Evaluation of tubal patency using hysterosalpingo-contrast sonography (HyCoSy) following salpingostomy and medical treatment of tubal pregnancy

2021 ◽  
Vol 20 (4) ◽  
pp. 12-16
Author(s):  
Aml El-Shabrawy ◽  
◽  
Ahmed Elsheikh ◽  
Samy Gebreel ◽  
Mohammed Elsokkary ◽  
...  
Keyword(s):  
Medical Treatment ◽  
Ectopic Pregnancy ◽  
Success Rate ◽  
Fallopian Tube ◽  
Tubal Pregnancy ◽  
Tubal Patency ◽  
Group I ◽  
Case Series Study ◽  
Maternity Hospitals ◽  
Significant Difference

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

scholarly journals Laparoscopic Excision of Coexisting Left Tubal and Right Pseudotubal Pregnancy after Conservative Management of Previous Ectopic Pregnancy with Methotrexate: An Unusual Clinical Entity

2015 ◽  
Vol 2015 ◽  
pp. 1-3
Author(s):  
Panayotis Xiromeritis ◽  
Chrysoula Margioula-Siarkou ◽  
Dimosthenis Miliaras ◽  
Ioannis Kalogiannidis
Keyword(s):  
Ectopic Pregnancy ◽  
Fallopian Tube ◽  
Tubal Pregnancy ◽  
Chorionic Villi ◽  
Tubal Patency ◽  
Laparoscopic Excision ◽  
Future Pregnancy ◽  
Ectopic Pregnancies ◽  
Left Fallopian Tube ◽  
The Right

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.

scholarly journals Endosurgical treatment techniques of progressive tubal pregnancy

2006 ◽  
Vol 5 (1) ◽  
pp. 73-75
Author(s):  
I. D. Yevtushenko ◽  
S. V. Rybnikov
Keyword(s):  
Surgical Treatment ◽  
Ectopic Pregnancy ◽  
Pregnancy Rate ◽  
Fallopian Tube ◽  
Research Method ◽  
Tubal Pregnancy ◽  
Prospective Analysis ◽  
Research Subjects ◽  
Tubal Patency ◽  
Treatment Techniques

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.

scholarly journals Factors affecting the success of fallopian tube recanalization in treatment of tubal obstructive infertility

2020 ◽  
Vol 48 (12) ◽  
pp. 030006052097921
Author(s):  
Huawei Shen ◽  
Mingjin Cai ◽  
Tingwei Chen ◽  
Duzhou Zheng ◽  
Shikuan Huang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Abdominal Surgery ◽  
Ectopic Pregnancy ◽  
Success Rate ◽  
Fallopian Tube ◽  
Multivariable Analysis ◽  
Factors Affecting ◽  
Tubal Patency ◽  
History Of ◽  
Artificial Abortion

Objective To examine potential risk factors associated with the success rate following fallopian tube recanalization (FTR) in infertile women with obstruction of the proximal fallopian tube. Methods We retrospectively studied patients who underwent FTR for tubal obstructive infertility between January 2016 and December 2018 at the Third Affiliated Hospital of Guangzhou Medical University. FTR was performed using a catheter and guidewire system to clear tubal obstruction. Predictive factors potentially associated with the success rate were assessed by logistic regression. Results A total of 762 patients were included. Multivariable analysis showed that age (odds ratio [OR] = 2.38, 95% confidence interval [CI]: 1.24–4.58), infertility type (OR = 2.82, 95% CI: 1.36–6.21), history of ectopic pregnancy (OR = 7.87, 95% CI: 4.05–15.81), history of abdominal surgery (OR = 4.30, 95% CI: 2.22–8.60), history of artificial abortion curettage (OR = 4.08, 95% CI: 2.12–8.03), and duration of infertility (OR = 2.03, 95% CI: 1.06–3.85) were independently associated with postoperative tubal patency. Conclusions Our findings suggest that risk factors, such as age ≥35 years, secondary infertility, duration of infertility ≥5 years, and histories of ectopic pregnancy, abdominal surgery, and artificial abortion curettage, affect the success rate of FTR. These factors may also predict surgical success in treating tubal obstructive infertility.

