scholarly journals Ectopic pregnancy

2020 ◽  
Vol 7 (1) ◽  
pp. 4-9
Author(s):  
I. V. Gadayeva ◽  
I. D. Khokhlova ◽  
T. A. Dzhibladze

Ectopic pregnancy is the most common cause of emergency conditions in gynecology. The main clinical manifestations of ectopic pregnancy, in the background of signs of pregnancy, are the menstrual irregularities, delayed menstruation, spotting (the most classic clinical picture), pain syndrome (with and without irradiation to the rectum, thigh) of varying intensity (depending on the type of the ectopic pregnancy), signs of intra-abdominal bleeding. The key to successful treatment is timely diagnosis and qualified, adequate medical care. The main laboratory and instrumental methods for diagnosing the ectopic pregnancy are the determination of the -subunit of hCG in blood serum (diagnostic accuracy of 85%) and ultrasound (diagnostic accuracy of 78100%). The treatment of ectopic pregnancy is surgical, the laparoscopic access is preferred. Laparotomy access is indicated for severe adhesions, hemorrhagic shock caused by significant intraperitoneal bleeding. The surgical intervention during tubal pregnancy is tubectomy. Tubotomy (retention of the fallopian tube) is irrational, since the operated fallopian tube causes a recurrence of tubal pregnancy.

2021 ◽  
Vol 20 (4) ◽  
pp. 12-16
Author(s):  
Aml El-Shabrawy ◽  
◽  
Ahmed Elsheikh ◽  
Samy Gebreel ◽  
Mohammed Elsokkary ◽  
...  

Objective. Ectopic pregnancy adversely affects the patency of the fallopian tube and consequently the future pregnancy. There are different options of conservative treatment of tubal pregnancy such as methotrexate and salpingostomy [1]. There is little information on the success rate of maintaining tubal patency after methotrexate and salpingostomy [2]. Therefore, the aim of this study is to evaluate the ipsilateral tubal patency using HyCoSy after treatment of tubal pregnancy with methotrexate therapy versus salpingostomy. Patients and methods. This was a case-series study conducted in Ain Shams and Al-Azhar University Maternity Hospitals to evaluate the ipsilateral tubal patency using hysterosalpingo-contrast sonography (HyC0Sy) following salpingostomy and medical treatment of tubal pregnancy. This study included patients who were admitted to Ain Shams and Al-Azhar University Maternity Hospitals for having tubal pregnancy and were treated either with methotrexate or salpingostomy over a 4-year period between January 2017 and December 2020. The patients seeking fertility were re-evaluated for fallopian tubes patency by hysterosalpingogram 3 months after discharge. The study included 2 groups of women: group I (n = 200): women who were treated with methotrexate, and group II (n = 140): women who underwent salpingostomy. Results. HSG was performed in 200 cases of patients with tubal pregnancy who were treated with methotrexate and 140 cases of patients who underwent salpingostomy. The patency of the ipsilateral tube was 85% after methotrexate treatment and 84.2% after salpingostomy. There was no statistically significant difference between the two groups. Conclusion. The findings suggest similar success rate in maintaining the patency of the fallopian tube with either methotrexate or salpingostomy. Key words: ectopic pregnancy, hysterosalpingography, methotrexate, infertility, salpingostomy


2018 ◽  
Vol 46 ◽  
pp. 5
Author(s):  
Jia-San Zheng ◽  
Zheng Wang ◽  
Jia-Ren Zhang ◽  
Shuang Qiu ◽  
Ren-Yue Wei ◽  
...  

