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Jongjakapun A, Salang L, Aueaungkul A, Kleebkaow P. Chronic interstitial ectopic pregnancy presenting with a negative urine pregnancy test. BMJ Case Rep 2024; 17:e259267. [PMID: 38589241 PMCID: PMC11015295 DOI: 10.1136/bcr-2023-259267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2024] Open
Abstract
The ampulla portion of the fallopian tube is the most common site of ectopic pregnancy (70%), with approximately 2% of pregnancies implanted in the interstitial portion. In general, an interstitial ectopic pregnancy (IEP) is difficult to diagnose and is associated with a high rate of complications-most patients with an IEP present with severe abdominal pain and haemorrhagic shock due to an ectopic rupture. Chronic tubal pregnancy (CTP) is an uncommon condition with an incidence of 20%. The CTP has a longer clinical course and a negative or low level of serum beta-human chorionic gonadotropin due to perished chorionic villi. This study presents a case of a woman who was diagnosed with a chronic IEP (CIEP) which was successfully treated by surgery. This case also acts as a cautionary reminder of considering a CIEP in women of reproductive age presenting with amenorrhea, vaginal bleeding and a negative pregnancy test.
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Affiliation(s)
- Apiwat Jongjakapun
- Obstetrics and Gynaecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Lingling Salang
- Obstetrics and Gynaecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Apiwat Aueaungkul
- Obstetrics and Gynaecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Pilaiwan Kleebkaow
- Obstetrics and Gynaecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
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Li Y, Yu Y, Kou XH, Han ZL. Forensic Analysis of Eighteen Tubal Pregnancy-Related Medical Damage. Fa Yi Xue Za Zhi 2023; 39:571-578. [PMID: 38228476 DOI: 10.12116/j.issn.1004-5619.2022.220707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
OBJECTIVES To analyze the cases of medical damage after misdiagnosis of tubal pregnancy, to explore the causes of medical damage, the causal relationship between medical malpractice and the damage consequences, as well as the causative potency, in order to provide evaluation ideas for forensic identification of such cases. METHODS Eighteen cases of forensic identification of tubal pregnancy related medical damage were collected and retrospectively analyzed from the aspects of age, maternity history, fertility requirements, risk factors, diagnosis and treatment, medical malpractice, damage consequences, and causative potency. RESULTS All 18 cases were tubal pregnancy, of which 17 cases had medical malpractice, resulting in 14 cases of affected tubal resection, 2 cases of hemorrhagic shock death, 1 case of intrauterine fetal death and affected tubal resection. The other case had the consequence of affected tubal resection, but there was no malpractice in the treatment. CONCLUSIONS Correct diagnosis is helpful to make appropriate treatment plan, prevent disease progression and reduce serious adverse consequences and the occurrence of medical disputes. Scientific and reasonable analysis of the causal relationship between medical malpractice and damage consequences and the causative potency is of great significance to the successful settlement of medical disputes.
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Affiliation(s)
- Ying Li
- Beijing Huaxia Evidence Identification Center, Beijing 100089, China
| | - Yong Yu
- Beijing Source of Judicial Identification Center of Scientific Evidence, Beijing 100062, China
| | - Xing-Hua Kou
- Beijing Huaxia Evidence Identification Center, Beijing 100089, China
| | - Zhan-Long Han
- Beijing Huaxia Evidence Identification Center, Beijing 100089, China
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Botsyurko R, Smoligová V. Bilateral tubal ectopic pregnancy after spontaneous conception. Ceska Gynekol 2023; 88:287-290. [PMID: 37643910 DOI: 10.48095/cccg2023287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
OBJECTIVE Presentation of a case report of a rare case of bilateral tubal pregnancy in a female patient after spontaneous conception. OBSERVATION We present a case of a 26-year-old female patient first hospitalized in the Gynecology Obstetrics Clinic of the Pilsen University Hospital, where a laparoscopy was indicated for suspicion of ectopic tubal pregnancy during which a left-sided salpingectomy was performed for a macroscopically clear finding of a tubal pregnancy on the left side, this finding was also confirmed histologically. Subsequently, the patient was discharged to home care. During a follow-up examination by a district gynaecologist, the patient complained of a recurrence of pain in the lower abdomen, on collection of hCG (human chorionic gonadotropin) its increase was detected and the patient was sent for a control gynaecological examination to Mulacova Hospital in Pilsen. On the examination in the outpatient clinic, she reported significant lower abdominal pain and collapsed during transvaginal ultrasound and was hospitalized. Subsequently, diagnostic laparoscopy was indicated during hospitalization, during which tubal pregnancy on the right and hemoperitoneum were macroscopically evident. A right-sided salpingectomy was performed for this finding with subsequent hCG drop, resolution of the discomfort and histological confirmation of tubal pregnancy on the right. CONCLUSION The incidence of such cases without prior ovulation stimulation is 1 out of 200,000 pregnancies and an estimated 1 out of 725 to 1 out of 1,580 ectopic pregnancies. Even so, bilateral tubal or heterotopic ectopic pregnancy should be considered in the differential diagnosis, as both conditions can be immediately life-threatening.
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Sun PP, Dong SY, Xie JL, Liu KK, Guo AP. Management of a uterine serosal heterotopic pregnancy after in vitro fertilization in a woman with bilateral salpingectomy: A case report and literature review. Medicine (Baltimore) 2022; 101:e32551. [PMID: 36595862 PMCID: PMC9794245 DOI: 10.1097/md.0000000000032551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
RATIONALE Heterotopic pregnancy (HP) is defined as the simultaneous presence of intrauterine pregnancy and ectopic pregnancy (EP). HP after bilateral salpingectomy is extremely rare and may lead to serious complications if it is misdiagnosed and untreated timely. Here, we presented the first reported case of uterine serosal HP in a woman after assisted reproductive technology with bilateral salpingectomy because of bilateral tubal ectopic pregnancy. PATIENT CONCERNS A 27-years-old pregnant woman after in vitro fertilization with bilateral salpingectomy complained of a sudden onset of unprovoked abdominal pain, which was persistent and dull. She denied vaginal bleeding. DIAGNOSES Serum beta-human chorionic gonadotropin levels are difficult to predict HP. Transvaginal ultrasonography demonstrated 1 gestational sac in the uterine cavity and 1 thick-walled cystic mass over the upper of the uterus, with a large amount of fluid in the Pouch of Douglas. Emergency laparotomy revealed a uterine serosal pregnancy combined with intrauterine pregnancy. INTERVENTIONS This patient was successfully managed via emergency laparotomy to remove residual tissue and repair the rupture of the uterine serosal pregnancy. OUTCOMES At postoperative 4 days, repeat transvaginal ultrosonography presented 1 intrauterine gestational sac with a visible fetal bud and cardiac tube pulsation. Now the patient recover well and is in an ongoing pregnancy. LESSONS It is noteworthy that HP/ectopic pregnancy is still not prevented after bilateral salpingectomy. In cases of multiple embryo transfer, even if intrauterine pregnancy has been established, it is important to rule out HP/ectopic pregnancy in time. Early diagnosis and early management can significantly improve clinical outcomes.
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Affiliation(s)
- Ping-Ping Sun
- The Reproductive Medicine Centre of Weifang People’s Hospital, Weifang, Shandong, China
| | - Shu-Yi Dong
- The Reproductive Endocrinology Department of Gaomi Maternity and Child Care Hospital, Weifang, Shandong, China
| | - Jin-Long Xie
- The Reproductive Medicine Centre of Weifang People’s Hospital, Weifang, Shandong, China
| | - Kun-Kun Liu
- The Reproductive Medicine Centre of Weifang People’s Hospital, Weifang, Shandong, China
| | - Ai-Ping Guo
- The Reproductive Endocrinology Department of Gaomi Maternity and Child Care Hospital, Weifang, Shandong, China
- * Correspondence: Ai-Ping Guo, The Reproductive Endocrinology Department of Gaomi Maternity and Child Care Hospital, No. 3188 Fenghuang Street of Gaomi, Weifang, Shandong Province 261000, China (e-mail: )
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Wang T, Li Q. Extratubal secondary trophoblastic implants (ESTI) following laparoscopic bilateral salpingectomy for ectopic pregnancy: problems that have been neglected for a long time. Gynecol Endocrinol 2022; 38:608-611. [PMID: 35604055 DOI: 10.1080/09513590.2022.2078962] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Background: Extratubal secondary trophoblastic implants following laparoscopic salpingectomy is an extremely rare form of persistent ectopic pregnancy. These cases usually result in a small amount of vaginal bleeding and sudden lower abdominal pain thereby presenting with hemoperitoneum in emergencies. Owing to the urgency of hemoperitoneum and the uncertainty of the location of persistent ectopic pregnancy after laparoscopic salpingectomy, the risk of reoperation is increased. It is necessary to prevent in first surgery and diagnose these cases in the early following up phase.Methods: We report a case of 26-year-old woman, gravida 3, para 0, presenting a little vaginal bleeding and slight lower abdominal pain after laparoscopic bilateral salpingectomy for more than 1 month. The patient's serum β-HCG was still high (3981 mIU/ml), and no abnormalities were found through auxiliary examination (ultrasound, abdominal CT, and pelvic MRI).Results: Finally, emergency laparoscopy revealed many blue purple nodules on the surface of ovaries, small intestine, omentum, and periumbilical peritoneum, with a diameter of 3-20 mm. The lesions were completely removed as far as possible. Pathology showed trophoblastic proliferation and β-HCG soon decreased to negative after this operation.Conclusion: Therefore, it is important to follow up serum β-HCG even after salpingectomy and avoid iatrogenic dissemination of trophoblast tissue through careful operation.
