Tubal schistosomiasis as a cause of ectopic pregnancy in endemic areas?; a report of three cases.

Tubal schistosomiasis as a cause of ectopic pregnancy is uncommon. We are reporting three cases of tubal pregnancies in which the histopathological examination showed a bilharzial disease of the tube. Schistosomiasis to Schistosoma haematobium occurs in Gabon with an incidence of 8% to 44% of the adult population, and schistosoma ova have been found in 2.5% of histopathological examinations in removal of any genital tissue. Even if schistosomiasis was not the main causative agent of infertility, in this population which has the lowest fertility index in subsaharan Africa, it might impair an already altered tubal function by salpingitis. We suggest that parasitic examination should be made as a part of the management program of infertility and after an ectopic pregnancy in endemic areas.     

Vulvar lesion in urogenital schistosomiasis (S. haematobium)

Genital schistosomiasis must be considered in women from endemic areas presenting with the following signs and symptoms: Vulvar papules, swelling or tumour irregular vaginal bleeding infertility, ectopic pregnancy Urinary tract schistosomiasis can affect the lower and upper female genital tract.     

Schistosomiasis: possible cause of ectopic pregnancy. Four clinical cases]

The Authors describe 4 cases of ectopic pregnancy associated with foci of schistosomiasis and point out the relevance of mass screening on urine, stool and vaginal secretions in those areas where schistosomiasis is endemic and frequent the involvement of female genital tract. Utilization of laparoscopy in all cases where as adnexal mass and/or a history of unexplained infertility is found is finally advocated.     

Pregnancy Following Infertility

Pregnancies of 112 patients who had conceived after a history of a minimum of 2 years of infertility were compared to an equal number of matching controls without prior infertility to find out any risk of increased pregnancy complications. These patients were at a significantly higher risk of developing first trimester bleeding, antepartum haemorrhage and intrauterine fetal death. Also there were higher rates of preterm delivery and Caesarean section. The patients in the study group had a significantly higher number of stillborn babies. The incidence of other complications such as ectopic pregnancy, multiple pregnancy, and medical complications was also higher in these patients but the difference was not statistically significant.     

Microscopic evidence of silent inflammation in grossly normal fallopian tubes with ectopic pregnancy

A normal laparoscopic examination of the pelvis in an infertile patient is usually considered sufficient evidence of normal tubal function. Twelve of 27 tubal ectopic pregnancies which occurred over a 4-year period in patients attending an infertility clinic were in patients with a previously "normal" laparoscopy. In eight patients, salpingectomy was performed, and the whole tube was available for examination by a single pathologist. The eight fallopian tubes, thoroughly examined histologically, all had evidence of ongoing, low-grade salpingitis or postinflammatory endosalpingeal disorganization in areas away from the ectopic pregnancy. These findings suggest that laparoscopy does not exclude significant microscopic tubal disease in at least some women with an apparently normal pelvis, and that this may be a cause of ectopic pregnancy and perhaps "idiopathic" infertility.     

Factors determining fertility after conservative or radical surgical treatment for ectopic pregnancy

Objective: To examine factors determining choice of radical or conservative surgical procedure for tubal ectopic pregnancy and subsequent pregnancy rates.Design: A retrospective study collating information from the operative notes and previous gynecologic history associated with the choice of procedure and pregnancy rates and outcome over 3 years after a primary tubal ectopic pregnancy.Patient(s): Thirty-four women who had undergone conservative (tube sparing) and 56 who had undergone radical (salpingectomy) surgical treatment for tubal ectopic pregnancy at least 3 years before the study.Main Outcome Measure(s): The main outcome measure was the occurrence of a pregnancy (live birth, miscarriage, or ectopic pregnancy) over 3 years after the ectopic pregnancy.Result(s): The type of surgery performed was not affected by a previous history of infertility, known pelvic inflammatory disease, the presence of tubal adhesions, or abnormalities on the contralateral tube. Intrauterine pregnancy was not more likely after conservative treatment of ectopic pregnancy but, equally important, the risk of a further ectopic pregnancy was not increased. The single factor that was clearly associated with future fertility problems was a past history of infertility.Conclusion(s): Better results may be obtained by careful selection of operative procedure based on history and findings at the time of surgery.     

An evaluation of studies concerning reproduction after first trimester induced abortion

This report gives an estimate of the United States population at risk of fertility complications after legally induced abortion. It also includes a review of the published literature concerning long-term effects of abortion, such as secondary infertility, ectopic pregnancy, and adverse pregnancy complications.     

