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Guo Q, Li Z, Jia S, Tong F, Ma L. Mechanism of Human Tubal Ectopic Pregnancy Caused by Cigarette Smoking. Reprod Sci 2023; 30:1074-1081. [PMID: 35962304 DOI: 10.1007/s43032-022-00947-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 04/14/2022] [Indexed: 10/15/2022]
Abstract
In the past few decades, the smoking rate of women of childbearing age has increased. Epidemiological data has repeatedly shown that smoking women have an increased risk of various reproductive diseases, including ectopic pregnancy (EP), decreased fertility, adverse pregnancy outcomes, and failure of assisted reproduction. The oviduct was the target of cigarette smoke in many in vivo and in vitro studies. The fallopian tube is a well-designed organ. Its function is to collect and transport the ova to the fertilized site and provide a suitable environment for fertilization and early embryonic development. Lastly, the fallopian tube transports the pre-implantation embryo to the uterus. Various biological processes can be studied in the fallopian tubes, making it an excellent model for toxicology. This paper reviews the roles of the fallopian tube in gametes and embryo transportation, and the possible mechanism tobacco smoke contributes to tubal EP. A possible signal pathway might be a model to develop intervention of EP for pregnant women exposed to smoking.
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Affiliation(s)
- Quan Guo
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Heping District Shenyang, 36 Sanhao Street, 110004, Shenyang, China.
| | - Zaiyi Li
- Reproductive Medicine Center, Seventh Affiliated Hospital, Sun Yat-Sen University, 628 Zhenyuan Road, Xinhu Street, Guangming District, Shenzhen, Guangdong, 510000, China
| | - Steve Jia
- RD Center, Pacificbio Inc. Irvine, Irvine, CA, 92602, USA
| | - Fangze Tong
- Murray Edwards College, University of Cambridge, Cambridge, CB3 0DF, UK
| | - Lin Ma
- Reproductive Medicine Center, Seventh Affiliated Hospital, Sun Yat-Sen University, 628 Zhenyuan Road, Xinhu Street, Guangming District, Shenzhen, Guangdong, 510000, China.
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Krick S, Helton ES, Easter M, Bollenbecker S, Denson R, Zaharias R, Cochran P, Vang S, Harris E, Wells JM, Barnes JW. ST6GAL1 and α2-6 Sialylation Regulates IL-6 Expression and Secretion in Chronic Obstructive Pulmonary Disease. Front Immunol 2021; 12:693149. [PMID: 34290711 PMCID: PMC8287524 DOI: 10.3389/fimmu.2021.693149] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 06/21/2021] [Indexed: 01/23/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a systemic disease strongly associated with cigarette smoking, airway inflammation, and acute disease exacerbations. Changes in terminal sialylation and fucosylation of asparagine (N)-linked glycans have been documented in COPD, but the role that glycosyltransferases may play in the regulation of N-linked glycans in COPD has not been fully elucidated. Recent studies suggest that modulation of ST6GAL1 (ST6 beta-galactoside alpha-2,6-sialyltransferase-1), which catalyzes terminal α2-6 sialylation of cellular proteins, may regulate inflammation and contribute to COPD phenotype(s). Interestingly, it has been previously demonstrated that ST6GAL1, a Golgi resident protein, can be proteolytically processed by BACE1 (beta-site amyloid precursor protein cleaving enzyme-1) to a circulating form that retains activity. In this study, we showed that loss of ST6GAL1 expression increased interleukin (IL)-6 expression and secretion in human bronchial epithelial cells (HBECs). Furthermore, exposure to cigarette smoke medium/extract (CSE) or BACE1 inhibition resulted in decreased ST6GAL1 secretion, reduced α2-6 sialylation, and increased IL-6 production in HBECs. Analysis of plasma ST6GAL1 levels in a small COPD patient cohort demonstrated an inverse association with prospective acute exacerbations of COPD (AECOPD), while IL-6 was positively associated. Altogether, these results suggest that reduced ST6GAL1 and α2-6 sialylation augments IL-6 expression/secretion in HBECs and is associated with poor clinical outcomes in COPD.
