scholarly journals Tubal patency after Laparoscopic salpingostomy versus Methotrexate therapy in undisturbed tubal pregnancy

2021 ◽  
Vol 5 (06) ◽  
pp. 01-05
Author(s):  
Waleed M. Tawfik ◽  
Ali A. Bendary ◽  
Mohamed A. Elgazar
Keyword(s):  
Ectopic Pregnancy ◽  
Dose Regimen ◽  
Tubal Pregnancy ◽  
Tubal Ectopic Pregnancy ◽  
Tubal Patency ◽  
Future Fertility ◽  
Multiple Dose Regimen ◽  
History Of ◽  
Future Pregnancy ◽  
Better Than

Future fertility after ectopic pregnancy is dependent on several factors, including age, history of infertility, history of previous EP, tubal rupture, and contralateral tubal lesion. Thus, it seems reasonable to assess tubal patency following a treatment of an ectopic pregnancy in those women who are willing to have future pregnancy. Aimed to: Compare between tubal patency after methotrexate & laparoscopic salpingostomy. The study included 72 patients equally divided in number into 2 main groups. First group: (36cases) Tubal ectopic pregnancy treated by MXT therapy single or multiple doses. Single dose regimen (MTX 1.0 mg/kg or 50 mg/m2 i.m or multiple dose regimen (MTX 1.0 mg/kg i.m days (0,2,4,6). Second group: - (36 cases) Tubal ectopic pregnancy treated by laparoscopic salpingostomy. After 3 months, we used laparoscopy with administration of methylene blue (MB) as a marker to detect the tubal patency. As regard to tubal patency, of 31 cases (86.1%) from 36 cases that treated by MTX were patent and 5 cases (13.9 %) were blocked. On the other side 21 cases (58.3 %) from 36 cases that treated by laparoscopic salpingostomy were patent and 15 cases (41.7 %) were blocked). Conclusions:Methotrexate is better than laparoscopic salpingostomy in treating undisturbed tubal pregnancy.

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 A Rare Case of Bilateral Tubal Ectopic Pregnancy Following Intracytoplasmic Sperm Injection-Embryo Transfer (ICSI-ET)

2020 ◽  
Vol 42 (03) ◽  
pp. 165-168
Author(s):  
Ferruh Acet ◽  
Ege Nazan Tavmergen Goker ◽  
Ismet Hortu ◽  
Gulnaz Sahin ◽  
Erol Tavmergen
Keyword(s):  
Ectopic Pregnancy ◽  
Embryo Transfer ◽  
Tubal Pregnancy ◽  
Serum Progesterone ◽  
Tubal Ectopic Pregnancy ◽  
Vitro Fertilization ◽  
Reproductive Techniques ◽  
History Of ◽  
Β Hcg

AbstractBilateral tubal ectopic pregnancy is a very rare form of ectopic pregnancy. The incidence is higher in women undergoing assisted reproductive techniques or ovulation induction. We report the case of bilateral tubal ectopic pregnancy. The patient was 30 years old and had a 3-year history of infertility; she was referred to the in-vitro fertilization (IVF) program because of tubal factor infertility. A pregnancy resulted from the transfer of two embryos during an artificial cycle. Despite the increase in β-hCG values during the follow-up, 22 days after the embryo transfer, the β-hCG levels were 2,408 U/L and the serum progesterone (P4) level was 10.53 ng/ml. After application with methotrexate, β-hCG levels did not decrease effectively. Moreover, the sonographic screening revealed a suspicious bilateral tubal focus for ectopic pregnancy. A mini-laparotomy was performed and a bilateral tubal pregnancy was found. In the case of unilateral tubal pregnancy after the transfer of two embryos, the situation of the other tube should be systematically checked and β-hCG levels should be monitored.

scholarly journals Hysterosalpingography for tubal patency after methotrexate therapy for ectopic pregnancy

2020 ◽  
Vol 6 (3) ◽  
pp. 76-79
Author(s):  
Ahmed A Aboelroose ◽  
Ahmed M Fakhr Eldein ◽  
Waleed A Sayed Ahmed ◽  
Omima T Taha
Keyword(s):  
Medical Treatment ◽  
Ectopic Pregnancy ◽  
Significant Risk ◽  
Methotrexate Therapy ◽  
Reproductive Age ◽  
P Value ◽  
University Hospitals ◽  
Tubal Ectopic Pregnancy ◽  
Tubal Patency ◽  
History Of

ntroduction: Ectopic pregnancy is a serious cause of tubal loss or dysfunction among women in the reproductive age. Medical treatment is a commonly prescribed management under certain circumstances. It is associated with a high success rate, but tubal affection is a result. This study evaluated the effect of medical treatment on patients with unruptured tubal pregnancy. Materials and methods: This was a prospective cohort study conducted at the Obstetrics and Gynecology Department of Suez Canal University Hospitals, from January 2016 to June 2019. We recruited Fifty- six patients with unruptured tubal pregnancy.All patients were managed with medical treatment, methotrexate therapy. After confirmation of successful medical treatment, hysterosalpingography was done three months after treatment for the evaluation of tubal patency.The outcome measure was the rate of tubal patency after medical treatment for unruptured tubal ectopic pregnancy. Results: The present study revealed that 71.4% of patients (40 cases) had patent tubes, and 28.6% had blocked tubes. Moreover, 21.4% of patients have ipsilateral tubal block only, 3.6% have a contralateral tubal block, and 3.6% have a bilateral tubal block. Significant risk factors for tubal block were history suggestive of PID, acute PID hospitalization, and history of septic miscarriage (p value < 0.05). Conclusion: Methotrexate provided successful fertility-preserving treatment for women with unruptured ectopic pregnancy, yet associated with tubal block

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.