Effect of Silver Nitrate Application on the Success of Endoscopic Dacryocystorhinostomy

2021 ◽  
pp. 194589242110427
Author(s):  
Yaser S. Çetin ◽  
Ramazan Akın ◽  
Ufuk Düzenli ◽  
Mahfuz Turan ◽  
Nazım Bozan
Keyword(s):  
Silver Nitrate ◽  
Success Rate ◽  
Postoperative Period ◽  
Revision Surgery ◽  
Granuloma Formation ◽  
Stent Insertion ◽  
Group Iii ◽  
Group I ◽  
Significant Difference ◽  
Silicone Stent

Objectives To compare the clinical outcomes of patients undergoing additional procedures in endoscopic endonasal dacryocystorhinostomy (End-DCR) surgery and discuss the factors affecting the success of End-DCR surgery in light of relevant literature. Methods The study included 155 patients who underwent End-DCR surgery in our clinic due to epiphora. This was a prospective randomized, single-blind, controlled trial. Group I (control) included 54 patients who did not undergo silicone stent insertion or silver nitrate application, group II included 51 patients who underwent silicone stent insertion only, and group III included 50 patients who underwent silver nitrate application only. Statistical analysis was performed on follow-up data regarding anatomic and functional success rates. Results Revision surgery was performed in 16 patients who developed persistent epiphora in the postoperative period, including 6 in group I, 7 in group II, and 3 in group III ( P = .4). The most common reason for revision surgery was stenosis of the neo-ostium ( n = 8), followed by granulation tissue formation ( n = 5) and synechia formation ( n = 3). Granuloma formation was the most common postoperative complication, and a significant difference was found among the groups with regard to granuloma formation ( P = .04). At postoperative month 12, the functional success rate was estimated to be 88%, 86%, and 94%, and the anatomic success rate was estimated to be 94%, 92%, and 96% in groups I, II, and III, respectively, with no significant difference, found among the 3 groups with regard to both rates ( P = .79 and P = .76, respectively). Conclusion The results indicated that stenting and silver nitrate application did not affect surgical success. Our preliminary results on silver nitrate cauterization showed that it is an effective, inexpensive, and practical method to reduce granulation formation in the postoperative period.

scholarly journals Ectopic Pregnancy in Two Cats

2018 ◽  
Vol 46 ◽  
pp. 5
Author(s):  
Jia-San Zheng ◽  
Zheng Wang ◽  
Jia-Ren Zhang ◽  
Shuang Qiu ◽  
Ren-Yue Wei ◽  
...  
Keyword(s):  
Ectopic Pregnancy ◽  
Fallopian Tube ◽  
Clinical Symptoms ◽  
Abdominal Cavity ◽  
Scar Tissue ◽  
Tubal Pregnancy ◽  
Abdominal Pregnancy ◽  
Fallopian Tubes ◽  
Gestational Sac ◽  
Ectopic Pregnancies

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.

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 Ectopic pregnancy

2020 ◽  
Vol 7 (1) ◽  
pp. 4-9
Author(s):  
I. V. Gadayeva ◽  
I. D. Khokhlova ◽  
T. A. Dzhibladze
Keyword(s):  
Diagnostic Accuracy ◽  
Ectopic Pregnancy ◽  
Fallopian Tube ◽  
Clinical Manifestations ◽  
Pain Syndrome ◽  
Tubal Pregnancy ◽  
Abdominal Bleeding ◽  
Intraperitoneal Bleeding ◽  
Instrumental Methods

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.