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Affiliation(s)
- Stefanie Krick
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, The University of Alabama at Birmingham, Birmingham, AL, United States
- Gregory Fleming James Cystic Fibrosis Research Center, The University of Alabama at Birmingham, Birmingham, AL, United States
| | - E. Scott Helton
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, The University of Alabama at Birmingham, Birmingham, AL, United States
| | - Molly Easter
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, The University of Alabama at Birmingham, Birmingham, AL, United States
| | - Seth Bollenbecker
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, The University of Alabama at Birmingham, Birmingham, AL, United States
| | - Rebecca Denson
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, The University of Alabama at Birmingham, Birmingham, AL, United States
| | - Rennan Zaharias
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, The University of Alabama at Birmingham, Birmingham, AL, United States
| | - Phillip Cochran
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, The University of Alabama at Birmingham, Birmingham, AL, United States
| | - Shia Vang
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, The University of Alabama at Birmingham, Birmingham, AL, United States
| | - Elex Harris
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, The University of Alabama at Birmingham, Birmingham, AL, United States
- Gregory Fleming James Cystic Fibrosis Research Center, The University of Alabama at Birmingham, Birmingham, AL, United States
| | - James M. Wells
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, The University of Alabama at Birmingham, Birmingham, AL, United States
- UAB Lung Health Center, Birmingham, AL, United States
- Birmingham VA Medical Center, Birmingham, AL, United States
| | - Jarrod W. Barnes
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, The University of Alabama at Birmingham, Birmingham, AL, United States
- Gregory Fleming James Cystic Fibrosis Research Center, The University of Alabama at Birmingham, Birmingham, AL, United States
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Fram KM, Saleh S, Thikerallah F, Fram F, Fram R, Rawahneh H, Khrais M, Darwish T. Setting priorities in the conventional approaches in managing ectopic pregnancy; is it time to reform? A teaching hospital experience. PRZEGLAD MENOPAUZALNY = MENOPAUSE REVIEW 2019; 18:222-226. [PMID: 32132886 PMCID: PMC7045355 DOI: 10.5114/pm.2019.93115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Accepted: 01/12/2020] [Indexed: 11/17/2022]
Abstract
THE AIM OF THE STUDY To review the management approaches of ectopic pregnancy (EP) at the Department of Obstetrics and Gynecology at Jordan University Hospital (JUH). MATERIAL AND METHODS All patients admitted to our department with the diagnosis of EP treated during the study period extending from January 2017 to June 2019. Data were collected retrospectively using the patients' files anonymously. Main outcome measures: age, parity, ectopic site, presentation, the main risk factor/s and the management plan. RESULTS In total, 65 cases of EP were managed during the study period. Overall, the mean age was 30 years. EP was located in the right tube in 23 cases, and in the left tube in 14 cases. Eleven patients presented with acute abdomen due to rupture of the EP and underwent urgent laparotomy; 7 of these cases were located on the right side. Conservative surgery (laparoscopy versus laparotomy) was the main line of management with attention to preserving the tube patency, followed by medical therapy when the patient fulfilled the criteria or those with pregnancy of unknown location. CONCLUSIONS EP is a life-threatening condition. It is time to reform the priorities in the conventional approach to management. Every effort ought to be applied to preserve the reproductivity of women who are diagnosed with EP at the JUH. We would suggest that salpingostomy needs to be considered the surgical treatment of choice for the majority of these cases.
