Ectopic tubal pregnancy after hysterectomy and tubal ligation

Posthysterectomy ectopic pregnancy is an unusual condition that may present soon after hysterectomy or several years later. Similarly, although tubal ligation is a widespread method of contraception, tubal pregnancy after tubal ligation is not common either. If any of these conditions are rare, having an ectopic pregnancy after hysterectomy and tubal ligation is even more infrequent and only one of such cases was found in our review of the literature. We describe the case of a 35-year-old patient, with history of bilateral tubal ligation and vaginal hysterectomy that looked for medical attention due to abdominal pain. A pregnancy test was positive and a transvaginal ultrasound demonstrated the presence of a gestational sac at the vaginal cuff, adjacent to the ovary. An exploratory laparotomy showed a ruptured ectopic pregnancy located in the distal portion of the left fallopian tube. The occurrence of an ectopic pregnancy several years following tubal ligation and vaginal hysterectomy is a rare phenomenon that appears to be secondary to a fistulous connection into the peritoneal cavity.     

Bilateral ectopic pregnancy after transfer of two embryos

OBJECTIVE: To report a case of bilateral tubal ectopic pregnancy (EP) after the transfer of two embryos. DESIGN: Case report. SETTING: University hospital. PATIENT(S): A 43-year-old multigravida with bilateral tubal pregnancy. INTERVENTION(S): Operative laparoscopy with right linear salpingostomy and left salpingectomy. MAIN OUTCOME MEASURE(S): Laparoscopy revealed an unruptured left isthmic tubal EP and an unruptured right ampullary tubal EP. RESULT(S): Pathology confirmed immature placental villi in the right tube and placental tissue in the left tube. The patient was discharged home without incident on the day after surgery. CONCLUSION(S): This is a rare case of bilateral tubal pregnancy after the transfer of only two embryos. It is critical to perform a close inspection of the abdomen, pelvis, and contralateral tube after surgery for EP.     

Bilateral tubal pregnancy after natural conception: a case report

BACKGROUND: Bilateral tubal pregnancy is very rare and usually follows ovulation stimulation. CASE: A 36-year-old woman with acute pelvic pain underwent emergency laparoscopy for suspected left ruptured tubal pregnancy. Bilateral hematosalpinx with a ruptured left tubal pregnancy and active bleeding from the right fallopian tube was noted during surgery, and bilateral salpingectomy was performed by laparoscopy. Pathologic examination of the left tube confirmed the presence of conception products and trophoblastic tissue. The right salpingectomy specimen contained some trophoblastic tissue resembling an earlier tubal pregnancy encased in a cyst. CONCLUSION: This was a rare case of spontaneous bilateral tubal pregnancy after conception at different times. The explanation of the presentation is uncertain. Laparoscopy remains the cornerstone of diagnosis and treatment in the majority of women with a tubal pregnancy; this is especially true in complex cases, such as bilateral tubal pregnancy.     

经阴道超声引导下减胎术在输卵管间质部妊娠合并宫内孕中的应用——减胎成功2例报告

目的探讨孕早期采用经阴道超声引导下减胎术减灭宫外妊娠胚芽的临床治疗效果。方法通过阴道超声减胎抽吸宫外妊娠组织。结果对2例诊断为未破裂输卵管间质部的早期异位活胎妊娠,通过经阴道超声引导下减胎穿刺治疗,被保留的宫内胎儿持续妊娠至足月分娩。结论孕早期采用经阴道超声引导下减胎术选择性抽吸输卵管间质部胚芽,可获得理想的临床治疗效果。但是本方法仅去除胚芽组织,对残余的绒毛组织,需密切追踪随访。     

Simultaneous tubal pregnancy and twisted ovarian cyst

Background Simultaneous or concomitant bilateral adnexal pathology is rare. But simultaneous tubal pregnancy and twisted ovarian cyst is even rarer.Case A 25-year-old woman, gravida 2, parity 0, presented with acute abdomen after 12 weeks of amenorrhea. Simultaneous right tubal pregnancy and twisted left ovarian cyst were intraoperatively diagnosed. Right salpingostomy and left salpingo-oophorectomy were performed. The follow-up serum beta-hCG was negative at the nineteenth postoperative day. She was well at discharge and throughout the 4-week follow-up period.Conclusion Although simultaneous or concomitant bilateral adnexal pathology is uncommon, a careful assessment of both adnexa is mandatory especially in the cases with inconsistent site of symptom and pathology in order to avoid undiagnosed simultaneous pathologies that may be missed.     

