Choriocarcinoma associated with ectopic pregnancy

Eight patients with choriocarcinoma associated with ectopic pregnancy were treated at the John I. Brewer Trophoblastic Disease Center of Northwestern University Medical School from 1962 through 1981. This represented 4% of the 197 patients with documented choriocarcinoma or 1.7% of all 459 patients with gestational trophoblastic disease treated with chemotherapy at the center during this 20-year period. The presenting signs and symptoms were similar to those classically outlined for ectopic pregnancies: amenorrhea and abdominal pain (88%), irregular vaginal bleeding (75%), positive pregnancy test (100%), and adnexal mass (50%). Six patients (75%) had metastatic disease and four of these six had one or more high-risk factors. Two patients (25%) died of metastatic disease, both of whom had received chemotherapy elsewhere before referral to the center.

Retroperitoneal hematoma from a ruptured tubal pregnancy as an unusual cause of a pelvic mass. A case report

Retroperitoneal hematoma can result from a ruptured tubal pregnancy and present as a pelvic mass. Such a case has not been described previously.

Primary choriocarcinoma of the fallopian tube. Report of a case with survival and postoperative delivery. Review of the literature

A patient is presented with primary choriocarcinoma of the fallopian tube arising from a tubal pregnancy. Treatment consisted of an initial operation including adnexectomy and resection of bilateral ovarian thecalutein cysts, followed by chemotherapy. The patient delivered a healthy infant 2 years later, and is alive and well 5 years after the event.

Ectopic pregnancy

Ectopic pregnancy is no longer dependent on laparotomy for definitive diagnosis. When patients present with massive hemoperitoneum, the diagnosis is usually obvious; but most patients do not present this way, so diagnostic aids are required. Culdocentesis is associated with unusually high false-negative and false-positive results. Laparoscopy is accurate but is an invasive procedure unwarranted in most cases for diagnosis. Although it is unusual to make the diagnosis of unruptured ectopic pregnancy by ultrasonography alone, when ultrasonography is combined with quantitative beta-subunit determinations of human chorionic gonadotropin, many ectopic pregnancies can be diagnosed before rupture occurs. The treatment of the woman with a ruptured ectopic pregnancy and in shock is immediate laparotomy and salpingectomy. Salpingostomy with removal of the ectopic mass and preservation of the tube may enhance a patient's subsequent fertility and may be useful in carefully selected women.

Reproductive outcome following two ectopic pregnancies

Consideration of reproductive potential following multiple ectopic pregnancies is important in counseling patients and when choosing a conservative surgical approach (salpingotomy, salpingostomy), partial salpingectomy, or in vitro fertilization. The cases of 336 patients at Yale-New Haven Hospital who had ectopic pregnancies between 1976 and 1981 were evaluated. Thirty-two patients (9.5%) had two ectopic pregnancies. Twenty-three patients (71.8%) were followed. Six of these (26.1%) were not able to conceive because of surgical sterilization, and four (17.4%) were not trying to conceive. Of those 13 patients (56.5%) actively trying to conceive and having at least one tube remaining, 4 (30.8%) had term intrauterine gestations. One had a third ectopic gestation, which represented 20% of all conceptions, or 7.7% of those individuals trying to conceive. Our results indicate that although the reproductive potential after two ectopic pregnancies is poor, viable pregnancies do occur, and the repeat ectopic pregnancy rate is not high enough to preclude a repeat conservative surgical approach.

Factors influencing fertility after ectopic pregnancy

Seventy-one cases of ectopic pregnancies that had been treated by salpingectomy or salpingo-oophorectomy were evaluated. All patients were attempting pregnancy after the surgical procedure. During a follow-up that ranged from 3 to 13 years the overall conception rate was 62%. Excluding the ectopic pregnancies, the uterine pregnancy rate was 52%. The repeat ectopic pregnancy rate was 12.6%. The uterine pregnancy rate was higher for patients treated by salpingectomy (p less than 0.02). The repeat ectopic pregnancy rate was similar after salpingectomy and salpingo-oophorectomy. The uterine pregnancy rate in women with a previous history of pelvic inflammatory disease was poor (19%), and those patients had a high incidence of recurrent ectopic pregnancy (27%). The pregnancy rate was higher in women who were under age 25 at the time of the ectopic pregnancy. Parity did not have an effect on future fertility.

Culdocentesis and ectopic pregnancy

Seventy-seven patients with ectopic pregnancy underwent culdocentesis; the tap was positive in 70%, negative in 10% and inadequate in 20%. A positive tap was significantly associated with a low hematocrit but was often obtained in patients without hypotension, tachycardia, peritoneal irritation or tubal rupture. While patients with peritoneal irritation were significantly more likely to have a large hemoperitoneum, many with 500 ml or more of hemoperitoneum did not have peritoneal irritation, hypotension, tachycardia, low hematocrit or tubal rupture. Culdocentesis is valuable for evaluating the patient suspected of having an ectopic pregnancy, and the absence of tachycardia, hypotension, low hematocrit or peritoneal irritation should not dissuade one from performing the test. A positive tap does not indicate tubal rupture, and a large hemoperitoneum may accumulate in its absence.

Bilateral tubal pregnancy following in vitro fertilization and embryo transfer

A case of bilateral tubal pregnancy resulting from in vitro fertilization and the transfer of two embryos is reported. Because the husband had retrograde ejaculation after surgical treatment of a malignant testicular tumour, cryopreserved semen was used.

Unusual presentations of ectopic pregnancy. A report of two cases

Extrauterine, or ectopic, pregnancy (EP) is located in the fallopian tube 95-97% of the time. EP occasionally continues to term, either in the abdomen or, more commonly, in the tube or ovary. Fistulae between the conceptus and the abdominal viscera or abdominal wall are most uncommon. Two rare clinical presentations of EP occurred at Good Shepherd Hospital. One was an advanced tubal pregnancy that formed a fistula with the abdominal wall and delivered spontaneously through the fistula, requiring surgical intervention. The second was an early tubal pregnancy that formed a fistula with the ileum, leading to severe rectal hemorrhage.