Background: Ectopic pregnancy mainly refers to tubal pregnancy and abdominal pregnancy. Tubal pregnancy presents as an implanted embryo that develops in the fallopian tubes, and is relatively common in humans. In animals, tubal pregnancy occurs primarily in primates, for example monkeys. The probability of a tubal pregnancy in non-primate animals is extremely low. Abdominal pregnancy is a type of ectopic pregnancy that occurs outside of the uterus, fallopian tube, ovary, and ligament(broad ligament, ovarian ligament, suspensory ligament).This paper describes two cases of ectopic pregnancy in cats.Cases: Cat 1. The presenting sign was a significant increase in abdominal circumference. The age and immune and sterilization status of the cat were unknown. On palpation, a 4 cm, rough, oval-shaped, hard mass was found in the posterior abdomen. Radiographic examination showed three high-density images in the posterior abdomen. The fetus was significantlycalcified and some feces was evident in the colon. The condition was preliminarily diagnosed as ectopic pregnancy. Cat 2. The owner of a 2-year-old British shorthair cat visited us because of a hard lump in the cat’s abdomen. The cat had a normal diet and was drinking normally. Routine immunization and insect repulsion had been implemented. The cat had naturally delivered five healthy kittens two months previous. Radiographs showed an oval-shaped mass with a clear edge in the middle abdominal cavity. Other examinations were normal. The case was preliminarily diagnosed as ectopic pregnancy, and the pregnancy was surgically terminated. The ectopic pregnancies were surgically terminated. During surgery, the structures of the uterus and ovary of cat 1 were found to be intact and the organs were in a normal physiological position.Cat 1 was diagnosed with primary abdominal pregnancy. In cat 2, the uterus left side was small and the fallopian tube on the same side was both enlarged and longer than normal. Immature fetuses were found in the gestational sac. Thus, cat 2 was diagnosed with tubal ectopic pregnancy based on the presenting pathology.Discussion: Cats with ectopic pregnancies generally show no obvious clinical symptoms. The ectopic fetus can remain within the body for several months or even years. Occasionally, necrotic ectopic tissues or mechanical stimulation of the ectopic fetus can lead to a systemic inflammatory response, loss of appetite, and apathy. The two cats in our reportshowed no significant clinical symptoms. To our knowledge, there have been no previous reports of the development of an ectopic fetus to maturity, within the abdominal cavity of felines, because the placenta of cats cannot support the growth and development of the fetus outside of the uterus. Secondary abdominal ectopic pregnancy, lacking any signs of uterine rupture is likely associated with the strong regenerative ability of uterine muscles. A damaged uterus or fallopian tube can quickly recover and rarely leaves scar tissue. In the present report, cat 1 showed no apparent scar tissue, nor signs of a ruptured ovary or fallopian tubes. It was diagnosed with primary ectopic abdominal pregnancy, which could arise from the descent of the fertilized egg from the fallopian tube into the abdominal cavity. There was an abnormal protrusion in left of the fallopian tubes in cat 2, to which the gestational sac was directly connected. Based on pathological examination of the uterus, fallopian tubes, and gestational sac, the cat was diagnosed with a tubal pregnancy. Placental tissues and signs of fetal calcification were observed in both the fallopian tube and gestational sac.Keywords: tubal pregnancy, abdominal pregnancy, feline, ectopic fetus, fallopian tube, gestational sac.


2021 ◽  
pp. 548-551
Author(s):  
Marina A. Kiyok ◽  

Ectopic pregnancy (EP) is a rare and severe complication of assisted reproductive techniques (ART). A specific feature of EP after ART is a high frequency of rare atypical forms of EP, the absence of a specific clinical picture and a high probability of recurrent EP, which makes certain difficulties in terms of diagnosis. Interstitial pregnancies occur in 1–6% of all ectopic pregnancies and in 7.3% cases of EB which were the results of in vitro fertilization programs (IVF). The anatomical features of the blood supply in the intramural segment of the fallopian tube provide favorable conditions for the progression of pregnancy on the average up to 10 weeks of gestation, simulating the intra-uterine pregnancy. Chorionic villi, growing into the thickness of the myometrium, create a high risk of profuse intra-abdominal bleeding. The article presents a clinical case of a rare form of ectopic pregnancy in the interstitial segment of the fallopian tube after IVF. The patient had previously undergone a bilateral salpingectomy by tubal pregnancies. This clinical example shows the meaning of precise diagnosis and timely provision of highly qualified specialized medical care.


