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Wu WF, Yi JS, Xie X, Liu CB. Risk factor for interstitial pregnancy following ipsilateral salpingectomy? A retrospective matched case control study. BMC Pregnancy Childbirth 2023; 23:826. [PMID: 38037027 PMCID: PMC10687775 DOI: 10.1186/s12884-023-06132-0] [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: 06/23/2023] [Accepted: 11/15/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Interstitial pregnancy may still happen even after ipsilateral salpingectomy, resulting in massive hemorrhage. Therefore, the purpose of the study is to identify risk factors associated with interstitial pregnancy following ipsilateral salpingectomy and discuss possible prevention. METHODS We conducted a retrospective cohort study in a single, large, university-affiliated hospital. Data of 29 patients diagnosed with interstitial pregnancy following ipsilateral salpingectomy from January 2011 to November 2020 were assigned into the case group (IP group). Whereas there were 6151 patients with intrauterine pregnancy after unilateral salpingectomy in the same period. A sample size of 87 control patients was calculated to achieve statistical power (99.9%) and an α of 0.05. The age, BMI and previous salpingectomy side between the two group were adjusted with PSM at a ratio of 1:3. After PSM, 87 intrauterine pregnancy patients were successfully matched to 29 IP patients. RESULTS After PSM, parous women were more common and intrauterine operation was more frequent in the IP group compared with control group (P<0.05). There was only one patient undergoing IVF-ET in the IP group as compared with 29 cases in the control group (3.4% vs. 33.3%, P<0.05). Salpingectomy was performed on 5 patients in the IP group and 4 patients in the control group due to hydrosalpinx (P<0.05). Logistic regression indicated that hydrosalpinx was the high risk factor of interstitial pregnancy following ipsilateral salpingectomy (OR = 8.175). CONCLUSIONS Hydrosalpinx appears to be an independent factor contributing to interstitial pregnancy following ipsilateral salpingectomy in subsequent pregnancy.
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Affiliation(s)
- Wei-Fang Wu
- Department of Obstetrics and Gynecology, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, 18, Daoshan Rd, 350001, Fuzhou, Fujian, China.
| | - Jing-Song Yi
- Department of Obstetrics and Gynecology, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, 18, Daoshan Rd, 350001, Fuzhou, Fujian, China
| | - Xi Xie
- Department of Obstetrics and Gynecology, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, 18, Daoshan Rd, 350001, Fuzhou, Fujian, China
| | - Chao-Bin Liu
- Department of Obstetrics and Gynecology, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, 18, Daoshan Rd, 350001, Fuzhou, Fujian, China.
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Recent progress in advanced biomaterials for long-acting reversible contraception. J Nanobiotechnology 2022; 20:138. [PMID: 35300702 PMCID: PMC8932341 DOI: 10.1186/s12951-022-01329-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 02/28/2022] [Indexed: 12/15/2022] Open
Abstract
Unintended pregnancy is a global issue with serious ramifications for women, their families, and society, including abortion, infertility, and maternal death. Although existing contraceptive strategies have been widely used in people's lives, there have not been satisfactory feedbacks due to low contraceptive efficacy and related side effects (e.g., decreased sexuality, menstrual cycle disorder, and even lifelong infertility). In recent years, biomaterials-based long-acting reversible contraception has received increasing attention from the viewpoint of fundamental research and practical applications mainly owing to improved delivery routes and controlled drug delivery. This review summarizes recent progress in advanced biomaterials for long-acting reversible contraception via various delivery routes, including subcutaneous implant, transdermal patch, oral administration, vaginal ring, intrauterine device, fallopian tube occlusion, vas deferens contraception, and Intravenous administration. In addition, biomaterials, especially nanomaterials, still need to be improved and prospects for the future in contraception are mentioned.
