Submited on: 26 Jul 2013 12:11:13 AM GMT
Published on: 26 Jul 2013 04:21:55 AM GMT
 

  • What are the main claims of the paper and how important are they?

    This is a case report of a patient who conceived spontaneously and had a previous history of ectopic pregnancy and kept initially for conservative management and given methotrexate but later taken up for laporotomy with suspected ruptured left ectopic and increasing beta hcg despite methotrexate and they found coincidenta right interstitiall prenancy besides the ruptired left ectopic pregnancyand so they proceeded with left salpingectomy and right salpingostomy in view of intact ectopic on right side and patient being infertile.


  • Are these claims novel? If not, please specify papers that weaken the claims to the originality of this one.

    No

    1)Rani VR,Pulliyath G.Viable intrauterine pregnancy after spontaneous bilateral tubal ectopics in a multiparous woman:a case report.J Med Case Rep 2013 jUN 20;7(1):159
    2)Mathlouthi N,Jellouli MA,Ben Temime R,Makhlouf T,Attia L,Abdellatif C.Spontaneous and simultaneous bilateral tubal pregnancy.Tunis Med 2012 jUL 90(7):582.
    3)Eze N,Obuna JA,Ejikeme BN.Billateral tibal ectopic pregnancies:a report of 2 cases .Ann Afr Med 2012apr-jun,11(2):112-5. .where they present 1 spontaneous and 1 bilateral ectopic following ovulation induction with cc.
    4)Shetty JP,Shetty B,Mkkanawar JH,Chandrika.Arare case of bilatera tubal pregnancy.J Indian Med Assoc 2011;109(7):506-7.
    5)Ghaffari F,Yazdi PE,Kiani K.Acase report of bilateral tubal ectopic pregnancy following day 5 embryo transfer. Arch Med Sci 2011;7(6):1087-1088.
    6)Balasubramaniam ES,Van Noorden S,El-Bahrawy M.The expression of interleukin -6,IL8,and their receptors in fallopian tubes with e4ctopic tubal gestation.Fert Steril 2012;98(4):898-904.
    7)Pehlivanov BK,Amaliev GI,Malinova ML,Amaliev IG.Bilateralsimulataneous isthmic ectopic pregnancy after clomiphene induction.Folia Med(Plovdiv)2012;54(4):78-9.


  • Are the claims properly placed in the context of the previous literature?

    Yes


  • Do the results support the claims? If not, what other evidence is required?

    Yes


  • If a protocol is provided, for example for a randomized controlled trial, are there any important deviations from it? If so, have the authors explained adequately why the deviations occurred?

    NA


  • Is the methodology valid? Does the paper offer enough details of its methodology that its experiments or its analyses could be reproduced?

    NA


  • Would any other experiments or additional information improve the paper? How much better would the paper be if this extra work was done, and how difficult would such work be to do, or to provide?

    I feel the author has reviewed the same thing which has been done a lot of times and not given importance to why and how spontaneous bilateral [pregnamncies should occur and reason in ART pregnancies why twin ectopic pregnancies are increasing .There are quiet a few grammatical errors -since it is vdery long i am trying to point examples to correct eg in abstract accordingly left rupture ectopic seen -eother write eft ruptured ectopic was seen,similarly in case report findings ine 14 &15,she was prepared for urgent laporomy as a case of left ruptured ectopicpregnancy .iN Laporotomy ,uterus was found fixed in the pelvis-please put a was and previous line urgent laporotomy as left rupture ectopic,in discussion line 21in us an estimated 30-40woman dies-please make ot women die ,next paragraph we performed insteasd of we perform left sal;pingectomy in our feautured case.


  • Is this paper outstanding in its discipline? (For example, would you like to see this work presented in a seminar at your hospital or university? Do you feel these results need to be incorporated in your next general lecture on the subject?) If yes, what makes it outstanding? If not, why not?

    Yes incidence of twin ectopic is increasing with ART -initially it was thought that using blastocysts may prevent but that has not been the case as shown by a case report given in reference.Reason given for greater incidence for ectioics in ivf seems to be a spray effect with greater amount of fluid and partly tuboperitoneal disease as otherwose still embryos should return back to cavity and partly embryo itself.other factor is with just use of cc greater incidence of ectopics identified,balasubramaniam identified greatewr IL6,8 and changed pattern of chemokines in patients who developed ectopics besides tole of prokineticins with chlamudial infections which needs further study to prevent more ectopic pregnancy incidence.Although rosk of future ectopic increases 10times with a salpingostomy like in this case the recent report of spontaneous pregnacy following biateral ectopic one cant challenge although ot remains debatable whether one should leave the tube behind in a nulliparous patienmt who most probabnly will need ivf in future.


  • Other Comments:

    No

  • Competing interests:
    None
  • Invited by the author to review this article? :
    No
  • Have you previously published on this or a similar topic?:
    Yes
  • References:

    Heterotopic pregnancy along with twin intrauterine viable pregnancies ending in live twin babies followingl aporotomy and surgical removal of tyhe secondary abdominal preg foll ivf presented in world congress on fallopian tubes in kolkata in 2005 .

  • Experience and credentials in the specific area of science:

    I have been practicing infertility ART and reproductive endocrinology for over 25 years.

  • How to cite:  Kaur K K.Review on Bilateral Ectopic Pregnancy: Case Report[Review of the article 'Bilateral Ectopic Pregnancy: Case Report ' by Mossa H].WebmedCentral 2013;4(7):WMCRW002811
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Bilateral Ectopic Pregnancy: Case Report
Posted by Dr. Pankaj P Salvi on 26 Jul 2013 04:52:23 PM GMT

  • What are the main claims of the paper and how important are they?

