Conservative surgical treatment of ectopic pregnancy. Avoiding partial salpingectomy

Salpingostomy is the preferred surgical method of managing ectopic gestation when patients desire future fertility. Problems with that technique stem principally from difficulties with hemostasis. While ligation of a single mesosalpingeal vessel has been described, blood to the site of the ectopic gestation is supplied primarily by the tubal branch of the ovarian artery. We developed a technique for ligating that vessel at both ends of the ectopic site. The technique may be combined with mesosalpingeal vessel ligation and leads to excellent hemostasis. Although blood vessels to the tube are interrupted, tubal length is preserved. Salpingostomy is thus possible, even in cases of large, actively bleeding or ruptured ectopic gestations. The need for partial salpingectomy, frequently utilized under those circumstances, is thus obviated. Salpingostomy may result in spontaneous recanalization; if anastomosis is needed subsequently, maximal tubal length is preserved.     

Ampullar ectopic pregnancy following ipsilateral partial isthmic salpingectomy

The study is about ampullar ectopic pregnancy following ipsilateral partial isthmic salpingectomy. An ectopic pregnancy is any pregnancy outside of the uterine cavity. Pregnancies in the fallopian tube account for 97 % of all ectopic pregnancies. Fifty-five percent of these pregnancies occur in the ampulla, 25 % in the isthmus, 17 % in the fimbriae, and 3 % of the pregnancy is situated in the abdominal cavity, ovary, or uterine cervix. Diagnosing an ectopic pregnancy can be difficult; however, the widespread availability of pregnancy tests and the present high-resolution ultrasound possibilities have resulted in earlier diagnosis and have thus reduced the chance of massive intraabdominal bleeding and hypovolemic shock at presentation. We present a rare case of a recurrent ectopic pregnancy, occuring in the distal remnant of the ampulla of the fallopian tube, after a previous partial ipsilateral salpingectomy. This case shows that a strict adherence to the Dutch guideline would probably have led to an earlier detection.     

Idiopathic postoperative ascites after laparoscopic salpingectomy for ectopic pregnancy

Postoperative ascites is a rare and serious complication of laparoscopic procedures. Urinary tract injury, bowel injury, and lymph duct injury are the common causes; however, in some patients no definitive cause can be identified after an extensive diagnostic work-up. We present a case of postoperative ascites of unknown origin. The patient recovered with general treatments. We presume that diffuse peritoneal injury may have been caused by unidentified substances in our patient.     

Abdominal compartment syndrome after laparoscopic salpingectomy for ectopic pregnancy

Abdominal compartment syndrome is a consequence of increased intraabdominal pressure. It can be triggered by inflammation, hemorrhage, chemical peritonitis, or prolonged insufflations during laparoscopy. It is a well-known phenomenon for intensive care specialists, but gynecologists are relatively unfamiliar with its occurrence. A woman with heterotopic pregnancy underwent urgent laparoscopy because of abdominal hemorrhage. The postoperative course was complicated by abdominal pain, ascites, bowel dysfunction, and renal failure, which resolved rapidly after catheterization and paracentesis. In this case, abdominal compartment syndrome developed after unremarkable laparoscopy, and appeared to be triggered by change of progesterone formulation. Decompression by paracentesis was lifesaving, and led to rapid resolution of the symptoms.     

Persistent peritoneal trophoblastic implantation following salpingotomy,salpingectomy, and methotrexate for ectopic pregnancy

A well recognized complication of conservative surgical treatment for tubal ectopic pregnancy, salpingotomy, is incomplete removal of trophoblastic tissue. Secondary trophoblastic implantation needs to be considered especially in cases of persistent disease following salpingectomy. We report an unusual and rare case of persistent peritoneal trophoblastic implantation following salpingotomy, salpingectomy and methotrexate for tubal ectopic pregnancy. This case illustrates that the treatment of ectopic pregnancy can prove to be difficult, even if the initial diagnosis is obvious. It shows that persistent trophoblastic disease can occur not only after salpingotomy but also after salpingectomy and methotrexate, hence the need for postoperative serum beta human chorionic gonadotrophin (Bhcg) in all cases. It also demonstrates that secondary implantation is a possibility in persistent disease and thorough examination of the pelvis, the peritoneal and serosal surfaces is mandatory.     

Recurrent ectopic pregnancy after partial salpingectomy, distal and proximal, therapeutic and prophylactic

Salpingectomy should always be complete. A patient had a third ectopic pregnancy following partial salpingectomy, of the ampullary and uterine parts, therapeutically and prophylactically.     

Ovarian response to gonadotropins after laparoscopic salpingectomy for ectopic pregnancy

ObjectiveTo evaluate whether laparoscopic salpingectomy compromises ovarian response in women undergoing controlled ovarian hyperstimulation in vitro fertilization (IVF).MethodsIn a retrospective study in Changsha, China, data from 76 women who underwent ovarian stimulation before and after laparoscopic salpingectomy for ectopic pregnancy were compared with those from 80 women who underwent 2 IVF cycles without surgical intervention between 2004 and 2009.ResultsThere were no differences in basal serum follicle-stimulating hormone (FSH) or estradiol (E₂); length of stimulation; or numbers of follicles, retrieved and fertilized oocytes, or high-quality embryos between the cycles before and after salpingectomy; however, initial and total doses of gonadotropins were significantly increased after surgery (P < 0.05). IVF parameters were also comparable between the 2 cycles among women without surgical intervention, except for a significant increase in initial and total doses of gonadotropins at the second cycle (P < 0.05). IVF parameters did not differ between the cycle subsequent to salpingectomy and the second cycle in women without surgical intervention. There were no significant differences between patients with unilateral and those with bilateral salpingectomy, nor between the operated and non-operated ovary in the same individual.ConclusionLaparoscopic salpingectomy had no detrimental effect on ovarian response during IVF–embryo transfer treatment.     

