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Sample records for tubal ectopic pregnancy

  1. Interventions for tubal ectopic pregnancy

    NARCIS (Netherlands)

    Hajenius, P. J.; Mol, F.; Mol, B. W. J.; Bossuyt, P. M. M.; Ankum, W. M.; van der Veen, F.

    2007-01-01

    BACKGROUND: Treatment options for tubal ectopic pregnancy are; (1) surgery, e.g. salpingectomy or salpingo(s)tomy, either performed laparoscopically or by open surgery; (2) medical treatment, with a variety of drugs, that can be administered systemically and/or locally by various routes and (3)

  2. Interventions for tubal ectopic pregnancy

    NARCIS (Netherlands)

    Hajenius, P. J.; Mol, B. W.; Bossuyt, P. M.; Ankum, W. M.; van der Veen, F.

    2000-01-01

    BACKGROUND: The diagnosis of ectopic pregnancy can now often be made by non-invasive methods due to sensitive pregnancy tests (in urine and serum) and high resolution transvaginal sonography, which have been integrated in diagnostic algorithms. These algorithms, in combination with the increased

  3. Ectopic pregnancy after two times tubal ligation: a case report

    Directory of Open Access Journals (Sweden)

    Farideh Keypour

    2013-06-01

    Full Text Available Background: Tubal sterilization is the permanent and effective contraception method. This can be performed at any time, but at least half are performed in conjunction with cesarean or vaginal delivery and are termed puerperal. The most complication after tubal ligation is ectopic pregnancy. Ectopic pregnancy is the leading cause of maternal death in first trimester.Case presentation: We present a 33 years old woman gravida5, para4, all normal vaginal delivery, presented with complaints of delayed menstrual period, pelvic pain and spotting. She underwent tubal ligation for two times. For the first time she had puerperal Pomeroy tubal sterilization after third child delivery. Intra uterine pregnancy occurred three years later. One day after vaginal delivery of fourth child, she underwent post partum tubal ligation with the Parkland method. Tubal pregnancy occurred nine months later. Physical examination identified acute abdomen. Pelvic ultrasound showed no gestational sac in uterine cavity. The sac with fetal pole was in right adnexa. Beta-HCG was 2840mIU/ml. She underwent laparotomy. Surgical management included salpingectomy with cornual resection in both sides. The surgery identified Ectopic pregnancy.Conclusion: Any symptoms of pregnancy in a woman after tubal ligation must be investigated; an ectopic pregnancy should be excluded. Ectopic pregnancy must be considered, in any woman with lower abdominal pain, missed period and vaginal bleed-ing. Conception after tubal sterilization can be explained by fistula formation and re-canalization of fallopian tube.

  4. Bilateral tubal ectopic pregnancies: A report of two cases | Eze ...

    African Journals Online (AJOL)

    Bilateral tubal ectopic pregnancies are rare occurrences. Two recently managed cases are discussed. The first was a single, sexually active 23-year-old nullipara with family history of twinning who presented with eight weeks amenorrhea, positive pregnancy test, lower abdominal discomfort and other clinical and ultrasound ...

  5. Ectopic pregnancy with tubal rupture: an analysis of 80 cases

    International Nuclear Information System (INIS)

    Ashfaq, S.; Aziz, S.; Hasan, M.; Sultan, S.; Irfan, S.M.

    2017-01-01

    Ectopic pregnancy (EP) is a major problem in obstetrics as there is evidence of increasing incidence throughout the world. It is an important cause of maternal morbidity and mortality. In Pakistan, the care seeking behaviour among female is limited that makes female vulnerable to die due to complication of ectopic pregnancy. The aim of this study is to determine the frequency of tubal rupture in ectopic pregnancy in Pakistani patients. Method: In this cross-sectional study data pertaining to age, gestational age, parity and duration of presenting symptoms were collected and analysed. Result: 80 patients were diagnosed to have ectopic pregnancy. The frequency of tubal rupture was 91.25%. It is encountered significantly more often in women with age of 26 years. More tubal rupture is found in patient with low parity, in which the frequency of tubal rupture is up to 100% and decrease up to 78.6% with increasing parity up to four. Furthermore, it is noted that increase in gestational age from 8 weeks to 10 weeks caused an increase in frequency of tubal rupture from 80 to 100% respectively. It is also noted that earlier the patient presents the lesser is the frequency of tubal rupture, as compared to late presentation beyond 3-4 days which make frequency up to 95%. Conclusion: Tubal rupture is still common cause of maternal morbidity and mortality, and is still a major challenge in gynaecological practice. Creating awareness amongst midwives and GPs regarding early diagnosis can contribute to decrease the mortality, morbidity and fertility loss related to EP. (author)

  6. Evidence-based management of non-tubal ectopic pregnancies.

    Science.gov (United States)

    Alalade, Aderemi Olaoluwa; Smith, Fredrick John Ennis; Kendall, Charlotte Emma; Odejinmi, Funlayo

    2017-11-01

    Recent advances in ultrasonography and the use of other modalities including magnetic resonance imaging scans have led to the early and more accurate diagnosis of non-tubal ectopic pregnancies (NTE). As a result, the management of these pregnancies has evolved. This article addresses the management options currently available for NTE. While surgical management remains the mainstay of treatment for ovarian, abdominal and cornual ectopics, there is growing evidence that some of these can be managed medically. Many authors have utilised a combination of medical and surgical approaches in the management of cervical and caesarean section (CS) scar ectopic pregnancies with good outcome. The availability of dedicated early pregnancy units has further improved diagnosis and more importantly the follow-up care for these patients. The rarity of cases and the difficulty of ethically organising randomised trials for NTE remain a problem in formulating consistent pathways for optimum management of women with NTE.

  7. Interventional ovarian tube catheterization in treating tubal ectopic pregnancy

    International Nuclear Information System (INIS)

    Hu Yi; Xiong Linhui; Du Pianqin; Chen Jiabin

    2004-01-01

    Objective: To explore the feasibility and curative effect of treating tubal pregnancy through the fallopian tube with interventional catheterization decrease the difficulty of the procedure and shorten the consuming time. Methods: Applying the method of interventional catheterization of fallopian tube and injecting 0.5 mg atropine at the cervix beforehand, then 70 mg MTX was administered into the fallopian tube. Results: 113 patients were successfully recovered with health except one without any adversary complication. Conclusions: The interventional fallopian tube catheterization for treating ectopic pregnancy is a simple, safe, minitraumatic, quick and effective method. (authors)

  8. High Titers of Chlamydia trachomatis Antibodies in Brazilian Women with Tubal Occlusion or Previous Ectopic Pregnancy

    Directory of Open Access Journals (Sweden)

    A. C. S. Machado

    2007-01-01

    Full Text Available Objective. To evaluate serum chlamydia antibody titers (CATs in tubal occlusion or previous ectopic pregnancy and the associated risk factors. Methods. The study population consisted of 55 women wih tubal damage and 55 parous women. CAT was measured using the whole-cell inclusion immunofluorescence test and cervical chlamydial DNA detected by PCR. Odds ratios were calculated to assess variables associated with C. trachomatis infection. Results. The prevalence of chlamydial antibodies and antibody titers in women with tubal occlusion or previous ectopic pregnancy was significantly higher (P<.01 than in parous women. Stepwise logistic regression analysis showed that chlamydia IgG antibodies were associated with tubal damage and with a larger number of lifetime sexual partners. Conclusions. Chlamydia antibody titers were associated with tubal occlusion, prior ectopic pregnancy, and with sexual behavior, suggesting that a chlamydia infection was the major contributor to the tubal damage in these women.

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

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    Mara Clapp

    2013-01-01

    Full Text Available 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.

  10. [Successive ectopic pregnancies associated with tubal shistosomiasis in a French traveler].

    Science.gov (United States)

    Laroche, Justine; Mottet, Nicolas; Malincenco, Marianna; Gay, Catherine; Royer, Pierre Yves; Riethmuller, Didier

    2016-01-01

    Schistosomiasis is the second endemic parasitic disease in the world and is a common cause of urogenital infections. Ectopic pregnancies due to tubal obstruction by schistosoma's eggs are usually reported in Africa. Schistosomiasis also affects travelers but infection of the female genital tract is less frequently described. We report an unusual clinical case of two successive ectopic pregnancies with tubal schistosomiasis in a French woman, seven years after a travel to Mali. The first event was discovered after histologic examination of salpingectomy and the second event required a controlateral salpingotomy with an injection of methotrexate, two months later.

  11. Methotrexate treatment in progressive tubal ectopic pregnancies and hCG-related clinicosurgical implications

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    Askin Dogan

    2016-06-01

    Full Text Available Our aim was to evaluate the relationship between the success of methotrexate treatment and β-hCG levels in progressive tubal ectopic pregnancies. We defined a retrospective cohort of 394 progressive tubal ectopic pregnancy patients treated with methotrexate. A single-dose methotrexate protocol using 50 mg/m2 was administered to patients with progressive tubal ectopic pregnancy. Surgery was performed in patients who exhibited signs of acute abdomen due to tubal rupture. Of 394 patients that received methotrexate treatment, 335 (84.6% responded to medical treatment, while the remaining 59 (15.36% underwent surgery due to treatment failure. β-hCG levels in the failure group were significantly higher as compared with the success group at Day 1, Day 4, and Day 7 (2116±3157 vs. 4178±3422, 2062±3551 vs. 4935±4103, and 1532±3007 vs. 3900±4783, respectively. The receiver operating characteristics curve for β-hCG levels at Day 1 was 0.738, with a cutoff value of 1418 mIU/mL, while sensitivity and specificity values reached the optimum for treatment success (83.1% and 59.4%, respectively. Medical treatment with methotrexate achieved an 85.02% success rate for the treatment of progressive tubal ectopic pregnancy, while success rates for medical treatment decreased significantly when initial β-hCG levels were >1418 mIU/mL.

  12. Ruptured Heterotopic Tubal Pregnancy for a Patient with a History of Segmental Salpingectomy from Ectopic Pregnancy: A Case Report

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    Nam, Kyung Bum; Namkung, Sook; Hong, Myung Sun; Kim, Heung Cheol; Cho, Young; Choi, Young Hee [Chuncheon Sacred Heart Hospital, Chyncheon (Korea, Republic of)

    2012-06-15

    Heterotopic pregnancy refers to the simultaneous development of an intrauterine pregnancy and an extrauterine pregnancy. We experienced a case of a ruptured heterotopic pregnancy for a patient with a history of a right segmental salpingectomy from an ectopic pregnancy. The 30-year-old patient with amenorrhea for six weeks complained of lower abdominal pain with hypovolemic shock. Transabdominal ultrasonography showed diffuse hemoperitoneum with a structure similar to an ectatic tube or a deformed cyst with no echogenic double ring or peripheral hypervascularity in the right adnexa and an intrauterine gestational sac. We considered a ruptured corpus luteum cyst as an ultrasonographic finding and found a ruptured tubal mass in the right salpinx and hemoperitoneum through an emergency laparotomy. We performed a right salpingectomy, and the histopathologic report confirmed ectopic pregnancy.

