A Ruptured Spontaneous Heterotopic Tubal Pregnancy With a Viable Intrauterine Pregnancy

An ectopic pregnancy is a pregnancy located outside of the intrauterine cavity.They comprise 1-2% of all first trimester pregnancies and 6% of pregnancy related deaths in the United States [1]. Ectopic pregnancies most commonly occur in the fallopian tube but can also implant in other locations, including the ovaries, peritoneal cavity, cesarean section scars and the cervix [2].

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Ectopic Pregnancy in Two Cats

Acta Scientiae Veterinariae ◽

10.22456/1679-9216.85155 ◽

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.

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Ruptured Tubal Ectopic Pregnancy at Fifteen Weeks Gestational Age

Clinical Practice and Cases in Emergency Medicine ◽

10.5811/cpcem.2019.1.40860 ◽

2019 ◽

Vol 3 (1) ◽

pp. 62-64 ◽

Cited By ~ 3

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.

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

Case Reports in Obstetrics and Gynecology ◽

10.1155/2013/906825 ◽

2013 ◽

Vol 2013 ◽

pp. 1-3 ◽

Cited By ~ 1

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.

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The Value of Color and Power Doppler in the Diagnosis of Ectopic Pregnancy

Donald School Journal of Ultrasound in Obstetrics & Gynecology ◽

10.5005/jp-journals-10009-1314 ◽

2013 ◽

Vol 7 (4) ◽

pp. 429-439 ◽

Cited By ~ 1

Author(s):

Ulrich Honemeyer ◽

Sanja Kupesic-Plavsic ◽

Afshin Pour-Mirza

Keyword(s):

Ectopic Pregnancy ◽

Obstet Gynecol ◽

Power Doppler ◽

Three Dimensional ◽

Uterine Cavity ◽

Lower Abdominal Pain ◽

First Trimester ◽

Tubal Pregnancy ◽

Ectopic Pregnancies ◽

Color And Power Doppler

ABSTRACT Implantation of the zygote outside the uterine cavity occurs in 2% of all pregnancies. The rate of ectopic pregnancies has increased from 0.5% in 1970 to 2% today. The prevalence of ectopic pregnancy in all women presenting to an emergency department with first-trimester bleeding, lower abdominal pain or a combination of the two is between 6 and 16%. When diagnosis is made early, the product of conception can be removed safely by laparoscopic surgery and be submitted for histological examination. Tubal rupture is a complication of late diagnosed tubal pregnancy which is more difficult to treat conservatively and often indicates tubectomy or segmental resection. In 5 to 15% of treated ectopic pregnancy cases, remnant conception product parts are diagnosed and may require a final methotrexate (MTX) injection. Rare sites of ectopic pregnancy include interstitial, cervical, abdominal and cesarean scar pregnancies. Our manuscript reviews and illustrates the use of novel sonographic methods such as three-dimensional ultrasound, multiplanar view, in combination with color and power Doppler ultrasound, for early detection of ectopic tubal pregnancy and of other, rare locations of ectopic pregnancy. How to cite this article Honemeyer U, Alkatout I, Plavsic SK, Pour-Mirza A, Kurjak A. The Value of Color and Power Doppler in the Diagnosis of Ectopic Pregnancy. Donald School J Ultrasound Obstet Gynecol 2013;7(4):429-439.

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Heterotopic Pregnancy: A Clinical Case Report

Bangladesh Medical Journal ◽

10.3329/bmj.v39i3.9950 ◽

1970 ◽

Vol 39 (3) ◽

Author(s):

S Chowdhury ◽

T Chowdhury

Keyword(s):

Abdominal Pain ◽

Case Report ◽

Ectopic Pregnancy ◽

Clinical Examination ◽

Clinical Case ◽

Lower Abdominal Pain ◽

Tubal Pregnancy ◽

Heterotopic Pregnancy ◽

Intrauterine Pregnancy ◽

Ectopic Pregnancies

Heterotopic pregnancy is coexistence of intrauterine and extrauterine pregnancies that is ectopic pregnancies. It is said to be rare. Here we report a case of 27 years old woman with heterotopic pregnancy. Patient had a typical presentation of severe lower abdominal pain following amenorrhoea for 2½ months. On clinical examination, there was suspicion of ectopic pregnancy but ultrasonography revealed early intrauterine pregnancy along with right tubal pregnancy with huge collection in abdomen . Immediate laparotomy was done and diagnosis was confirmed as a case of heterotopic pregnancy.DOI: http://dx.doi.org/10.3329/bmj.v39i3.9950 BMJ 2010; 39(3)