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Laparoscopic Management of 42 Cases of Tubal Stump Pregnancy and Postoperative Reproductive Outcomes. J Minim Invasive Gynecol 2019; 27:618-624. [PMID: 31726111 DOI: 10.1016/j.jmig.2019.04.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 04/05/2019] [Accepted: 04/26/2019] [Indexed: 01/06/2023]
Abstract
STUDY OBJECTIVE Tubal stump pregnancy is a rare variant of ectopic pregnancy. The aim of this study was to evaluate laparoscopic surgery for tubal stump pregnancy and to investigate postoperative pregnancy outcomes. DESIGN Retrospective study. SETTING University-affiliated hospital. PATIENTS Patients (n = 42) diagnosed with tubal stump pregnancy. INTERVENTIONS Data were extracted from the electronic medical records system of the hospital. MEASUREMENTS AND MAIN RESULTS Patients diagnosed with tubal stump pregnancy between June 2010 and July 2018 were included. Data included demographic characteristics, gravidity and parity, history of pelvic surgery, clinical features, and treatment. All procedures were laparoscopic. Postoperative pregnancy outcomes were identified from electronic medical records or by telephone. Patients' mean age was 30 (range, 21-39) years. Twelve of 42 tubal stump pregnancies (28.6%) had ruptured ectopic pregnancy at the time of operation. The remaining 30 cases had intact stump pregnancy during surgery. Patients were followed for a mean of 31 (range, 10-60) months. Follow-up data were available for 33 of 39 patients (3 with heterotopic tubal stump pregnancy were not included in follow-up data because all resulted in a live births and had no desire for future pregnancy). Eighteen of 28 patients (64.3%) who attempted conception had intrauterine pregnancies (IUPs) during the follow-up period; of these 18 IUPs, 14 (77.8%) resulted in live births. There was 1 case of uterine rupture in a singleton pregnancy at 20+5 weeks that resulted in fetal death. Three of 18 IUPs (16.7%) ended in the first trimester with spontaneous abortions. CONCLUSION Laparoscopic surgery is a feasible option for tubal stump pregnancy and is associated with favorable pregnancy outcomes.
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Yang X, Zhu L, Le F, Lou H, Zhao W, Pan P, Zou Y, Jin F. Proximal Fallopian Tubal Embolization by Interventional Radiology prior to Embryo Transfer in Infertile Patients with Hydrosalpinx: A Prospective Study of an Off-label Treatment. J Minim Invasive Gynecol 2019; 27:107-115. [PMID: 31580926 DOI: 10.1016/j.jmig.2019.02.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 02/23/2019] [Accepted: 02/27/2019] [Indexed: 11/17/2022]
Abstract
STUDY OBJECTIVE To evaluate in vitro fertilization (IVF) outcomes of proximal fallopian tube embolization by interventional radiology compared with laparoscopic salpingectomy before embryo transfer (ET) in patients with hydrosalpinx. DESIGN A single-center, off-label, nonrandomized prospective study. SETTING Academic university hospital. PATIENTS One hundred fifty-five patients with hydrosalpinx were identified on ultrasound or hysterosalpingography desiring IVF between April 2016 and December 2017. INTERVENTIONS Radiologically guided tubal occlusion with embolization microcoils (RTO-EM) and laparoscopic salpingectomy. MEASUREMENTS AND MAIN RESULTS Of the 155 analyzed patients, 42 were treated with RTO-EM and 113 with laparoscopic salpingectomy. The subsequent IVF outcomes, including implantation, clinical pregnancy, miscarriage, ectopic pregnancy, and ongoing pregnancy (i.e., a fetal heartbeat on ultrasound beyond 10 weeks) were compared between the 2 groups. Implantation and clinical pregnancy per ET cycle in the RTO-EM group were similar to that of the salpingectomy group (26.7% vs 30.2% [p = .51] and 39.0% vs 45.3% [p = .40], respectively), with a similar miscarriage rate. There was no statistically significant difference in ectopic pregnancies between the 2 groups. Moreover, no difference was detected in ongoing pregnancy per cycle between the 2 groups (33.9% vs 41.2%; p = .32). The ongoing-pregnancy rate per patient following RTO-EM was 47.6% (20 of 42) compared with 61.9% (70 of 113) following salpingectomy (odds ratio, 0.56; 95% confidence interval, 0.27-1.14; p = .11). CONCLUSION Pregnancy in the RTO-EM group was comparable to the salpingectomy group in patients with hydrosalpinx before ET treatment. RTO-EMs may be an alternative to salpingectomy for patients with hydrosalpinx planning for IVF-ET.
