Reproductive performance after local and systemic prostaglandin for ectopic pregnancy

Summary The injection of different substances into early, unruptured tubal pregnancies is increasingly advocated. In this study, fertility was evaluated after treatment of tubal pregnancy by means of prostaglandins. The overall tubal patency rate was 86.4% and 14 of 20 patients (70%) could subsequently achieve pregnancy.     

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.     

Unsuccessful treatment of tubal pregnancy by shock wave lithotripsy

A tubal pregnancy was unsuccessfully treated by means of a lithotrypter.     

氨甲喋呤单次肌肉注射治疗输卵管妊娠疗效分析

目的 探讨氨甲喋呤（ＭＴＸ）单次肌肉注射治疗输卵管妊娠的疗效,并观察失败的相关因素及其数量与失败可能性的关系。方法 对４１例治疗成功和１１例治疗失败病例的临床资料、包块面积改变以及血清β－ｈＣＧ值的变化进行对比分析。结果 失败组平均停经时间６３．４天、血β－ｈＣＧ平均１５７７６．５ＩＵ／Ｌ、治疗３日后β－ｈＣＧ平均下降１８．３％、治疗后包块平均面积增加６４．２％。成功组平均停经时间５６．４天、血β     

输卵管妊娠患者巨细胞病毒感染分析

目的 探讨输卵管妊娠患者生殖道巨细胞病毒感染情况。方法 应用酶联免疫吸附技术(ELLSA)检测输卵管妊娠患者直清中巨细胞病毒(cytomegalovius, CMV)IgG抗体和特异性IgM抗体,同时应用多聚酶链反应(PCR)检测输卵管妊娠患者宫颈分泌物、宫腔冲洗物以及手术时输卵管妊娠组织标本中CMV DNA。结果 49例输卵管妊娠患者血清IgG抗体阳性21例,阳性率42.86％;宫颈分泌物CMV DNA阳性10例,阳性率20.40％;宫腔冲洗物CMV DNA阳性9例,阳性率18.36％;输卵管妊娠组织CMV DNA阳性4例,阳性率8.16％;其中1例血清IGg抗体阳性并伴有宫颈、宫腔分泌物及输卵管妊娠组织CMV DNA阳性;4例宫颈组织与宫腔组织同时阳性。结论 既往曾有过巨细胞病毒感染者发生输卵管妊娠的风险增加,巨细胞病毒感染,尤其是生殖道巨细胞病毒感染可以导致输卵管妊娠。     

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.     

Ectopic pregnancy following tubal sterilization

Over a 5 year period 232 ectopic pregnancies were recorded at Ullevaal Hospital in Oslo, Norway. There had been 10,294 births during this July 1976 to June 1981 period. In 3 cases tubal sterilization had been performed prior to the development of the extrauterine pregnancy. A total of 1047 female tubal sterilizations were performed during these 5 years. Almost all the sterilizations were done by laparoscopy. Different methods of sterilization were used: unipolar diathermy; spring clips according to Hulka; silicone rings; and endotherm coagulation. Each case of the 3 ectopic pregnancies, observed following tubal sterilization, is reviewed. A 36 year old patient became pregnant 3 years after diathermy sterilization. The right tube was found normal, and the pregnancy located in the lateral part of the divided left tube. 14 months following silicone ring sterilization a 26 year old patient had an ectopic pregnancy in the lateral right tube. The silicone ring was in perfect position on the left side. The medial right tube showed fibrous scarring after the ring application, but the ring was located in the mesosalpinx. A 37 year old patient was admitted to the hospital after a tubal pregnancy 10 months after diathermy sterilization. The pregnancy was in the lateral part of the tube. Both tubes had been transected, and there was a diastase of about 2 centimeters. The etiology of ectopic pregnancies is complex. It is only recently that previous sterilization has been recognized as a factor in this condition. Luteal phase pregnancies are because of a failure in the timing of the procedure and are unrelated to the procedure itself. Pregnancies resulting from operative failure range from 0-2.4/1000 sterilizations in different series. Technical failure may be caused by recanalization, fistula formation, and product failure. An important cause of ectopic pregnancy after laparoscopic sterilization is probably fistula formation that allows sperm to pass out of the uterus. Such fistulas have frequently been documented. Thus, if it is considered necessary to confirm tubal occlusion by salpingogram, this should be delayed for at least 12 weeks. As fistula formation probably is a major cause in this entity, division of the tube at the time of sterilization is neither necessary nor desirable. It is important to damage the tube in the isthmic segment and to minimize the involvement of the parametrium in the destructive process.     

Factors affecting the pregnancy rate after microsurgical reversal of tubal ligation

Objective

To evaluate the factors affecting the pregnancy rate after microsurgical reversal of tubal ligation.