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Affiliation(s)
- Ting Wang
- Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, People's Republic of China
| | - Qin Li
- Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, People's Republic of China
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Düz SA. FERTILITY OUTCOMES AFTER MEDICAL AND SURGICAL MANAGEMENT OF TUBAL ECTOPIC PREGNANCY. Acta Clin Croat 2022; 60:347-353. [PMID: 35282476 PMCID: PMC8907964 DOI: 10.20471/acc.2021.60.03.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 04/23/2021] [Indexed: 11/24/2022] Open
Abstract
The objective was to investigate whether the method of treatment (surgical or medical) affects achieving a new pregnancy, as well as the time to and prognosis of the new pregnancy, in women with ectopic pregnancy (EP). Information on patients treated in our hospital between 2013 and 2014 for EP was retrieved from the computerized patient records. Data on whether these patients achieved pregnancy after EP treatment, time from treatment to new pregnancy, and prognosis of pregnancy were collected by phone interviews. A total of 101 women were analyzed. In addition to descriptive analysis, the χ2-test and Kruskal Wallis test were used to compare the groups. A new pregnancy was present in 84 (83.2%) of the women after EP treatment. There was no significant difference among the women having undergone medical treatment (methotrexate), surgical treatment, medical treatment followed by surgical treatment, or observational management approach in terms of achieving a new pregnancy after treatment and time to and prognosis of the new pregnancy. The study could not determine which treatment method would be superior in women with EP and in planning future pregnancy, but concluded that close clinical and laboratory monitoring is appropriate before deciding on aggressive interventions.
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Affiliation(s)
- Senem Arda Düz
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Inonu University Faculty of Medicine, Malatya, Turkey
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Po L, Thomas J, Mills K, Zakhari A, Tulandi T, Shuman M, Page A. Guideline No. 414: Management of Pregnancy of Unknown Location and Tubal and Nontubal Ectopic Pregnancies. J Obstet Gynaecol Can 2021; 43:614-630.e1. [PMID: 33453378 DOI: 10.1016/j.jogc.2021.01.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To provide an evidence-based algorithm to guide the diagnosis and management of pregnancy of unknown location and tubal and nontubal ectopic pregnancy. TARGET POPULATION All patients of reproductive age. BENEFITS, HARMS, AND COSTS The implementation of this guideline aims to benefit patients with positive β-human chorionic gonadotropin results and provide physicians with a standard algorithm for expectant, medical, and surgical treatment of pregnancy of unknown location and tubal pregnancy and nontubal ectopic pregnancies. EVIDENCE The following search terms were entered into PubMed/Medline and Cochrane in 2018: cesarean section, chorionic gonadotropin, beta subunit, human/blood, fallopian tubes/surgery, female, fertility, humans, infertility, laparoscopy, methotrexate, methotrexate/administration & dosage, methotrexate/therapeutic use, pregnancy (abdominal, angular, cervix, cornual, ectopic, ectopic/diagnosis, ectopic/diagnostic imaging, ectopic/drug therapy, ectopic/epidemiology, ectopic/mortality, ectopic/surgery, heterotopic, interstitial, isthmo-cervical, ovarian, tubal, unknown location), recurrence, risk factors, salpingectomy, salpingostomy, tubal pregnancy, ultrasonography, doppler ultrasonography, and prenatal. Articles included were randomized controlled trials, meta-analyses, systematic reviews, observational studies, and case reports. Additional publications were identified from the bibliographies of these articles. Only English-language articles were reviewed. VALIDATION METHODS The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and weak recommendations). INTENDED AUDIENCE Obstetrician-gynaecologists, family physicians, emergency physicians, midwives, registered nurses, nurse practitioners, medical students, and residents and fellows. SUMMARY STATEMENTS (GRADE RATINGS IN PARENTHESES) RECOMMENDATIONS (GRADE RATINGS IN PARENTHESES).
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Drakou A, Cosmo E, Ehrstedt C, Claesson R. [Tubal pregnancy with fetus in situ in the 17th gestational week, a case report]. Lakartidningen 2020; 117:FX4E. [PMID: 32430904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
An ectopic pregnancy occurs when a blastocyst implants outside the uterus cavity. It is a condition with increased morbidity and mortality for women in reproductive age. Most of the ectopic pregnancies (95.5%) are located in the fallopian tube. We report a case of an ectopic pregnancy that progressed unruptured and with fetus in situ up to 17 gestational weeks. This case is rare, especially in developed countries where patients have access to healthcare. With this case report we would like to emphasize that ectopic pregnancy should be among the differential diagnoses of abdominal pain even in the second trimester of pregnancy but also the importance of an early vaginal ultrasound examination in its diagnosis.
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Affiliation(s)
| | - Eva Cosmo
- överläkare, VO obstetrik och gynekologi, Centralsjukhuset Kristianstad
| | - Cecilia Ehrstedt
- överläkare, VO obstetrik och gynekologi, Centralsjukhuset Kristianstad
| | - Rickard Claesson
- med dr, biträdande sjukhuschef, Ljungby Lasarett, Region Kronoberg
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Bárta J, Klát J. Bilateral simultaneous tubal pregnancy. Ceska Gynekol 2020; 85:15-17. [PMID: 32414280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVE We present a rare case of peroperatively diagnosed bilateral tubular pregnancy. DESIGN Case report. SETTING Department of Obstetrics and Gynekology, Novy Jicin Hospital. CONCLUSION In the case of ectopic pregnancy always think about the possibility of contralateral pathology and during the surgical revision remember a thorough inspection of both fallopian tubes.
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Abstract
Tubal pregnancy represents an entity that every gynecologist will encounter during professional life. Because of the high prevalence among the pregnant population, standardized protocols are needed in order to choose the optimal strategy for each case. Accurate ultrasound pictures are supporting a more precise diagnosis of ectopic tubal pregnancy, the evolution of which should be closely monitored in follow-up with serial β-hCG values. Laparoscopy, intramuscular methotrexate, and active expectant management are all involved, however, tailoring the best treatment to the patient's needs is the challenge to focus on. This manuscript describes how in routinary practice an evidence-based diagnostic process should be the key factor to go for the best possible management. When possible, a longsighted less invasive approach should be preferred, aiming to preserve the patient's fertility for years to come. An optimal choice of the management should involve the patient or the couple in the decision-making process to reach the ultimate goal of compliance.
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Affiliation(s)
- Lorenzo Sabbioni
- Local Health Authority of Reggio Emilia, Division of Obstetrics and Gynecology, Cesare Magati Hospital, Scandiano, Italy
| | - Emanuela Carossino
- Local Health Authority of Reggio Emilia, Division of Obstetrics and Gynecology, Cesare Magati Hospital, Scandiano, Italy
| | - Filiberto Maria Severi
- Division of Obstetrics and Gynecology, Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Stefano Luisi
- Division of Obstetrics and Gynecology, Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
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Abstract
RATIONALE Abdominal pain in pregnancy represents a demanding diagnostic challenge in the emergency department (ED) due to the extensive list of differential diagnoses to be considered, coupled with the possibility of each disease having nonclassical, atypical signs and symptoms, resultant from the patient's pregnant state. Additionally, emergency physicians (EPs) face limitations on investigative imaging modalities because of the need to minimize fetal radiation exposure. EPs have to tackle this diagnostic challenge while performing a balancing act to maximize both maternal and fetal outcomes in a time-sensitive manner, becauser any delays in decision-making at the ED may threaten the safety of mother and child. Two common causes of abdominal pain in pregnancy presenting to the ED are acute appendicitis and ectopic pregnancy. The latter is almost always diagnosed by 10 weeks of gestation. Here, we report an extremely rare case of unilateral live spontaneous twin tubal ectopic pregnancy presenting past 12 weeks of gestation, diagnosed after magnetic resonance imaging (MRI) of the abdomen. PATIENT CONCERNS A 37-year-old gravida 2 para 1 at 12 weeks and 6 days of gestation presented to our ED with a 2-day history of right iliac fossa pain, not associated with vaginal bleeding, fever, diarrhea, and vomiting. On examination, she was tachycardic (pulse rate 124 beats/min) and hypertensive (blood pressure 142/88 mm Hg). There was marked tenderness and guarding at the lower abdomen. DIAGNOSES Blood investigations were unremarkable, while abdominal ultrasonography found a live twin gestation with foetal heartbeats of 185 and 180 beats/min. MRI of the abdomen revealed an empty uterine cavity; 2 amniotic sacs and fetuses of diameter 10 cm, and a single placenta were noted in the right uterine adnexa. The patient was diagnosed with right live monochorionic diamniotic twin tubal pregnancy. INTERVENTION Our patient underwent emergency laparoscopic right salpingectomy. OUTCOMES The operation was successful and her postoperative care remained uneventful up to discharge. LESSONS Ectopic pregnancy cannot be ruled out based on prior normal antenatal examinations and gestational age of >10 weeks. EPs should not hesitate to order MRI scans for further evaluation if ultrasonography and laboratory findings are equivocal.
