scholarly journals Spontaneous Bilateral Tubal Ectopic Pregnancy in a Low-Risk Patient: A Case Report with Implications for Preoperative Patient Counseling

2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Josephine Eva Gathura ◽  
Amro Elfeky ◽  
Rodney McLaren ◽  
David Herzog ◽  
Richard Grazi
Keyword(s):  
Ectopic Pregnancy ◽  
Preoperative Planning ◽  
Evidence Based ◽  
Patient Counseling ◽  
Tubal Ectopic Pregnancy ◽  
The Poor ◽  
Bilateral Salpingectomy ◽  
Ectopic Pregnancies ◽  
Evidence Based Guideline ◽  
Preoperative Patient

Bilateral tubal ectopic pregnancies (BTP) are the rarest form of ectopic pregnancy. They are difficult to diagnose preoperatively, and an evidence-based guideline for management does not exist. In this report, we discuss a 35-year-old patient who presented with suspected right tubal ectopic pregnancy. BTP was diagnosed intraoperatively, and a laparoscopic bilateral salpingectomy was performed without complication. The diagnosis was subsequently confirmed by pathology. This case highlights the importance of patient counseling and comprehensive preoperative planning. Due to the poor presurgical diagnosis of BTP, patient counseling should include the possibility of BTP, appropriate options for management, and potential loss of fertility following treatment. In addition, all cases of suspected ectopic pregnancy necessitate a thorough preoperative investigation of bilateral adnexa and intraoperative inspection of the pelvis.

scholarly journals Non-surgical management of unruptured tubal ectopic pregnancy

2017 ◽  
Vol 6 (7) ◽  
pp. 3041
Author(s):  
Anjali Choudhary ◽  
Priyanka Chaudhari ◽  
Neeta Bansal
Keyword(s):  
Ectopic Pregnancy ◽  
Medical Management ◽  
Expectant Management ◽  
First Trimester ◽  
Response To Treatment ◽  
Surgical Trauma ◽  
Tubal Ectopic Pregnancy ◽  
Beta Hcg ◽  
Surgical Options ◽  
Ectopic Pregnancies

Background: Ectopic pregnancy is still the leading cause of pregnancy related morbidity in the first trimester. Since majority of the women who present with ectopic pregnancies are sub fertile and young, there is a role for non-surgical options of managing these pregnancies. Expectant and medical management not only serves to conserve the fallopian tubes but also saves women from surgical trauma and morbidity. The objective of this retrospective study was to share our experience of treating un-ruptured tubal ectopic pregnancies conservatively.Methods: Women diagnosed with un-ruptured tubal ectopic pregnancy, fit for conservative /medical management were included. Women with serum beta HCG levels less than 1000 mIU/L were treated expectantly and women with Bet HCG levels >1000 but <10,000 mIU /L were given Injectable methotrixate. Response to treatment was monitored by serial beta HCG levels.Results: Total 37 women included in the study.12% women showed complete resolution with expectant treatment alone and 88% resolved after a single dose methotrixate.Conclusions: Many women with un-ruptured tubal ectopic pregnancies would benefit from expectant management, or methotrixate therapy. Methotrixate used in carefully selected women is safe and effective in resolving these cases with good post treatment reproductive outcome.

scholarly journals Endometrial Inhibin/Activin β-B Subunit Expression Is Related to Decidualization and Is Reduced in Tubal Ectopic Pregnancy

2008 ◽  
Vol 93 (6) ◽  
pp. 2375-2382 ◽  
Author(s):  
A. W. Horne ◽  
S. van den Driesche ◽  
A. E. King ◽  
S. Burgess ◽  
M. Myers ◽  
...  
Keyword(s):  
Ectopic Pregnancy ◽  
Stromal Fibroblasts ◽  
Tubal Ectopic Pregnancy ◽  
B Subunit ◽  
Subunit Expression ◽  
Igf Binding ◽  
Differential Gene ◽  
Ectopic Pregnancies ◽  
Igf Binding Protein