Extremes of body mass index do not affect first-trimester pregnancy outcome in patients with infertility

OBJECTIVE: The study was undertaken to ascertain whether body mass index (BMI) affects first-trimester pregnancy outcome in patients with infertility. STUDY DESIGN: Records of 494 patients with a singleton gestation after treatment for infertility at a single academic center were retrospectively reviewed. Patients were classified with regard to BMI and treatment protocol. Outcomes were defined as ongoing pregnancy, spontaneous abortion, or ectopic pregnancy. RESULTS: The average rate of spontaneous abortion was 21.5% and of ongoing pregnancy 75.1%. This did not differ significantly in any of the BMI groups. When patients were further subdivided according to diagnosis or fertility treatment, the spontaneous abortion rate remained the same. CONCLUSION: The likelihood of a spontaneous abortion, ongoing pregnancy, or ectopic pregnancy in singleton gestations in the first trimester, after treatment for infertility, was not affected by BMI.     

Early recognition of ectopic pregnancy in an infertility population

On an infertility service, 170 patients were evaluated for possible ectopic pregnancy using tests for beta-human chorionic gonadotropin levels, ultrasound, and clinical examination. Thirty-four (20%) of those evaluated underwent laparoscopy, of whom 31 (91%) were found to have ectopic pregnancies. Only three of the ectopic pregnancies were ruptured; only two women had significant hemoperitoneum and only two required transfusion. Subsequent intrauterine pregnancy occurred in 5 of 11 patients who underwent salpingectomy (45%) and in 1 of 15 patients who underwent salpingotomy (7%). There were no subsequent pregnancies in five patients after expression of the ectopic from the tube. Early intervention in an infertile population decreases morbidity and may favor conservative tubal surgery, although our series could not confirm the benefits of such surgery.     

Outcome of laparoscopic versus traditional surgery for ectopic pregnancies.

OBJECTIVE: To compare pregnancy rates after three surgical procedures for ectopic pregnancy (EP) over a 9-year period for normal and infertility patients. DESIGN: In a retrospective analysis, we examined crude pregnancy rates and life-table analysis of cumulative pregnancy rates. A proportional hazard regression model was used to examine relative risk of type of surgery and fertility rates. PATIENTS, PARTICIPANTS: One hundred twenty-six cases of EPs were reviewed at the Cleveland Clinic Foundation, a tertiary institution. MAIN OUTCOME MEASURES: Comparisons of rates of viable term deliveries were calculated between three types of surgery and were stratified according to the status of infertility. Confidence intervals for relative risk of surgery and fertility status on future pregnancy were calculated. RESULTS: No difference in pregnancy rates was observed after the three procedures (P = 0.08). Normals had a significantly higher (4 times higher) pregnancy rate than infertility patients, independent of surgical procedure. CONCLUSION: Successful pregnancy after EP is related to history of infertility rather than type of surgery to treat ectopic event. More randomized study is needed to examine laparoscopic salpingostomy, especially in patients with other infertility problems.     

Risk factors for ectopic pregnancy: a case-control study

AIM: To identify the risk factors for ectopic pregnancy. METHODS: We conducted a prospective case-control study for the role of several risk factors in the occurrence of ectopic pregnancy in Turkey. A total of 225 cases and 375 controls were compared for sociodemographic characteristics, cigarette smoking, obstetric, gynaecological, surgical histories, the presence or absence of assisted conception and contraceptive usage. RESULTS: The main risk factors for ectopic pregnancy were prior ectopic pregnancy (adjusted odds ratio (AOR): 13.1) and a history of infectious reproductive system (AOR for pelvic inflammatory disease: 6.8). Other risk factors found to be associated with an increased risk for ectopic pregnancy were multisexual partner (AOR: 3.5), history of infertility (AOR: 2.5), induced conception cycle (AOR: 3.4), current intrauterine device usage (AOR: 3.2), prior Caesarean section (AOR: 2.1) and cigarette smoking at the time of conception (AOR=1.7). On the contrary, barrier methods were protective from ectopic pregnancy (AOR: 0.4). CONCLUSIONS: The increased awareness and knowledge of risk factors have enabled an early and accurate diagnosis of ectopic pregnancy. This study has found prior pelvic infection to be a major aetiological factor for ectopic pregnancy. Furthermore, other factors found to be associated with ectopic pregnancy, such as prior ectopic pregnancy, infertility history and induced conception cycle, may be the result of a previous pelvic infection that may cause tubal sequelae. These factors are potential targets for intervention and modification.     