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Affiliation(s)
- Chen-June Seak
- Department of Emergency Medicine, Lin-Kou Medical Center, Chang Gung Memorial Hospital
- College of Medicine, Chang Gung University, Taoyuan, Taiwan, Republic of China
| | | | | | | | - Chen-Ken Seak
- Sarawak General Hospital, Kuching, Sarawak, Malaysia
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Chirculescu B, Chirculescu R, Ionescu M, Peltecu G, Panaitescu A. Complete Tubal Abortion: A Rare Form of Ectopic Pregnancy. Chirurgia (Bucur) 2017; 112:68-71. [PMID: 28266296 DOI: 10.21614/chirurgia.112.1.68] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2017] [Indexed: 11/23/2022]
Abstract
Tubal abortion is characterized by the extrusion of an ectopic product of conception implanted in the fallopian tube through the abdominal ostium into the peritoneal cavity. It can be either complete or incomplete and may lead to severe bleeding. Recognition of a complete tubal abortion may be challenging but is essential because it allows conservative management which make possible preservation of tubal function and fertility without the need for further cytostatic therapy. A case of a 30 years-old woman admitted for lower abdominal pain is reported.The level of hCG was 659.2 mU/mL and transvaginal ultrasound reveled a fluid collection in the pouch of Douglas. Laparoscopy was subsequently performed for the suspicion of ectopic pregnancy with hemoperitoneum. Corroborating the hCG dynamics with the laparoscopic findings, the diagnosis of complete tubal abortion was established. The histopathological examination confirmed the presence of intermediate trophoblastic cells in the tissue collected during laparoscopy. Ultrasound examination helps recognition of hemoperitoneum but adds little value to the diagnosis of tubal abortion. Laparoscopic findings alone are only suggestive for complete tubal abortion but in combination with hCG dynamics, the diagnosis can be established. Conservative management might be sufficient in complete tubal abortion and ensures preservation of tubal function and fertility.
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Lu J, Yue X, Xu C, Lu X. Primary Gestational Trophoblastic Disease of the Fallopian Tube: A Case Series Analysis and Literature Review. J Reprod Med 2017; 62:147-152. [PMID: 30230306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To review the clinicopathological characteristics, diagnosis, and treatment of tubal gestational trophoblastic disease (GTD) misdiagnosed as tubal pregnancy. STUDY DESIGN From January 1, 2004, to December 31, 2013, a total of 619 patients with GTD were recorded at the Obstetrics and Gynecology Hospital of Fudan University. Among them, 4 cases of tubal GTD were initially misdiagnosed as tubal pregnancies. We retrospectively analyzed the clinicopathologic characteristics, diagnosis, treatment, and prognosis of those 4 patients. RESULTS All 4 patients showed symptoms similar to those of tubal pregnancy. The serum human chorionic gonadotropin (β-hCG) level at presentation was elevated >50,000 mIU/mL. All cases were treated by laparoscopic surgery. Misdiagnosis of the 3 cases of complete hydatidiform mole (CHM) and 1 choriocarcinoma were identified by postoperational histopathology. At 7 days postoperation the β-hCG level decreased to 304–6,115 mIU/mL. One case of tubal CHM received a second operation, and 3 cases received chemotherapy due to the unsatisfactory decrease in β-hCG level. The patient with choriocarcinoma received routine adjuvant chemotherapy. All of the patients achieved complete remission, and none relapsed for a median of 20 months’ follow-up. CONCLUSION Tubal GTD is rare and is often misdiagnosed for tubal pregnancy. Salpingectomy, intraoperative frozen section, and close follow-up were recommended, and prophylactic chemotherapy was unnecessary.
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Riestenberg CK, Nixon MD, Harris ID, Farah-Eways L. Heterotopic Triplet Pregnancy in Gonadotropin Stimulation Cycle: A Case Report. J Reprod Med 2017; 62:190-193. [PMID: 30230793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Heterotopic pregnancy is defined as the simultaneous presence of 2 or more pregnancies at different implantation sites, most commonly one intrauterine and one ectopic. Triplet heterotopic pregnancy refers to the presence of specifically 3 concurrent gestations with at least 1 being abnormally implanted. Heterotopic pregnancy is a potentially life-threatening condition that requires thorough diagnostic workup and prompt intervention. CASE We report the fourth case of triplet heterotopic pregnancy after ovarian stimulation with gonadotropins. A 24-year-old woman, G0, presented at 6 weeks of gestation with bilateral tubal ectopic pregnancies and a nonviable intrauterine pregnancy (IUP) after gonadotropin stimulation cycle. Bilateral tubal pregnancies were removed laparoscopically and the nonviable IUP via dilation and curettage. CONCLUSION Although rare, heterotopic pregnancy of 2 or more gestations must be kept in mind when managing patients undergoing treatment with ART. Careful examination of bilateral adnexa and consideration of uterine sampling at the time of surgery for ectopic pregnancy is advisable, even for patients with few or no risk factors.
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Ikechebelu JI, Eleje GU, Onviaorah IV, Ukah CO. Spontaneous Synchronous Tubal Pregnancy with Prior Successful in Vitro Fertilization and Embryo Transfer. A Case Report. J Reprod Med 2016; 61:519-523. [PMID: 30383956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Synchronous (bilateral) ectopic preg- nancy is a very rare gynecological entity resulting in most cases from assisted reproduction techniques. Al- though few cases of bilater- al ectopic pregnancy have been reported in Nigeria, spontaneous bilateral tubal pregnancy in a woman with a diagnosis of bilateral tubal blockage and prior success- ful in vitro fertilization and embryo transfer (IVF-E T) is paradoxically rare and, to the best of our knowledge, has not been reported in Nigeria. CASE A 37-year-old Nigerian woman presented with ruptured ectopic pregnancy associated with hemoperito- neum with previous diagnosis of bilateral tubal blockage and prior successful IVF-ET She subsequently under- went a laparotomy and the diagnosis of bilateral tubal pregnancy was made during surgery and confirmed by histology. Bilateral salpingectomy was done. CONCLUSION This was the first case of spontaneous bilateral tubal pregnancy in a woman with previous di- agnosis of bilateral tubal blockage and prior successful IVF-ET in Nigeria. There is no evidence-based guideline presently available on the management of bilateral ectopic pregnancy.
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Abstract
The estimated prevalence of ectopic pregnancy (EP) is 1-2% worldwide. Bilateral tubal pregnancies represent the rarest form of heterotopic pregnancy, and spontaneously conceived are extremely unusual, as many cases are derived from assisted reproductive techniques. We describe a case of bilateral tubal pregnancy after clomiphene therapy and sexual intercourse in which the second EP was not contemporarily revealed.
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Affiliation(s)
- Sandro Gerli
- a Department of Obstetrics and Gynecology , University of Perugia , Perugia , Italy
| | - Claudia Giordano
- a Department of Obstetrics and Gynecology , University of Perugia , Perugia , Italy
| | - Gian Carlo Di Renzo
- a Department of Obstetrics and Gynecology , University of Perugia , Perugia , Italy
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Levine D, McInnes M. Re: Accuracy of first-trimester ultrasound in diagnosis of tubal ectopic pregnancy in the absence of an obvious extrauterine embryo: systematic review and meta-analysis. Ultrasound Obstet Gynecol 2016; 48:129. [PMID: 27377787 DOI: 10.1002/uog.15877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 01/30/2016] [Indexed: 06/06/2023]
Affiliation(s)
- D Levine
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA, 02215, USA
| | - M McInnes
- Department of Radiology, University of Ottawa, The Ottawa Hospital Civic Campus, Ottawa, Ontario, Canada
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Mohammed AZ, Uzoho CC, Galadanci HS, Ashimi A. Ruptured Tubal Gestation: An Unusual Presentation of Schistosoma Haematobium Infection of the Fallopian Tube. Trop Doct 2016; 34:48-9. [PMID: 14959982 DOI: 10.1177/004947550403400125] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
An unusual mode of presentation of schistosomiasis in the form of a ruptured tubal pregnancy in a previously asymptomatic 23-year-old woman is described. Histological examination of the salpingectomy specimens demonstrated Schistosoma haematobium ova.
