Second Ectopic Pregnancy Following Laparoscopic Sterilization

Summary: An unusual case of a second ectopic pregnancy occurring after a technically correct laparoscopic sterilization is presented. The incidences of second ectopic pregnancy and failed sterilization are discussed. The unusual means of fertilization occurring here is postulated, and the safest management of ectopic pregnancy occurring after laparoscopic sterilization is proposed.     

A Survey of Tubal Ectopic Pregnancy, with Particular Reference to Cases Following Sterilization

In a series of 47 ectopic pregnancies occurring over a 2-year period, 5 followed tubal sterilization. Foreknowledge of the previous sterilization resulted in delay of surgical management. Sterilization techniques should be revised to prevent the incidence of ectopic pregnancy.     

Recurrent Tubal Ectopic Pregnancy Management and the Risk of a Third Ectopic Pregnancy

Study ObjectiveTo evaluate the rate of a third ectopic pregnancy according to the modality of treatment of the second ectopic pregnancy.DesignRetrospective cohort study.SettingUniversity-affiliated tertiary medical center.PatientsOne hundred eleven women who had 2 ectopic pregnancies and a third consecutive pregnancy between 2003 and 2018.InterventionsSurgery or medical treatment as required.Measurements and Main ResultsWith regard to the modality of treatment of the second ectopic pregnancy, the patients were divided into 3 groups: expectant management, medical treatment with methotrexate, and laparoscopic salpingectomy. Univariate and multivariate analyses were conducted to assess the association of various parameters of the second ectopic pregnancy with the occurrence of a third ectopic pregnancy in the consecutive pregnancy. Twenty women (18.0%) were managed expectantly, 55 (49.6%) were treated with methotrexate, and 36 (32.4%) underwent surgery. Expectant management resulted in significantly higher rates of a third ectopic pregnancy compared with treatment with methotrexate or surgical intervention (50.0% vs 18.2% and 13.8%, respectively; p = .005). In the cases of 2 ipsilateral ectopic pregnancies, the interventional approach (medical or surgical treatment) resulted in lower recurrence rates compared with expectant management (25.7% vs 60.0%, respectively; p = .043).ConclusionThe risk of a third episode of an ectopic pregnancy after expectant management of a second ectopic pregnancy is extremely high. An interventional approach by treatment with methotrexate or salpingectomy is therefore preferred for recurrent ectopic pregnancy management, especially in ipsilateral recurrences.     

Positive Kleihauer Result Following an Ectopic Pregnancy

Summary: The case presented highlights the risk of fetomaternal haemorrhage in ectopic pregnancy. With the current shortages of anti-D, it may be necessary to reduce administration of anti-D, but this may result in an increase in rhesus isoimmunization. As Kleihauer testing may be of limited value (1), recommendations by deCrespigny and Davison (2) for the use of a reduced dose of 30 meg anti-D in all rhesus negative women with early pregnancy complications including ectopic pregnancy, would seem appropriate.     

Cervical Incompetence in a Pregnancy Following a Cervical Ectopic Pregnancy

Summary: A case of cervical incompetence is reported which occurred in a pregnancy which followed soon after treatment of a cervical ectopic pregnancy using a Foley catheter. Very few pregnancies following cervical pregnancy have been reported. Although this isolated case is clouded by other risk factors, cervical incompetence should be considered as a potential complication of such pregnancies.     

Repeat Sterilization Reversal

Thirteen women had repeat sterilization reversal using microsurgery either because of failed IVF or personal preference for microsurgery. Six pregnancies occurred in 5 women resulting in 5 livebirths and 1 miscarriage. Pregnancy occurred in all 3 patients having isthmic anastomosis in the second sterilization reversal. Preliminary hysteroscopic tubal cannulation would have excluded operation on 2 patients who had tubal blockage extending several centimetres proximal to the site of the first anastomosis.     

Ectopic Pregnancy Following Laparoscopic-Assisted Vaginal Hysterectomy in Tubectomised Women

Objectives

To determine the serum levels of anti-dsDNA, anti-histone, and anti-nucleosome antibodies after laparoscopic ovarian electrocauterization in patients with polycystic ovarian syndrome (PCOS).

Methods

Our study was performed on 35 patients with PCOS resistant to medical therapy, 35 patients with unexplained infertility, and 35 healthy fertile individuals. Patients with PCOS underwent laparoscopic electrocauterization while those with unexplained infertility underwent diagnostic laparoscopy. Serum levels of anti-dsDNA, anti-histone, and anti-nucleosome antibodies were measured at baseline and 1 month after operation and were compared between groups.

Result

Baseline characteristics were similar between groups. Patients with PCOS had significantly higher levels of anti-dsDNA compared to unexplained infertility (p < 0.001) and control groups (p = 0.001). Anti-histone antibodies were higher in PCOS group compared to control group (p = 0.001). In those patients suffering from PCOS, anti-histone antibody increased significantly 1 month after ovarian electrocauterization (p = 0.017). Similarly, serum levels of anti-nucleosome antibodies increased significantly 1 month after operation (p < 0.001).