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Structural Changes in the Fallopian Tubes in Patients With Ectopic Pregnancy

Russian Sklifosovsky Journal Emergency Medical Care ◽

10.23934/2223-9022-2020-9-4-598-605 ◽

2021 ◽

Vol 9 (4) ◽

pp. 598-605

Author(s):

G. P. Titova ◽

M. M. Damirov ◽

I. V. Anchabadze ◽

A. A. Medvedev

Keyword(s):

Ectopic Pregnancy ◽

Fallopian Tube ◽

Structural Changes ◽

Tube Wall ◽

First Trimester ◽

Tubal Pregnancy ◽

Fallopian Tubes ◽

Depth Of Penetration ◽

Morphological Examination ◽

Surgical Interventions

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.

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Ectopic pregnancy in animals and humans

Reproduction ◽

10.1530/rep.1.00606 ◽

2006 ◽

Vol 131 (4) ◽

pp. 631-640 ◽

Cited By ~ 41

Author(s):

Juan Manuel Corpa

Keyword(s):

Ectopic Pregnancy ◽

Peritoneal Cavity ◽

Animal Species ◽

Pathological Condition ◽

First Trimester ◽

Farm Animals ◽

Abdominal Pregnancy ◽

Human Beings ◽

First Trimester Of Pregnancy ◽

Ectopic Pregnancies

Ectopic pregnancy denotes a pregnancy occurring elsewhere than in the cavity of the uterus. This pathology has been recognised for years and it causes numerous maternal deaths during the first trimester of pregnancy. While this condition is well-known in humans, it is rarely diagnosed in animals. However, the causes and mechanisms leading to an ectopic implantation of the ovum are not always clearly defined in humans or animals. Two types of ectopic pregnancy are mainly recognized: (1) tubal pregnancy occurs when an oocyte is fertilized and then remains in the oviduct and (2) abdominal pregnancy occurs when the gestation develops in the peritoneal cavity. The latter may be subdivided into two subtypes: the primary form, when a fertilized oocyte enters the peritoneal cavity and becomes attached to the mesentery or abdominal viscera, and the secondary form, which follows the rupture of an oviduct or the uterus after the fetus has been implanted, and the fetus is expelled into the peritoneal cavity. Cornual, ovarian and cervical ectopic locations are less frequent. Several differences exist in ectopic pregnancies between human beings and animal species. While abdominal pregnancy has been described in both human and animal species, tubal ectopic pregnancies would appear to be restricted to primates. Other than anecdotal cases, this pathological condition does not occur in laboratory, domestic or farm animals. Several factors are described as being the cause of these differences.

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A Case of Fallopian Tube Adenofibroma: Difficulties Associated with Differentiation from Ectopic Pregnancy

Clinical Medicine Insights Case Reports ◽

10.4137/ccrep.s18859 ◽

2014 ◽

Vol 7 ◽

pp. CCRep.S18859

Author(s):

Akimune Fukushima ◽

Tadahiro Shoji ◽

Shino Tanaka ◽

Toru Sugiyama

Keyword(s):

Ectopic Pregnancy ◽

Fallopian Tube ◽

Inflammatory Diseases ◽

Cystic Tumor ◽

Test Results ◽

Intrauterine Pregnancy ◽

Macroscopic Findings ◽

Gestational Sac ◽

Ectopic Pregnancies ◽

Left Fallopian Tube

Benign solid tumors of the fallopian tubes are extremely rare and often difficult to differentiate from tumors associated with adjacent organs or from various inflammatory diseases. Here, we present a patient who was diagnosed with ectopic pregnancy, based on preoperative tests and intraoperative macroscopic findings, but was later diagnosed with a fallopian tube adenofibroma, based on histopathological evidence, and intrauterine pregnancy. Although initial pregnancy test results were positive, no gestational sac (GS) was seen in the uterus and the patient was diagnosed with an ectopic pregnancy and underwent emergency laparoscopic surgery. A 20-mm, fetus-like solid mass was noted inside the GS-like cystic tumor of the left fallopian tube. From histopathological findings, the lesion was identified as a serous fallopian tube adenofibroma. The baby was born healthy with no problems. This case report suggests that fallopian tube adenofibroma should be considered in the differential diagnosis of suspected ectopic pregnancies.

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

Case Reports in Surgery ◽

10.1155/2015/645826 ◽

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.

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