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Affiliation(s)
- A Z Mohammed
- Department of Pathology, Bayero University Kano, Nigeria.
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Abi Khalil ED, Mufarrij SM, Moawad GN, Mufarrij IS. Spontaneous Bilateral Ectopic Pregnancy: A Case-Report. J Reprod Med 2016; 61:306-308. [PMID: 27424379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Bilateral tubal pregnancies in the absence of preceding induction of ovulation are rare. They are usually diagnosed at the time of surgery. CASE We report a case of spontaneous bilateral tubal pregnancies diagnosed intraoperatively. A 28-year-old primigravida presented with light vaginal bleeding and abdominal pain 6 weeks after her last menstrual period. Her β-hCG level was 8,240 mIU/mL. Ultrasonography showed evidence of right tubal ectopic pregnancy. Laparoscopy revealed the presence of a simultaneous left tubal ectopic pregnancy. A bilateral laparoscopic salpingectomy was performed without complications, and the pathology report confirmed the diagnosis. CONCLUSION The diagnosis of bilateral tubal pregnancy is usually made intraoperatively, thus highlighting the importance of closely examining both tubes at the time of surgery, even in the presence of significant adhesive disease.
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Melcer Y, Maymon R, Vaknin Z, Pansky M, Mendlovic S, Barel O, Smorgick N. Primary Ovarian Ectopic Pregnancy: Still a Medical Challenge. J Reprod Med 2016; 61:58-62. [PMID: 26995890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To investigate the clinical presentation of women with primary ovarian pregnancy diagnosed in recent years and to compare it to tubal pregnancy. STUDY DESIGN Seven women treated for primary ovarian pregnancy from 2002-2013 were retrospectively identified and compared to 42 women with tubal pregnancies (involving either tubal rupture or tubal abortion) operated on during the same period. In the ovarian pregnancy group the pathology examination confirmed primary ovarian pregnancy according to the Spiegelberg criteria. RESULTS Seven women underwent surgery for primary ovarian pregnancy during the study period. Five women presented with hemodynamic shock. A ruptured ovarian pregnancy was identified in all cases. Wedge resection was performed by laparotomy in 1 case and by laparoscopy in 6 cases. The mean estimated blood loss was significantly higher in those women with ovarian versus tubal pregnancy (1057.1 ± 472.1 mL vs. 250.2 ± 241.5 mL, respectively, p<0.001). Moreover, a statistically significant difference was found when we compared postoperative hospitalization days (2 ± 0.6 vs. 1.3 ± 0.7, respectively; p=0.01) in the ovarian pregnancy group as compared with the tubal pregnancy group. CONCLUSION Primary ovarian ectopic pregnancy is still a major challenge for early diagnosis and treatment; it is associated with rupture and massive intraabdominal bleeding.
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Richardson A, Gallos I, Dobson S, Campbell BK, Coomarasamy A, Raine-Fenning N. Accuracy of first-trimester ultrasound in diagnosis of tubal ectopic pregnancy in the absence of an obvious extrauterine embryo: systematic review and meta-analysis. Ultrasound Obstet Gynecol 2016; 47:28-37. [PMID: 25766776 DOI: 10.1002/uog.14844] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Revised: 03/02/2015] [Accepted: 03/07/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVES To determine the accuracy of ultrasound in the diagnosis of a tubal ectopic pregnancy in the absence of an obvious extrauterine embryo. METHODS This was a systematic review conducted in accordance with the PRISMA statement and registered with PROSPERO. We searched MEDLINE, EMBASE and The Cochrane Library for relevant citations from database inception to July 2014. Studies were selected in a two-stage process and their data extracted by two reviewers. Accuracy measures were calculated for each ultrasound sign, i.e. empty uterus, pseudosac, adnexal mass and free fluid in the pouch of Douglas, alone and in various combinations. Individual study estimates were plotted in summary receiver-operating characteristics curves and forest plots for examination of heterogeneity. The quality of included studies was assessed. RESULTS Thirty-one studies including 5858 women were selected from 19,959 citations. Following meta-analysis, an empty uterus on ultrasound was found to predict an ectopic pregnancy with a sensitivity of 81.1% (95% CI, 42.1-96.2%) and specificity of 79.5% (95% CI, 68.9-87.1%). The corresponding performance of the pseudosac, adnexal mass and free fluid were: 5.5% (95% CI, 3.3-9.0%) and 94.2% (95% CI, 75.9-98.8%); 63.5% (95% CI, 48.5-76.3%) and 91.4% (95% CI, 83.6-95.7%); and 47.2% (95% CI, 33.2-61.7%) and 92.3% (95% CI, 85.6-96.0%), respectively. CONCLUSION Visualization of an empty uterus, adnexal mass, free fluid or a pseudosac has poor sensitivity for the diagnosis of a tubal pregnancy when an obvious extrauterine embryo is absent, but it has good specificity. We can therefore infer that ultrasound is more useful for 'ruling in' a tubal pregnancy than 'ruling out' one. However, the findings were limited by the poor quality of some included studies and heterogeneity in the index test and reference standard.
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Affiliation(s)
- A Richardson
- Nurture Fertility, The East Midlands Fertility Clinic, Nottingham, UK
- Division of Child Health, Obstetrics and Gynaecology, School of Medicine, University of Nottingham, Nottingham, UK
| | - I Gallos
- School of Clinical and Experimental Medicine, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - S Dobson
- Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, UK
| | - B K Campbell
- Division of Child Health, Obstetrics and Gynaecology, School of Medicine, University of Nottingham, Nottingham, UK
| | - A Coomarasamy
- School of Clinical and Experimental Medicine, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - N Raine-Fenning
- Nurture Fertility, The East Midlands Fertility Clinic, Nottingham, UK
- Division of Child Health, Obstetrics and Gynaecology, School of Medicine, University of Nottingham, Nottingham, UK
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Andreeva P, Dimitrov I. [SUCCESSFUL LAPAROSCOPIC TREATMENT OF HETEROTOPIC PREGNANCY AFTER ICSI / FREEZE EMBRYO TRANSFER - A CASE REPORT.]. Akush Ginekol (Sofiia) 2016; 55:52-55. [PMID: 29370495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The coexistence of extrauterine and intrauterine or haeterotopic pregnancy (HP) is a rare condition with reported incidence of 1 in 8000 to 1 in 30 000 pregnancies in natural conceived pregnancies, but with the widespread application of assisted reproductive technologies (ART) the incidence of HP in women with ART has risen to about 0.09% to 1.00%. We have reported a case of a 36 old woman, pregnant in 9 gestation week, gravidity 2, 0 para, who have achieved a pregnancy after in-vitro fertilization - embryo-transfer of two freeze embryos, developed after an ICSI procedure with donor eggs. The patient attended our clinic because of acute abdominal pain. She was evaluated by trans-vaginal sonography and coexistence of ectopic tubal and intrauterine pregnancy has been confirmed. Emergency laparoscopy was carried out. Left tubal ectopic pregnancy and hemoperitoneum (1200 ml) were diagnosed. Left salpingectomy was performed. At present, the patient is at 24 gestation week and the pregnancy is developing in a proper manner. We report such a case due to the increase of the awareness to the condition and the possibility of a successful treatment by a laparoscopic surgery. Intrauterine pregnancy does not exclude extrauterine pregnancy especially in cases after in-vitro fertilization.
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Berretta R, Dall'Asta A, Merisio C, Monica M, Lori L, Galli L, Mautone D, Frusca T. Tubal ectopic pregnancy: our experience from 2000 to 2013. Acta Biomed 2015; 86:176-180. [PMID: 26422433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/26/2014] [Accepted: 03/06/2015] [Indexed: 06/05/2023]
Abstract
In this paper we summarize our experience in diagnosis and treatment of 402 retrospectively collected tubal EP and review the most recent topics from the literature. Systemic Methotrexate (MTX) was effective in 56 out of 65 patients (failure rate 13.8%), in whom hCG level was significantly lower when compared to the failure group (p<0,05); we performed 299 salpingectomies, 297 of whom through laparoscopic approach. MTX single-dose is safe and effective in eligible patients; surgery represents the treatment of most of the EPs, mainly through laparoscopic approach.