Abstract Context: Ectopic pregnancy is common but remains difficult to diagnose accurately. There is no serum test to differentiate ectopic from intrauterine gestation. Objective: Our objective was to investigate differential gene expression in decidualized endometrium of ectopic pregnancy. Design: Tissue and serum analysis informed by microarray study was performed. Setting: The study was performed at a large United Kingdom teaching hospital. Patients or Other Participants: Women undergoing surgical termination of pregnancy (n = 8), evacuation of uterus for miscarriage (n = 6), and surgery for tubal ectopic pregnancy (n = 11) were included in the study. Endometrium was collected from normally cycling women undergoing hysterectomy. Interventions: Decidualized endometrium was subjected to microarray analysis, morphological assessment, and immunohistochemistry. Endometrial stromal fibroblasts were cultured in the presence of decidualizing stimuli. Main Outcome Measures: Differential expression of potentially secreted molecules was calculated. Results: Inhibin/activin β-B expression was lower in decidualized endometrium from ectopic pregnancies when compared with that of ongoing pregnancies (P &lt; 0.01) or miscarriages (P &lt; 0.01). The localization of the β-B subunit was more marked in decidualized than nondecidualized stroma. Decidualization of stromal fibroblasts in vitro was associated with increased β-B expression (P &lt; 0.05). Endometrial stroma of ectopic pregnancies was less decidualized morphologically (P &lt; 0.05), with lower prolactin (P &lt; 0.01) and IGF binding protein-1 (P &lt; 0.005) expression. Serum activin B was lower in ectopic pregnancies (P &lt; 0.005) than in intrauterine pregnancies, whereas there was no difference in progesterone concentrations. Conclusions: Despite similar concentrations of progesterone, the endometrium of ectopic pregnancies is less decidualized than intrauterine pregnancies. Expression of the β-B subunit is related to decidualization and can be detected in the circulation as activin B. Serum activin B concentrations are lower in ectopic pregnancy.

scholarly journals Unexpected rupture of an expectantly managed tubal ectopic pregnancy: a reminder for enhanced diligence

2019 ◽  
Vol 12 (12) ◽  
pp. e230876
Author(s):  
Amenda Ann Davis ◽  
Kusum Lata ◽  
Akshita Panwar ◽  
Alka Kriplani
Keyword(s):  
Ectopic Pregnancy ◽  
Chorionic Gonadotropin ◽  
Expectant Management ◽  
Close Monitoring ◽  
Original Diagnosis ◽  
Tubal Ectopic Pregnancy ◽  
Β Hcg ◽  
Ectopic Pregnancies ◽  
Asymptomatic Women ◽  
Low Serum

Expectant management of tubal ectopic pregnancies is a feasible and possibly preferable method of management in asymptomatic women with low serum β-human chorionic gonadotropin (hCG). This involves serial monitoring of β-hCG until negative, after which it is deemed as spontaneously resolved ectopic pregnancy. We describe a case of tubal ectopic pregnancy which was expectantly managed with an initial β-hCG of 585 mIU/mL until undetectable. This patient presented with ruptured ectopic pregnancy 8 weeks after the original diagnosis, at the level of 5 mIU/mL. This highlights the importance of close monitoring in the expectant management of tubal ectopic pregnancies, with the incorporation of imaging, even when serial β-hCG shows a persistently reducing trend.

scholarly journals Ruptured Tubal Ectopic Pregnancy at Fifteen Weeks Gestational Age

2019 ◽  
Vol 3 (1) ◽  
pp. 62-64 ◽  
Author(s):  
Justine Stremick ◽  
Kyle Couperus ◽  
Simeon Ashworth
Keyword(s):  
Abdominal Pain ◽  
Ectopic Pregnancy ◽  
Gestational Age ◽  
Vaginal Bleeding ◽  
First Trimester ◽  
Second Trimester ◽  
Intrauterine Pregnancy ◽  
Tubal Ectopic Pregnancy ◽  
Ectopic Pregnancies ◽  
First Trimester Ultrasound

Tubal ectopic pregnancies are commonly diagnosed during the first trimester. Here we present a second-trimester tubal ectopic pregnancy that was previously misdiagnosed as an intrauterine pregnancy on a first-trimester ultrasound. A 39-year-old gravida 1 para 0 woman at 15 weeks gestation presented with 10 days of progressive, severe abdominal pain, along with vaginal bleeding and intermittent vomiting for two months. She was ultimately found to have a ruptured left tubal ectopic pregnancy. Second-trimester ectopic pregnancies carry a significant maternal mortality risk. Even with the use of ultrasound, they are difficult to diagnose and present unique diagnostic challenges.

scholarly journals Use of FloSeal Sealant in the Surgical Management of Tubal Ectopic Pregnancy