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Affiliation(s)
- Kamil M. Fram
- Department of Obstetrics and Gynecology, Jordan University Hospital, Amman, Jordan
| | - Shawqi Saleh
- Department of Obstetrics and Gynecology, Jordan University Hospital, Amman, Jordan
| | - Fidaa Thikerallah
- Department of Obstetrics and Gynecology, Jordan University Hospital, Amman, Jordan
| | - Farah Fram
- Department of Obstetrics and Gynecology, Jordan University Hospital, Amman, Jordan
| | - Rand Fram
- Department of Obstetrics and Gynecology, Jordan University Hospital, Amman, Jordan
| | - Hadeel Rawahneh
- Department of Obstetrics and Gynecology, Jordan University Hospital, Amman, Jordan
| | - Mai Khrais
- Department of Obstetrics and Gynecology, Jordan University Hospital, Amman, Jordan
| | - Tamara Darwish
- Department of Obstetrics and Gynecology, Jordan University Hospital, Amman, Jordan
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van Rijswijk J, van Welie N, Dreyer K, Tajik P, Lambalk CB, Hompes P, Mijatovic V, Mol BWJ, Zafarmand MH. Tubal flushing with oil- or water-based contrast medium: can we identify markers that indicate treatment benefit? Hum Reprod Open 2019; 2019:hoz015. [PMID: 31334364 PMCID: PMC6638263 DOI: 10.1093/hropen/hoz015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 04/23/2019] [Indexed: 02/01/2023] Open
Abstract
STUDY QUESTION Can we identify patient characteristics that distinguish which ovulatory infertile women undergoing hysterosalpingography (HSG) benefit more or less from flushing with oil-based contrast medium compared to water-based contrast medium? SUMMARY ANSWER In ovulatory infertile women, HSG with oil-based contrast medium resulted in higher 6-month ongoing pregnancy and live birth rates as compared to HSG with water-based contrast medium and this treatment effect was independent of characteristics of the couple. WHAT IS KNOWN ALREADY We recently showed that in infertile women undergoing HSG, flushing with oil-based contrast medium resulted in more ongoing pregnancies than flushing with water-based contrast medium. STUDY DESIGN, SIZE, DURATION We used data from our randomized clinical trial (RCT) in which 1,119 ovulatory infertile women undergoing HSG during fertility work-up were randomized for use of oil-based (N = 557) or water-based (N = 562) contrast medium. PARTICIPANTS/MATERIALS, SETTING, METHODS We built logistic regression models to predict ongoing pregnancy and live birth (secondary outcome) as a function of the specific contrast, the specific marker, and marker-by-contrast-interaction. Markers considered were female age, maternal ethnicity, female smoking, body mass index (BMI), duration of infertility, infertility being primary or secondary, sperm quality, and previous appendectomy. MAIN RESULTS AND THE ROLE OF CHANCE The 6-month ongoing pregnancy rates in the overall population were 39.7% after use of oil-based contrast versus 29.1% after use of water-based contrast medium [relative risk (RR), 1.37; 95% confidence interval (CI), 1.16–1.61; P < 0.001]. Among the studied baseline characteristics, BMI (P = 0.002) and semen volume (P = 0.02) were statistically significant prognosticators. The treatment effect of oil-based contrast was stronger in women with a BMI ≤30 kg/m2 [RR, 1.54; 95% CI, 1.23–1.92; P = 0.002], and in women whose partner had a semen volume >3 ml [RR, 1.77; 95% CI, 1.28–2.46; P = 0.02]. Also, in women who smoked, the treatment effect of flushing with oil was stronger, but this interaction did not reach statistical significance (P = 0.066). We found no positive effect of oil-based contrast in obese women. We found similar but weaker associations for live birth, which was probably due to lower number of events resulting in less power. LIMITATIONS, REASONS FOR CAUTION The RCT was restricted to infertile ovulatory women younger than 39 years of age without endocrinological disorders and at low risk for tubal pathology. Our results should not be generalized to infertile women who do not share these features. WIDER IMPLICATIONS OF THE FINDINGS All infertile, ovulatory women younger than 39 years with a low risk for tubal pathology will benefit from an HSG with oil-based contrast; therefore, this should be offered to them after fertility work-up. STUDY FUNDING/COMPETING INTEREST(S) The original H2Oil RCT was an investigator-initiated study that was funded by the two academic institutions (AMC and VUmc) of the Amsterdam UMC. The study displayed in this paper was funded by an unconditional research grant from Guerbet. B.W.M. is supported by an NHMRC Practitioner Fellowship (GNT1082548). K.D. reports consultancy for Guerbet, during the conduct of the study, and also reports research grants from Guerbet. C.B.L. reports grants from Guerbet, during the conduct of the study, and grants from Ferring, grants from Merck, and personal fees from Ferring, outside the submitted work. P.H. reports grants from Guerbet, during the conduct of the study, and grants from Ferring and Merck, outside the submitted work. V.M. reports receiving travel and speakers fee as well as research grants from Guerbet. B.W.M. reports consultancy for ObsEva, Merck, Merck KGaA, and Guerbet, and research grants from Guerbet and Merck. The other authors have no conflict of interest to declare. TRIAL REGISTRATION NUMBER NTR 3270 www.trialregister.nl TRIAL REGISTRATION DATE 1 February 2012. DATE OF FIRST PATIENT’S ENROLMENT 3 February 2012.