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Affiliation(s)
- Roberto Berretta
- Department of Surgical Sciences, Obstetrics and Gynecology Unit, University of Parma, Parma, Italy.
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Ivkošić IE, Bauman R, Ujević B, Vasilj O, Kojić IP, Ivkošić A, Vukušić D, Turudić TP. SPONTANEOUS HETEROTOPIC, ECTOPIC CERVICAL AND ECTOPIC TUBAL PREGNANCY - EVER PRESENT DIAGNOSTIC DIFFICULTY: THREE CASE REPORTS. Acta Clin Croat 2015; 54:367-370. [PMID: 26666110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Abstract
The incidence of heterotopic/ectopic pregnancy in recent times has increased partly due to the increase in assisted reproductive technologies, whereas such medical cases and cervical pregnancy in particular are extremely rare with spontaneous conception. We report on three patients referred to our department in one week: one patient each with spontaneous heterotopic pregnancy, cervical pregnancy and tubal pregnancy. All of them had conceived spontaneously and were properly diagnosed and treated, however, additional care is needed in diagnosing and managing the potentially fatal consequences of ectopic pregnancy if not recognized early and managed properly, despite its low incidence.
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Helmy S, Mavrelos D, Sawyer E, Ben-Nagi J, Koch M, Day A, Jurkovic D. Serum Human Chorionic Gonadotropin (β- hCG) Clearance Curves in Women with Successfully Expectantly Managed Tubal Ectopic Pregnancies: A Retrospective Cohort Study. PLoS One 2015; 10:e0130598. [PMID: 26135923 PMCID: PMC4489732 DOI: 10.1371/journal.pone.0130598] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 05/21/2015] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To establish clearance curves for serum β -hCG in women with successfully expectantly managed tubal ectopic pregnancies. DESIGN Retrospective cohort study. Non- viable tubal ectopic pregnancy was diagnosed on transvaginal ultrasound. If initial serum β hCG was less than 5000 IU/L and patients were asymptomatic, expectant management was offered. Patients underwent serial β hCG measurements until serum β hCG was less than 20 IU/l, or the urine pregnancy test was negative. SETTING Early Pregnancy and Gynaecology Assessment Unit, Kings College Hospital, London (December 1998 to July 2006). PATIENTS We included 161 women with diagnosed non-viable tubal ectopic pregnancy who underwent successful expectant management. MAIN OUTCOME MEASURE Serum β hCG level. RESULTS Mean initial serum β- hCG was 488 IU/L (41 - 4883) and median serum β hCG clearance time was 19 days (5 - 82). The average half-life of β hCG clearance was 82.5 hours (±SD 50.2) in patients with steadily declining serum β- hCG levels compared to 106.7 hours (±SD 72.0) in patients with primarily plateauing β-hCG levels in the declining phase. However, these differences were not significant (p>0.05). CONCLUSION We identified a median follow-up of 19 days until serum β hCG clearance in women with tubal ectopic pregnancy and successful expectant management. Although non- significant, women with initially plateauing serum β hCG showed a longer follow-up time until clearance compared to women with steadily declining β hCG levels. This information may serve as a guideline enabling clinicians to predict the length of follow-up for women with tubal ectopic pregnancy and expectant management.
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MESH Headings
- Abortion, Spontaneous/blood
- Abortion, Spontaneous/diagnosis
- Abortion, Spontaneous/diagnostic imaging
- Abortion, Spontaneous/pathology
- Adolescent
- Adult
- Biomarkers/blood
- Chorionic Gonadotropin, beta Subunit, Human/blood
- Female
- Half-Life
- Humans
- Pregnancy
- Pregnancy, Tubal/blood
- Pregnancy, Tubal/diagnosis
- Pregnancy, Tubal/diagnostic imaging
- Pregnancy, Tubal/pathology
- Retrospective Studies
- Ultrasonography
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Affiliation(s)
- Samir Helmy
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
- Early Pregnancy and Gynaecology Assessment Unit, King’s College Hospital, London, United Kingdom
| | - Dimitrios Mavrelos
- Early Pregnancy and Gynaecology Assessment Unit, King’s College Hospital, London, United Kingdom
| | - Elinor Sawyer
- Early Pregnancy and Gynaecology Assessment Unit, King’s College Hospital, London, United Kingdom
| | - Jara Ben-Nagi
- Early Pregnancy and Gynaecology Assessment Unit, King’s College Hospital, London, United Kingdom
| | - Marianne Koch
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
- Karl Landsteiner Society, Vienna, Austria
| | - Andrea Day
- Gynaecology Diagnostic and Outpatient Treatment Unit, University College Hospitals London (UCL), London, United Kingdom
| | - Davor Jurkovic
- Gynaecology Diagnostic and Outpatient Treatment Unit, University College Hospitals London (UCL), London, United Kingdom
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Kuna K, Grbavac I, Vuković A, Bilić N, Kraljević Z, Butorac D. Coexistence of ruptured ectopic tubal pregnancy, dermoid and endometriotic cyst with tubo-ovarian abscess in the same adnexa: case report. Acta Clin Croat 2015; 54:103-106. [PMID: 26058252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Abstract
A 32-year-old pregnant woman presented to the hospital with abdominal pain and minimal vaginal bleeding. Transvaginal ultrasound revealed visible fluid in pelvic region with suspected tubal rupture, and subsequently laparoscopy was performed. During laparoscopy, additional gynecologic pathologies were noticed. Histopathologic finding showed dermoid and endometriotic cyst, as well as tubo-ovarian abscess in the same adnexa. This case report highlights the necessity of considering multiple diagnoses in the same organic system, which may be encountered by surgeon and histopathologist.
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Memon Z, Sheikh SS. Tubo-omental ectopic pregnancy. J PAK MED ASSOC 2015; 65:215-217. [PMID: 25842562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Tubo-omental pregnancy is a very rare form of ectopic pregnancy. Here we present a case of tubo-omental pregnancy diagnosed at surgical exploration. A 26-year-old woman presented with abdominal discomfort, nausea and vomiting. There was ectopic pregnancy with viable foetus in the right adnexa and haemoperitonium. Laparotomy was performed and on exploration tubo-omental pregnancy was found attached to fimbria at one side and omentum at the other. Fimriaectomy and partial omentectomy was performed. The patient had a successful post-operative recovery.
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Petre I, Bernad E, Mureşan A, Bordianu A, Bernad SI, Băcean O, Folescu R, Milulescu A, Pantea S. Choriocarcinoma developed in a tubal pregnancy - a case report. Rom J Morphol Embryol 2015; 56:871-874. [PMID: 26429189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Carcinoma of the Fallopian tube is the least frequent tumor of the female genital tract. The diagnosis is difficult but could be made more frequently if the causes of abnormal bleeding were thoroughly investigated by means of cytology and endometrial curettage. Treatment is by resection of the tumor, total hysterectomy, and bilateral salpingo-oophorectomy followed by chemotherapy. A 25-year-old patient, presented herself at the emergency room, accusing intense lower abdominal pains, accompanied by vaginal bleeding. The histological aspect corroborated with the Ki-67 index is strongly suggestive for a choriocarcinoma developed in a tubal ectopic pregnancy.
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Affiliation(s)
- Izabella Petre
- Department of Obstetrics and Gynecology, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania;
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Okmen F, Zeybek B, Akdemir A, Ergenoglu AM, Yeniel O, Ulukus M. Is there a relationship between age and side dominance of tubal ectopic pregnancies? --A preliminary report. Ginekol Pol 2014; 85:677-681. [PMID: 25322539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Abstract
OBJECTIVES To determine whether there exists a relationship between age and side dominance of tubal ectopic pregnancies. MATERIAL AND METHODS One hundred twenty patients were retrospectively analyzed. The sides of the tubal ectopic pregnancies were recorded on the basis of laparoscopy or laparotomy findings. Five age groups were created: 20-24, 25-29, 30-34, 35-39, and > or = 40 years. RESULTS Of the patients who were > 30 years of age, 46 (69%) and 21 (31%) had tubal ectopic pregnancies on the right and left sides, respectively (p = 0.002). In the 35-39 years of age group, 17 of 20 patients (85%) had tubal ectopic pregnancies on the right, and 3 of 20 patients (15%) on the left side (p = 0.002). In the 30-34 years of age group, 26 of 39 patients (67%) and 13 of 39 patients (33%) had tubal ectopic pregnancies on the right and left sides, respectively (p = 0.037). In the > or = 40 years of age group, 3 of 8 patients (37%) had tubal ectopic pregnancy on the right side, while 5 patients (63%) on the left side (p = 0.48). CONCLUSIONS Patients who are between the age of 30-40 years have a right-sided dominance of tubal ectopic pregnancy however studies that involve larger numbers of subjects are needed to make definitive conclusions about women older than 40 years of age.