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Affiliation(s)
- Xinyun Yang
- Department of Reproductive Endocrinology, Women's Hospital, Zhejiang University School of Medicine (Drs. Yang, Zhu, Le, Lou, Zhao, Pan, and Jin); Department of Reproductive Endocrinology, Hangzhou Women's Hospital (Dr. Zhu); Department of Radiology, Women's Hospital, Zhejiang University School of Medicine (Dr. Zou), Hangzhou, Zhejiang, P.R. China
| | - Linling Zhu
- Department of Reproductive Endocrinology, Women's Hospital, Zhejiang University School of Medicine (Drs. Yang, Zhu, Le, Lou, Zhao, Pan, and Jin); Department of Reproductive Endocrinology, Hangzhou Women's Hospital (Dr. Zhu); Department of Radiology, Women's Hospital, Zhejiang University School of Medicine (Dr. Zou), Hangzhou, Zhejiang, P.R. China
| | - Fang Le
- Department of Reproductive Endocrinology, Women's Hospital, Zhejiang University School of Medicine (Drs. Yang, Zhu, Le, Lou, Zhao, Pan, and Jin); Department of Reproductive Endocrinology, Hangzhou Women's Hospital (Dr. Zhu); Department of Radiology, Women's Hospital, Zhejiang University School of Medicine (Dr. Zou), Hangzhou, Zhejiang, P.R. China
| | - Hangying Lou
- Department of Reproductive Endocrinology, Women's Hospital, Zhejiang University School of Medicine (Drs. Yang, Zhu, Le, Lou, Zhao, Pan, and Jin); Department of Reproductive Endocrinology, Hangzhou Women's Hospital (Dr. Zhu); Department of Radiology, Women's Hospital, Zhejiang University School of Medicine (Dr. Zou), Hangzhou, Zhejiang, P.R. China
| | - Wei Zhao
- Department of Reproductive Endocrinology, Women's Hospital, Zhejiang University School of Medicine (Drs. Yang, Zhu, Le, Lou, Zhao, Pan, and Jin); Department of Reproductive Endocrinology, Hangzhou Women's Hospital (Dr. Zhu); Department of Radiology, Women's Hospital, Zhejiang University School of Medicine (Dr. Zou), Hangzhou, Zhejiang, P.R. China
| | - Peipei Pan
- Department of Reproductive Endocrinology, Women's Hospital, Zhejiang University School of Medicine (Drs. Yang, Zhu, Le, Lou, Zhao, Pan, and Jin); Department of Reproductive Endocrinology, Hangzhou Women's Hospital (Dr. Zhu); Department of Radiology, Women's Hospital, Zhejiang University School of Medicine (Dr. Zou), Hangzhou, Zhejiang, P.R. China
| | - Yu Zou
- Department of Reproductive Endocrinology, Women's Hospital, Zhejiang University School of Medicine (Drs. Yang, Zhu, Le, Lou, Zhao, Pan, and Jin); Department of Reproductive Endocrinology, Hangzhou Women's Hospital (Dr. Zhu); Department of Radiology, Women's Hospital, Zhejiang University School of Medicine (Dr. Zou), Hangzhou, Zhejiang, P.R. China.
| | - Fan Jin
- Department of Reproductive Endocrinology, Women's Hospital, Zhejiang University School of Medicine (Drs. Yang, Zhu, Le, Lou, Zhao, Pan, and Jin); Department of Reproductive Endocrinology, Hangzhou Women's Hospital (Dr. Zhu); Department of Radiology, Women's Hospital, Zhejiang University School of Medicine (Dr. Zou), Hangzhou, Zhejiang, P.R. China.