Design

Retrospective clinical study.

Setting

Private practice affiliated with a tertiary care center.

Patient(s)

One hundred twenty-eight consecutive patients who underwent tubal reversal between October 1992 and May 2001.

Intervention(s)

Microsurgical tubal reanastomosis performed by a single surgeon.

Main outcome measure(s)

Subsequent pregnancy rates were evaluated with Fisher’s exact tests and logistic regression according to clinical characteristics of patients.

Result(s)

The pregnancy rate was 85.7% (54 out of 63) in patients ≤35 years of age vs. 45.5% (10 out of 22) in patients >35 years. The odds ratio (OR) between the two age groups was 7.20, with a 95% confidence interval (CI) of 2.41 to 21.55. The pregnancy rate was 85.4% (35 out of 41) in patients with body mass index (BMI) ≤25 compared with 65.9% (29 out of 44) in patients with BMI >25 (OR 3.02; CI 1.04 to 8.77). Patients sterilized ≤8 years had a pregnancy rate of 87.2% (34 out of 39), vs. 65.2% (30 out of 46) in patients sterilized >8 years (OR 3.63; CI 1.19 to 11.09).

Conclusion(s)

Age was the primary statistically significant factor affecting pregnancy rate in tubal reversal patients. Body mass index and duration of sterilization had smaller, but statistically significant, associations with pregnancy rate.     

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.     

甲氨蝶呤和米非司酮联合治疗非破裂型输卵管妊娠

目的探讨甲氨蝶呤(MTX)和米非司酮联合治疗非破裂型输卵管妊娠的效果。方法米非司酮300mg一次顿服,MTX20mg静注×5d。单用MTX的病人设为对照组。结果MTX和米非司酮联合治疗的成功率为87.5％,明显高于对照组。观察治疗期间病情变化,发现疗效与血β-hCG高低及有无心管搏动有关。结论MTX和米非司酮联合治疗非破裂型输卵管妊娠安全有效,适用于生命体征平稳、无剧烈腹痛、无心管搏动及血β-hCG＜30μg/L的非破裂型输卵管妊娠。     

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.     

腹腔镜输卵管妊娠保守性手术50例临床分析

目的:探讨腹腔镜输卵管妊娠保守性手术的临床效果。方法:借助腹腔镜技术在微创下清除妊娠物。结果:保留输卵管,恢复快。结论:对于未婚及希望保留生育功能的患者,腹腔镜手术更优于开腹手术。     

Fertility outcomes subsequent to treatment of tubal ectopic pregnancy in younger Turkish women

Study Objective

The assessment of future fertility in patients that were hospitalized with diagnosis of tubal ectopic pregnancy.

Design

Between January 1998 and September 2008, we retrospectively reviewed 219 tubal ectopic pregnancy patients who were hospitalized. The patients using contraceptive methods, underwent previous pelvic or tubal surgery, pregnancy after in vitro fertilization, over the age of 28, and extratubal ectopic pregnancies were excluded. Patients who actively attempted to conceive were included. We called all the patients to see whether they had pregnancy in 24 months, and how long they had waited for this after the operation. Overall, we could not reach 14 patients who were treated surgically (n = 9) or medically (n = 5).

Setting

Department of Obstetrics and Gynecology, Ege University, Izmir, Turkey.

Participants

Women aged between 18 and 28 years that were treated because of tubal ectopic pregnancy and have concerns about infertility.

Interventions

Medical treatment with methotrexate (n = 34), salpingectomy (n = 62) salpingostomy (n = 37).

Main Outcome Measures

Intrauterine pregnancy rates, ectopic pregnancy rates and mean time to pregnancy after interventions.

Results

After questionnaire: in the methotrexate group; six of 29 (20%) had no pregnancy; 23 (79%) of them conceived, but three (10%) of the pregnancies were extrauterine. Thirty-seven patients received salpingostomy and 62 patients composed the salpingectomy group. Intrauterine pregnancy rates up to 24 months were established as 65.2% in salpingectomy (n = 55) and 60.1% in the salpingostomy (n = 35) groups respectively. No significant difference was noticed when pregnancy rates were compared among three groups (P = 0.942). Mean time to pregnancy in methotrexate group was 7.8 ± 2.2 months, and in salpingostomy and salpingectomy groups was 8.7 ± 2.2 and 9.3 ± 3.1 months respectively (P = 0.841).

Conclusion

Since we found no difference in terms of pregnancy rates among three groups, medical treatment appears to be more favored with early and accurate diagnosis. After salpingectomy, patients may conceive later in life when compared with other groups so selected patients should be assessed according to their age for the decision of assisted reproductive techniques.     