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30
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Aminu MB, Abdullahi K, Dattijo LM. Tubal ectopic gestation associated with genital schistosomiasis: a case report. Afr J Reprod Health 2014; 18:144-146. [PMID: 25022151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Schistosoma are trematode blood flukes of the family Schistosomidae affecting the urinary and gastro-intestinal tracts. Riverine areas of the world such as in Africa, Eastern Mediterranean, Central American and East Asia are endemic for the disease, with S. haematobium accounting for most of the symptomatic genital infection. A case of a 25-year-old woman with 8 weeks amenorrhoea, lower abdominal pain and per vaginal bleeding was managed for ruptured ectopic pregnancy and discovered to have tubal infection by Schistosoma on histological examination is presented.
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Frates MC, Doubilet PM, Peters HE, Benson CB. Adnexal sonographic findings in ectopic pregnancy and their correlation with tubal rupture and human chorionic gonadotropin levels. J Ultrasound Med 2014; 33:697-703. [PMID: 24658951 DOI: 10.7863/ultra.33.4.697] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVES To determine whether the distribution of transvaginal sonographic findings of ectopic pregnancy has changed since the studies done 20 years ago and to explore the correlation of tubal rupture with transvaginal sonographic findings and human chorionic gonadotropin (hCG) levels. METHODS Patients with ectopic pregnancy who underwent transvaginal sonography before treatment were included. Sonograms and medical records were retrospectively reviewed. The presence of a tubal ring, the presence of a yolk sac, embryonic cardiac activity, the degree of vascularity on color Doppler imaging, hCG levels, and results of surgery were recorded. RESULTS Our study included 231 ectopic pregnancies. A positive sonographic adnexal finding was present in 219 cases (94.8%): adnexal mass in 218 (94.4%) and a moderate-to-large amount of free fluid in 84 (36.4%). The adnexal masses were graded as follows: 1, nonspecific mass (125 cases [54.1% of total]); 2, tubal ring without a yolk sac or embryo (57 [24.7%]); 3, yolk sac but no embryonic heartbeat (19 [8.3%]); and 4, embryo with cardiac activity (17 [7.4%]). The mean hCG level increased as the grade ascended from 1 to 4. Thirty-six patients had tubal rupture at surgery within 24 hours of the sonogram. A moderate-to-large amount of free fluid was significantly associated with tubal rupture (P < .05) but had low sensitivity, specificity, and positive predictive value for rupture. Other sonographic findings and hCG levels were not significantly related to tubal rupture. CONCLUSIONS Transvaginal sonography showed an adnexal abnormality in nearly 95% of our patients with ectopic pregnancy, most commonly a nonspecific adnexal mass. Embryonic cardiac activity was seen in fewer than 10%. Neither sonographic findings nor hCG levels were useful predictors of tubal rupture.
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Affiliation(s)
- Mary C Frates
- Department of Radiology, Brigham and Women's Hospital Harvard Medical School, 75 Francis St, Boston, MA 02115 USA.
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Søreide K. [Acute abdominal pain--the usual suspects?]. Tidsskr Nor Laegeforen 2013; 133:2162-3. [PMID: 24172630 DOI: 10.4045/tidsskr.13.1125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Petersen PE, Isachsen K, Hansen MB. [A young woman with acute abdominal pain]. Tidsskr Nor Laegeforen 2013; 133:2159-62. [PMID: 24172629 DOI: 10.4045/tidsskr.12.1329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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McCullough MC, Hart S, Gilbert-Barnes E, Spellacy WN. The gynecologist's role in preventing overdiagnosis of ectopic molar pregnancy: a case report. J Reprod Med 2013; 58:351-353. [PMID: 23947088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Ectopic hydatidiform mole is a rare, yet overdiagnosed, entity. A diagnosis of ectopic molar pregnancy requires close follow-up, has implications on future fertility, and may require chemotherapy. Patients diagnosed with a hydropic abortus do not require hormone surveillance or abstinence from pregnancy for the extended time period generally recommended for patients diagnosed with a complete or partial hydatidiform mole. The correct classification of products of conception is clinically important because each of the three diagnoses has a different potential for malignant transformation. CASE A 29-year-old woman, G5P2104, with ectopic pregnancy and without clinical or laboratory data suspicious for molar pregnancy required ancillary histopathologic testing for accurate diagnosis. CONCLUSION This case illustrates the vital role of the gynecologist in assimilating information to prevent over-diagnosis of ectopic molar pregnancy. General gynecologists must therefore understand the histopathologic options available for differentiating hydropic products of conception, partial hydatidiform mole and complete hydatidiform mole.
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Affiliation(s)
- Mona C McCullough
- Department of Obstetrics and Gynecology, University of South Florida, 2 Tampa General Circle, STC 6th Floor, Tampa, FL 33606, USA.
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35
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O WS, Li HWR, Liao SB, Cheung ANY, Ng EHY, Yeung WSB, Ho JCM, Tang F. Decreases in adrenomedullin expression and ciliary beat frequency in the nasal epithelium in tubal pregnancy. Fertil Steril 2013; 100:459-63.e1. [PMID: 23663996 DOI: 10.1016/j.fertnstert.2013.04.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2012] [Revised: 04/04/2013] [Accepted: 04/04/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To study adrenomedullin (ADM) expression and its relation to ciliary beat frequency (CBF) in the nasal mucociliated epithelium in tubal ectopic pregnancy (tEP). DESIGN Experimental study. SETTING University teaching hospital. PATIENT(S) Women with tEP and normal intrauterine pregnancy matched for age and gestational age were recruited. Healthy nonpregnant women were also recruited as nonpregnant controls. INTERVENTION(S) Nasal epithelial brushing. MAIN OUTCOME MEASURE(S) Adrenomedullin expression in nasal epithelium (measured by real-time reverse transcription-polymerase chain reaction, plasma ADM concentration (measured by ELISA), and CBF (measured by photometric method). RESULT(S) We have demonstrated a similar decrease in ADM expression and CBF in the nasal mucociliated epithelium, as well as in plasma ADM concentration, in women with tEP compared with normal pregnant women. Adrenomedullin up-regulates nasal CBF via the ADM receptor, as in the oviduct. There is significant correlation between nasal and oviductal CBF. CONCLUSION(S) Nasal epithelium ADM and CBF, as well as plasma ADM, are possible predictors of women at risk of tEP.
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Affiliation(s)
- Wai Sum O
- Department of Anatomy, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China.
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Hamura NN, Bolnga JW, Wangnapi R, Horne AW, Rogerson SJ, Unger HW. The impact of tubal ectopic pregnancy in Papua New Guinea--a retrospective case review. BMC Pregnancy Childbirth 2013; 13:86. [PMID: 23557190 PMCID: PMC3633071 DOI: 10.1186/1471-2393-13-86] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Accepted: 03/27/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ectopic pregnancy (EP) is an important cause of morbidity and mortality amongst women of reproductive age. Tubal EP is well described in industrialised countries, but less is known about its impact in low-resource countries, in particular in the South Pacific Region. METHODS We undertook a retrospective review of women with tubal EP treated at a provincial referral hospital in coastal Papua New Guinea over a period of 56 months. Demographic and clinical variables were obtained from patients' medical records and analysed. The institutional rate of tubal EP was calculated, and diagnosis and management reviewed. Potential risk factors for tubal EP were identified, and delays contributing to increased morbidity described. RESULTS A total of 73 women had tubal EP. The institutional rate of tubal EP over the study period was 6.3 per 1,000 deliveries. There were no maternal deaths due to EP. The mean age of women was 31.5+/-5.7 years, 85% were parous, 67% were rural dwellers and 62% had a history of sub-fertility. The most commonly used diagnostic aid was culdocentesis. One third of women had clinical evidence of shock on arrival. All women with tubal EP were managed by open salpingectomy. Tubal rupture was confirmed for 48% of patients and was more common amongst rural dwellers. Forty-three percent of women had macroscopic evidence of pelvic infection. Two-thirds of patients received blood transfusions, and post-operative recovery lasted six days on average. Late presentation, lack of clinical suspicion, and delays with receiving appropriate treatments were observed. CONCLUSIONS Tubal EP is a common gynaecological emergency in a referral hospital in coastal PNG, and causes significant morbidity, in particular amongst women residing in rural areas. Sexually transmitted infections are likely to represent the most important risk factor for tubal EP in PNG. Interventions to reduce the morbidity due to tubal EP include the prevention, detection and treatment of sexually transmitted infections, identification and reduction of barriers to prompt presentation, increasing health workers' awareness of ectopic pregnancy, providing pregnancy test kits to rural health centres, and strengthening hospital blood transfusion services, including facilities for autotransfusion.