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Affiliation(s)
- Joukje van Rijswijk
- Department of Reproductive Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Nienke van Welie
- Department of Reproductive Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Kim Dreyer
- Department of Reproductive Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Parvin Tajik
- Centre for Reproductive Medicine, Department of Obstetrics and Gynaecology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Cornelis B Lambalk
- Department of Reproductive Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Peter Hompes
- Department of Reproductive Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Velja Mijatovic
- Department of Reproductive Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Ben W J Mol
- Department of Obstetrics and Gynaecology, Monash Medical Centre, Monash Health and Monash University, Melbourne, Australia
| | - Mohammad H Zafarmand
- Centre for Reproductive Medicine, Department of Obstetrics and Gynaecology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.,Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
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Aiken CE, Tarry‐Adkins JL, Spiroski A, Nuzzo AM, Ashmore TJ, Rolfo A, Sutherland MJ, Camm EJ, Giussani DA, Ozanne SE. Chronic fetal hypoxia disrupts the peri-conceptual environment in next-generation adult female rats. J Physiol 2019; 597:2391-2401. [PMID: 30791124 PMCID: PMC6487938 DOI: 10.1113/jp277431] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 02/15/2019] [Indexed: 02/02/2023] Open
Abstract
KEY POINTS Exposure to chronic hypoxia during gestation influences long-term health and development, including reproductive capacity, across generations. If the peri-conceptual environment in the developing oviduct is affected by gestational hypoxia, then this could have implications for later fertility and the health of future generations. In the present study, we show that the oviducts of female rats exposed to chronic hypoxia in utero have reduced telomere length, decreased mitochondrial DNA biogenesis and increased oxidative stress The results of the present study show that exposure to chronic gestational hypoxia leads to accelerated ageing of the oviduct in early adulthood and they help us understand how exposure to hypoxia during development could influence reproductive health across generations. ABSTRACT Exposure to chronic hypoxia during fetal development has important effects on immediate and long-term outcomes in offspring. Adverse impacts in adult offspring include impairment of cardiovascular function, metabolic derangement and accelerated ovarian ageing. However, it is not known whether other aspects of the female reproductive system may be similarly affected. In the present study, we examined the impact of chronic gestational hypoxia on the developing oviduct. Wistar rat dams were randomized to either normoxia (21%) or hypoxia (13%) from day 6 post-mating until delivery. Post-delivery female offspring were maintained in normoxia until 4 months of age. Oviductal gene expression was assayed at the RNA (quantitative RT-PCR) and protein (western blotting) levels. Oviductal telomere length was assayed using Southern blotting. Oviductal telomere length was reduced in the gestational hypoxia-exposed animals compared to normoxic controls (P < 0.01). This was associated with a specific post-transcriptional reduction in the KU70 subunit of DNA-pk in the gestational hypoxia-exposed group (P < 0.05). Gestational hypoxia-exposed oviducts also showed evidence of decreased mitochondrial DNA biogenesis, reduced mtDNA copy number (P < 0.05) and reduced gene expression of Tfam (P < 0.05) and Pgc1α (P < 0.05). In the hypoxia-exposed oviducts, there was upregulation of mitochondrial-specific anti-oxidant defence enzymes (MnSOD; P < 0.01). Exposure to chronic gestational hypoxia leads to accelerated ageing of the oviduct in adulthood. The oviduct plays a central role in early development as the site of gamete transport, syngamy, and early development; hence, accelerated ageing of the oviductal environment could have important implications for fertility and the health of future generations.