Clinical characteristics of persistent gestational trophoblastic neoplasia after partial hydatidiform molar pregnancy

OBJECTIVE: To identify clinical characteristics associated with developing persistent gestational trophoblastic neoplasia (GTN) after partial hydatidiform molar pregnancy (PHM). STUDY DESIGN: Utilizing the Donald P. Goldstein in patients who developed persistence between 1973 and 1989. CONCLUSION: Older age at diagnosis and history of prior mole were significantly more common in women who developed persistence after partial molar pregnancy in referral of patients the earlier cohort but not in idefined clinical the recent cohort. In recent years no clinical factor was at increase their risk significantly associated with rsistence. database at the New England Trophoblastic Disease Center, 284 women with partial molar pregnancy diagnosed between 1973 and 2003 were characteristics identified. Clinical charac- for pe teristics, such as gravidity, parity, age, uterine size, gestational age at diagnosis, human chorionic gonadotropin levels at presentation and time to development of persistence (GTN) were analyzed. Data were also divided into 2 cohorts, an earlier one (1973-1989) and a later one (1990-2003), in order to look at potential changes over time. RESULTS: GTN developed in 5.6% of partial molar pregnancies. Older maternal age was significantly associated with development of persistent GTN in the earlier cohort but not in the recent cohort. Previous molar pregnancy was also statistically significantly more common the development of +/-after PHM.     

Repeated ectopic pregnancy on the tubal stump after laparoscopic salpingectomy

A 40-year-old woman who had undergone laparoscopic right salpingectomy because of a tubal pregnancy 10 years ago presented to our hospital with severe lower abdominal pain. Ectopic pregnancy with internal bleeding was suspected after evaluation. With laparoscopy, repeated ectopic pregnancy on the tubal stump was diagnosed and treated successfully.     

Twin ectopic pregnancy after ipsilateral salpingectomy: A report of cases

Background

Ectopic pregnancy continues to be a significant cause of maternal morbidity and mortality. Recurrent ectopic pregnancy in the remnant portion of the tube after a previous ipsilateral salpingectomy has only rarely been reported. We present unusual cases of ipsilateral ectopic pregnancy occurring in the stump of an ectopic site.

Omental trophoblastic implants after surgical management of ectopic pregnancy

Peritoneal implants secondary to a tubal ectopic pregnancy or extratubal omental secondary trophoblastic implants (ESTI) are a rare entity often underestimated or unknown. It can be responsible of rising in the ?-hCG titer after salpingectomy for ectopic tubal pregnancy. Moreover, implants on the omentum are exceptional. This particular localization is exceptional and its physiopathology, diagnosis, surgical management and follow-up are discussed in this paper.     

Intratubal methotrexate for prevention of persistent ectopic pregnancy after salpingotomy

STUDY OBJECTIVE: To investigate whether frequency of persistent ectopic pregnancy after linear salpingotomy can be reduced by prophylactic administration of a single intraoperative injection of local methotrexate. DESIGN: Prospective, randomized, controlled trial (Canadian Task Force classification I). SETTING: University-affiliated hospital. PATIENTS: Sixty-five women with unruptured ectopic pregnancy. INTERVENTION: Laparoscopic salpingotomy with or without a single intratubal dose of methotrexate 1 mg/kg. MEASUREMENTS AND MAIN RESULTS: In the prophylaxis group, 22 patients received a single dose of intratubal methotrexate 1 mg/kg after linear salpingotomy; 43 controls had only linear salpingotomy. Six women (14%) in the control group developed persistent ectopic pregnancy, compared with none in the prophylaxis group (p <0.05). CONCLUSION: In our opinion, intratubal methotrexate injection during laparoscopic salpingotomy is a practical option for women with unruptured ectopic pregnancy.     

Unilateral twin ectopic pregnancy managed with laparoscopic salpingectomy

We describe a rare case of unilateral twin tubal ectopic pregnancy in a multiparous lady in the right fallopian tube that was confirmed on laparoscopy and managed by laparoscopic salpingectomy.     

Persistent ectopic pregnancy following ipsilateral “salpingectomy”

Persistent ectopic pregnancy (PEP) following ipsilateral “salpingectomy” is a rare occurrence. This report describes this uncommon condition in a 26-year-old woman who presented with a sudden onset of right fossa iliac pain following an earlier salpingectomy. At laparoscopy, a persistent ipsilateral EP in the right fallopian tube stump was found. At the initial laparoscopy, an endoloop was used for salpingectomy, and a tubal stump of about 4 cm was left. This poses the questions: Are salpingectomies performed with endoloops true salpingectomies or partial salpingectomies? Do women managed with endoloops need to have human chorionic gonadotropin (hCG) follow-up, as do those with salpingostomy?