Association Between Vaginal Gardnerella and Tubal Pregnancy in Women With Symptomatic Early Pregnancies in China: A Nested Case-Control Study

The early diagnosis and treatment of ectopic pregnancy (EP) remains a major challenge. Despite a known link between vaginal microbiota and female reproductive health, few studies have focused on the association between vaginal microbiota and pregnancy location. This nested case-control study aimed to characterize the vaginal microbiota in tubal pregnancy (TP) among symptomatic women in early pregnancy. Women with symptomatic early pregnancy of unknown location (PUL) were included in this study. 16S rDNA gene sequencing was performed to assess vaginal microbial diversity and relative abundance. Machine learning and multivariate logistic regression were also used to evaluate the association between Gardnerella and TP. The results indicate that the vaginal microbiome in TP was more diverse (Shannon, p < 0.05) and was different in composition to that of women with intrauterine pregnancy (IUP) (weighted Unifrac, R = 0.08, p = 0.01). The genus Gardnerella was significantly enriched in TP. The XGBoost analysis was able to classify Gardnerella-induced TP more reliably (AUC = 0.621). Moreover, after adjusting potential confounders, our results indicate a robust association between Gardnerella and TP (as a continuous variable, adjusted OR: 12.0, 95% CI: 2.1–67.4, p < 0.01; as a categorical variable (≥0.85%), and adjusted OR: 4.2, 95% CI: 2.0–8.8, p < 0.01). In conclusion, we found that higher virginal Gardnerella levels were associated with TP in women with symptomatic early pregnancy.

A case of bilateral tubal pregnancy

A large number of works are currently devoted to the issues of ectopic pregnancy, both in the periodic literature and in manuals where the chapter on ectopic pregnancy is highlighted in an independent section.

OVARIAN ECTOPIC PREGNANCY- A RARE CASE REPORT

Background:Ovarian pregnancy is classified as a rare cause of non tubal pregnancy wherein maximum ends in rupture in early months of pregnancy. Sign and symptoms often mimic tubal rupture. To distinguish between the two based on presenting complaints and ultrasonography findings is difficult. Generally confirmation of ovarian preganancy is done only after histopathological examination due to its similarity in presenting complaints to tubal pregnancy. Medical management has also been tried for unruptured ectopic pregnancy. Case:Presenting a rare case report of ruptured left ovarian pregnancy. pt was 26yrs old multiparous with previous two cesarean 7yrs and 4 yrs back with one MTP kit taken 6 months back with pain in left iliac fossa. USG findings were suggestive of tubal rupture, however during laparotomy ruptured left ovarian pregnancy was diagnosed followed by left oopherectomy later on confirmed by histopathological examination.

Diagnosis and therapy of tubal pregnancy Löhnberg (Zeit. f. Geb., Bd. 84)

Based on the analysis of 152 operated cases of tubal pregnancies, Lhnberg (Zeit. F. Geb., Bd. 84) determines the likelihood of sweeping tubal pregnancies with inflammatory diseases of the appendages in 10% and attaches particular importance in recognition to anamnestic indications of cramping pains. Uterine pregnancy after ectopic pregnancy occurs 6 times more often than pregnancy in another tube.

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

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.

The risk factors of rupture and abortion of tubal pregnancy——a retrospective study based on 2280 tubal pregnancy cases

【Objective】The morbidity of ectopic pregnancy is about 1%~2%, and it accounts for about 10% of maternal death. Tubal rupture and tubal abortion can both lead to massive hemorrhage, but their risk factors are lack of study. Through studying the ectopic cases at the third affiliated hospital of Sun Yat-Sen University, the study aims to analyze the risk factors of tubal rupture and tubal abortion. 【Methods】To collect the ectopic pregnancy cases undergoing surgeries from the year 2011 to the year 2019 retrospectively, divide them into ruptured group, aborted group, and unruptured and unaborted group. T-test, Mann–Whitney–Wilcoxon test and Pearson’s chi-square, and Fisher’s exact test were applied for univariate analysis. Multivariate logistic regression analysis was used to identify the risk factors of tubal rupture and tubal abortion (variables with a P value < 0.1 by univariate analysis were entered into the multivariate analysis). 【Results】Abdominal pain(OR:3.101, 95%CI:1.812–5.306, P < 0.001), cervical lifting pain(OR:2.942, 95%CI:2.046–4.231, P < 0.001), the mass diameter ≥ 4cm(OR:2.874, 95%CI:2.095–3.941, P < 0.001), HCG ≥ 5000U/L(OR:2.588, 95%CI:1.900-3.526, P < 0.001), adnexal tenderness(OR:1.893, 95%CI:1.296–2.764, P = 0.001), age ≥ 35(OR:1.781, 95%CI:1.232–2.573, P = 0.002), aspirating blood during culdocentesis(OR:1.497, 95%CI:1.081–2.074, P = 0.015) are the risk factors of tubal rupture, while vaginal bleeding(OR:0.271, 95%CI:0.196–0.375, P < 0.001) is the protective factor of tubal rupture. HCG < 2000U/L (OR:3.554, 95%CI:2.401–5.260, P < 0.001) and mass diameter ≥ 4cm (OR:2.732, 95%CI:1.900-3.929, P < 0.001) are the risk factors of tubal abortion. 【Conclusions】When facing an ectopic pregnancy patient considering pelvic bleeding happens, if HCG ≥ 5000U/L, it’s more likely to be tubal rupture, if HCG < 2000U/L, it’s more likely to be tubal abortion.

T. n. "Spontaneous cure" of tubal pregnancy

T. n. Spontaneous cure of tubal pregnancy, according to Ntirnbergera (Arch. F. Gyn., Bd. 121, H. 1), is an accidental clinical variant of those reverse development processes that are often found in tubal pregnancy.