Transvaginal Natural Orifice Transluminal Endoscopic Surgery for Tubal Stump Pregnancy

ObjectiveTo demonstrate a case of left tubal stump pregnancy successfully treated using our 2-step technique for transvaginal natural orifice transluminal endoscopic surgery (vNOTES).DesignDemonstration of the technique using surgical video footage.SettingTertiary university hospital.InterventionsA 27-year-old gravida 3 para 0 patient with a history of laparotomy, left salpingectomy owing to a ruptured tubal pregnancy, was referred to our hospital because of a pregnancy of unknown location. Her serum β human chorionic gonadotropin level was 8400 U/L, and a transvaginal ultrasound revealed an ectopic pregnancy in the left tubal stump. After discussing medical and surgical treatment options, the patient underwent a 2-step vNOTES approach. First, a diagnostic vNOTES was performed using a 5-mm trocar with autoretracting blade. After confirmation of the diagnosis, the trocar was removed, and the incision was enlarged with blunt dissection. A self-constructed pessary port was then placed through the enlarged colpotomy, and the ectopic pregnancy in the left tubal stump was excised using an advanced bipolar device. The colpotomy was closed with running resorbable sutures. The duration of the surgery was 36 minutes, and the patient was discharged on postoperative day 1 without any complications.ConclusionTubal stump pregnancy is a rare form of ectopic pregnancy with an incidence of approximately 0.4% of all ectopic pregnancies [1]. Treatment options include conservative medical management using methotrexate and surgery. Successful surgical treatment using laparoscopy has been previously reported [1,2]. This case demonstrates that vNOTES may be a minimally invasive option for the surgical treatment of tubal stump pregnancy in selected cases.     

A case of tubal endometriosis mimicking the appearances of tubal pregnancy at laparoscopy

Tubal pregnancy is a common gynaecological emergency. Due to the accuracy of transvaginal ultrasonography and serum human chorionic gonadotrophin (hCG) analysis is being managed more frequently by laparoscopy in asymptomatic patients. A case of presumed tubal pregnancy is presented in which the evidence generated by ultrasonography, hCG levels and laparoscopy all suggested tubal pregnancy. However, histological examination showed a tubal endometrioma. This case highlights the importance of histological analysis of all surgical specimens and provides a rare differential diagnosis of tubal mass.     

Transvaginal ultrasound-guided aspiration and instillation of hyperosmolar glucose for treatment of unruptured tubal heterotopic pregnancy

Objectives To report a case of tubal heterotopic pregnancy (HP) treated conservatively with transvaginal ultrasound-guided aspiration and instillation of hyperosmolar glucose. Methods Aspiration of the tubal ectopic pregnancy and hyperosmolar glucose instillation was performed with a 16-gauge needle under transvaginal ultrasound guidance. Results Unruptured tubal HP with positive cardiac activity was treated successfully without any further interventions, and intrauterine pregnancy has reached full-term without any complications. Conclusions Early diagnosis of this life-threatening condition is the key to its successful treatment. Transvaginal ultrasound-guided aspiration and hyperosmolar glucose injection can be safely performed for the treatment of unruptured tubal HP.     

Microsurgical salpingostomy is not an obsolete procedure.

OBJECTIVE--A review of the results of microsurgery for bilateral distal tubal blockage. DESIGN--A retrospective review. SETTING--Hammersmith Hospital London and local private hospitals. SUBJECTS--388 patients with bilateral ampullary occlusion treated between 1971 and 1988 by microsurgery. INTERVENTIONS--Full investigation for other causes of infertility followed by abdominal microsurgical salpingostomy. Repeated meticulous follow-up was essential with check laparoscopy one year after surgery. MAIN OUTCOME MEASURE--Successful pregnancy in relation to tubal damage. RESULTS--In 65 women microsurgery followed tubal reocclusion after failed conventionally performed salpingostomy. 74 women (23%) had one term pregnancy after primary salpingostomy and 12 women (18%) after repeat salpingostomy. Over half the women having a term pregnancy subsequently had a second infant. The tubal damage was classified in four stages according to the degree of mucosal damage and tubal fibrosis, the presence of isthmic disease and the quality of tubal and ovarian adhesions. Approximately one quarter of patients had stage I disease and amongst these 39% had babies after primary salpingostomy and 25% after repeat salpingostomy. CONCLUSION--Microsurgical salpingostomy is a specialized procedure. Proper selection of patients, competent microsurgical technique and adequate follow-up appear crucial to success. In selected patients treatment by salpingostomy gives better results than multiple cycles of in vitro fertilization.     