    Bilateral Ectopic pregnancy in the tubes is the rarest form of ectopic pregnancy.

    In an intact contraleral tube with bleeding and ruptured ectopic pregnancy in the ipsilateral tube go ahead with salpingectomy.

    The aim in bilateral tubal ectopic is to try and preserve at least one tube by salpingostomy based on the intraoperative findings but not to compromise in the safety of the patient if its bleeding, in this case of bleeding it maymandate bilateral tubal resection.

    The preferred way is conservative management and minimally invasive surgery. All these claims are perfectly accepted and extremely important.


  • Are these claims novel? If not, please specify papers that weaken the claims to the originality of this one.

    These claims are not novel and there are books and literatures on this available at all important search engines.

    e.g TeLindes textbook of gynaecological surgery, William's Obstetrics, Munro Kerr's operative obstetrics etc.


  • Are the claims properly placed in the context of the previous literature?

    Yes


  • Do the results support the claims? If not, what other evidence is required?

    yes


  • If a protocol is provided, for example for a randomized controlled trial, are there any important deviations from it? If so, have the authors explained adequately why the deviations occurred?

    This A case report and the methodology for reporting the finds etc is not a standard one.


  • Is the methodology valid? Does the paper offer enough details of its methodology that its experiments or its analyses could be reproduced?

    No


  • Would any other experiments or additional information improve the paper? How much better would the paper be if this extra work was done, and how difficult would such work be to do, or to provide?

    Details of the exact clinical findings and the surgical findings with the intra-operative videos and pictures would be additional improvement work.


  • Is this paper outstanding in its discipline? (For example, would you like to see this work presented in a seminar at your hospital or university? Do you feel these results need to be incorporated in your next general lecture on the subject?) If yes, what makes it outstanding? If not, why not?

    No. Not an appropriate method of reporting . Details of the intra-operative findings lacking.


  • Other Comments:

    The case of bilateral tubal ectopic pregnancy is indeed very rare and the case report shall definately add to the world literature.

  • Competing interests:
    None
  • Invited by the author to review this article? :
    No
  • Have you previously published on this or a similar topic?:
    No
  • References:
    None
  • Experience and credentials in the specific area of science:

    I have myself done bilateral salpingectomy for the case of bilateral tubal ectopic pregnancy with hemodynamic unstable patient with ipsilateral ruptured tubal ectopic pregnancy, and 6-7 cm contralateral tubal ectopic pregnancy detedted intra-operatively and had to get 2-3 relatives inside the operation theatre to really show them the bilaterally damaged fallopian tubes due to ectopic pregnancies and get written informed consent to perform bilateral salpingectomy to save the life of the patient.

  • How to cite:  Salvi P P.Bilateral Ectopic Pregnancy: Case Report[Review of the article 'Bilateral Ectopic Pregnancy: Case Report ' by Mossa H].WebmedCentral 2013;4(7):WMCRW002807
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Bilateral ectopic pregnancy. Case report
Posted by Prof. Galal Lotfi on 26 Jul 2013 11:15:20 AM GMT

  • What are the main claims of the paper and how important are they?

    Seeing a case of bilateral ectopic pregnancy is rarer and could be once in alive time, so it should be reported no matter what 


  • Are these claims novel? If not, please specify papers that weaken the claims to the originality of this one.

    Yes, it is a case report that could be once in alive time


  • Are the claims properly placed in the context of the previous literature?

    Reasonable. 


  • Do the results support the claims? If not, what other evidence is required?

    Satisfactory


  • If a protocol is provided, for example for a randomized controlled trial, are there any important deviations from it? If so, have the authors explained adequately why the deviations occurred?

    Case report is not in need for that


  • Is the methodology valid? Does the paper offer enough details of its methodology that its experiments or its analyses could be reproduced?

    In the management, bhcg was higher than 7000 and most of papers stick to the cutting level of 5000 if thou are going to go conservatively. So whhe they embarked on methotrexate, knowing that the possibility off rupture is going to be there, and adhesions and subsequently recurrent ectopic. They counselled the relatives before doing the surgery. Why, do they have a consent. What if relatives said don't do the surgery. Very perplexing. 


  • Would any other experiments or additional information improve the paper? How much better would the paper be if this extra work was done, and how difficult would such work be to do, or to provide?

    If medical treatment and conservative surgery increase the rate of recurrent ectopic, do they have any recommendations so we dont use methotrexate if fertility is on the stake 


  • Is this paper outstanding in its discipline? (For example, would you like to see this work presented in a seminar at your hospital or university? Do you feel these results need to be incorporated in your next general lecture on the subject?) If yes, what makes it outstanding? If not, why not?

    No because

    In the management, bhcg was higher than 7000 and most of papers stick to the cutting level of 5000 if thou are going to go conservatively. So whhe they embarked on methotrexate, knowing that the possibility off rupture is going to be there, and adhesions and subsequently recurrent ectopic.

    They counselled the relatives before doing the surgery. Why, do they have a consent. What if relatives said don't do the surgery. Very perplexing.


  • Other Comments:

    The language and grammer, past and present need some amendment 

  • Competing interests:
    None
  • Invited by the author to review this article? :
    Yes
  • Have you previously published on this or a similar topic?:
    No
  • References:
    None
  • Experience and credentials in the specific area of science:

    Yes I have

  • How to cite:  Lotfi G .Bilateral ectopic pregnancy. Case report[Review of the article 'Bilateral Ectopic Pregnancy: Case Report ' by Mossa H].WebmedCentral 2013;4(7):WMCRW002804
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