2013 ◽  
Vol 2013 ◽  
pp. 1-3 ◽  
Author(s):  
Mara Clapp ◽  
Jaou-Chen Huang
Keyword(s):  
Ectopic Pregnancy ◽  
Surgical Management ◽  
Thermal Injury ◽  
Tubal Pregnancy ◽  
Effective Alternative ◽  
Intrauterine Pregnancy ◽  
Tubal Ectopic Pregnancy ◽  
Tubal Patency ◽  
Ectopic Pregnancies

Background. Surgery is sometimes required for the management of tubal ectopic pregnancies. Historically, surgeons used electrosurgery to obtain hemostasis. Topical hemostatic sealants, such as FloSeal, may decrease the reliance on electrosurgery and reduce thermal injury to the tissue.Case. A 33-year-old G1 P0 received methotrexate for a right tubal pregnancy. The patient became symptomatic six days later and underwent a laparoscopic right salpingotomy. After multiple unsuccessful attempts to obtain hemostasis with electrocoagulation, FloSeal was used and hemostasis was obtained. Six weeks later, a hysterosalpingogram (HSG) confirmed tubal patency. The patient subsequently had an intrauterine pregnancy.Conclusion. FloSeal helped to achieve hemostasis during a laparoscopic salpingotomy and preserve tubal patency. FloSeal is an effective alternative and adjunct to electrosurgery in the surgical management of tubal pregnancy.

scholarly journals Chronic Tubal Ectopic Pregnancy with Diagnostic Conundrum: A Case Report

2021 ◽  
Vol 6 (2) ◽  
pp. 192-194
Author(s):  
Vishal Sharma ◽  
Ravi Dutt Wadhwa
Keyword(s):  
Case Report ◽  
Ectopic Pregnancy ◽  
Gestational Age ◽  
First Trimester ◽  
Present Case Report ◽  
Tubal Ectopic Pregnancy ◽  
Threatening Condition ◽  
Life Threatening ◽  
First Trimester Of Pregnancy ◽  
Ectopic Pregnancies

Ectopic pregnancy is a life threatening condition and mostly ectopic pregnancies occurs in fallopian tube. The most common site of ectopic tubal pregnancy is ampulla. Ectopic pregnancy is a complication of pregnancy and usually easy to diagnose by ultrasonography during the first trimester of pregnancy. Due to limited healthcare resources in developing countries, women do not undergo for ultrasound examination during pregnancy which leads to late diagnosis. In most of cases women with ectopic pregnancy are asymptomatic, unless ruptured. The mean gestational age for clinical presentation of ectopic pregnancy is 7.2 weeks after the last normal menstrual period. In rural population, late presentations of ectopic pregnancies are more commonly seen because of lack of modern diagnostic ability. Present case report is a rare case of non-viable, unruptured, tubal ampullary chronic ectopic pregnancy of 12 weeks gestational age. Keywords: Ectopic pregnancy, Unruptured, gestational age, ultrasonography.

scholarly journals Molecular therapy for ectopic pregnancy

2019 ◽  
Vol 2 (2) ◽  
pp. 38-39
Author(s):  
Agus Cakhantara ◽  
Aditya Prabawa
Keyword(s):  
Cell Death ◽  
Literature Review ◽  
Randomized Trial ◽  
Ectopic Pregnancy ◽  
Molecular Target ◽  
Therapeutic Use ◽  
Molecular Therapy ◽  
Tubal Ectopic Pregnancy ◽  
Placental Cell ◽  
Ectopic Pregnancies

Objective : To compare treatment in ectopic pregnancy within combination gefitinib, methotrexat and methotrexat only Method : Literature Review Result : Ectopic pregnancies are serious condition that can be fatal, therefore the prompt therapeutic is essential. There some recent studies explain molecular target therapeutic use combination of gefitinib and methotrexat is more effective inducing placental cell death and can rapidly resolve tubal ectopic pregnancy than methotrexate only. If a large clinical randomized trial confirm these finding, these combination could become a new medical option for ectopic pregnancy Conclusion : Combination gefitinib and methotrexate is more effective in ectopic pregnancy than methotrexate only

scholarly journals LETROZOLE - NOVEL DRUG FOR MEDICAL MANAGEMENT FOR TUBAL ECTOPIC PREGNANCY

