipline has leveraged the potential for the healthcare industry to innovate, regulate and disseminate proprietary products with relative ease. The rise and fall of four novel gynaecological devices represent excellent examples of ethical dilemmas in clinical medicine. This paper aims to deconstruct the power versus knowledge conflict, and suggest that reappraisal and recourse to Aristotelian virtue ethics will assist in shifting the decisional power balance primarily towards the physician.
Heterotopic pregnancy is defi ned as the coexistence of intrauterine and extra uterine pregnancy. A high index of suspicion is needed for early and timely diagnosis and intervention. Clinicians should remain alert to the possibility of heterotopic pregnancy even when an intrauterine pregnancy is confi rmed. Management options for heterotopic pregnancy includes expectant management, surgical intervention, medical management as well as transabdominal sonographic guided aspiration of the ectopic gestational embryo.With early diagnosis and treatment, 70% of the intrauterine pregnancies will reach viability
Amniotic band destruction syndrome is rare. It is a constellation of major and minor abnormalities, which arises from lacerated amniotic band. The amniotic band syndrome involving umbilical cord constriction is even rare. We describe a case of umbilical cord constriction resulting in fetal demise and limb defects in second trimester.