2021 ◽  
Vol 9 (4) ◽  
pp. 598-605
Author(s):  
G. P. Titova ◽  
M. M. Damirov ◽  
I. V. Anchabadze ◽  
A. A. Medvedev

Relevance.Ectopic (extrauterine) pregnancy (EP) occupies a leading place in the structure of urgent gynecological morbidity. This pathology poses a threat to the health and life of a woman, being one of the leading causes of maternal mortality during pregnancy during the first trimester. Among emergency gynecological operations, surgical interventions for EP make up about 50%, and in recent years, most operations have been performed by the laparoscopic method. However, up to now, the pathomorphological changes in the fallopian tubes in patients with EP remain poorly understood.Purpose of the study. To study the features of pathomorphological changes in the fallopian tubes in women with tubal pregnancy, operated on by the laparoscopic method, to substantiate the volume of surgery in patients with this pathology.Material and methods. Morphological examination was performed in 100 women operated on for tubal pregnancy using the laparoscopic method. A comprehensive morphological study of the fallopian tubes removed during the operation was carried out.Results and discussion. The implantation of the ovum in the fallopian tube led to significant changes in its macro- and microstructure, which were caused by the invasion of chorionic villi and involved all layers of the tube wall, differing only in the depth of penetration and prevalence. The anatomical features of the structure of the fallopian tubes contributed to the deep invasion of the ovum into the myosalpinx and subserous parts of the tube, creating the possibility of wall rupture in this area.Conclusions. 1. In all cases of ectopic pregnancy, implantation of the ovum was accompanied by invasion of cytotrophoblast and syncytiotrophoblast, and it involved all layers of the tube wall, differing only in depth and prevalence. The invasive properties of the cytotrophoblast lead to the development of pronounced degenerative changes in the tube wall, which leads to functional inferiority of the tube after the onset of tubal pregnancy in it.2. The chronic productive endomyosalpingitis diagnosed in most patients with ectopic pregnancy with deformation of the tube lumen against the background of changes in the tube wall caused by cytotrophoblastic invasion is an indication for tubectomy. Performing organ-preserving operations on an anatomically and functionally altered fallopian tube is impractical, since it is a high risk factor for recurrent tubal pregnancy in this tube.


2019 ◽  
Vol 10 (4) ◽  
pp. 79-87
Author(s):  
Aelita A. Kamalova ◽  
Ilmira M. Urazmanova ◽  
Ramilya F. Khayretdinova ◽  
Asilya N. Badretdinova

The article presents current data on the etiology, diagnosis and treatment of acute pancreatitis in children. Over the past 10-15 years, the incidence of pancreatitis has increased and is 3.6-13.3 cases per 100,000 children. According to the results of an international study INSPPIRE a group of researchers involving in to the study of pediatric pancreatitis gave a definition of acute, acute recurrent and chronic pancreatitis and developed clinical guidelines for the management of this pathology in children. Acute pancreatitis is a polyetiological disease, the causes of which may be abnormalities in the development of the pancreatobiliary system, drugs, injuries, infections, systemic diseases. Diagnosis is based on clinical manifestations and laboratory and instrumental data. Clinically acute pancreatitis is manifested by abdominal, dyspeptic and asthenic syndromes. Particular attention is paid to the timely diagnosis of pancreatitis in children with unexplained abdominal pain syndrome. In such cases, it is mandatory to determine the level of amylase and lipase. Transabdominal ultrasound is the screening method among instrumental methods. Computed tomography and magnetic resonance imaging are necessary imaging techniques for suspected pancreatic necrosis. Magnetic resonance cholangiopancreatography, in turn, plays an important role in the diagnosis of anomalies and lesions of the biliary and pancreatic ducts. There are modern classification, diagnostic criteria of acute pancreatitis, laboratory and instrumental methods of the diagnosis and approaches to the treatment in children in the article.


Author(s):  
Mojgan Akbarzadeh-Jahromi ◽  
Sahand Mohammadzadeh ◽  
Neda Soleimani

A woman aged 41, referred with spotting, abdominal and cervical motion tenderness and adnexal mass. βHCG was positive and ultrasonography confirmed tubal pregnancy with an alive fetus. Pathology showed intact dilated fallopian tube with a fetus of 10 weeks.Advanced tubal pregnancy is uncommon and never lead to alive fetus.