Conclusion

Laparoscopic ovarian electrocauterization in patients with PCOS results in increased levels of anti-histone and anti-nucleosome antibodies. Anti-dsDNA, anti-histone, and anti-nucleosome antibodies also increase after diagnostic laparoscopy in those with unexplained infertility. Patients with PCOS have higher levels of anti-dsDNA and anti-histone antibodies compared to those with unexplained infertility and healthy fertile subjects.     

Fertility Following Laparoscopic Removal of Rudimentary Horn with an Ectopic Pregnancy

Background: Rudimentary horn pregnancies are rare. Although there have been previous reports of laparoscopic management, reports of successful pregnancies following previous excision of rudimentary horn were not found. Laparotomy remains the more common approach.Case presentation: We report the story of a woman found to have a rudimentary horn pregnancy who chose to be managed laparoscopically, and subsequently became pregnant and delivered a viable term infant 15 months following laparoscopic surgery.Discussion: The laparoscopic approach proffers decreased hospital stay, operating time, and potential for adhesions and is thus an important option for treatment of rudimentary horn pregnancies.     

两种不同治疗方法对异位妊娠预后影响的临床分析

目的:分析评价药物保守治疗和手术治疗异位妊娠对患者预后的影响。方法:对有生育要求的171例异位妊娠患者,分别对其中65例实施肌内注射MTX(药物组),106例行输卵管切除术(手术组)。结果:药物组中,在经过1或2个疗程MTX化疗后,彻底治愈51例,治愈率为78.5%,平均治疗时间为21±7天。手术组,治愈率为100%。随访2年,两组再次宫内受孕的成功率药物组45.1%,手术组51.9%,差异无显著性(P>0.05)。结论:肌内注射MTX治疗未破裂异位妊娠是一种安全而较为有效的治疗措施,其治疗后再次宫内受孕的成功率与手术组相比无明显差异。     

Ectopic Pregnancy

One out of every 100 to 300 pregnancies is ectopic, and the prevalence is increasing. The classic triad of symptoms; amenorrhea, abdominal pain, and abnormal bleeding, varies greatly among individuals, and ectopic pregnancies frequently are confused with other conditions, such as ovarian cyst, pelvic inflammatory disease, and spontaneous abortion. Ruptured ectopic pregnancies cause hemorrhage and shock and are the leading cause of maternal mortality in the first trimester. Although conservation surgery and tuboplasty have improved the fertility outlook of the ectopic patient, only one-third of such women will be delivered of a live baby. In this overview of ectopic pregnancy, the etiology, symptoms, physical findings, and management/treatment are presented.     

16例重复多次异位妊娠诊治分析

目的 :分析重复多次异位妊娠的诊断、治疗及结局。方法 :回顾性分析 1 995年 5月至 2 0 0 0年 1 2月我院 1 6例重复 2次以上异位妊娠的诊断 ,前次妊娠盆腔粘连情况、治疗方式与本次妊娠之间的关系。结果 :重复 2次以上异位妊娠 1 6例 ,发生率为 0 697% ,重复异位妊娠发生于原患侧与对侧比例基本相同。经腹保守性手术后再次异位妊娠 85 7%发生于原患侧 ,腹腔镜保守手术无同侧复发 ,两者有显著差异 (P <0 .0 5)。药物保守后原患侧再次异位妊娠与保守性手术相比无差异 (P >0 .0 5)。结论 :异位妊娠药物保守治疗与保守手术效果相近。如何防止异位妊娠重复发生 ,提高宫内妊娠率有待进一步研究     

Myometrial Pseudoaneurysm and Myelosuppression Following Conservative Management of Cesarean Scar Ectopic Pregnancy

BackgroundTreatment of cesarean scar pregnancy is based on clinical context. This report describes two rare complications of conservative management: non-steroidal anti-inflammatory drug–induced methotrexate myelosuppression and myometrial pseudoaneurysm.CaseA 34-year-old woman was treated conservatively for a cesarean scar pregnancy with systemic methotrexate and intragestational potassium chloride, resulting in pancytopenia secondary to concurrent non-steroidal anti-inflammatory drug use. She presented again with a myometrial pseudoaneurysm, which was treated with bilateral uterine artery embolization and, ultimately, hysterectomy. The final pathology report confirmed a pseudoaneurysm, retained villi within the myometrium, and acute endometritis and myometritis.ConclusionMyelosuppression resulting from use of non-steroidal anti-inflammatory drugs affecting renal excretion of methotrexate can occur at low dosages. Additionally, there is a risk of pseudoaneurysms with vascular damage and trophoblastic tissue. Drug interactions and procedure-related risks must be considered when managing cesarean scar pregnancy conservatively.