Ectopic pregnancy: diagnostic dilemma and delay

A retrospective analysis of 1 1 1 consecutive ectopic pregnancies was done regarding diagnostic difficulties and delay. Absence of amenorrhea before onset of symptoms was frequent (44.1%), as was a negative two-minute slide pregnancy test (50.0%). The main factors causing diagnostic delay were the use of therapeutic drug trials and misdiagnosis at curettage. Diagnostic delay can be reduced by early use of more sensitive pregnancy tests in patients predisposed to ectopic pregnancy, more critical use of drug trial therapy in patients with gynecologic diagnostic problems, early resort to laparoscopy and rapid pathologic examination of tissue obtained from curettage done in suspected cases of spontaneous abortion or menorrhagia to detect decidual changes or Arias-Stella phenomenon.     

腹腔镜早期诊治可疑异位妊娠的临床意义

目的 评估可疑异位妊娠(ectopic pregrnancy，EP)患者腹腔镜(laparoscopy，LSC)早期诊断和急诊手术的临床价值。方法 回顾分析1998年8月至2003年8月收治的经LSC手术治疗的可疑EP患者186例，均在入院24h内接受急诊LSC手术。结果 185例手术经腹腔镜完成，l例中转开腹，均无并发症发生。术中诊断EP172例(均经病理证实)，术前诊断符合率92．5％；其余病例依次为卵巢囊肿9例(4．8％)，宫内妊娠黄体破裂5例(2．7％)。32例合并不孕患者中25例有盆腔粘连，17例有输卵管卵巢病变，均行相应处理。12例少见异位妊娠(包括4例输卵管间质部妊娠，4例卵巢妊娠，3例腹腔妊娠，l例子宫肌壁间妊娠)，15例休克型异位妊娠，经腹腔镜手术亦获满意治疗效果。结论 急诊LSC手术不仅可早期确诊可疑EP患者，为保守性治疗赢得时间，而且还可同时对不孕症患者进行诊治。急诊LSC手术治疗休克型及少见异位妊娠亦是可行且安全的。     

Cesarean Scar Defects: An Underrecognized Cause of Abnormal Uterine Bleeding and Other Gynecologic Complications

The gynecologic sequelae due to deficient uterine scar healing after cesarean section are only recently being identified and described. These include conditions such as abnormal bleeding, pelvic pain, infertility, and cesarean scar ectopic pregnancy, as well as a potentially higher risk of complications and difficulties during gynecologic procedures such as uterine evacuation, hysterectomy, endometrial ablation, and insertion of an intrauterine device. The proposed mechanism of abnormal uterine bleeding is a pouch or “isthmocele” in the lower uterine segment that causes delayed menstrual bleeding. The prevalence of symptomatic or clinically relevant cesarean scar defects (CSDs) ranges from 19.4% to 88%. Possible risk factors for CSD include number of cesarean sections, uterine position, labor before cesarean section, and surgical technique used to close the uterine incision. There are no accepted guidelines for the diagnostic criteria of CSD. We propose that a CSD be defined on transvaginal ultrasound or saline infusion sonohysterography as a triangular hypoechoic defect in the myometrium at the site of the previous hysterotomy. We also propose a classification system to aid in standardized classification for future research. Surgical techniques for repair of CSD include laparoscopic excision, resectoscopic treatment, vaginal revision, and endometrial ablation.     

Ruptured ectopic pregnancy: risk factors for a life-threatening condition

Introduction  Ectopic pregnancy is a significant cause of maternal morbidity and mortality. The widely used features to establish the diagnosis of ectopic pregnancy are not always sufficient to predict rupture. Problem  To determine the risk factors for rupture of an ectopic pregnancy to help physicians identify those women who are at greatest risk. Materials and methods  The study group comprises the cases of ectopic pregnancy who were treated in the gynecologic department of the General Hospital “George Gennimatas” in Athens, Greece, from January 1988 to December 2006. The following parameters were retrospectively examined: rupture status, past history of pelvic infection or ectopic pregnancy, use of IUCD, operations for infertility treatment/tubal surgery, parity and gestational age. The study group was divided into two subgroups: ruptured ectopic pregnancies and unruptured ectopic pregnancies. Where appropriate, Student’s t test, Mann–Whitney–Wilcoxon test for independent samples, Pearson’s chi-square and Fisher’s exact test were applied. Statistical analysis was performed with STATA 8.0 statistical software. Results  Two hundred and twenty-three cases of ectopic pregnancy were retrieved in the studied period. One hundred and forty-four (65%) of them were cases with ruptured ectopic pregnancies and 79 (35%) were cases with unruptured ectopic pregnancies. Fifty-five of the 144 patients (38.2%) with ruptured ectopic pregnancy and 18 of the 79 (22.8%) patients with unruptured ectopic pregnancy had a past history of ectopic pregnancy (P = 0.019, Pearson’s chi-square). Moreover, there was a statistically significant positive association between rupture and parity (1.19 ± 1.02 for ruptured cases vs. 0.85 ± 0.89 for unruptured cases; P = 0.015, Mann–Whitney–Wilcoxon test for independent samples). A positive association of borderline significance existed between rupture and gestational age (53.9 ± 4.7 vs. 52.9 ± 4.9 days; P = 0.093, Mann–Whitney–Wilcoxon test for independent samples). No statistically significant associations were found concerning past history of pelvic infection, use of IUCD and operations for infertility treatment–tubal surgery. Conclusions  Previous history of ectopic pregnancy and parity seem to be significant risk factors for rupture of an ectopic pregnancy.     