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Affiliation(s)
- Nancy N Hamura
- Department of Obstetrics and Gynaecology, Modilon General Hospital, P.O. Box 2119, Madang, 511, Papua New Guinea
| | - John W Bolnga
- Department of Obstetrics and Gynaecology, Modilon General Hospital, P.O. Box 2119, Madang, 511, Papua New Guinea
| | - Regina Wangnapi
- Papua New Guinea Institute of Medical Research, PO Box 378, Madang, 511, Papua New Guinea
| | - Andrew W Horne
- MRC Centre for Reproductive Health, The Queen’s Medical Research Institute, The University of Edinburgh, Edinburgh, UK
| | - Stephen J Rogerson
- Department of Medicine (Royal Melbourne Hospital), The University of Melbourne, Melbourne, Australia
| | - Holger W Unger
- Department of Medicine (Royal Melbourne Hospital), The University of Melbourne, Melbourne, Australia
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Epee-Bekima M, Overton C. Diagnosis and treatment of ectopic pregnancy. Practitioner 2013; 257:15-2. [PMID: 23634634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The most common site of localisation of an ectopic pregnancy is the fallopian tube. Rarely an ectopic pregnancy can be found in the ovary, a caesarean section scar, the abdomen or the cervix. Risk factors are previous ectopic pregnancy, PID, endometriosis, previous pelvic surgery, the presence of a coil and infertility. However, a third of women with an ectopic pregnancy have no known risk factors. NICE recommends a low threshold for offering a pregnancy test to women of childbearing age when they attend the surgery. Symptoms and signs appear when the tube starts to tear. When the tube ruptures, the woman will quickly become unwell and haemodynamically unstable because of rapid intra-abdominal blood loss. The most common symptoms of ectopic pregnancy are pelvic or abdominal pain, amenorrhoea, missed period or abnormal period and vaginal bleeding. A positive diagnosis of a urinary tract infection or gastroenteritis does not exclude an ectopic pregnancy. Signs of suspected ectopic pregnancy include pelvic, abdominal, adnexal or cervical motion tenderness, rebound tenderness and abdominal distension. Women who are haemodynamically unstable, or in whom there is significant concern about the degree of pain or bleeding, should be referred directly to A&E, irrespective of the result of the pregnancy test. Stable patients with bleeding who have pain or a pregnancy of six weeks gestation or more or a pregnancy of uncertain gestation should be referred immediately to an early pregnancy assessment (EPA) service, or out-of-hours gynaecology service if the EPA service is not available. Diagnosis is confirmed by transvaginal ultrasound scan to identify the location of the pregnancy.
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Kirk E, McDonald K, Rees J, Govind A. Intramural ectopic pregnancy: a case and review of the literature. Eur J Obstet Gynecol Reprod Biol 2013; 168:129-33. [PMID: 23375906 DOI: 10.1016/j.ejogrb.2012.12.036] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Revised: 11/11/2012] [Accepted: 12/13/2012] [Indexed: 12/20/2022]
Abstract
An intramural ectopic is a rare type of ectopic pregnancy in which the gestational sac is implanted within the myometrium, separate from the endometrial cavity and Fallopian tubes. There are only 53 cases in the published literature. We report a case of intramural ectopic pregnancy treated surgically and review the published data on this rare type of ectopic pregnancy, with respect to aetiology, diagnosis and management.
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Affiliation(s)
- Emma Kirk
- Department of Obstetrics and Gynaecology, North Middlesex University Hospital NHS Trust, Sterling Way, London N18 1QX, United Kingdom.
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Mohtashami F, Kamencic H. Enigmatic pregnancy. J Obstet Gynaecol Can 2013; 35:9-10. [PMID: 23343789 DOI: 10.1016/s1701-2163(15)31037-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Fariba Mohtashami
- Department of Obstetrics and Gynecology, University of Saskatchewan, Regina SK
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Kovachev E, Kozovski I, Ivanov S, Kornovski Y, Mircheva N, Koleva P, Tsonev A, Ismail E, Kisyov S, Kolev N. [A case of bilateral tubal pregnancy after IVF - ET]. Akush Ginekol (Sofiia) 2013; 52:33-37. [PMID: 24283077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The authors describe a rare case of bilateral tubal pregnancy after IVF. The patient is with secondary infertility. The preceding diagnostic laparoscopy excluded the presence of tubal factor. The results of the spermogram show average to severe form of Oligoasthenozoospermia. Short protocol with GnRH-antagonist was performed and two embryos were transferred on the third day. On the 36th day after the embryo transfer the patient was hospitalized with abdominal pain in the right hypogastric region, clinical and ultrasound indications for hemoperitoneum. Urgent laparotomy was performed followed by salpingectomy dextra due to hemoperitoneum caused by tubal abortion. The examination of the left adnexa reveals uruptured tubal pregnancy in the isthmic part of the tube and the decision for salpingectomy sinistra was taken. Histological examinations confirmed the diagnosis of ectopic pregnancy in both tubes. The frequency of some rare forms and localizations of ectopic as well as heterotopic pregnancies increase after ART.
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41
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Meuleman T, Vestjens B. [A Zambian woman with vaginal bleeding]. Ned Tijdschr Geneeskd 2013; 157:A5458. [PMID: 23369817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
A woman reported with vaginal bleeding and abdominal pain in a Zambian hospital. Examination with ultrasound showed an intact gravidity outside the cavum uteri and free abdominal fluid. Laparotomy revealed an ectopic gravidity in the right tube. Subsequently, a tubectomy was performed with success.
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Affiliation(s)
- Tess Meuleman
- LUMC, Leiden. Afd. Gynaecologie en Verloskunde, the Netherlands.
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42
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Lee SW, Choi HJ, Lee YK, Yoon JH. Omental implantation secondary to ruptured tubal pregnancy with a negative urine pregnancy test: a case report. J Reprod Med 2013; 58:89-92. [PMID: 23447928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND The first steps in the diagnosis of an ectopic pregnancy are to use a sensitive qualitative urine test to detect the beta-subunit of human chorionic gonadotropin (beta-hCG) and to perform a transvaginal ultrasonograph. y negative urine pregnancy test result is generally used to exclude an ectopic pregnancy; however, a few studies have reported the presence of a ruptured ectopic pregnancy in a patient with a negative urine pregnancy test result. Furthermore, because secondary omental implantation (SOI) is rare and probably underestimated or misdiagnosed, a case of an SOI with a negative urine hCG test has never been reported. CASE This was a very rare case of an SOI from a ruptured tubal pregnancy in a patient with an initial series of negative urine pregnancy tests and decreased levels of serum beta-hCG. The SOI was managed with laparoscopy. CONCLUSION For patients diagnosed with tubal or ovarian pregnancy who have negative urine pregnancy test results and decreased levels of serum beta-hCG, late-onset omental implantation should be considered as a possibility.
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MESH Headings
- Adult
- Chorionic Gonadotropin, beta Subunit, Human/urine
- Female
- Humans
- Laparoscopy
- Pregnancy
- Pregnancy, Abdominal/diagnosis
- Pregnancy, Abdominal/etiology
- Pregnancy, Abdominal/surgery
- Pregnancy, Abdominal/urine
- Pregnancy, Tubal/diagnosis
- Pregnancy, Tubal/urine
- Rupture, Spontaneous/complications
- Rupture, Spontaneous/diagnosis
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Affiliation(s)
- Suk Woo Lee
- Department of Obstetrics and Gynecology, The Catholic University of Medicine of Korea, Seoul
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Friedman AM, Martin B, Matteson KA. Ectopic pregnancy after hysterectomy: a case report. J Reprod Med 2013; 58:75-76. [PMID: 23447924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Ectopic pregnancy after hysterectomy is an unusual diagnosis that may lead to significant morbidity, especially when diagnosis is not timely. CASE A 41-year-old woman presenting with abdominal pain and vaginal bleeding 5 years after a vaginal hysterectomy was found to have a tubal ectopic pregnancy, which required emergent surgical intervention. CONCLUSION Ectopic pregnancy after hysterectomy represents a challenging diagnosis because it is counter-intuitive and very uncommon. The diagnosis of posthys-terectomy ectopic pregnancy, though exceptionally rare, should be considered for women presenting with abdominal pain after hysterectomy.
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Affiliation(s)
- Alexander M Friedman
- Divisio of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, PA 19104, USA.