Bilateral tubal pregnancies after the termination of intrauterine pregnancy following gamete intrafallopian transfer

It is well known that the prevalence of heterotopic pregnancies following assisted reproductive technology (ART) is much higher than among spontaneous pregnancies. Here, we illustrate a very rare case of bilateral simultaneous tubal pregnancies combined with intrauterine pregnancy (incomplete abortion) following gamete intrafallopian transfer (GIFT). In this case, unsuspected bilateral tubal pregnancies were diagnosed when laparotomy was performed 10 days after the termination of an intrauterine pregnancy. We conclude that a careful monitoring after the termination of an intrauterine pregnancy should be performed when the patient has prolonged genital bleeding, which might be a warning signal of heterotopic pregnancy existence even in patients without any risk factors of ectopic pregnancy. (Reprod Med Biol 2002; 1 : 65–67)     

Bilateral tubal pregnancies after a single‐embryo transfer

Case

To present an extremely rare case of bilateral tubal pregnancies following a single‐embryo transfer in a woman with a 4 year history of infertility prior to seeking assisted reproductive technology.

Outcome

A pregnancy resulted from the transfer of an embryo that had been thawed from a frozen blastocyst during a hormone replacement cycle. An ultrasound that was performed at 5 weeks and 5 days of gestation revealed a gestational sac, embryo, and heartbeat in the right fallopian tube and similar signs of a gestational sac in the left fallopian tube. A laparoscopy revealed clear signs of an ectopic pregnancy in the ampulla of the right fallopian tube. Signs of swelling also were seen in the ampulla of the left fallopian tube. As the possibility of bilateral tubal pregnancies could not be ruled out, both fallopian tubes were removed. Pathological tests revealed chorionic villi and trophoblasts in both the left and right fallopian tubes.

Conclusion

All previously reported cases of bilateral tubal pregnancies have been a result of multiple ovulations or multiple‐embryo transfer and no case of bilateral tubal pregnancies after a single‐embryo transfer has ever been reported. No genetic testing was performed; thus, it cannot be definitively stated that the divided chorionic villi and trophoblasts came from only one embryo.     

Simultaneous bilateral tubal pregnancies after in vitro fertilization and embryo transfer: report of a case.

Ectopic pregnancies continue to be a major complication of in vitro fertilization and embryo transfer (IVF-ET). A case of bilateral simultaneous tubal pregnancy after IVF-ET is described. The patient underwent ovum pick-up (OPU) through a laparotomy with concomitant pelvic surgery. Embryo transfer (ET) was performed two days after OPU; this resulted in bilateral tubal pregnancies, diagnosed and treated one month apart. There are several possible causal mechanisms for the increased rate of ectopic pregnancies following IVF-ET. It is important to recognize that care in the transfer technique, with respect to the catheter position and limiting the volume of transfer medium to 20 microL, and an awareness of previous occlusion of the tubal ostia, or of a salpingectomy before IVF-ET, can help to minimize this complication rate. Two important points are the possibility of a simultaneous bilateral tubal pregnancy after IVF-ET, and the necessity of carefully examining both adnexa at the time of surgery for an ectopic pregnancy. Early and accurate diagnosis of a simultaneous bilateral ectopic pregnancy can prevent the necessity of a second operation and reduce maternal morbidity and mortality.     

Broad ligament twin pregnancy. A case report

BACKGROUND: Broad ligament pregnancy is an uncommon form of ectopic pregnancy. CASE: A 34-year-old, 11-week-pregnant woman, gravida 2, para 0, presented with left lower abdominal pain. She had undergone a right salpingectomy due to tubal pregnancy six years previously. She had a left broad ligament twin pregnancy, and excision of the pregnancy and left tube were performed. She was well at discharge and the six-week follow-up. CONCLUSION: This is the first case report of a broad ligament twin pregnancy after spontaneous conception.     