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Affiliation(s)
- Catherine E. Aiken
- University of Cambridge Metabolic Research Laboratories and MRC Metabolic Diseases UnitWellcome Trust‐MRC Institute of Metabolic Science, Addenbrooke's Treatment Centre, Addenbrooke's HospitalCambridgeUK
- University Department of Obstetrics and GynaecologyUniversity of Cambridge, CambridgeUK
| | - Jane L. Tarry‐Adkins
- University of Cambridge Metabolic Research Laboratories and MRC Metabolic Diseases UnitWellcome Trust‐MRC Institute of Metabolic Science, Addenbrooke's Treatment Centre, Addenbrooke's HospitalCambridgeUK
| | - Ana‐Mishel Spiroski
- Department of Physiology, Development and NeuroscienceUniversity of CambridgeCambridgeUK
| | - Anna M. Nuzzo
- Dipartimento di Scienze ChirurgicheUniversita degli Studi di TorinoTurinItaly
| | - Thomas J. Ashmore
- University of Cambridge Metabolic Research Laboratories and MRC Metabolic Diseases UnitWellcome Trust‐MRC Institute of Metabolic Science, Addenbrooke's Treatment Centre, Addenbrooke's HospitalCambridgeUK
| | - Alessandro Rolfo
- Dipartimento di Scienze ChirurgicheUniversita degli Studi di TorinoTurinItaly
| | - Megan J. Sutherland
- Department of Physiology, Development and NeuroscienceUniversity of CambridgeCambridgeUK
| | - Emily J. Camm
- Department of Physiology, Development and NeuroscienceUniversity of CambridgeCambridgeUK
| | - Dino A. Giussani
- Department of Physiology, Development and NeuroscienceUniversity of CambridgeCambridgeUK
| | - Susan E. Ozanne
- University of Cambridge Metabolic Research Laboratories and MRC Metabolic Diseases UnitWellcome Trust‐MRC Institute of Metabolic Science, Addenbrooke's Treatment Centre, Addenbrooke's HospitalCambridgeUK
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Influence of Active Exposure to Tobacco Smoke on Nitric Oxide Status of Pregnant Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15122719. [PMID: 30513890 PMCID: PMC6313314 DOI: 10.3390/ijerph15122719] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 11/14/2018] [Accepted: 11/14/2018] [Indexed: 12/12/2022]
Abstract
Smoking tobacco can impair proper vascular endothelial functioning. This is exhibited through reduced nitric oxide synthesis as well as activity due to accompanying oxidative stress. We examined the relationship between nitric oxide and markers of oxidative stress/antioxidant defense in serum of smoking and non-smoking pregnant women. Subjects included 99 healthy pregnant women, who were tested for nitric oxide (NO), endothelial (eNOS) and inducible (iNOS) nitric oxide synthase, total oxidant capacity (TOC), and total antioxidant capacity (TAC). NO, eNOS, and TAC serum concentrations were significantly lower (p < 0.005), but iNOS (p < 0.05) and TOC (p < 0.001) were higher in smokers than in non-smokers. Multivariate regression analysis showed associations between NO concentration and eNOS, TAC, and smoking status in the whole group of patients. In the model estimated separately for smokers, the highest impact of eNOS (β = 0.375; p = 0.021) and cotinine (β = −0.323; p = 0.037) was indicated for NO concentration. In the model of non-smokers, eNOS (β = 0.291, p = 0.030) and TAC (β = 0.350; p = 0.015) were important for NO level. Smoking during pregnancy could exacerbate oxidative stress, impair the action of nitric oxide synthases, and adversely affect the balance of oxygen and nitrogen metabolism. Relationships between NO concentrations and TAC in the studied women’s blood can confirm the antioxidant nature of nitric oxide.