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Gong W, Li X, Ren H, Han C, Li Y, Wu Z. Superselective uterine arterial embolization combined with transcatheter intra-arterial methotrexate infusion in 40 cases with fallopian tube ectopic pregnancy. CLIN EXP OBSTET GYN 2013; 40:222-226. [PMID: 23971243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
PURPOSE To evaluate the therapeutic results of superselective uterine artery infusion and embolization in 40 patients with fallopian tube ectopic pregnancy, and to explore the role of this minimally invasive treatment as an alternative to surgery. MATERIALS AND METHODS Superselective catheterization of uterine artery through cannulation of femoral artery was achieved in 40 patients with fallopian tube ectopic pregnancy (EP). Location of the lesions involved feeding arteries and active bleeding were observed through angiography. Methotrexate (MTX) diluted in saline water was slowly infused into the target artery. Small gelatin spongy particles were used to embolize the uterine artery until its branches were totally obliterated. Follow-up was undertaken to observe the results of the treatment. RESULTS Superselective uterine arterial infusion and embolization were successfully performed in all 40 patients without any related complications. Active bleeding in the peritoneum in 33 cases ceased soon after embolization. The embryos in 13 patients were confirmed to have died by ultrasound three days after the procedure. Beta-human chorionic gonadotropin ((beta-hCG) value dropped to below 15 IU/L at three to 21 days. Hemorrhage in the peritoneum dissolved after seven days in all cases. Mixed mass disappeared after one month. Hysterosalpingography was performed three months after the procedure in 19 patients and patent fallopians were demonstrated in 16 patients. CONCLUSIONS Superselective uterine arterial infusion and emboliztion is a minimally invasive procedure, which can be used to effectively treat EP by disabling the ectopic embryo and leaking arteries with the advantages of preserving the fallopian tubes.
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Affiliation(s)
- W Gong
- Division of interventional Radiology, Tang Du Hospital, The Fourth Military Medical University, Xi'an, China
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Malek-Mellouli M, Youssef A, Mbarki M, Ben Amara F, Neji K, Reziga H. [Medical treatment of non ruptured interstitial pregnancy]. Tunis Med 2012; 90:421-423. [PMID: 22585660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Lukásová T, Ventruba T, Ventruba P, Záková J, Sochorová K. [Heterotopic pregnancy as an complication during pregnancy and labour--the case report]. Ceska Gynekol 2012; 77:153-156. [PMID: 22702074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
UNLABELLED Heterotopic gravidity (HG) is a rare co-existence of intrauterine and ectopic pregnancy with higher incidence in pregnancies after in vitro fertilisation (IVF). Diagnosis of HG is demanding. HG is commonly identificated when rupture or hemoperitoneum occurs. CASE REPORT 35-year-old woman after 3rd cycle of IVF for absolute tubar factor. Two embryos transfered. Ectopic implatation of second embryo in uterine corner occured. Patient hospitalized with acute deteriorating symptoms of hemoperitoneum in 6th week of gestation. Diagnostic laparoscopy performed with ectopic cornual gravidity detection. Decision made to retain the intrauterine gravidity. Induction of the labour in the 40th week of gestation performed. Placenta retained after the delivery of a normal newborn. Lysis manualis performed, uterine hypothonia followed. On suspicion of placenta percreta laparotomy indicated. Acute supracervical abdominal simplex hysterectomy performed. Histologic examination confirmed the diagnosis of placenta percreta. CONCLUSION The diagnosis of HG is based on the assesment of clinical symptoms, transvaginal ultrasound and endoscopic diagnostics with eventual intervention. In case of hemoperitoneum urgent surgical intervention indicated. Placenta percreta is a rare complication increased in incidence by the presence of myometrial dammage usually from past uterine surgery. Presence of the scar tissue and abnormal placentation might also be a random coincidence. Placenta percreta is a life threatening complication with a great risk of hemmorhage and commonly requires acute surgical intervention.
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Affiliation(s)
- T Lukásová
- Gynekologicko-porodnická klinika LF MU a FN Brno
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Huchon C, Panel P, Kayem G, Bassot A, Nguyen T, Falissard B, Fauconnier A. Is a standardized questionnaire useful for tubal rupture screening in patients with ectopic pregnancy? Acad Emerg Med 2012; 19:24-30. [PMID: 22221975 DOI: 10.1111/j.1553-2712.2011.01238.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Physical examination, ultrasonography, and laboratory tests fail to reliably establish the preoperative diagnosis of tubal rupture in patients with ectopic pregnancy (EP), leading to a high rate of diagnostic laparoscopy. The aim of this study was to construct and to evaluate a clinical prediction rule for tubal rupture screening based on a self-assessment questionnaire, among patients with EP. METHODS A standardized questionnaire was constructed via semistructured interviews of patients with acute pelvic pain. Features associated with tubal rupture were then identified in 141 prospectively included patients with tubal pregnancy, including 30 with tubal rupture, in five hospitals. Multiple logistic regression was used to select the best combination of independent features for predicting tubal rupture. Cross-validation was with the jackknife method. The main outcome measure was diagnostic accuracy of the questionnaire for ruling out tubal rupture. RESULTS Eighty-nine items characterizing acute pelvic pain were identified. Among them, four contributed independently to the diagnosis of tubal rupture: vomiting during pain, diffuse abdominal pain, acute pain for longer than 30 minutes, and flashing pain. The presence of one or more of these features had 93% sensitivity (95% confidence interval [CI] = 84% to 100%) and 44% specificity (95% CI = 35% to 53%) for tubal rupture, with a negative likelihood ratio for ruling out tubal rupture of 0.16. CONCLUSIONS These results suggest that a standardized questionnaire may contribute to ruling out tubal rupture in patients with EP.
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Affiliation(s)
- Cyrille Huchon
- Service de Gynécologie et Obstétrique, CHI Poissy Saint-Germain en Laye, Poissy, France.
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Shetty JP, Shetty B, Makkanavar JH. A rare case of bilateral tubal pregnancy. J Indian Med Assoc 2011; 109:506-507. [PMID: 22315849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Diagnosis of ectopic pregnancy continues to be an important challenge. Here a case of incidental diagnosis of bilateral tubal ectopic pregnancy is reported. There was a ruptured tubal ectopic pregnancy on the left side and chronic ruptured tubal ectopic pregnancy on the right side. Leading cause of first trimester maternal deaths is due to complications of ectopic pregnancy. Here an unusual case of ectopic pregnancy is reported in which the patient had spontaneous bilateral tubal ectopic pregnancy which presented with left tubal rupture and subsequently emergency exploratory laparotomy revealed bilateral tubal mass, which on histopathological examination confirmed tubal pregnancy.
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Affiliation(s)
- J P Shetty
- Department of Pathology, KS Hegde Medical Academy, Mangalore
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49
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Ljuca D, Hudić I, Hadzimehmedović A. Heterotopic pregnancy in natural conception -- our initial experience: case report. Acta Clin Croat 2011; 50:249-252. [PMID: 22263391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
Heterotopic pregnancy refers to the presence of simultaneous pregnancies at two different implantation sites. Heterotopic pregnancy is rare, estimated to occur in 1 per 30,000 pregnancies. We report a case of a 27-year-old woman presented to the emergency department with the diagnosis of ruptured ectopic pregnancy. Careful ultrasound assessment indicated the diagnosis of heterotopic pregnancy. Right salpingectomy with removal of the hemoperitoneum and suction curettage were performed. Our operative diagnosis of heterotopic pregnancy was confirmed by histopathology. Heterotopic pregnancy can occur in the absence of any predisposing risk factors, and the detection of intrauterine pregnancy does not exclude the possibility of the simultaneous existence of ectopic pregnancy. Transvaginal ultrasound and assessment of the whole pelvis, even in the presence of intrauterine pregnancy, can be an important aid in the diagnosis of heterotopic pregnancy.
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Affiliation(s)
- Dzenita Ljuca
- University Department Gynecology and Obstetrics, Tuzla University Clinical Center, Tuzla, Bosnia and Herzegovina
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50
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Mancera Reséndiz MA, Arredondo Merino RR, Gómezpedroso Rea FJ, Rivera Rodríguez P, Rosas Priego PI. [Spontaneous heterotopic pregnancy. Case report]. Ginecol Obstet Mex 2011; 79:377-381. [PMID: 21966830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Heterotopic pregnancy has increased in frequency due to the increasing number of assisted reproductive procedures. The diagnosis is difficult even with ultrasonography. OBJECTIVE To report the case of a patient with heterotopic pregnancy without a history of in vitro fertilization or fertility treatment. CONCLUSIONS Heterotopic pregnancy is a rarity that requires a high diagnostic suspicion, specialized desk studies and early surgical care to ensure a favorable outcome to the embryo.
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