  13. Ruptured Heterotopic Tubal Pregnancy for a Patient with a History of Segmental Salpingectomy from Ectopic Pregnancy: A Case Report

    International Nuclear Information System (INIS)

    Nam, Kyung Bum; Namkung, Sook; Hong, Myung Sun; Kim, Heung Cheol; Cho, Young; Choi, Young Hee

    2012-01-01

    Heterotopic pregnancy refers to the simultaneous development of an intrauterine pregnancy and an extrauterine pregnancy. We experienced a case of a ruptured heterotopic pregnancy for a patient with a history of a right segmental salpingectomy from an ectopic pregnancy. The 30-year-old patient with amenorrhea for six weeks complained of lower abdominal pain with hypovolemic shock. Transabdominal ultrasonography showed diffuse hemoperitoneum with a structure similar to an ectatic tube or a deformed cyst with no echogenic double ring or peripheral hypervascularity in the right adnexa and an intrauterine gestational sac. We considered a ruptured corpus luteum cyst as an ultrasonographic finding and found a ruptured tubal mass in the right salpinx and hemoperitoneum through an emergency laparotomy. We performed a right salpingectomy, and the histopathologic report confirmed ectopic pregnancy.

  14. Secondary abdominal appendicular ectopic pregnancy.

    Science.gov (United States)

    Nama, Vivek; Gyampoh, Bright; Karoshi, Mahantesh; McRae, Reynold; Opemuyi, Isaac

    2007-01-01

    Although the case fatality rate for ectopic pregnancies has decreased to 0.08% in industrialized countries, it still represents 3.8% of maternal mortality in the United States alone. In developing countries, the case fatality rate varies from 3% to 27%. Laparoscopic management of tubal pregnancies is now the standard form of treatment where this technology is available. Abdominal pregnancies are rare, and secondary implantation of tubal ectopic pregnancies is the most common cause of abdominal gestations. We present an interesting case of secondary implantation of a tubal ectopic pregnancy to highlight the appendix as a possible secondary implantation site after a tubal ectopic pregnancy.

  15. The ESEP study: Salpingostomy versus salpingectomy for tubal ectopic pregnancy; The impact on future fertility: A randomised controlled trial

    Directory of Open Access Journals (Sweden)

    van Mello Norah M

    2008-06-01

    Full Text Available Abstract Background For most tubal ectopic pregnancies (EP surgery is the treatment of first choice. Whether surgical treatment should be performed conservatively (salpingostomy or radically (salpingectomy in women wishing to preserve their reproductive capacity, is subject to debate. Salpingostomy preserves the tube, but bears the risks of both persistent trophoblast and repeat ipsilateral tubal EP. Salpingectomy, avoids these risks, but leaves only one tube for reproductive capacity. This study aims to reveal the trade-off between both surgical options: whether the potential advantage of salpingostomy, i.e. a better fertility prognosis as compared to salpingectomy, outweighs the potential disadvantages, i.e. persistent trophoblast and an increased risk for a repeat EP. Methods/Design International multi centre randomised controlled trial comparing salpingostomy versus salpingectomy in women with a tubal EP without contra lateral tubal pathology. Hemodynamically stable women with a presumptive diagnosis of tubal EP, scheduled for surgery, are eligible for inclusion. Patients pregnant after in vitro fertilisation (IVF and/or known documented tubal pathology are excluded. At surgery, a tubal EP must be confirmed. Only women with a tubal EP amenable to both interventions and a healthy contra lateral tube are included. Salpingostomy and salpingectomy are performed according to standard procedures of participating hospitals. Up to 36 months after surgery, women will be contacted to assess their fertility status at six months intervals starting form the day of the operation. The primary outcome measure is the occurrence of spontaneous viable intra uterine pregnancy. Secondary outcome measures are persistent trophoblast, repeat EP, all pregnancies including those resulting from IVF and financial costs. The analysis will be performed according to the intention to treat principle. A cost-effectiveness analysis will be performed within a decision

  16. Surgical management of tubal pregnancy

    NARCIS (Netherlands)

    Mol, F.

    2013-01-01

    The work presented in this thesis first addresses the magnitude of the clinical problem of surgically treated tubal pregnancy in The Netherlands. Next, we studied the adherence to recommendations from the Dutch guideline on diagnosis and management of ectopic pregnancy. A systematic review and

  17. Ectopic ovarian pregnancy

    International Nuclear Information System (INIS)

    Sachdev, P.S.; Jatoi, N.; Memon, R.A.; Sachdev, C.S.

    2003-01-01

    A case of ectopic ovarian pregnancy is presented occurring in a 24 years old woman after natural conception. The clinical diagnosis was ruptured tubal pregnancy. Gross findings were suggestive of ruptured corpus luteum cyst on exploration. The histopathological examination of specimen brought forward the diagnosis of ovarian pregnancy. (author)

  18. Ectopic Pregnancy: Reasons for the High Tubal Rupture Rates in a ...

    African Journals Online (AJOL)

    Tropical Journal of Obstetrics and Gynaecology ... The case notes were reviewed to obtain information on the socio demographic characteristics of the patients, clinical history and operative findings. Results: Of the ... Besides, majority of our women present late making them more vulnerable to ruptured ectopic pregnancy.

  19. Ectopic Pregnancy

    Science.gov (United States)

    ... woman is pregnant. If you have an ectopic pregnancy, the fertilized egg grows in the wrong place, ... tubes. The result is usually a miscarriage. Ectopic pregnancy can be a medical emergency if it ruptures. ...

  20. Ectopic Pregnancy

    Science.gov (United States)

    ... caused by blood loss) lower back pain What Causes an Ectopic Pregnancy? An ectopic pregnancy usually happens because a fertilized ... protect against sexually transmitted infections (STDs) that can cause PID. If ... about the pregnancy being ectopic, talk to your doctor — it's important ...

  1. Suspected ectopic pregnancy.

    Science.gov (United States)

    Seeber, Beata E; Barnhart, Kurt T

    2006-02-01

    Women who present with pain and bleeding in the first trimester are at risk for ectopic pregnancy, a life-threatening condition. Conditions that predispose a woman to ectopic pregnancy are damaged fallopian tubes from prior tubal surgery or previous pelvic infection, smoking, and conception using assisted reproduction. Many women without risk factors can develop an ectopic pregnancy. A diagnostic algorithm that includes the use of transvaginal ultrasonography, human chorionic gonadotropin (hCG) concentrations, and, sometimes, uterine curettage can definitively diagnose women at risk in a timely manner. The absence of an intrauterine pregnancy above an established cut point of hCG is consistent with an abnormal pregnancy but does not distinguish a miscarriage from an ectopic pregnancy. When the initial hCG value is low, serial hCG values can be used to determine whether a gestation is potentially viable or spontaneously resolving. The minimal rise in hCG for a viable pregnancy is 53% in 2 days. The minimal decline of a spontaneous abortion is 21-35% in 2 days, depending on the initial level. A rise or fall in serial hCG values that is slower than this is suggestive of an ectopic pregnancy. Women diagnosed with an unruptured ectopic pregnancy are potential candidates for medical management with methotrexate. Intramuscular injection with methotrexate can be used to safely treat an ectopic pregnancy with success rates, tubal patency rates, and future fertility that are similar to those obtained with conservative surgery. Success rates using methotrexate are inversely rated to baseline hCG values and are higher using "multidose" compared with "single-dose" regimens. Surgical treatment may be conservative or definitive and should be attempted in most cases via laparoscopy.

  2. Analysis of tubal pregnancy

    International Nuclear Information System (INIS)

    Malik, N.; Iqbal, F.; Tayyeb, R.

    2001-01-01

    Objective: This study was carried out to determine the frequency, etiological factors, modes of presentation, accuracy of diagnostic modalities, operative findings and surgical treatment of tubal pregnancies. Design: Observational study. Place and duration of study: This study was conducted in gynae unit iii, Sir Ganga Ram Hospital, Lahore from January 1995 to December 1996. Subject and Methods: All the patients diagnosed as a case of tubal pregnancy in two years period were included in the study. Detailed history regarding the symptoms and risk factors of tubal pregnancy was taken followed by clinical examination. The diagnostic and treatment modality used and operative findings were also recorded. All the data was recorded on a proforma and finally the results were analysed. Results: Incidence of tubal pregnancy was found out to be 1:305 deliveries. Out of these, 70% of the cases occurred in the age group of 21-30 years and in patients with low parity (in para 0-2) 65% of the patients had high risk factor e.g previous abdominopelvic surgery PID or history of infertility. Pain was the commonest symptom (90% of cases) followed by vaginal bleeding (80%) adnexal masses (70%) and amenorrhea (65%). Acute tubal pregnancy was found in 85% of the cases while 15% of cases had chronic tubal pregnancy. Tubal pregnancy in the ampullary region was detected in 65% patients. Conclusion: Previous abdominopelvic surgery, PID or history of infertility and use of intra-uterine contraceptive device are the main etiologic factors. Most of the patients present at a very late stage with ruptured tubal pregnancy followed by salpingostomy in 95% of cases. Only 5% of cases had conservative surgical treatment i.e salpingostomy. Culdocentesis ultrasonography and laparoscopy were good diagnostic modalities. (author)

  3. Embarazo ectópico tubárico roto posterior a esterilización quirúrgica (Ruptured tubal ectopic pregnancy after surgical sterilization

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    Ismael Suárez Torres

    2014-07-01

    Full Text Available Resumen (español La esterilización tubárica quirúrgica es un método comúnmente utilizado de anticoncepción. Aunque el embarazo después de la esterilización es poco común, este puede ocurrir y cuando esto ocurre existe un riesgo substancial de convertirse en un embarazo ectópico. Se presenta el caso un embarazo ectópico posterior a la esterilización quirúrgica tubárica en una paciente de 38 años, V gesta, III paras, I cesárea, con antecedentes de uso de dispositivos intrauterinos por varios años antes de la salpingectomía realizada 12 meses antes durante la cesárea, quien consultó por presentar marcada palidez cutáneo-mucosa, retraso menstrual y dolor abdominal de fuerte intensidad. Durante la laparotomía ambas trompas estaban separadas en dos porciones. La porción terminal de la trompa derecha se observó la presencia de una tumoración compatible con un embarazo ectópico tubárico roto. Abstract (english Surgical tubal sterilization is a commonly used method of contraception. Although pregnancy after sterilization is uncommon, when it occurs, there is a substantial risk that it will be an ectopic pregnancy. We report a case of ruptured tubal ectopic pregnancy following surgical tubal sterilization in a 38 years-old patient, gravida V, para III, cesarean I, with history of intrauterine device use for many years before salpingectomy performed 12 months before during cesarean section, who consulted for presenting menstrual delay and severe abdominal pain. During laparotomy both tubes were separated in two portions. There was observed in terminal portion of right tube the presence of a tumor compatible with ruptured tubal ectopic pregnancy.

  4. Prediction of Tubal Ectopic Pregnancy Using Offline Analysis of 3-Dimensional Transvaginal Ultrasonographic Data Sets: An Interobserver and Diagnostic Accuracy Study.