2015 ◽  
Vol 2015 ◽  
pp. 1-3
Author(s):  
Panayotis Xiromeritis ◽  
Chrysoula Margioula-Siarkou ◽  
Dimosthenis Miliaras ◽  
Ioannis Kalogiannidis

Tubal pregnancy concerns 97% of all ectopic pregnancies. Treatment can be either surgical (salpingostomy or salpingectomy) or medical (methotrexate administration). We present a case of a pseudotubal pregnancy after methotrexate treatment of a previous ectopic pregnancy. A37-year-old woman was diagnosed with ectopic pregnancy in the left Fallopian tube. A year ago, she had an ectopic pregnancy in the right tube, which was successfully treated with intramuscular methotrexate. During laparoscopy, two tubal masses were revealed, one in each Fallopian tube, and bilateral salpingectomy was performed. Histological analysis confirmed tubal pregnancy in the left Fallopian tube and presence of endosalpingitis in the right tube with no signs of chorionic villi. The optimal management of such cases has not yet been clarified. However, evaluation of tubal patency after a medically treated ectopic pregnancy would permit proper counsel of the patient on her fertility options, in order to choose the appropriate method of conception to achieve and accomplish a future pregnancy.


2020 ◽  
Vol 20 (4) ◽  
pp. 1895-7
Author(s):  
Nnabuike Chibuoke Ngene ◽  
Ongombe Lunda

Background: It is uncommon to find ampullary tubal pregnancy in the second trimester. Methods: A 35-year-old G4P3 at 16 gestational weeks presented with a day history of sudden severe lower abdominal pain and no vaginal bleeding. The patient had a normal pulse of 82/minutes, haemoglobin concentration of 6.3 g/dl and ultrasonography showed an empty uterus with an alive fetus in the right adnexa. She was provisionally diagnosed to have an abdominal pregnancy. Results: The patient had an emergency laparotomy where 2.2 L of haemoperitoneum and a slow-leaking right ampullary tubal pregnancy were found. Right total salpingectomy was performed and she had an uncomplicated post-operative fol- low-up. Histology of the lesion confirmed tubal pregnancy. Conclusion: The growth of a pregnancy in the ampulla beyond the first trimester is possibly due to increased thickness and or distensibility of the fallopian tube. A tubal pregnancy may present with a normal pulse despite significant haemorrhage. Keywords: Abdominal pain; ampullary tubal ectopic pregnancy; Bezold–Jarish-like reflex.


2006 ◽  
Vol 5 (1) ◽  
pp. 73-75
Author(s):  
I. D. Yevtushenko ◽  
S. V. Rybnikov

Research purpose: to increase the efficiency of endosurgical treatment of women with progressive tubal pregnancy. Research method: prospective analysis. Research subjects: in 75 female patients, to whom salpingotomy and salpingorrhaphy had been per-formed, tubal patency was found; in 10% - tubal patency was laboured; in 9,5% of patients there was an obstruction. In 52,9% of women, to whom salpingotomic orifice was not sutured, tubal patency was found; in 32,4% of patients tubal patency was disturbed; in 14,7% the fallopian tube was obstructed and in 17,6% of patients tubo-peritoneal fistula formed. Uterine pregnancy rate of salpingotomy and salpingorrhaphy - 34,1%, of women, to whom salpingotomic orifice was not sutured - 20,6%. Performance of endoscopic salpingotomy with suture of the defect at isthmial and ampullar location of the fetal ovum helps to increase the efficien-cy of surgical treatment of the ectopic pregnancy.


2004 ◽  
Vol 132 (5-6) ◽  
pp. 163-166
Author(s):  
Milan Dokic ◽  
Dusan Perisic

The evolution of the process can take two different directions. If an intact pregnancy continues to grow, there is a tubal abortion or a rupture of the Fallopian tube. In the oppsote case, there is spontaneous resorption of the tubal pregnancy. In certain cases with the application of methotrexate, the ectopic pregnancy growth can be interrupted and spontaneous resorption can be induced. Nowadays, the international standards of treating patients with early ectopic gravidities and no peritoneal effusions, with ?-HCG values below 6000 Ul/I, gestational sac diameter below 3 cm, and without any visible heart action, imply methotrexate treatment. The objective of this study is to prove the efficiency of methotrexate use in patients who meet the above criteria. The first group did not manifest satisfying decrease of ?-HCG after two measurements, so methotrexate was used, while the second group showed satisfying decrease of ?-HCG, measured on the third day. Comparing the velocity of decrease of ?-HCG level among both groups of patients, it was proved that iatrogenically induced decrease, that is to say the achieved resorption, was equal to the spontaneous resorption, which justified the use of methotrexate in ectopic pregnancy treatment.


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