输卵管妊娠患者腹腔镜保守性手术后生育状况及其影响因素分析

目的观察腹腔镜保守性手术治疗输卵管妊娠后患者生育状况并探讨其影响因素。方法对2001年1月至2004年5月佛山市第一人民医院接受腹腔镜保守性手术治疗的162例输卵管妊娠患者（A组）,观察其术后输卵管通畅程度、再次宫内妊娠率、异位妊娠再发等情况,并与同期接受输卵管大部分切除的96例患者（B组）进行对比分析;采用Logistic回归分析术前血人绒毛膜促性腺激素（HCG）水平等因素对术后生育结局的影响。结果腹腔镜保守性手术组与患侧输卵管大部分切除术组术后持续性异位妊娠发生率分别为8.02%、1.04%;随访2～5年,保守性手术组和患侧输卵管大部分切除术组再次宫内妊娠率分别为71.6%、38.5%,两组比较差异有统计学意义（P〈0.05）。在单因素分析中,腹腔镜保守性手术治疗输卵管妊娠术后宫内妊娠率分别与术前血HCG水平、包块大小、盆腔粘连情况、患侧输卵管破裂与否、对侧输卵管闭锁与否、术后患侧或对侧输卵管通畅与否、既往异位妊娠病史相关（P〈0.05）;在多因素分析中,术后宫内妊娠率与术前血HCG水平、盆腔粘连情况、患侧输卵管术后通畅与否、既往异位妊娠病史相关（P〈0.05）。结论腹腔镜保守性手术治疗输卵管妊娠具有微创、安全及再次宫内妊娠率高等优点。术前血HCG水平、盆腔粘连情况、患侧输卵管术后通畅与否、既往异位妊娠病史是影响术后宫内妊娠率的相对独立因素。对于严重盆腔粘连或重复同侧输卵管妊娠者,不建议行保守性手术。     

Ectopic pregnancy in a distal tubal remnant

Ectopic pregnancy is a well-recognized complication of tubal reanastomosis (Young PE, Egan JE, Barlow JJ: Reconstructive surgery for infertility at the Boston Hospital for Women. Am J Obstet Gynecol 108: 1092, 1970 and Hodari AA, Vibhasiri A, Isaac AY: Reconstructive tubal surgery for midtubal obstruction. Fertil Steril 28: 620, 1977). We describe here, however, a case of tubal pregnancy occurring in a tubal remnant on the opposite side to a successful tubocornual reanastomosis.     

应用PCR技术对输卵管妊娠患者性传播疾病病原体感染的研究

目的探讨输卵管妊娠(TP)患者性传播疾病(STD)病原体的感染情况。方法2001年1月至2002年12月间,东莞市人民医院及中山大学东华医院,应用聚合酶链反应技术对249例TP患者的宫颈分泌物及子宫内膜活检标本进行了7种常见STD病原体的检测。结果解脲支原体(UU)的检出率最高,达27.71%和23.29%,其次为沙眼衣原体(CT)20.88%和17.27%,与对照组比较差异有显著性(P<0.05),淋球菌(NG)检出率为7.63%和8.84%、乙型肝炎病毒(HBV)检出率6.02%和4.81%、乳头状瘤病毒(HPV)检出率为3.61%和4.02%、单纯疱疹病毒(HSV)检出率为2.41%和1.20%、梅毒螺旋体(TMP)检出率为0.40%和0。同时还发现各种病原体的上行性感染及混合感染情况。结论与TP相关的病原体中以UU最多见,各种病原体混合感染占一定比例。     

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.     

Rupture of tubal pregnancy in the Vilnius population

OBJECTIVES: To evaluate the determinants of tubal rupture in women who suffered from ectopic pregnancy in relation to their demographic profile and medical history. STUDY DESIGN: This retrospective observational clinical study was conducted in five general hospitals in Vilnius, Lithuania. The population was composed of 879 women with surgically proven ectopic pregnancy. Tubal rupture was diagnosed at the time of surgery. Univariate and multivariate logistic regression analyses were performed to identify the risk factors for tubal rupture. RESULTS: The occurrence of tubal rupture was 29.5% (259/879). It was encountered significantly more often in women with age of > or =35 years (odds ratio 1.9 [1.3-2.8]). Patients whose EP was located in the isthmus were at higher risk of having tubal rupture (odds ratio 3.2 [2.2-4.5]) while known risk factors for EP were not associated with an elevated risk. CONCLUSIONS: Our data suggest that age of > or =35 years and implantation in the straightest segment of the tube could be associated with increased rate of tubal rupture. Of particular interest is the overall tubal rupture prevalence (29.5%) observed since these women were managed in an environment where transvaginal ultrasound equipment and quantitative assessment of beta-human chorionic gonadotrophin were not routinely available.