Incidental ectopic pregnancy.

Three cases of incidental ectopic pregnancy are described in which the patients were found to have unsuspected ectopic pregnancy when operated for an elective gynecologic procedure.     

Synchronous intrauterine and ectopic pregnancy associated with clomiphene citrate

Although synchronous intrauterine and ectopic pregnancies associated with the use of clomiphene citrate for infertility are rare, the actual incidence might, in fact, be considerably higher than previously thought. The cornerstone for ruling out an extrauterine gestation is the presence of sonographic evidence of an intrauterine pregnancy, as the possibility of concomitant intrauterine and extrauterine gestation is perceived to be statistically rare. This has resulted in an unacceptably high incidence of negative ultrasound interpretations. During a recent 12 month period, four women treated with clomiphene citrate for infertility were diagnosed as having concomitant intrauterine and ectopic pregnancies. Three had pelvic sonograms that were erroneous for the extrauterine component. However, successful evacuation of the products of ectopic gestation was performed in each, despite an immediate preoperative false-negative ultrasound report. Three of the women delivered healthy normal infants at full term, and the fourth woman spontaneously aborted the products of the concomitant intrauterine gestation. All four did well postoperatively, and no gross complications were encountered. Reassessment of ultrasound diagnostic criteria and the use of more sensitive methods, such as endovaginal ultrasound in high risk patients, are indicated for any symptomatic patient using clomiphene citrate for infertility. Awareness of the prevalence of this entity and the limitations of ultrasound will lead to prompt intervention and improved survival rates.     

The occurrence of ectopic pregnancy with and without clomiphene citrate use in assisted and nonassisted reproductive technology

An eleven-year review of treatment records of patients who became pregnant as a result of infertility treatment (n=3692) was conducted. All records were examined to determine whether clomiphene citrate (CC) was used in the cycle of conception and whether or not an ectopic pregnancy occurred. Data were additionally analyzed for the incidence of ectopic pregnancy with and without assisted reproductive technology (ART). The incidence of ectopic pregnancy was similar between CC (3.4%) and non-CC (3.4%) treatment groups receiving non-ART treatment. For non-ART treatments, tubal disease and severe endometriosis resulted in an increase in ectopic pregnancies independent of CC use. The incidence of ectopic pregnancy in patients receiving CC + human menopausal gonadotropin (hMG) for in vitro fertillization (5.4%) and gamete intrafallopian transfer (3.1%) was similar compared to ART treatments with hMG alone. The incidence of ectopic pregnancy was more closely associated with infertility diagnosis rather than CC use.Presented in part at the Annual Meeting of the Pacific Coast Fertility Society in Palm Springs, California, April 12, 1989.     

淋病生殖道感染现状及规范治疗

淋病是由淋病奈瑟菌感染泌尿生殖系统所致的化脓性炎性疾病,可引起女性盆腔炎性疾病、慢性盆腔疼痛、异位妊娠或不孕等,对生殖系统造成严重的不良后果。因此,充分认识淋病,掌握其流行病学特征及规范治疗具有重要意义。     

不孕患者子宫内膜息肉的宫腔镜诊治临床分析

目的:探讨不孕患者子宫内膜息肉(EP)发生的相关因素及宫腔镜下EP清除术对助孕效果的影响。方法:接受宫腔镜检查的不孕患者855例,其中EP患者202例(EP组),宫腔正常者653例(对照组)。分析年龄、体质量指数、不孕年限、不孕类型及合并症等与EP发生的相关性;采用宫腔镜术联合药物(三联疗法)治疗,分析术后助孕效果。结果:EP发病率为23.6%,原发不孕、不孕年限>5年者EP发病率增高,EP患者合并子宫内膜异位症、子宫肌瘤、月经稀发几率明显增高(P<0.05);患者接受"三联疗法"治疗后,经助孕后临床妊娠率与对照组比无差异(P>0.05)。结论:宫腔镜手术有助于提高EP检出率,联合药物治疗的"三联疗法"是治疗EP的有效方法。