The effectiveness of anti-adhesive barrier based on carboxymethylcellulose 5 mg and sodium hyaluronate 2.5 mg in various methods of surgical treatment of ectopic tubal pregnancy

GYNECOLOGY ◽  
2019 ◽  
Vol 21 (2) ◽  
pp. 71-75
Author(s):  
Larisa E Fitisheva ◽  
Vadim G Mozes ◽  
Igor S Zaharov ◽  
Kira B Mozes
Keyword(s):  
Surgical Treatment ◽  
Fallopian Tube ◽  
Laparoscopic Resection ◽  
Randomized Study ◽  
Sodium Hyaluronate ◽  
Tubal Pregnancy ◽  
Postoperative Adhesions ◽  
Adhesion Barrier ◽  
Significant Difference

Aim. To evaluate the effectiveness of the anti-adhesive barrier in the form of a gel based on carboxymethylcellulose 5 mg and sodium hyaluronate 2.5 mg with various techniques of surgical treatment of ectopic tubal pregnancy. Materials and methods. A randomized study was conducted on 98 women who underwent laparoscopic resection of the ampulla of the fallopian tube, together with a embryo, followed by neostomatoplasty or salpingostomy with or without an anti-adhesive barrier. The primary outcome of the study was the incidence of uterine pregnancy and its outcomes at 18 months of follow-up; secondary outcomes were the frequency of adhesions in the pelvis, the frequency of patency of the operated fallopian tube according to second look laparoscopy with chromohydrotubation by 3 months of follow-up. Results. At 3 months of follow-up, the use of an anti-adhesion barrier reduced the incidence of postoperative adhesions in the area of the operated fallopian tube and the degree of adhesions in the pelvis; increased the frequency of patency of the operated fallopian tube when performing laparoscopic resection of a portion of the ampulla of the fallopian tube, followed by neostomatoplasty. By the 18th month of observation, no statistically significant difference in the incidence of spontaneous pregnancy and its outcomes in the studied women was detected. Conclusion. Use of 5 mg carboxymethylcellulose and 2.5 mg sodium hyaluronate anti-adhesive barrier with various organ-preserving methods of surgical treatment of ectopic tubal pregnancy reduces the frequency and extent of postoperative adhesions in the area of the operated fallopian tube, in the small pelvis, but does not increase fertility in the postoperative period.

The effect of ultrasonography in predicting medical treatment success in ectopic pregnancy

2019 ◽  
Vol 1 (1) ◽  
pp. 5-7
Author(s):  
Meric Balikoglu ◽  
Burak Bayraktar ◽  
Mert Mevlüt Akar
Keyword(s):  
Single Dose ◽  
Medical Treatment ◽  
Ectopic Pregnancy ◽  
Adnexal Mass ◽  
Treatment Success ◽  
Dose Methotrexate ◽  
Treatment Prediction ◽  
Significant Difference ◽  
Mass Size ◽  
The Right

Ectopic pregnancy(EP) treatment success in a single dose methotrexate(MTX) regimen is decided by more than 15% β chorionic gonadotropin reduction in the 4th and 7th days after administration of 50mg/m² of medication.  In our study , it was aimed whether the EP mass size less than 40mm detected by ultrasonography and the adnexal side on which it was located had an effect on the success of medical treatment. 82 patients who treated with MTX included in the study were divided into two groups as those with a single dose of methotrexate success and those without (n:67 vs n:15). The groups were compared in terms of age, parity, size of adnexal mass detected on ultrasonography, and the side of ectopic pregnancy. The parity rates and the age of patients were similar in both groups(p = 0.615, p = 0.742). Although the average adnexal mass size was found to be higher in the patient group those single dose MTX treatment was not successful, there was no statistically significant difference(p = 0.098). Ectopic pregnancy was frequently observed on the right side in the group in which the medical treatment was successful(66 % vs 33%). The effect of ectopic pregnancy mass size on medical treatment prediction was investigated in cases with mass size less than 40mm. Ectopic pregnancy mass size, even if it is below 40 mm, may not indicate the medical treatment success.

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