    Science.gov (United States)

    Infante, Fernando; Espada Vaquero, Mercedes; Bignardi, Tommaso; Lu, Chuan; Testa, Antonia C; Fauchon, David; Epstein, Elisabeth; Leone, Francesco P G; Van den Bosch, Thierry; Martins, Wellington P; Condous, George

    2017-12-08

    To assess interobserver reproducibility in detecting tubal ectopic pregnancies by reading data sets from 3-dimensional (3D) transvaginal ultrasonography (TVUS) and comparing it with real-time 2-dimensional (2D) TVUS. Images were initially classified as showing pregnancies of unknown location or tubal ectopic pregnancies on real time 2D TVUS by an experienced sonologist, who acquired 5 3D volumes. Data sets were analyzed offline by 5 observers who had to classify each case as ectopic pregnancy or pregnancy of unknown location. The interobserver reproducibility was evaluated by the Fleiss κ statistic. The performance of each observer in predicting ectopic pregnancies was compared to that of the experienced sonologist. Women were followed until they were reclassified as follows: (1) failed pregnancy of unknown location; (2) intrauterine pregnancy; (3) ectopic pregnancy; or (4) persistent pregnancy of unknown location. Sixty-one women were included. The agreement between reading offline 3D data sets and the first real-time 2D TVUS was very good (80%-82%; κ = 0.89). The overall interobserver agreement among observers reading offline 3D data sets was moderate (κ = 0.52). The diagnostic performance of experienced observers reading offline 3D data sets had accuracy of 78.3% to 85.0%, sensitivity of 66.7% to 81.3%, specificity of 79.5% to 88.4%, positive predictive value of 57.1% to 72.2%, and negative predictive value of 87.5% to 91.3%, compared to the experienced sonologist's real-time 2D TVUS: accuracy of 94.5%, sensitivity of 94.4%, specificity of 94.5%, positive predictive value of 85.0%, and negative predictive value of 98.1%. The diagnostic accuracy of 3D TVUS by reading offline data sets for predicting ectopic pregnancies is dependent on experience. Reading only static 3D data sets without clinical information does not match the diagnostic performance of real time 2D TVUS combined with clinical information obtained during the scan. © 2017 by the American

  5. US findings of tubal pregnancy

    International Nuclear Information System (INIS)

    Lee, Hwa Sung; Kim, Hyun Hee; Jee, Mi Hyun; Kweon, Young Hwa; Oh, Yoon Jin; Hong, Ju Hee; Kim, Soon Yong; Kim, Sang Young

    1994-01-01

    Early diagnosis of ruptured and unruptured tubal pregnancy became more accurate with the introduction of transvaginal sonographic equipment. The management principle of tubal pregnancy might be changed according to the sonographic findings. The purposes of this study were to define the sonographic findings of tubal pregnancy and to determine whether it is possible to differentiate the unruptured tubal pregnancies from the ruptured ones depending on the sonographic findings. The authors investigated the sonographic findings of the surgically confirmed 25 tubal pregnancy patients. There were 22(88%) unruptured and 3(12%) ruptured tubal pregnancies. Unruptured pregnancies showed tubal ring in 8, well defined hematosalpinx in 11, and poorly defined hematosalpinxin 2 patients. Ruptured pregnancies showed tubal sac with irregular margin in 2, and ill-defined hematosalpinx in one patient. In summary, well marginated tubal ring and hematosalpinx suggested unruptured tubal pregnancy, while tubal sac with irregular margin suggested ruptured pregnancy. However, it was difficult to differentiate the unruptured tubal pregnancy from the ruptured one when hematosalpinx was ill-defined

  6. Ruptured tubal molar pregnancy

    African Journals Online (AJOL)

    2011-05-19

    May 19, 2011 ... In most instances, moles develop within the uterine cavity, but may occur at ... Patients with tubal molar pregnancy are very difficult to distinguish .... There was a left-sided adnexal mass, whose size could not be appreciated ...

  7. Successful Management of Tubal Ectopic Pregnancy with Transvaginal Sonography Guided Intracardiac KCL Injection and Systemic Methotrexate - A Case Report

    Directory of Open Access Journals (Sweden)

    Sumesh Choudhary

    2014-01-01

    Full Text Available Background: Methotrexate (Mtx is an accepted modality for conservative treatment of ectopic pregnancy. However, there is no consensus regarding its use in live ectopic pregnancy and high serum beta-human chorionic gonadotrophin (β-hCG titres. Concurrent use of intra-sac hypertonic KCl, to produce cardiac asystole with systemic Mtx potentially improve outcome in live ectopic gestations with very high serum β-hCG titres. Here a successful management of live ectopic pregnancy in a 25-year-old nulliparous woman, with very high β-hCG titres (29502.04mIU/mL, using ultrasound-guided intra-cardiac potassium chloride (KCl injection and systemic Mtx is reported. No treatment related complications were encountered. However, individualized treatment with a stringent follow-up regime is mandatory in such cases.

  8. A case of bilateral tubal pregnancy

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    Ayano Funamizu

    2017-11-01

    Full Text Available Bilateral tubal pregnancy is very rare and occurs in only 1 out of every 200,000 spontaneous pregnancies. In this case, a 29-year-old woman with a history of primary infertility underwent treatment with human menopausal gonadotropin (hMG-human chorionic gonadotropin (hCG, and became pregnant. A gestational sac (GS was not detected in the uterus and transvaginal ultrasonography (USG revealed GS with fetal heartbeat in the left adnexa at 7 weeks and 6 days of gestation. The patient underwent laparoscopic surgery and ultimately, bilateral tubal pregnancy was diagnosed. Consequently, bilateral fallopian tube resection was performed. Afterwards, she conceived by assisted reproductive technology (ART and delivered vaginally. This case suggests that even if a GS is found in one fallopian tube by USG, it is important to evaluate the other fallopian tube carefully. Keywords: bilateral tubal pregnancy, ectopic pregnancy, human menopausal gonadotropin, laparoscopy

  9. Persistent ectopic pregnancy after linear salpingotomy: a non-predictable complication to conservative surgery for tubal gestation

    DEFF Research Database (Denmark)

    Lund, Claus Otto; Nilas, Lisbeth; Bangsgaard, Nannie

    2002-01-01

    BACKGROUND: The drawback of conservative surgery for ectopic pregnancy (EP) is the risk of persistent trophoblast. The purpose was to characterize patients who develop persistent ectopic pregnancy (PEP) after salpingotomy for EP and to assess prognostic factors. METHODS: The medical records of 417...... patients treated by salpingotomy for EP were reviewed. Forty-eight (11.5%) patients were diagnosed with persistent EP. The data were analyzed using the Mann-Whitney U-test, Fischer's exact test or the chi2-test. RESULTS: Of 417 women, 48 (11,5%) were treated for PEP by either repeat surgery (n = 25......) or methotrexate (n = 23). Oral methotrexate failed in 4/19 cases while intramuscular (i.m.) methotrexate was successful in 4/4 cases. Women treated for PEP had a higher preoperative and a slower postoperative decline of serum human chorionic gonadotropin (hCG). Both the preoperative and the early postoperative h...

  10. Spontaneous Unruptured Bilateral Tubal Pregnancy: A Case Report

    Directory of Open Access Journals (Sweden)

    Nayereh Ghomian

    2015-11-01

    Full Text Available Bilateral spontaneous tubal ectopic pregnancy is the rarest form of extra uterine pregnancy. The diagnosis is usually made intraoperatively and levels of serum BHCG and ultrasound has not been useful in the diagnosis of bilateral tubal ectopic pregnancy. A 33-year-old woman with 8 weeks amenorrhea and sever lower abdominal pain was admitted. A transvaginal pelvic ultrasound revealed left adnexal mass and massive fluid collection in the pelvis and abdomen. The serum BHCG was 5,700 mIU/ml and in laparotomy bilateral unruptured tubal pregnancy was noted. Left salpingectomy and right salpingostomy were performed. The diagnosis of bilateral spontaneous tubal ectopic pregnancy is usually made intraoperatively. Both tubes at the time of surgery should be closely examined in order to prevent maternal morbidity and mortality.

  11. Cornual ectopic pregnancy; Report of three cases

    OpenAIRE

    espitia de la hoz, Franklin jose

    2014-01-01

    Ectopic pregnancy is the implantation of the fertilized ovum outside the uterine cavity,its main location is in the tube. Non tubal forms include: the cornual pregnancy, ovarianpregnancy, abdominal pregnancy, cervical pregnancy, intraligamentary pregnancy andpregnancy in a rudimentary uterine horn. Three cases of cornual ectopic pregnancyare described. Surgical management, with wedge resection via laparotomy trophoblast,without resorting to hysterectomy was performed, correlating histopatholo...

  12. The diagnosis and treatment of tubal pregnancy with selective salpingography

    International Nuclear Information System (INIS)

    Li Qunying

    2000-01-01

    Objective: To study feasibility of diagnosing and treating tubal pregnancy with selective salpingography. methods: 13 women diagnosed clinically as ectopic pregnancy without abdominal bleeding were studied and confirmed as tubal pregnancy with selective salpingography, MTX was then injected through fallopian tube. Urine hCG, blood β-hCG and US were studied during follow-up. Results: 12 cases tubal pregnancy were confirmed as well as 1 case of intra-uterine pregnancy. X-ray showed a localized dilation of fallopian tube, half-loop, ring-like or irregular shaped filling defect. In one case, cluster of grapes appearance of contrast medium could be seen at the umbrella end of fallopian tube. Of the 12 cases of tubal pregnancy, 10 were successfully treated, the successful rate was 83%. Conclusion: Selective salpingography is a simple safe and effective method of diagnosing and treating tubal pregnancy

  13. Adnexal mass in tubal pregnancy

    International Nuclear Information System (INIS)

    Lee, Hee Jung; Kim, Jung Sik; Chu, Yang Ku

    1993-01-01

    Off the evaluation of clinical significance and pathologic correlation of echogenic adnexal mass in tubal pregnancy, which is separated from ipsilateral ovary, we performed a retrospective analysis of 15 proved tubal pregnancies. All showed hematosalpinx containing blood coagulum and chorionic villi with intact fallopian tube.The echogenicity of the adnexal mass was considered to represent the nonclotted or clotted blood within the fallopian tube. We conclude that the discrete, echogenic adnexal mass is the suggestive finding of unrupturedtubal pregnancy

  14. MR features of ectopic pregnancy

    International Nuclear Information System (INIS)

    Tamai, Ken; Togashi, Kaori; Koyama, Takashi

    2007-01-01

    Ectopic pregnancy (EP), in which a fertilized ovum implants outside the uterine cavity, is the leading cause of pregnancy-related death in the first trimester. EP is usually suspected by a positive pregnancy test and an empty uterus on transvaginal sonography (TVS). Although TVS is the initial modality of choice, it may occasionally fail to demonstrate the implantation site. When TVS findings are indeterminate, magnetic resonance imaging (MRI) may provide better delineation of the focus of EP owing to its excellent tissue contrast. The key MRI features of EP include gestational sac (GS)-like structures that typically appear as a cystic sac-like structure, frequently associated with surrounding acute hematoma of distinct low intensity on T2-weighted images. In tubal pregnancy, an enhanced tubal wall on postcontrast images may be another diagnostic finding. Ruptured EP is inevitably associated with acute hematoma outside these structures. In intrauterine EP, recognition of the relationship between GS-like structure and the myometrium can aid in differentiating from normal pregnancy. Diagnostic pitfalls include heterotopic pregnancy, decidual changes in endometrial cyst and theca lutein cysts mimicking GS-like structures. Knowledge of a spectrum of clinical and MRI features of EP is essential for establishing an accurate diagnosis and determining appropriate management. (orig.)