Effect of the number and depth of embryos transferred and unilateral or bilateral transfer in tubal embryo transfer (TET)

Purpose Our purpose was to evaluate the possible effects of the number of embryos transferred, the depth of embryos placed within the tube(s), and unilateral or bilateral tubal transfer on pregnancy initiation in tubal embryo transfer (TET).Methods One hundred eight consecutive TET cycles were analyzed. Oocyte retrievals were carried out by transvaginal ultrasound-guided aspiration of follicles. Forty-eight hours after oocyte retrieval, the developing embryos at the stage of two to four cells were transferred into the fallopian tube(s) by laparoscopy. A maximum of four embryos was transferred to each patient.Results The pregnancy rates were similar among the cycles in which two, three, or four embryos were transferred. In addition, there was no significant difference in the pregnancy rate whether the embryos were deposited >4 cm or between 3 and 4 cm into the tube(s). Although the pregnancy rate was greater in cycles of bilateral tubal transfer, the difference from that of unilateral transfers was not significant.Conclusion Our data indicate that when two to four embryos were transferred and the embryos were placed 3 cm within the tube(s), unilateral or bilateral tubal transfer had little influence on the ultimate success of TET.Presented at the 7th World Congress on IVF and Assisted Procreation, June 30–July 3, 1991, Paris, France.     

Tubal pregnancy after clomiphene treatment: are you sure is not bilateral?

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.     

Bilateral hematosalpinx in a case of ectopic pregnancy: a clinical dilemma

A 31-year-old woman with a positive pregnancy test and a transvaginal ultrasound scan result that was suggestive of a right tubal ectopic pregnancy underwent a laparoscopy, which showed bilateral hematosalpinx. In the presence of active bleeding and deteriorating hemodynamic status of the patient, a minilaparotomy was performed that revealed a right-sided hematosalpinx and a left-sided ectopic gestation.     

Embarazo ectópico bilateral espontáneo

Spontaneous bilateral ectopic pregnancy is a rare event and is difficult to diagnose preoperatively. We report a case diagnosed by transvaginal ultrasonography in a patient without risk factors. Laparoscopic left salpingectomy and right linear salpingostomy were performed. This case illustrates the importance of carefully examining both adnexa when ultrasound examination or surgery are performed.     

Ectopic pregnancy following emergency contraception with ethinyloestradiol-levonorgestrel: a case report.

BACKGROUND: Emergency contraception with ethinyloestradiol-levonorgestrel is effective, and ectopic pregnancy following its failure is rare. CASE: A 21-year-old nulligravid Japanese woman with regular menstrual periods took ethinyloestradiol-levonorgestrel pills for emergency contraception (EC) 36 and 48 hours after a coitus complicated by retention of the condom in the vagina. She started bleeding vaginally 24 days after that intercourse. As the bleeding continued for three weeks she consulted a gynaecologist. The pregnancy test was positive. Two weeks later she complained of lower abdominal pain, and transvaginal ultrasonography suggested a pelvic blood collection. At emergency surgery, she was found to have a left tubal pregnancy. CONCLUSION: Although ectopic pregnancy after failure of EC is rare, one should be alert to its possible occurrence.     

Unusual presentation of a third tubal pregnancy. A case report

A rare case occurred of a third ectopic pregnancy associated with a previous right partial salpingectomy and left total salpingectomy/cornual resection. The ectopic implantation was in the right fimbrial stump. Some suspicion of pregnancy should always be maintained despite any history of previous bilateral tubal "removal."     

Ectopic pregnancy after transmyometrial embryo transfer: case report.

OBJECTIVE: To report a case of ectopic pregnancy after transvaginal transmyometrial ET. DESIGN: Case report. SETTING: University-based IVF program. PATIENT(S): A woman with tubal subfertility and a history of difficult ETs. INTERVENTION(S): Transvaginal transmyometrial ET performed to avoid a difficult transcervical ET. MAIN OUTCOME MEASURE(S): Expected improvement in the pregnancy rate in a selected group of patients. RESULT(S): Tubal pregnancy. CONCLUSION(S): Transmyometrial ET is an attractive alternative to difficult transcervical ET but is not free of complications.