Persistent ectopic syndrome

Persistent ectopic syndrome is a complication of conservative surgery for tubal pregnancy. This study is directed toward the escalating conservatism in the treatment of tubal ectopic pregnancy and its possible sequelae. Residual trophoblast propagation after initial surgery is becoming more frequent. Two cases are reported. The first woman was admitted with an acute abdomen; salpingectomy was performed to control hemorrhage from tubal rupture at the site of the previous salpingostomy. The second woman was treated by fimbrial expression. Because of the recurrence of pain, the beta human chorionic gonadotropin (BHCG) levels were measured; they indicated fresh trophoblastic activity. She was treated with methotrexate orally, 10 mg/d for 5 days. The need for BHCG surveillance of conservatively managed tubal ectopic pregnancy is stressed. The value of using methotrexate when tubal integrity persists is discussed in the light of its traditional role against trophoblastic tumours.

Ectopic tubal pregnancy treated by operative laparoscopy

Between July 1986 and May 1988, all 23 patients with ectopic tubal pregnancies of 5 to 10 1/2 weeks' gestation and with serum beta-human chorionic gonadotropin levels between 51 and 92,610 mIU/ml (first international reference preparation) were treated by operative laparoscopy. Twenty-two (96%) of the ectopic pregnancies were unruptured or leaking and one (4%) was ruptured. Fifteen patients (65%) were treated with electrosurgical linear salpingotomy, and three of these patients (20%) later needed subsequent operative procedures. Six patients (26%) were treated with laparoscopic partial or total salpingectomy, and two patients were treated with either fimbrial expression of the pregnancy or completion of a partial abortion. Twenty patients (87%) spent less than 24 hours in the hospital for successful treatment of the ectopic pregnancy. It is concluded that operative laparoscopy should be considered an alternative to laparotomy or minilaparotomy for the treatment of ectopic pregnancy.

Histopathologic study of ampullary and isthmic tubal ectopic pregnancy

A histopathologic study of 84 ampullary and seven isthmic tubal ectopic pregnancies was conducted. In 52.2% of ampullary pregnancies, the gestations were found intraluminally, and in most of these cases (85.1%), the muscularis was preserved. In isthmic pregnancies, the gestations were usually found extraluminally or both intraluminally and extraluminally. The disruption of the tubal wall was more extensive in isthmic pregnancy. This study suggests that in isthmic pregnancy, the trophoblast penetrates the tubal wall relatively early. It appears that linear salpingostomy could be done for ampullary pregnancy without jeopardizing luminal integrity. Its use for isthmic pregnancy is still unclear.

Tubal pregnancy causing haematoma in intra-uterine pregnancy diagnosed by ultrasound; a case report

Combined intra- and extra-uterine gestations have been increasingly reported during the last few decades. Patients with a history of prior pelvic inflammatory disease and/or ovulation induction before pregnancy are thought to have greater risk for heterotopic gestations. We present a case of tubal pregnancy causing haematoma formation through the tube thus threatening a simultaneous intra-uterine pregnancy demonstrated by ultrasound scanning. The validity of serial ultrasound scannings is emphasized, and attention must be given for mutual heterotopic pregnancies by patients at risk.

Heterotopic pregnancy after in vitro fertilization and ovulatory drugs

We report two cases of heterotopic pregnancy in women who were previously infertile. One of these patients conceived with the aid of ovulation stimulatory drugs, and the other from in vitro fertilization. In each case an ultrasound of the pelvis revealed a viable intrauterine pregnancy (twins in one case). Both patients presented in hypovolemic shock and required exploratory laparotomy. At the time of surgery a ruptured ectopic pregnancy with accompanying hemoperitoneum was found in each. Simultaneous ectopic and intrauterine pregnancy, though rare, should be suspected in patients who conceive with the aid of ovulatory drugs or in vitro fertilization.

Tubal pregnancy associated with a benign cystic teratoma of the fallopian tube. A case report

A benign teratoma of the fallopian tube occurred in association with a tubal pregnancy. This rare finding should be considered when two masses are present within a fallopian tube.

Tubal occlusion as a result of retained ectopic pregnancy: a case report

During a laparoscopic examination for infertility, a retained ectopic pregnancy was unexpectedly found occluding the fallopian tube. This case report raises concerns that observant management and medical treatment of ectopic pregnancy may lead to intratubal retention of and occlusion by chorionic tissue.

Distal segment tubal pregnancy after segmental resection for an isthmic pregnancy. A case report

The second case occurred of pregnancy in the remaining distal segment of a fallopian tube after segmental resection for an isthmic pregnancy.