  15. Endometrial cysteine-rich secretory protein 3 is inhibited by human chorionic gonadotrophin, and is increased in the decidua of tubal ectopic pregnancy

    DEFF Research Database (Denmark)

    Horne, A W; Duncan, W C; King, A E

    2009-01-01

    Ectopic pregnancy (EP) remains a considerable cause of morbidity and occasional mortality. Currently, there is no reliable test to differentiate ectopic from intrauterine gestation. We have previously used array technology to demonstrate that differences in gene expression in decidualized...... was inversely proportional to serum hCG concentrations (P caused a reduction in CRISP-3 expression (P pregnancy of unknown...... gestation-matched women undergoing surgical termination of pregnancy (n = 8), evacuation of uterus for miscarriage (n = 6) and surgery for EP (n = 11) was subjected to quantitative RT-PCR, morphological assessment, immunohistochemistry and western blot analysis. Sera were analysed for progesterone and human...

  16. The Clinical and Ultrasonic Study of Clinically Suspected Ectopic Pregnancy: Laying Emphasis on 15 proven Ectopic Pregnancies

    Energy Technology Data Exchange (ETDEWEB)

    Byun, Myung Ho; Chung, Yung Sun [Chonnam National University College of Medicine, Gwangju (Korea, Republic of)

    2010-05-15

    Ectopic preganacies are unsuccessful pregnancies that result from implantation of fertilized ovum occurring in an aberrant area. Aside from an emergency case, the early diagnosis of ectopic pregnancy is very difficult particularly in a case with insidious onset and mild clinical manifestations. Early diagnosis not only reduces the danger, but also simplifies the management of ectopic pregnancy. Ultrasonography has been an indispensable diagnostic tool in Obstetrics and Gynecology. In the authors' experience, clinical suspected ectopic pregnancy was one of the common indications for performing ultrasonography. Since Kobayashi at al. reported the appearances of ectopic pregnancy utilizing bistable B-scan ultrasonography, the ultrasonic findings of ectopic pregnancy have been reported by many authors. But, its accuracy and reliability in the diagnosis of ectopic pregnancy are still open to controversy. The authors studied 65 cases of clinically suspected ectopic pregnancy with Picker 80 L gray scale ultrasonography from Aug. 1982 to June. 1983. There were 29 confirmed cases, of which 15 were proved to have ectopic pregnancy and 14 were proved to have diseases other than ectopic pregnancy by surgical and histopathological study or by laparoscopy and follow up study. 29 confirmed cases were reviewed. The results were as follows: 1. Among 15 ectopic pregnancies, there were 12 ampullary pregnancies, 2 isthmic pregnancies and 1 interstitial pregnancy. Among 14 cases of no ectopic pregnancy, there were 5 intrauterine pregnancies, 3 myoma uteri, 2 P.I.D., and 1 case of dermoid cyst, cystic teratoma, H-mole and tubal hematoma due to previous tuball ligation, respectively. 2. The age distribution of ectopic pregnancy was from 22 to 41 years. The common clinical manifestations of ectopic pregnancy were lower abdominal pain (73.3%), vaginal spotting or bleeding (73.3%) and amenorrhea (66.7%). 3. Positive result of urine immunologic pregnancy test was 28.6% in ectopic

  17. The Clinical and Ultrasonic Study of Clinically Suspected Ectopic Pregnancy: Laying Emphasis on 15 proven Ectopic Pregnancies

    International Nuclear Information System (INIS)

    Byun, Myung Ho; Chung, Yung Sun

    2010-01-01

    Ectopic preganacies are unsuccessful pregnancies that result from implantation of fertilized ovum occurring in an aberrant area. Aside from an emergency case, the early diagnosis of ectopic pregnancy is very difficult particularly in a case with insidious onset and mild clinical manifestations. Early diagnosis not only reduces the danger, but also simplifies the management of ectopic pregnancy. Ultrasonography has been an indispensable diagnostic tool in Obstetrics and Gynecology. In the authors' experience, clinical suspected ectopic pregnancy was one of the common indications for performing ultrasonography. Since Kobayashi at al. reported the appearances of ectopic pregnancy utilizing bistable B-scan ultrasonography, the ultrasonic findings of ectopic pregnancy have been reported by many authors. But, its accuracy and reliability in the diagnosis of ectopic pregnancy are still open to controversy. The authors studied 65 cases of clinically suspected ectopic pregnancy with Picker 80 L gray scale ultrasonography from Aug. 1982 to June. 1983. There were 29 confirmed cases, of which 15 were proved to have ectopic pregnancy and 14 were proved to have diseases other than ectopic pregnancy by surgical and histopathological study or by laparoscopy and follow up study. 29 confirmed cases were reviewed. The results were as follows: 1. Among 15 ectopic pregnancies, there were 12 ampullary pregnancies, 2 isthmic pregnancies and 1 interstitial pregnancy. Among 14 cases of no ectopic pregnancy, there were 5 intrauterine pregnancies, 3 myoma uteri, 2 P.I.D., and 1 case of dermoid cyst, cystic teratoma, H-mole and tubal hematoma due to previous tuball ligation, respectively. 2. The age distribution of ectopic pregnancy was from 22 to 41 years. The common clinical manifestations of ectopic pregnancy were lower abdominal pain (73.3%), vaginal spotting or bleeding (73.3%) and amenorrhea (66.7%). 3. Positive result of urine immunologic pregnancy test was 28.6% in ectopic pregnancy

  18. Interventional treatment of un-ruptured tubal pregnancy

    International Nuclear Information System (INIS)

    Shan Hong; Ma Zhuang; Jiang Zaibo; Yan Ying; Guan Shouhai; Zhu Kangshun; Huang Mingsheng; Chen Hanwei

    2000-01-01

    Objective: To discuss some concept about interventional treatment of tubal pregnancy. Methods: The procedure of trans-vaginal tubal intra-gestational SAC injection (IGSI) or percutaneous intra-utero-arterial infusion (IUAI) was selected for treatment of 40 patients with un-ruptured tubal pregnancy. Methotrexate (MTX), Rosch-Thurmoud fallopian tube catheterization set, and the general angiographic catheters of 4.1-5.0 F were used for the procedure. Ultrasound and urine beta-hCG were the main indexes monitoring the therapeutic effects. Results: 12 of 40 patients underwent a total of 15 IGSI. Of these, 3 patients required a second injection; 28 of 40 cases were treated with IUAI. The total successful rate of termination of ectopic pregnancy was 97.5%, the mean resolution time for reduction of beta-hCG concentration was 11.7 days (range 4-28), the range of menstruation recovery time was 7-45 days. Conclusion: The interventional therapy for tubal pregnancy will be more widely applied, on the basis of a better understanding about the pathology, characteristics of embryonic sac development and blood supply, the regular change of concentration of serum and urine hCG in tubal pregnancy

  19. Ruptured Ectopic Pregnancy

    Directory of Open Access Journals (Sweden)

    Valentina Park

    2016-09-01

    Full Text Available History of present illness: A 21-year-old female presented with sudden onset suprapubic abdominal pain associated with dysuria. The patient also experienced near syncope during bowel movements three times three days ago without falling or losing consciousness. She denied fever, nausea, and vomiting. She stated that she was five weeks pregnant by last menstrual period. She had an ultrasound a few weeks before that showed no intrauterine pregnancy, but she had not followed up for additional testing. Significant findings: The patient’s serum beta-hCG was 5,637 mIU/mL. The transvaginal ultrasound showed an empty uterus with free fluid posteriorly in the pelvis and Pouch of Douglas (00:00. A 4.5 cm heterogeneous mass was visible in the left adnexa concerning for an ectopic pregnancy (00:10. Discussion: Ectopic pregnancies are a leading cause of maternal morbidity and mortality, as well as decreased fertility.1,2 Differentiating between an ectopic pregnancy and a normal early pregnancy may be difficult, since ultrasound and quantitative beta-hCG may show inconclusive results.3,4 Patients who have used fertility treatment may further complicate the picture because they are at risk for heterotypic pregnancies.5 Ectopic pregnancies most commonly implant in the fallopian tube, but may alternatively implant in the ovary, cervix, abdomen, or uterine cornua.4 Ultrasonography may show an empty uterus, adnexal mass, pelvic free fluid, or an extra-uterine gestational sac, yolk sac, and/or embryo.6 Treatment options for ectopic pregnancy include surgery or methotrexate.2,4 Some patients may be candidates for close outpatient surveillance if the diagnosis is unclear or in very limited cases for early, non-ruptured ectopic pregnancies.2,4

  20. CT appearance and features of tubal pregnancy

    Energy Technology Data Exchange (ETDEWEB)

    Xiaohong, Wang; Hong, Shan; Zaibo, Jiang; Xinghe, Deng; Xiaochun, Meng; Bingbing, Ye; Mingyue, Luo; Yunya, Lin [Sun Yat-sen Univ., Guangzhou (China). The Third Univ. Hospital, Dept. of Radiology

    2004-06-01

    Objective: To investigate the CT appearance and features of tubal pregnancy. Methods: Precontrast and postcontrast CT scans were employed in 38 patients who were clinically and ultrasonographically suspected of tubal pregnancy. 34 of them were verified as tubal pregnancy through operative pathology. Results: 1. The direct CT imaging feature was the whole pregnancies sac (4/34, 11.8%) or half-baked pregnancies sac (14/34, 41.2%); 2. The indirect CT imaging features were: (1) abnormal density image, which could be enhanced, in a cystic mass around adnexal area (8/34, 23.5%); (2) mix density mass around adnexal area, which was mainly solid and had mild to moderate inhomogeneous enhancement (19/34, 55.9%); (3) large area irregular shadow with high density were found beside the uterus, with no enhancement (3/34, 8.8%). (4) bloody density in uterus-rectum-fossa (23/34, 67.6%). 3. The CT imaging features of tubal pregnancy was classified as: (1) Pregnant sac type (4/34, 11.8%); (2) Cystic (8/34, 23.5%); (3) Massive type (17/34, 50%); (4) Chronic mass type (2/34, 5.9%); (5) Bleeding type (3/34, 8.8%). 4. The CT imaging appearance of tubal pregnancy related with the pregnancy location; 5. The CT imaging appearance of tubal pregnancy related with the clinical significant. Conclusion: The CT imaging appearance of tubal pregnancy has some features, which can help in the diagnosis or differential diagnosis of the pelvis masses. CT scan is an effective supplementary attempt to the clinically and ultrasonographically suspected tubal pregnancy patients.