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Cai HL, Pan LY, Wang SF, Tian Y, Zheng XZ, Yang Y, Li K. Discussion on operative skills in the embolization of hydrosalpinx by hysteroscopic placement of a microcoil. Medicine (Baltimore) 2019; 98:e14721. [PMID: 30882637 PMCID: PMC6426551 DOI: 10.1097/md.0000000000014721] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
This study aims to discuss the operative skills of hysteroscopic tubal embolization and reduce the occurrence of complications.Ninety-four patients were divided into group A and group B. The main surgical technique in group A: when the inner sleeve is sent to the fallopian tube and no longer accessible (but no >3 cm), remove the guide wire and put into the microcoil. But in group B, there are four major surgical techniques. First, the depth at which the guide wire enters the tube was controlled at 2 cm. Second, the inner diameter of the fallopian tube must be explored to determine the type and shape of the coils. Third, saline should be used to separate the catheter. Fourth, it is to control the release speed of the coils. The superiority of the improved operation method was confirmed by comparing the surgical failure rate, incidence of complications, and cost of surgery before and after the procedure.The reoperation rate of group A was 10% (3/30), while that of group B was 2.68% (3/112). The ectopic microcoils rate of group A was 6.67% (2/30), while that of group B was 0.89% (1/112). The microcoil damages rate of group 23.33% (7/30), while that of group B was 8.04% (9/112). All P values were <.01, and the difference was statistically significant.Hysteroscopic tubal embolization is currently a new surgical procedure to block the fallopian tubes and prevent the reverse flow of fluid in the fallopian tubes into the uterine cavity. After we improved surgical techniques, the surgical failure rate, complication rate, and operation cost of fallopian tube embolization were significantly lower than before the improved method was applied. The improved techniques led to a higher success rate.
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Affiliation(s)
- Hua-Lei Cai
- Department of Obstetrics and Gynecology, The Affiliated Hospital of Guizhou Medical University
| | - Le-Yun Pan
- Department of Obstetrics and Gynecology, The Affiliated Baiyun Hospital of Guizhou Medical University
| | - Shun-Fang Wang
- Department of Obstetrics and Gynecology, The Affiliated Baiyun Hospital of Guizhou Medical University
| | - Yu Tian
- Department of Obstetrics and Gynecology, The Affiliated Baiyun Hospital of Guizhou Medical University
| | - Xiao-Zhu Zheng
- Department of Obstetrics and Gynecology, The Affiliated Baiyun Hospital of Guizhou Medical University
| | - Yan Yang
- Department of Obstetrics and Gynecology, The Affiliated Baiyun Hospital of Guizhou Medical University
| | - Kun Li
- Department of Surgical, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
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Current techniques and outcomes in hysteroscopic sterilization: current evidence, considerations, and complications with hysteroscopic sterilization micro inserts. Curr Opin Obstet Gynecol 2017; 29:218-224. [PMID: 28537948 DOI: 10.1097/gco.0000000000000369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE OF REVIEW To describe the current data regarding effectiveness, complications, postoperative evaluation, and surgical interventions associated with Essure hysteroscopic sterilization. RECENT FINDINGS Hysteroscopic sterilization is a commonly performed procedure that is offered as a well tolerated, effective, outpatient method of permanent sterilization. Over the past several years, concerns have been raised regarding correct placement and postoperative complications. This has led to statements by both the Food and Drug Administration (FDA) in October, 2016 and American Association of Gynecologic Laparoscopists in February, 2017, as a significant portion of women seek removal of these devices. A current black-box warning issued by the FDA in 2016 recommends discussion of 'the probabilities of rates or events' of adverse outcomes associated with Essure placement. SUMMARY Although hysteroscopic sterilization is usually a safe, effective option for permanent contraception, new evidence regarding complications has emphasized the need for proper education and counseling. Appropriate patient selection and knowledge of potential complications is paramount to ensuring patients, and medical providers are well informed and have realistic expectations regarding potential placement and postoperative issues.
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