Spontaneous resolution of ectopic pregnancy

Fourteen patients with ampullary tubal pregnancy confirmed by laparoscopy were initially managed conservatively. Serum human chorionic gonadotropin (hCG) levels were measured daily and strict clinical monitoring performed. In nine patients (64%), the tubal pregnancy spontaneously resolved. In four cases (29%), surgery was ultimately necessary. One patient with a coexistent intra- and extrauterine pregnancy was also successfully managed conservatively. There was a high probability of spontaneous resolution of the pregnancy when the serum hCG level at diagnosis was less than 1000 mIU/mL. Hysterosalpingography was performed after the spontaneous resolution of the tubal pregnancies. Tubal patency was demonstrated in all six patients, and three are currently pregnant. We conclude that conservative therapy allows spontaneous resolution of certain types of ectopic pregnancy.

Is tubal rupture a discriminating factor in the surgical conservative treatment of ectopic pregnancy?

217 women have been submitted to a surgical intervention for ectopic pregnancy in the years 83 - 84 - 85 in five hospitals in Piedmont. The rupture has been observed in 147 cases (67%). The percentage of women who presented a rupture was higher among those who underwent annexiectomy (75%), average among those who underwent salpingectomy (69%) and lower in case of conservative intervention (52%). Owing to these rather high percentages, we cannot state that the rupture is a discriminating factor as far as it concerns the choice of intervention, even if a fairly more conservative orientation is evident in case of unruptured tube.

Ectopic pregnancy: which treatment? Analysis of 217 cases

The Authors describe the various types of treatment performed on 217 cases of ectopic pregnancy examined, which took place in the years 1983 - 84 - 85 in five among the main Hospital in Piedmont. 136 salpingectomies (62%), 41 annexiectomies (18%), 40 conservative interventions (20%) were performed. In most cases the destructive intervention was performed in the presence of a tubal rupture; no meaningful relations between the location and the type of surgical treatment have been found in the ectopic pregnancy. Conservative interventions have been more frequent on young women (under 35: 97%) and desiring children either because nullipara (65%) or because uniparous (27%). The highest number of conservative interventions was performed in the largest of the five Hospitals examined (23 cases: 57%). There is therefore a remarkable relation between diagnostic and therapeutic means and the possibility of performing the surgery most appropriate to the specific requirements of each case.

Tubal pregnancy and the risk of subsequent infertility

One hundred forty-one women with tubal infertility, all of whom had been pregnant at least once before, were interviewed concerning their reproductive, contraceptive, medical, and sexual histories. Their responses were compared with those of a control group of 467 fertile women. A higher percentage of cases (13%) than controls (1%) had had a tubal pregnancy. From these percentages, we estimate that 92% of tubal infertility in women who have had a tubal pregnancy results from tubal pregnancy itself or factors that predisposed to its occurrence. We also estimate that approximately one-fifth of women who suffer a tubal pregnancy will subsequently be infertile because of a tubal abnormality. After controlling for the joint effects of several known risk factors for tubal pregnancy that independently predispose to infertility (eg, a history of pelvic inflammatory disease), the relative risk of tubal infertility associated with tubal pregnancy was 15.0 (95% confidence interval 5.2-43.6). However, because we had no sensitive indicator of antecedent tubal disease, we were extremely limited in our attempt to determine the extent to which this association was actually due to the consequences of the tubal pregnancy itself.

Ectopic pregnancy in an undescended fallopian tube: an unusual presentation

A case of a ruptured ectopic pregnancy in an undescended fallopian tube is presented. The tube and its ipsilateral ovary were located near the splenic flexure of the colon. The embryology and the differential diagnosis of this potentially fatal condition are discussed.

Morular metaplasia of the endometrium misdiagnosed as adeno-acanthoma in a patient with tubal pregnancy. A case report

A 41-year-old woman underwent a fractional dilatation and curettage for menorrhagia and a diagnosis of adeno-acanthoma was made from the curettings. However, the subsequent hysterectomy and bilateral salpingo-oophorectomy specimen revealed the presence of a clinically undiagnosed tubal pregnancy and extensive immature squamous metaplasia (morules) of the endometrium. No malignancy was present. A review of the original curettings lead to the recognition of the benign lesion already present at that stage. Difficulties in the differential diagnosis are discussed. The presence of endometrial polyps is considered as a possible factor responsible for the morular metaplasia rather than the tubal pregnancy, which seems to be a previously undescribed and interesting coincidence.

Ectopic pregnancy presenting as intermittent rectal bleeding and anemia. A case report

A case report is presented of a patient with anemia and intermittent rectal hemorrhage caused by a tubal pregnancy eroding into the rectum. A search through the clinical literature on ectopic gestation reveals the rarity of such an occurrence.