  1. CT appearance and features of tubal pregnancy

    International Nuclear Information System (INIS)

    Wang Xiaohong; Shan Hong; Jiang Zaibo; Deng Xinghe; Meng Xiaochun; Ye Bingbing; Luo Mingyue; Lin Yunya

    2004-01-01

    Objective: To investigate the CT appearance and features of tubal pregnancy. Methods: Precontrast and postcontrast CT scans were employed in 38 patients who were clinically and ultrasonographically suspected of tubal pregnancy. 34 of them were verified as tubal pregnancy through operative pathology. Results: 1. The direct CT imaging feature was the whole pregnancies sac (4/34, 11.8%) or half-baked pregnancies sac (14/34, 41.2%); 2. The indirect CT imaging features were: (1) abnormal density image, which could be enhanced, in a cystic mass around adnexal area (8/34, 23.5%); (2) mix density mass around adnexal area, which was mainly solid and had mild to moderate inhomogeneous enhancement (19/34, 55.9%); (3) large area irregular shadow with high density were found beside the uterus, with no enhancement (3/34, 8.8%). (4) bloody density in uterus-rectum-fossa (23/34, 67.6%). 3. The CT imaging features of tubal pregnancy was classified as: (1) Pregnant sac type (4/34, 11.8%); (2) Cystic (8/34, 23.5%); (3) Massive type (17/34, 50%); (4) Chronic mass type (2/34, 5.9%); (5) Bleeding type (3/34, 8.8%). 4. The CT imaging appearance of tubal pregnancy related with the pregnancy location; 5. The CT imaging appearance of tubal pregnancy related with the clinical significant. Conclusion: The CT imaging appearance of tubal pregnancy has some features, which can help in the diagnosis or differential diagnosis of the pelvis masses. CT scan is an effective supplementary attempt to the clinically and ultrasonographically suspected tubal pregnancy patients

  2. Ultrasonogram of tubal pregnancy: Unruptured or ruptured?

    International Nuclear Information System (INIS)

    Lee, Hee Jung; Kim, Jung Sik; Lee, Sung Moon; Kim, Hong; Woo, Seong Ku; Yeun, Seong Do; Lee, Doo Ryong

    1993-01-01

    To evaluate the usefulness of ultrasonography in the differentiation of the unruptured ones, we performed prospective ultrasonographic study in 56 patients with tubal pregnancy and subsequently correlated with the surgical (45 cases) and laparoscopic (11 cases) findings. The criterion for unruptured tubal pregnancy was the visualization of extra uterine gestational sac or a mass that was separated from the ipsilateral ovary. All cases were confirmed surgically or laparoscopically within 48 hours after sonographic examination. Forty five (80%)cases were proved as unruptured, tubal pregnancy, while 11 (20%) as ruptured one. Extra uterine gestational sac was seen in 31/45 (69%) in unruptured group and 2/11 (18%) in ruptured group. A mass separated from the ipsilateral ovary was seen in 7 unruptured tubal pregnancies and 2 ruptured pregnancies. A mass that was not separated from the ipsilateral ovary was seen in 13 cases. Seven of these were ruptured pregnancies, while 6 were unrupture dones. Using our criteria, the unruptured tubal pregnancy was diagnosed with a sensitivity of 84%, a specificity of 64%, an accuracy of 80%, a positive predictive value of 90% and a negative predictive value of 50%. We conclude that ultrasonography is useful in the differentiation of the unruptured tubal pregnancy from the ruptured one

  3. Simultaneous Bilateral Tubal Pregnancy After In Vitro Fertilization and Embryo Transfer

    Directory of Open Access Journals (Sweden)

    Sunduz Ozlem Altinkaya

    2008-09-01

    Conclusion: The diagnosis of ectopic or heterotopic pregnancy should always be considered in patients undergoing IVF-ET because of its increased incidence with this technique compared with natural conception. Although the incidence of bilateral tubal pregnancy is not high, sonographers and surgeons should examine both adnexa when diagnosing an ectopic pregnancy, especially in IVF-ET patients. Early diagnosis is essential for the prevention of significant maternal morbidity and mortality.

  4. Bilateral Tubal Pregnancy without Known Risk Factor

    Directory of Open Access Journals (Sweden)

    Hyacinthe Zamané

    2017-01-01

    Full Text Available Spontaneous bilateral ectopic gestation is very rare. The authors report a case diagnosed and taken care of at Yalgado Ouedraogo Teaching Hospital, Ouagadougou. It was a 30-year-old patient with no known pathological history. She had presented at the obstetric emergencies with a state of hypovolemic shock by haemoperitoneum with digestive disorders, pelvic pain, vaginal bleeding, and a mention of delayed menstruation. The ultrasound coupled with the urinary immunological pregnancy test confirmed the diagnosis of ruptured ectopic pregnancy and a bilateral form was suspected. A laparotomy in emergency confirmed the diagnosis of bilateral ectopic gestation with a right ampullary unruptured pregnancy and a left isthmic ruptured gestation. A bilateral salpingectomy was performed and counseling was made for the use of medical help of procreation in case of future need of pregnancy.

  5. Ruptured ectopic pregnancy diagnosed with computed tomography

    International Nuclear Information System (INIS)

    Michalak, Maciej; Żurada, Anna; Biernacki, Maciej; Zygmunt, Kozielec

    2010-01-01

    The rupture of ectopic pregnancy (EP) still remains the primary and direct cause of death in the first trimester of pregnancy. Ultrasonography is known to be a modality of choice in EP diagnostics. We found a severe discrepancy between the frequency of ectopic pregnancies (EP) and the number of available computed tomography (CT) examinations. A 29-year-old woman was admitted to the emergency department with a history of abdominal pain, nausea, vomiting and collapse. Sonographic findings of a suspected EP were unclear. Moreover, not all features of intrauterine pregnancy were present. Due to the patient’s life-threatening condition, an emergency multi-slice CT with MPR and VRT reconstructions was performed, revealing symptoms of a ruptured EP. In the right adnexal area, a well-vascularized, solid-cystic abnormal mass lesion was found. Intraperitoneal hemorrhage was confirmed intraoperatively, and the right fallopian tube with a tubal EP was resected. In the surgery in situ, as well as in the pathological examination of the tumor mass, a human embryo of approximately 1.5 cm in length (beginning of the 8 th week of gestation) was found. Although ultrasonography still remains the first-line imaging examination in EP diagnostics, sometimes the findings of suspected EPs are unclear and not sufficient. The rupture of EP, with serious bleeding and symptoms of shock, may require an emergent pelvic and abdominal CT inspection. A clear correlation was found between the macroscopic CT images and the intraoperatively sampled material

  6. Ectopic pregnancy: current clinical trends, a fifteen year study.

    Science.gov (United States)

    Weekes, L R

    1981-09-01

    This paper reviews the clinical recognition, diagnosis, and management of ectopic pregnancy at the Queen of Angels Hospital for the past 15 years. The incidence of ectopic pregnancy to deliveries is 1:195. Pain is the cardinal symptom of ectopic pregnancy, and amenorrhea of some degree was present in all cases. Pelvic inflammatory disease is a factor in the development of tubal pregnancy in some women. A careful history and thorough physical examination are important in making a careful diagnosis. The only laboratory procedures which are of any value are the blood type and the Rh determination. While examination of endometrial tissue obtained by biopsy or curettage has proved useful in ectopic pregnancy diagnosis, it is not totally decisive. Culdocentesis has proved to be the diagnostic procedure of the greatest value in recognizing intraperitoneal hemorrhage and it increases the correct preoperative diagnosis from 65-70% to 95%. Laparoscopy is useful when the physician is in doubt about the nature of the problem and it has produced an increase in the number of ectopic pregnancies diagnosed. Ultrasound is another useful tool in confirming a diagnosis of ectopic pregnancy; its accuracy ranges from 70-92%. A newly developed pregnancy test is more sensitive than conventional pregnancy tests and would be positive for pregnancy. Women who have had a previous ectopic pregnancy have a higher subsequent incidence of persistent infertility, recurrent ectopic pregnancy, and pregnancy wastage; the risk of another ectopic pregnancy increases 30-50 fold. While extopic pregnancy does recur, it is true that about 1/3 of those women do have successful pregnancies. Where previous induced abortion has occurred, there is a 10-fold increased risk of ectopic pregnancy. Women who become pregnant accidentally with an IUD in place have a greater likelihood of experiencing an extrauterine pregnancy. Abdominal pregnancy is often encountered as an aborting ectopic pregnancy during the 1st

  7. Clinical observation of interventional treatment for tubal pregnancy

    International Nuclear Information System (INIS)

    Chen Zhilin; Zhang Qing; Ye Lijing; He Mei

    2002-01-01

    Objective: To investigate a new method to of conservative treatment of treat tubal pregnancy. Methods: 20 cases of tubal pregnancy were treated by two conservative methods. Among them, 10 cases received single dose 5-fluorouracil perfusion through the super selective catheterization for uterus artery. Others took RU486 orally and received intra-muscular injection of testosterone. Results: Hospitalization was shorter, less salpingectomy was recommended, and blood HCG decreased faster in interventional group, than in control group. Conclusion: The 5-fluorouracil interventional treatment had its advantages for tubal pregnancy

  8. Tubal Ectopic Gestation Associated with Genital Schistosomiasis: A ...

    African Journals Online (AJOL)

    AJRH Managing Editor

    tract include: dyspareunia, bloody cervical discharge, dysmenorrhea, chronic pelvic pain and pelvic pseudotumour. Infertility may also result from tubal occlusion, secondary to the fibrosis2-6. Female reproductive tract infection/ parasitisation with Schistosoma species has been documented in countries where the parasite is.

  9. Interventional therapy for tubal pregnancy (report of 20 cases)

    International Nuclear Information System (INIS)

    Cao Xusheng; Gu Tongxiao; Liu Huisheng; Zhang Junfeng; Huang Jinyou; Hu Xiumin

    2000-01-01

    Objective: To search an approach to treat tubal pregnancy in a safe and economic way. Methods: 20 cases of tubal pregnancy were studied. Under fluoroscopic guidance, a 3F catheter was introduced to the site of tubal gestation through the uterine cavity, and methotrexate 30 mg in 10 ml saline was injected. Results: On the 5th day after operation, the level of serum hCG began to decline reaching the normal value on the 21 st-28 th day. The gestation sac was absorbed after 2-2.5 months. In 6 cases the fallopian tube was re-canalized after 3 months. Conclusion: Interventional therapy is a valuable and practical method for tubal pregnancy

  10. Ovarian Ectopic Pregnancy: a Rare Case Report

    Directory of Open Access Journals (Sweden)

    N Lotfian

    2017-02-01

    Full Text Available Background and aim: Ovarian pregnancy is an uncommon form of ectopic pregnancy which usually diagnosed so late. The aim of this study is to report a case of ovarian ectopic pregnancy Case presentation: A 19 years old woman, with a history of polycystic ovary, first pregnancy, gestation age 9 weeks and 4 days, visited the doctor. She was complaining of severe abdomen pain and vaginal spotting and she was bedridden because of threatened miscarriage. She had discharged from hospital with progesterone suppository prescription. Requesting a transvaginal ultrasound and heterogeneous echogenic mass (size18×8/5 was shown near the left ovary. It was shown as ectopic pregnancy. The patient was hospitalized by ectopic pregnancy in ovary diagnosis and she was treated by methotrexate. Conclusion: In pregnant women that complain of bleeding and spotting in early pregnancy, in addition to threatened abortion, ectopic pregnancy should exist even in the absence of clinical symptoms, should be considered.

  11. Biomarkers for Ectopic Pregnancy and Pregnancy of Unknown Location

    OpenAIRE

    Senapati, Suneeta; Barnhart, Kurt T.

    2013-01-01

    Early pregnancy failure is the most common complication of pregnancy, and 1–2% of all pregnancies will be ectopic. As one of the leading causes of maternal morbidity and mortality, diagnosing ectopic pregnancy and determining the fate of a pregnancy of unknown location are of great clinical concern. Several serum and plasma biomarkers for ectopic pregnancy have been investigated independently and in combination. The following is a review of the state of biomarker discovery and development for...