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 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.

scholarly journals A retrospective study of ectopic pregnancy at a tertiary care centre

2017 ◽  
Vol 6 (12) ◽  
pp. 5241 ◽  
Author(s):  
Archana Mehta ◽  
Shehla Jamal ◽  
Neerja Goel ◽  
Mayuri Ahuja
Keyword(s):  
Risk Factors ◽  
Retrospective Study ◽  
Ectopic Pregnancy ◽  
Clinical Presentation ◽  
Tertiary Care ◽  
Fetal Loss ◽  
Tubal Pregnancy ◽  
Tertiary Care Centre ◽  
Future Fertility ◽  
Ectopic Pregnancies

Background: Ectopic pregnancy is a global problem and is the most common life-threatening emergency in early pregnancy leading to significant morbidity and fetal loss. It occurs in variable presentations. The rate of ectopic pregnancies has increased from 0.5% in 1970 to 2% today. The aim of this study was to determine the incidence, clinical presentation, risk factors, treatment, and morbidity and mortality associated with ectopic pregnancy.Methods: The present retrospective study was conducted over a period of three years in the department of obstetrics and gynecology at SMS and R, Greater Noida, UP from Feb 2014 to Jan 2017.A total of 80 patients with ectopic pregnancy were analyzed regarding clinical presentation, risk factors, operative findings and treatment modality.Results: Total number of 80 cases of ectopic pregnancies were admitted during this period against 2645 deliveries representing frequency of 3%. Majority of cases (43.75%) were in the age group of 25-29 years and 41.25% were gravida 4 and above. Risk factors were identifiable in 66.25% of cases. Previous abortion was the most common risk factor (31.25%). The classical triad of amenorrhea, pain abdomen and vaginal bleeding was present in 71.25% of cases. More than half of case (55%) had ruptured tubal pregnancy on admission. Unruptured tubal pregnancy was seen in 10% case. Interestingly we found one rare case of bilateral ectopic pregnancy. Salpingectomy by open method was the mainstay of treatment (86.25%).Conclusions: Ectopic pregnancy is still a major challenge in gynecological practice. In our country most of the cases present late after tubal rupture requiring radical surgical treatment. Early diagnosis and timely intervention in the form of medical treatment or conservative surgery not only reduces maternal morbidity but also preserves future fertility.

Conservative surgical management of ectopic pregnancy and its role in preservation of future fertility

2021 ◽  
Vol 12 (6) ◽  
pp. 64-68
Author(s):  
Indranil Dutta ◽  
Dilip Kumar Dutta ◽  
Rumpa Banerjee Dutta
Keyword(s):  
Ectopic Pregnancy ◽  
Surgical Management ◽  
West Bengal ◽  
Induced Abortion ◽  
Segmental Resection ◽  
Ectopic Gestation ◽  
Future Fertility ◽  
History Of ◽  
Related Mortality

Background: Maternal Mortality is one of the most important issues in our country. Ectopic Gestation is one of the few reasons which contribute to it. The first successful surgical management of a tubal ruptured ectopic pregnancy occurred in 1883. In those times mortality was approximately 60%. Since then lot of development in management of ectopic pregnancy has taken place which has resulted in reduction of related mortality. But still it remains as one of the important topics as now due to more infections (i.e PID) and resulting ectopic gestations and further operative salphingectomies, there is a reduced chance of patient to conceive naturally afterwards. Hence role of conservative surgeries comes to the front. Aims and Objectives: Role of Conservative Surgical Management of Ectopic pregnancy and its relation to future fertility. Materials and Methods: This Study was undertaken at GICE Clinic, Cure Hospital, Kalyani, West Bengal India from January, 2008 to January 2019. During this period 64 patients were diagnosed and operated for Ectopic pregnancy. Results: Forty (62.5%) cases were in between 20-30 years of age. Forty-four (68.7%) cases had no issue. Forty-eight (75.0%) cases were from low socio-economic group. Sixty patients (93.7%) had the history of amenorrhea. It was also observed that history of induced abortion was in 20 (31.2%) cases, PID in 12 (18.7%) cases, appendectomy – 6 (9.4%) cases and history of previous IUCD insertion - 4 (6.3%) were found to be common amongst ectopic gestation cases. Twenty-four (37.5%) cases underwent linear salpingostomy, 8 (12.5%) cases had segmental resection with end to end anastomosis whereas 16 (25.0%) cases had salpingectomy and 16 (25.0%) cases had salpingo-opherectomy with tubectomy [opposite tube] were advocated. In 4(6.3%) cases of linear salpingostomy and 4 (6.3%) cases of segmental resection, the cases had to be re-operated again for unstable haemodynamic condition within 24 hours and were subsequently advocated to salpingectomy. Conclusion: Linear Salpingostomy was found to be a better option for women who desire to become future mother, than that of segmental resection and salpingectomy on affected tube (although pregnancy was reported as opposite tube)

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