2020 ◽  
pp. 1-2
Author(s):  
Rana Choudhary ◽  
Seema Pandey ◽  
Priyanka Vora
Keyword(s):  
Ectopic Pregnancy ◽  
Medical Management ◽  
Maternal Morbidity ◽  
First Trimester ◽  
Tubal Ectopic Pregnancy ◽  
Future Fertility ◽  
Life Threatening ◽  
Diagnostic Modalities ◽  
Ectopic Pregnancies ◽  
Novel Drug

Ectopic pregnancy is one of the most common life-threatening conditions leading to increased maternal morbidity and mortality in the first trimester. With advances in diagnostic modalities, one can now diagnose most ectopic pregnancies before their rupture and other catastrophic events. Methotrexate is the most common drug used for medical management but has adverse effects and needs strict monitoring. We report a case of tubal ectopic pregnancy which was successfully managed with letrozole. We were able to prevent maternal morbidity, reduce cost of therapy and preserve future fertility in our patient.

Caution with bilateral salpingectomy and consideration of tubal stump ectopic in IVF

2020 ◽  
Vol 13 (11) ◽  
pp. e235893
Author(s):  
Swee Lin Yip ◽  
Shahul Hameed Mohamed Siraj ◽  
Jerry Kok Yen Chan
Keyword(s):  
Ectopic Pregnancy ◽  
Cystic Mass ◽  
In Vitro Fertilisation ◽  
Beta Human Chorionic Gonadotropin ◽  
Life Threatening ◽  
History Of ◽  
Bilateral Salpingectomy ◽  
Ectopic Pregnancies ◽  
The Right

We report a 35-year-old female patient with a history of bilateral salpingectomy from ectopic pregnancies presenting with a positive serum beta-human chorionic gonadotropin (bhCG) result following in vitro fertilisation (IVF) treatment. Apart from per vaginal spotting, she remained asymptomatic. Initial ultrasound showed an empty uterus with a cystic mass on the right side of the uterus. Serum beta-hCG was trended. A follow-up pelvic ultrasound 1 week later showed a live pregnancy in the right adnexa. A diagnostic laparoscopy was performed, which revealed an unruptured right stump ectopic pregnancy that was successfully removed. As a stump ectopic pregnancy can be a potentially life-threatening occurrence, we emphasise caution with salpingectomy and the consideration of tubal stump ectopic pregnancies following IVF treatment.

scholarly journals An analysis of tubal ectopic pregnancy in a rural tertiary care hospital in India: a retrospective study

2019 ◽  
Vol 8 (9) ◽  
pp. 3466
Author(s):  
Chandana Galidevara ◽  
Swaramya C.
Keyword(s):  
Risk Factors ◽  
Ectopic Pregnancy ◽  
Tertiary Care ◽  
Care Hospital ◽  
Common Procedure ◽  
Tubal Ectopic Pregnancy ◽  
Retrospective Data Analysis ◽  
History Of ◽  
Wound Discharge ◽  
Ectopic Pregnancies

Background: The objective of this study was to analyse distribution of predisposing risk factors for ectopic pregnancy and to study the various modalities of management instituted along with surgical characteristics.Methods: This is a retrospective data analysis of tubal ectopic pregnancies (EP) managed in a tertiary rural referral centre over three years.Results: A total of 160 women were managed for tubal EP. Majority of the women belonged to the age group of 21-30 years (73%). Multigravidae constituted 71.3% of the women and overall, 90.6% women conceived spontaneously. History of ovulation induction was present in 3.7% of women, IUI in 1.2% and IVF in 4.4%. Risk factors encountered in the study include previous EP (9.4%), history of tubal sterilisation (6.9%), caesarean section (13.1%), PID (7.5%), miscarriage (25%), tubal recanalization (3.7%). Conservative management was instituted in 16.8%. Amongst the women managed surgically, 67.5% underwent laparotomy with the remaining being managed laparoscopically. Of the surgically managed patients 72.9% had ruptured EP. There was a predominance of right sided ectopic in our study (79%) and ampullary region of the fallopian tube was the most common site of tubal EP (81.2%). The most common procedure performed was total salpingectomy (56.4%). Supportive treatment with blood transfusion was required amongst 18.8% of the women who had EP. In the postoperative period, fever was noted in 13.5% of women and 2.5% needed intensive care unit admission for hemodynamic stabilisation. The incidence of wound discharge was 12% of women who underwent surgery.Conclusions: This study underpins the importance of early diagnosis, appropriate clinical managementwith timely intervention to improve outcomes associated with EP and to prevent severe morbidity and mortality.

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