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Yu M, Wang H, Liu J, Qin H, Liu S, Yan Q. The sialyltransferase ST3Gal3 facilitates the receptivity of the uterine endometrium
in vitro
and
in vivo. FEBS Lett 2018; 592:3696-3707. [DOI: 10.1002/1873-3468.13252] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 08/13/2018] [Accepted: 09/02/2018] [Indexed: 01/03/2023]
Affiliation(s)
- Ming Yu
- Department of Biochemistry and Molecular Biology Liaoning Provincial Core Lab of Glycobiology and Glycoengineering Dalian Medical University China
| | - Hao Wang
- Department of Biochemistry and Molecular Biology Liaoning Provincial Core Lab of Glycobiology and Glycoengineering Dalian Medical University China
| | - Jianwei Liu
- Department of Biochemistry and Molecular Biology Liaoning Provincial Core Lab of Glycobiology and Glycoengineering Dalian Medical University China
| | - Huamin Qin
- Department of Pathology The Second Affiliated Hospital of Dalian Medical University China
| | - Shuai Liu
- Department of Biochemistry and Molecular Biology Liaoning Provincial Core Lab of Glycobiology and Glycoengineering Dalian Medical University China
| | - Qiu Yan
- Department of Biochemistry and Molecular Biology Liaoning Provincial Core Lab of Glycobiology and Glycoengineering Dalian Medical University China
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Yang M, Cidan L, Zhang D. Retroperitoneal ectopic pregnancy: a case report and review of the literature. BMC Pregnancy Childbirth 2017; 17:358. [PMID: 29037192 PMCID: PMC5644087 DOI: 10.1186/s12884-017-1542-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 10/08/2017] [Indexed: 11/10/2022] Open
Abstract
Background Retroperitoneal ectopic pregnancy (REP) is an extremely rare type of ectopic pregnancy, with a total of less than 20 cases reported in the English literature. However, failure to recognize REP may result in severe consequences. Case presentation We report a case of 32-year-old woman with REP. She had amenorrhea, left lower abdominal pain, but no vaginal bleeding. Her urine human chorionic gonadotropin (HCG) test was positive and blood HCG level was 1880 m-international units per milliliter (mIU/mL). Transvaginal ultrasound sonography showed a left adnexal mass. Laparoscopy found an enlarged uterus, normal right uterine tube and ovary, and normal left uterine tube. The left ovary was partly covered by a blood clot, but appeared normal after removing the clot. There was a 10-mm circular peritoneal defect located lateral to the left sacrocervical ligament, anterior to the left ovarian fossa, and next to the lower edge of the left broad ligament. The patient was diagnosed of having REP with the gestational tissues covered by the peritoneum. The REP was removed by laparoscopic surgery. Bleeding was stopped by bipolar coagulation and absorbable hemostatic cellulose. The patient recovered smoothly and was discharged on the next day after surgery. Her blood HCG returned to normal range 29 days after surgery. Conclusions REP is very rare, but in any suspected case of ectopic pregnancy, caution must be paid to find signs of REP when the common sites of ectopic pregnancy do not have any positive findings.
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Affiliation(s)
- Man Yang
- Section of Reproductive Endocrinology, Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, No. 20 Section 3 of South Renmin Road, Chengdu, Sichuan Province, 610041, China
| | - Lamu Cidan
- Section of Reproductive Endocrinology, Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, No. 20 Section 3 of South Renmin Road, Chengdu, Sichuan Province, 610041, China
| | - Dan Zhang
- Section of Reproductive Endocrinology, Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, No. 20 Section 3 of South Renmin Road, Chengdu, Sichuan Province, 610041, China.
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