  12. An Appraisal of the Management of Ectopic Pregnancy in a Nigerian ...

    African Journals Online (AJOL)

    2011-12-31

    Dec 31, 2011 ... Analysis was carried out using Epi‑info 2008 version 3.5.1. Results: ... Keywords: Appraisal, Ectopic pregnancy, Management .... and beta human chorionic gonadotrophin (hCG) assay. .... 7th ed. Oxford, London: Blackwell Science; 2007. p. 106‑16. 5. ... rcog.org.uk/resources/Public/pdf/green_top21 tubal.

  13. Preliminary study of interventional treatment for tubal pregnancy

    International Nuclear Information System (INIS)

    Tang Yukuan; Chen Hanwei; Li Kaifang; Jiang Zaibo; Ma Zhuang; Liu Huanling

    2000-01-01

    Objective: To study the clinical value and methods of interventional treatment for tubal pregnancy. Methods: Two different methods were used in the interventional treatment of 18 patients with tubal pregnancy, which were transvaginal tubal intra-gestational methotrexate (MTX) injection and intra-utero-arterial MTX infusion. The former was selected for the treatment of 8 patients and the latter for 10 patients. Cook-fallopian tube catheterization set and the general angiographic catheters of 4.1 Fr Cobra were used. After the treatment, conditions of the patients, β-HCG level and ultrasound changes of the pregnant bladder were the main indexes for monitoring the therapeutic effect in this study. Results: The successful rate, cure rate, embryo killing rate reached 100%, 88.9%(16/18) and 94.4% (17/18) respectively. Two cases of intra-utero-arterial MTX infusion treatment failed, β-HCG was reduced to normal level with an average of 11.2 +- 11.6 d (3-28 d). In 10 cases, the ultrasound showed that the pregnancy bladder disappeared in 2-3 weeks, accounting for 76.9% (10/13). The longest time was 60 days. The range of menstruation recovery was 37 +- 9 d (21-50 d). Conclusions: Interventional treatment of tubal pregnancy is effective, reliable and easy for operation. It will be especially effective by arterial procedure. Interventional treatment will be a important method for terminating tubal pregnancy

  14. Moral absolutism and ectopic pregnancy.

    Science.gov (United States)

    Kaczor, C

    2001-02-01

    If one accepts a version of absolutism that excludes the intentional killing of any innocent human person from conception to natural death, ectopic pregnancy poses vexing difficulties. Given that the embryonic life almost certainly will die anyway, how can one retain one's moral principle and yet adequately respond to a situation that gravely threatens the life of the mother and her future fertility? The four options of treatment most often discussed in the literature are non-intervention, salpingectomy (removal of tube with embryo), salpingostomy (removal of embryo alone), and use of methotrexate (MXT). In this essay, I review these four options and introduce a fifth (the milking technique). In order to assess these options in terms of the absolutism mentioned, it will also be necessary to discuss various accounts of the intention/foresight distinction. I conclude that salpingectomy, salpingostomy, and the milking technique are compatible with absolutist presuppositions, but not the use of methotrexate.

  15. Transuterinal artery interventional therapy for fallopian tubal pregnancy

    International Nuclear Information System (INIS)

    Jiang Zaibo; Shan Hong; Guan Shouhai; Ma Zhuang; Huang Mingsheng; Li Zhengran; Zhu Kangshun; Chen Hanwei; Xiao Jibo; Mu Yongsheng

    2001-01-01

    Objective: To study the methods and clinical effect of transuterinal artery interventional therapy of fallopian tubal pregnancy. Methods: The authors cured 34 cases of fallopian tubal pregnancy by interventional methods. In the procedure, 4.1 - 5.0 F catheters were used for performing super selective angiography in uterine artery and then infusing Methotrexate 50-100 mg. Finally gelfoam particles or stripes were used to embolise uterine artery. Before and after the procedure, patients showed changes of clinical symptom, physical signs. Value of urine β-hCG and size of pregnancy cyst were studied. Results: 31 cases were succeeded. The successful rate was 91%. 37 fallopian tubal arteries were displayed in 40 uterine arterial angiographies. The stain of ovary was shown done in 21 cases, the appearance rate was 68%. The stain of pregnant cyst was in six cases, the appearance rate was 18%. Conclusion: It is safe and efficient in performing transuterine artery chemo-embolization for therapy of fallopian tubal pregnancy. It could prevent and control fatal bleeding induced by pregnancy cyst rupture

  16. Transvaginal sonographic findings of the ectopic pregnancy

    Energy Technology Data Exchange (ETDEWEB)

    Jun, Soon Ae; Youn, Chang Seon; Han, Sei Yul; Cho, Joo Youn; Chang, Sang Sik; Cha, Kwang Yul; Cha, Kyung Sub [Cha Women' s Hospital, Sungnam (Korea, Republic of)

    1989-08-15

    Transvaginal(TV) sonography uses high-frequency transducer and allows access to the uterus and adnexa, provides better resolution and more accurate diagnosis of ectopic pregnancy. To determine the value and the utility of TV sonography for a suspected ectopic pregnancy, we studied 56 women during 4 months from January to April 1989. Of 56 patients 46 had an surgically confirmed ectopic pregnancy, 5 had not an ectopic pregnancy and 5 had not follow up. TV sonography provides definite sonographic diagnosis of ectopic pregnancy including an extrauterine gestational sac 34 cases(74%), extrauterine embryo 9 caes(19.7%), hematosalpinx 10 cases(21.7%). Overall adnexal mass was detected in 38 cases(82.6%) at initial TV sonography and in 44 cases(95.6%) at follow up TV sonography. Additional findings were uterine decidual reaction 19 cases(41.3%), pseudo G-sac 4 cases(8.7%), cul-de-sac fluid 42 cases(91.2%). Follow-up TV sonography showed newly developed or growing adnexal mass in 8 among 9 cases. False positive 5 cases were two ovarian cysts, one incomplete abortion, two parametrial thickening due to previous ectopic pregnancy and salpingectomy. TV sonography may improve the govality of patient management by early diagnosis and early surgical treatment, so may preserve fertility. In conclusion, we may suggest that TV sonography is an integral part of diagnostic modality in suspected ectopic pregnancy.

  17. Transvaginal sonographic findings of the ectopic pregnancy

    International Nuclear Information System (INIS)

    Jun, Soon Ae; Youn, Chang Seon; Han, Sei Yul; Cho, Joo Youn; Chang, Sang Sik; Cha, Kwang Yul; Cha, Kyung Sub

    1989-01-01

    Transvaginal(TV) sonography uses high-frequency transducer and allows access to the uterus and adnexa, provides better resolution and more accurate diagnosis of ectopic pregnancy. To determine the value and the utility of TV sonography for a suspected ectopic pregnancy, we studied 56 women during 4 months from January to April 1989. Of 56 patients 46 had an surgically confirmed ectopic pregnancy, 5 had not an ectopic pregnancy and 5 had not follow up. TV sonography provides definite sonographic diagnosis of ectopic pregnancy including an extrauterine gestational sac 34 cases(74%), extrauterine embryo 9 caes(19.7%), hematosalpinx 10 cases(21.7%). Overall adnexal mass was detected in 38 cases(82.6%) at initial TV sonography and in 44 cases(95.6%) at follow up TV sonography. Additional findings were uterine decidual reaction 19 cases(41.3%), pseudo G-sac 4 cases(8.7%), cul-de-sac fluid 42 cases(91.2%). Follow-up TV sonography showed newly developed or growing adnexal mass in 8 among 9 cases. False positive 5 cases were two ovarian cysts, one incomplete abortion, two parametrial thickening due to previous ectopic pregnancy and salpingectomy. TV sonography may improve the govality of patient management by early diagnosis and early surgical treatment, so may preserve fertility. In conclusion, we may suggest that TV sonography is an integral part of diagnostic modality in suspected ectopic pregnancy

  18. POST STERILISATION ECTOPIC PREGNANCY IN A TERTIARY CARE CENTRE IN NORTH KERALA

    Directory of Open Access Journals (Sweden)

    Kusumam Vilangot Nhalil

    2017-03-01

    Full Text Available BACKGROUND To study the proportion of ectopic pregnancies with a history of female sterilisation and to assess the risk factors associated with post sterilisation ectopic pregnancy. MATERIALS AND METHODS This is a descriptive cross-sectional study. Cases of ectopic pregnancy that were admitted in Department of Obstetrics and Gynaecology, Kozhikode, from February 2014 to July 2015 are included in the study. Details of patient were collected and they were examined in person. Investigations were recorded and clinical findings were noted. Later outcome of cases was also recorded. Data from the study was coded and entered in MS Excel and analysed with SPSS software. RESULTS There were 372 cases of ectopic pregnancies, of which 51 had history of female sterilisation. Ectopic tubal pregnancies after tubal sterilisation accounted for 13.7% of all the ectopic pregnancies in this study. 45% cases occurred in patients less than 30 years. More than 75% cases of ectopic pregnancy in the study presented at less than 7 weeks. Abdominal pain was the main symptom with which they presented. Out of the 51 cases, more than 80% patients had undergone sterilisation by modified Pomeroy’s technique while 17.6% cases had undergone laparoscopic sterilisation. 98% of the patients had their sterilisation done before 30 years of age. 64.7% cases had undergone sterilisation from a secondary care centre while 35.5% had it from a tertiary care centre. In the present study, more than half of the cases presented (as ectopic pregnancy within 5 years after sterilisation. 15% cases had history of pelvic inflammatory disease. Bilateral near total salpingectomy was done in all cases. CONCLUSION In the present study, it is observed that ectopic pregnancies following female sterilisation are not rare. It constituted 13.7% cases of ectopic pregnancies. There may be a delay in diagnosis as there is a history of sterilisation. Absence of amenorrhoea does not rule out ectopic. Most of

  19. Cost-effectiveness of salpingotomy and salpingectomy in women with tubal pregnancy (a randomized controlled trial).

    Science.gov (United States)

    Mol, F; van Mello, N M; Strandell, A; Jurkovic, D; Ross, J A; Yalcinkaya, T M; Barnhart, K T; Verhoeve, H R; Graziosi, G C; Koks, C A; Mol, B W; Ankum, W M; van der Veen, F; Hajenius, P J; van Wely, M

    2015-09-01

    Is salpingotomy cost effective compared with salpingectomy in women with tubal pregnancy and a healthy contralateral tube? Salpingotomy is not cost effective over salpingectomy as a surgical procedure for tubal pregnancy, as its costs are higher without a better ongoing pregnancy rate while risks of persistent trophoblast are higher. Women with a tubal pregnancy treated by salpingotomy or salpingectomy in the presence of a healthy contralateral tube have comparable ongoing pregnancy rates by natural conception. Salpingotomy bears the risk of persistent trophoblast necessitating additional medical or surgical treatment. Repeat ectopic pregnancy occurs slightly more often after salpingotomy compared with salpingectomy. Both consequences imply potentially higher costs after salpingotomy. We performed an economic evaluation of salpingotomy compared with salpingectomy in an international multicentre randomized controlled trial in women with a tubal pregnancy and a healthy contralateral tube. Between 24 September 2004 and 29 November 2011, women were allocated to salpingotomy (n = 215) or salpingectomy (n = 231). Fertility follow-up was done up to 36 months post-operatively. We performed a cost-effectiveness analysis from a hospital perspective. We compared the direct medical costs of salpingotomy and salpingectomy until an ongoing pregnancy occurred by natural conception within a time horizon of 36 months. Direct medical costs included the surgical treatment of the initial tubal pregnancy, readmissions including reinterventions, treatment for persistent trophoblast and interventions for repeat ectopic pregnancy. The analysis was performed according to the intention-to-treat principle. Mean direct medical costs per woman in the salpingotomy group and in the salpingectomy group were €3319 versus €2958, respectively, with a mean difference of €361 (95% confidence interval €217 to €515). Salpingotomy resulted in a marginally higher ongoing pregnancy rate by

  20. ANALYSIS OF RISK FACTORS ECTOPIC PREGNANCY

    Directory of Open Access Journals (Sweden)

    Budi Santoso

    2017-04-01

    Full Text Available Introduction: Ectopic pregnancy is a pregnancy with extrauterine implantation. This situation is gynecologic emergency that contributes to maternal mortality. Therefore, early recognition, based on identification of the causes of ectopic pregnancy risk factors, is needed. Methods: The design descriptive observational. The samples were pregnant women who had ectopic pregnancy at Maternity Room, Emergency Unit, Dr. Soetomo Hospital, Surabaya, from 1 July 2008 to 1 July 2010. Sampling technique was total sampling using medical records. Result: Patients with ectopic pregnancy were 99 individuals out of 2090 pregnant women who searched for treatment in Dr. Soetomo Hospital. However, only 29 patients were accompanied with traceable risk factors. Discussion:. Most ectopic pregnancies were in the age group of 26-30 years, comprising 32 patients (32.32%, then in age groups of 31–35 years as many as 25 patients (25.25%, 18 patients in age group 21–25 years (18.18%, 17 patients in age group 36–40 years (17.17%, 4 patients in age group 41 years and more (4.04%, and the least was in age group of 16–20 years with 3 patients (3.03%. A total of 12 patients with ectopic pregnancy (41.38% had experience of abortion and 6 patients (20.69% each in groups of patients with ectopic pregnancy who used family planning, in those who used family planning as well as ectopic pregnancy patients with history of surgery. There were 2 patients (6.90% of the group of patients ectopic pregnancy who had history of surgery and history of abortion. The incidence rate of ectopic pregnancy was 4.73%, mostly in the second gravidity (34.34%, whereas the nulliparous have the highest prevalence of 39.39%. Acquired risk factors, i.e. history of operations was 10.34%, patients with family planning 20.69%, patients with history of abortion 41.38%, patients with history of abortion and operation 6.90% patients with family and history of abortion was 20.69%.

  1. Interventional radiology and endovascular surgery in the treatment of ectopic pregnancies

    Energy Technology Data Exchange (ETDEWEB)

    Fornazari, Vinicius Adami Vayego; Szejnfeld, Denis; Elito, Julio Júnior; Goldman, Suzan Menasce [Universidade Federal de São Paulo, São Paulo, SP (Brazil)

    2015-07-01

    The advent of interventional radiology enabled remarkable advances in diagnosis and treatment of several situations in obstetrics and gynecology. In the field of obstetrics, these advances include temporary occlusion of the iliac arteries to the management of placenta accreta and/or prior, arteriovenous fistulas after embolization of uterine curettage and management of ectopic uterine and extra-uterine pregnancies. The non-tubal ectopic pregnancy, either cervical, abdominal, ovarian or in a cesarean scar, often represents major therapeutic challenge, especially when exists a desire to maintain fertility. Despite the systemic methotrexate therapy and surgical resection of the ectopic gestational sac be the most used therapeutic options, the interventionist approach of non-tubal ectopic pregnancies, direct injection of methotrexate in the gestational sac and intra-arterial chemoembolization of uterine arteries constitute in the currently literature viable, safe, effective modalities with low morbidity, shorter hospital stay, and rapid clinical recovery. Because of little variety of materials used, and the increase in training of specialists in the area, the radiological intervention as a treatment option in ectopic pregnancies is financially viable and present considerable accessibility in the world and at most of Brazilian medical centers.

  2. Treatment of tubal pregnancy by uterine artery perfusion and embolization

    International Nuclear Information System (INIS)

    Ni Caifang; Zou Jianwei; Zhao Hui; Jin Yonghai; Zhu Xiaoli; Liu Yizhi; He Qi; Shen Zhongji

    2006-01-01

    Objective: To study the feasibility, safety, and efficacy of the treatment for tubal pregnancy by interventional technique of transuterine arterial catheterization perfusion and embolization. Methods: Using modified Seldinger technique, 42 cases of tubal pregnancy received super-selective angiography of uterine artery, followed by perfusion of 50-100 mg methotrexate (MTX) through the catheter and embolization of uterine artery with gelatin sponge. Before and after the procedure, changes of clinical symptoms, physical signs, value of β-hCG and size of pregnancy cyst of patients were studied. Concentrations of MTX in peripheral blood were studied at 0.5, 6, 12, 24, 36, 48 hours after the procedure. Results: 38 out of 42 cases were cured with successful rate of 90.5%(38/42). The average time of β-hCG decreasing to normal was 8.26 ± 2.04 days. The concentration of MTX in peripheral blood with 50 mg or 75 mg dosage could not be detected at 36 hours after the procedure but could be detected as 0.01 μmol/L at 48 hours after the procedure with a dosage of 100 mg. Conclusions: It is simple, safe and efficient in performing trans-uterine artery chemo-embolization for therapy of fallopian tubal pregnancy, especially for those who complicated with manipules bleeding and also as the first choice for prevention of high risk massive hemorrhage. (authors)

  3. [Management of ectopic pregnancy in Conakry, Guinea].

    Science.gov (United States)

    Sy, T; Diallo, Y; Toure, A; Diallo, F B; Balde, A A; Hyjazi, Y; Diallo, M S

    2009-12-01

    Ectopic pregnancy is one of the most frequent hemorrhagic emergencies encountered in gynecology and obstetrics. The purpose of this 16-month descriptive prospective study at the Ignace Deen Gynecology-Obstetric clinic at Conakry University Hospital in Guinea was to assess diagnostic techniques and therapeutic attitudes regarding ectopic pregnancy in a low-resource setting. The frequency of ectopic pregnancy was 1.4%. Mean patient age was 28.9 years. Ectopic pregnancy was often observed at the second or third pregnancy (47.1%) in women who were giving birth for the second or third time (36.0%) and had a history of sexually transmitted infections (88.2%) or abortions (43.1%). Most women had no schooling (60.8 %), were poor and lived in a marital home (86.3%). Presenting symptoms included the classic triad of amenorrhea (98.0%), abdominopelvic pain (92.2%), and vaginal bleeding (62.7%). Definitive diagnosis was achieved by ultrasound examination in 76.6% of cases and by puncture of the Douglas pouch in 84%. The most frequent site of ectopic pregnancy was the ampulla of the uterine tube (66.9%). Abdominal and ovarian pregnancy was observed in 3 and 4 of the 51 cases respectively. Surgical management was performed in all cases. The most frequent procedure was salpingectomy (80.3%). Proper treatment of sexually transmitted infections (STI), start-up of post-abortion care facilities, and provision of information during early consultation at the first signs of pregnancy would help reduce the frequency and improve the prognosis of ectopic pregnancy.

  4. Splenic rupture masquerading ruptured ectopic pregnancy | Kigbu ...

    African Journals Online (AJOL)

    The classical triad of presentation of delayed menses, irregular vaginal bleeding and abdominal pain may not be encountered at all! Overwhelming features of abdominal pain, amenorrhea, pallor, abdominal tenderness, shifting dullness with positive pregnancy test gave a clinical diagnosis of ruptured ectopic pregnancy.

  5. Frequency of ectopic pregnancy in a medical centre, Kingdom of Saudi Arabia

    International Nuclear Information System (INIS)

    Aziz, S.; Wafi, B.A.; Swadi, H.A.

    2011-01-01

    To asses the frequency of ectopic pregnancy and to evaluate the relevance of the risk factors in a Medical Center, Kingdom of Saudi Arabia (KSA). This retrospective study was done in Royal Commission Medical Centre, Yanbu Industrial City, KSA over a period of four years, where the medical records of patients with the diagnosis of ectopic pregnancy were reviewed. Data was collected on initial presentation, chief medical complaints, socio demographic characteristics, past obstetrics and gynaecological history, history of previous surgeries (tubal, ovarian and/or uterine), history of infertility and use of ovulation induction and history of contraception was obtained. A total of 66 cases were included in the study. Results: The frequency of ectopic pregnancy was 0.58% .Mean age was 30 +- 4 years. Multiparous women were found to be more prone to ectopic pregnancy (64%).Most frequent gestational age was 6-8 weeks. Majority (37.8%) of the patients had previous medical induced or spontaneous abortion. 18% had previous pelvic surgery, 15% used different treatments for infertility including ovulation induction, Intrauterine Insemination (IUI), and In vitro Fertilization (IVF) and 9% of patients had history of ectopic pregnancy, 4.5% of patients had Intrautrine Contraceptive Device (IUCD) in situ. 3% of patients had uterine fibroids. Conclusion: Study has found that previous abortions are major etiological factor for ectopic pregnancy. Further more the other factors were IUCD use, previous pelvic surgeries, infertility, previous ectopic and induced conception cycles which may be the result of a previous pelvic infection that may cause tubal sequelae. (author)

  6. Spontaneous Bilateral Tubal Gestation: A Rare Case Report

    Directory of Open Access Journals (Sweden)

    Marwah Sheeba

    2016-01-01

    Full Text Available Here a case is presented where the woman after a positive pregnancy test underwent medical abortion for unwanted pregnancy without ultrasound confirmation of intrauterine pregnancy. On persistence of symptoms, a second opinion was procured, when examination and a transvaginal ultrasound scan revealed ruptured unilateral tubal ectopic pregnancy. However upon subsequent laparotomy (considering deteriorating hemodynamic status of the patient, intraoperatively it turned out to be a bilateral tubal ectopic gestation.

  7. Embryonic miRNA profiles of normal and ectopic pregnancies.

    Directory of Open Access Journals (Sweden)

    Francisco Dominguez

    Full Text Available Our objective was to investigate the miRNA profile of embryonic tissues in ectopic pregnancies (EPs and controlled abortions (voluntary termination of pregnancy; VTOP. Twenty-three patients suffering from tubal EP and twenty-nine patients with a normal ongoing pregnancy scheduled for a VTOP were recruited. Embryonic tissue samples were analyzed by miRNA microarray and further validated by real time PCR. Microarray studies showed that four miRNAs were differentially downregulated (hsa-mir-196b, hsa-mir-30a, hsa-mir-873, and hsa-mir-337-3p and three upregulated (hsa-mir-1288, hsa-mir-451, and hsa-mir-223 in EP compared to control tissue samples. Hsa-miR-196, hsa-miR-223, and hsa-miR-451 were further validated by real time PCR in a wider population of EP and control samples. We also performed a computational analysis to identify the gene targets and pathways which might be modulated by these three differentially expressed miRNAs. The most significant pathways found were the mucin type O-glycan biosynthesis and the ECM-receptor-interaction pathways. We also checked that the dysregulation of these three miRNAs was able to alter the expression of the gene targets in the embryonic tissues included in these pathways such as GALNT13 and ITGA2 genes. In conclusion, analysis of miRNAs in ectopic and eutopic embryonic tissues shows different expression patterns that could modify pathways which are critical for correct implantation, providing new insights into the understanding of ectopic implantation in humans.

  8. Cervical Ectopic Pregnancy in Resource Deprived Areas: A Rare ...

    African Journals Online (AJOL)

    2016-06-02

    Jun 2, 2016 ... Cervical ectopic pregnancy is a rare, life threatening form of ectopic pregnancy ... cervical, resource deprived areas, difficult diagnosis, management ... drome, prior instrumentation or therapeutic abortion .... CONCLUSION.

  9. Success and spontaneous pregnancy rates following systemic methotrexate versus laparoscopic surgery for tubal pregnancies: A randomized trial

    DEFF Research Database (Denmark)

    Krag Moeller, Lars Bo; Moeller, Charlotte; Thomsen, Sten Grove

    2009-01-01

    . A total of 106 women diagnosed with ectopic pregnancy (EP). Methods. Between March 1997 and September 2000, 1,265 women were diagnosed with EP, 395 (31%) were eligible, 109 (9%) were randomized of whom 106 had an EP. The study was originally powered to a sample size of 422 patients. The women were......Objective. To determine which treatment should be offered to women with a non-ruptured tubal pregnancy: a single dose of methotrexate (MTX) or laparoscopic surgery. Design. Prospective, randomized, open multicenter study. Setting. Seven Danish departments of obstetrics and gynecology. Sample...... (n.s.). Conclusions. In women with an EP, who are hemodynamically stable and wishing to preserve their fertility, medical treatment with single dose MTX tends to be equal to treatment with laparoscopic surgery regarding success rate, complications, and subsequent fertility. Although the two treatment...

  10. Cost-effectiveness of salpingotomy and salpingectomy in women with tubal pregnancy (a randomized controlled trial)

    NARCIS (Netherlands)

    Broekmans, FJM; Mol, F.; Mello, N.M.; Strandell, Annika; Strandell, Karin; Jurkovic, Davor; Ross, Jackie; Barnhart, K.; Yalcinkaya, Tamer; Verhoeve, H.R.; Graziosi, G.C.M.; Koks, Carolien A M; Klinte, Ingmar; Hogstrom, Lars; Janssen, Ineke; Kragt, Harry; Hoek, Annemieke; Trimbos-Kemper, Trudy; Willemsen, Wim; Ankum, W.M.; Mol, Benwillem; Wely, M.; van der Veen, Fulco; Hajenius, Petra J

    2015-01-01

    STUDY QUESTION: Is salpingotomy cost effective compared with salpingectomy in women with tubal pregnancy and a healthy contralateral tube? SUMMARY ANSWER: Salpingotomy is not cost effective over salpingectomy as a surgical procedure for tubal pregnancy, as its costs are higher without a better

  11. Discussion of indication for selecting ectopic pregnancy treated by trans-uterine artery embolization

    International Nuclear Information System (INIS)

    Xu Wenjian; Ni Caifang; Tan Xiaomei

    2007-01-01

    Objective: To discuss the selection of indication for using uterine artery perfusion and embolization in tubal pregnancy. Methods: Fifty one cases of tubal pregnancy were treated by superselective trans-uterine artery (TUA) catheterization with perfusing Methorexate (MTX) and then embolized the uterine arteries by gelfoam. The comparisons among serum β-HCG concentration, abdominal bleeding and the size of the ectopic mass could state the importance of the indication selection preproceduralty. Results: Forty eight of the 51 cases were cured by this method, when the ectopic mass size ≥5 cm, the cure rate was low, 33.33% (P<0.01), although the serum β-HCG concentration was ≤10 000 mIU/ml with no abdominal hemorrhage; otherwise, with mass size ≤5 cm, without consideration of the serum β-HCG concentration and abdominal bleeding, the cure rate was 97.92%. Conclusion: The technique of trans-uterine artery MTX perfusion and embolization selection of close clinical could result in satisfactory treatment for tubal pregnancy. Careful selection of indication, close clinical observation and neady for any emergency should always be on alert. (authors)

  12. The value of creatine kinase, estradiol and progesterone levels in early diagnosis of ectopic pregnancies: a prospective controlled study

    Directory of Open Access Journals (Sweden)

    Feride Mimaroğlu

    2010-06-01

    Full Text Available INTRODUCTION: To evaluate the role of serum creatine kinase, progesterone and estradiol as a biochemical marker in the early diagnosis of tubal pregnancy. MATERIAL-METHODS: A prospective controlled study was carried out on 44 women with first trimester pregnancy. First group (n=22 with tubal pregnancy formed the study group and second group (n=22 with normal intrauterine pregnancy was taken as controls. Serum beta hCG, creatine kinase, progesterone and estradiol levels in the two groups were compared. Surgical treatment had choosen as a treatment modality of ectopic pregnancy. RESULTS: The optimal cutoff value of creatine kinase to be used for the prediction of ectopic pregnancy was 45 IU/l, which resulted in a sensitivity of 86%, specificity of 31%, positive predictive value 55 % and negative predictive value 70 %. The same values for estradiol and progesterone were detected >225 pg/ml, 100 %, 68 %, 75%, 100 % and >13 ng/mL, 95 %, 81 %, % 84, % 97 in discriminating ectopic pregnancies. According to AUC levels there was a significant difference between estradiol-creatine kinase levels, progesterone-estradiol levels and progesterone–creatin kinase levels (p values 0.024, 0.0082, and 0.0001, respectively. CONCLUSION: Serum creatine kinase values appear to be a useful marker in the diagnosis of ectopic pregnancy.

  13. Non-invasive diagnosis and management of ectopic pregnancy

    NARCIS (Netherlands)

    van Mello, N.M.

    2013-01-01

    The work presented in this thesis begins with a focus on non-invasive diagnostic methods for ectopic pregnancy. The heterogeneity found in studies on diagnostic tests for ectopic pregnancy has led to an international recommendation on uniform definitions of early pregnancy complications. Hereafter,

  14. Association of anti-Chlamydia antibodies with ectopic pregnancy in ...

    African Journals Online (AJOL)

    Background: Ectopic pregnancy remains a major public health problem especially in many developing countries where it is a significant contributor to pregnancy related morbidity and mortality. Objective: To determine the association between prior Chlamydia trachomatis infection and the risk of ectopic pregnancy. Methods: ...

  15. Ectopic pregnancy in women with recurrent miscarriage.

    Science.gov (United States)

    Ticconi, Carlo; Capogna, Maria V; Martelli, Federica; Borelli, Barbara; Bruno, Valentina; Ergasti, Raffaella; Sorge, Roberto; Piccione, Emilio; Pietropolli, Adalgisa

    2018-05-01

    The aim of this study was to investigate the possible association between recurrent miscarriage (RM) and ectopic pregnancy (EP). In this case-control retrospective study, the clinical cards of women followed as outpatients in the RM and low-risk pregnancy offices of the Obstetrics and Gynecology Unit at the Policlinico Tor Vergata University Hospital were carefully reviewed for the occurrence of EP. Overall, 598 women with RM and 2043 normal women without RM (controls) were included in the study. Among these women, 4974 pregnancies were analyzed, in which 2028 miscarriages occurred. The EP rate (3.51%) was significantly higher in RM than in control women (1.51%) [odds ratio = 2.31 (95% confidence interval: 2.3-2.4)]; it was particularly high in women with primary RM (5.11%). However, when EP rates were calculated not by women but by overall pregnancies, no differences could be found between RM and control women. In control women, the absence of a miscarriage in the reproductive history was associated with a lower rate of EP. Women with RM, particularly primary RM, are at increased risk of EP. This increased risk seems to be dependent on the high number of pregnancies occurring in women with RM rather than to specific characteristics of these women. © 2018 Japan Society of Obstetrics and Gynecology.

  16. Persistent ectopic pregnancy after milking procedure: Case report

    Directory of Open Access Journals (Sweden)

    Semra Kayataş

    2014-03-01

    Full Text Available Ectopic pregnancy is the settlement of the pregnancy product at any site other than the endometrium. The incidence of ectopic pregnancy have increased in the last 20 years. Increased frequency and early diagnosis has led to conservative treatment methods to become more favorable. Follow-up, medical management and surgical managements are considered as conservative methods. As salpingostomy is the most common conservative surgical method, milking is considered as an alternative conservative surgical method. The most important complication of the conservative surgery is the persistence of ectopic pregnancy because of the residual trophoblastic tissue. Since the prediction of the persistent ectopic pregnancy is difficult after the conservative surgery, β-HCG follow up is so important for early diagnosis. In this case report we have discussed the case of the patient who admitted to our clinic with persistent ectopic pregnancy with acute abdomen, after the treatment with milking procedure whom than treated by salpingectomy procedure.

  17. Ectopic Pregnancy in Lagos State University Teaching Hospital ...

    African Journals Online (AJOL)

    We set out to determine the socio-demographic factors,pattern of presentation and management of ectopic pregnancy in a University Teaching Hospital in Lagos, Nigeria. A retrospective descriptive analysis of all cases of ectopic pregnancy over a 2-year period was carried out. The case notes were retrieved from the ...

  18. Ectopic pregnancy experience in a tertiary health facility in South ...

    African Journals Online (AJOL)

    Background: Ectopic pregnancy is a life-threatening gynecological emergency, and a significant cause of maternal morbidity and mortality in Nigeria. Objective: To determine the incidence, clinical presentation, risk factors and management outcomes of ectopic pregnancies in a tertiary health facility. Methods: A retrospective ...

  19. Risk factors and outcomes of ectopic pregnancies at Aminu Kano ...

    African Journals Online (AJOL)

    Objectives: To determine the incidence, risk factors, clinical presentation, morbidity and mortality of ectopic pregnancies at Aminu Kano Teaching Hospital. Methods: It is a retrospective study of patients with ectopic pregnancies treated at Aminu Kano Teaching Hospital (AKTH), Nigeria, from 1st January, 2005 to 31st ...

  20. Impact of ectopic pregnancy for reproductive prognosis in next generation

    DEFF Research Database (Denmark)

    Kårhus, Line Lund; Egerup, Pia; Skovlund, Charlotte Wessel

    2014-01-01

    The impact of an ectopic pregnancy in the next generation is unknown. Our aim was to compare reproductive outcomes in daughters of women with and without ectopic pregnancy. Designed as a historical prospective controlled cohort study with data collected in four Danish registries from 1977-2009, w...

  1. Role of ultrasound in detection of ectopic pregnancy: our experience

    International Nuclear Information System (INIS)

    Moshin, H.; Khan, M.N.; Jadun, C.K.; Tanveer-ul-Jaq

    2001-01-01

    Objective: To determine the efficacy of ultrasound in detection of ectopic pregnancy. Design: It was an observational and prospective study. The study was conducted from January, 2000 in the Radiology Department of the Agha Khan University Hospital, Karachi. Subjects and Methods: Four hundred patients were referred for sonography with a query of ectopic pregnancy. Most of the patients had clinical symptoms of vaginal bleeding and lower abdominal pain with history of missed periods. For the evaluation biphasic ultrasound was performed that included suprapubic and trans vaginal ultrasound. After analyzing internal architecture prospective sonographic diagnosis was made. Results: The most common site of ectopic pregnancy was fallopian tubes. Positive diagnosis was made in 96.3% cases and negative diagnosis in 4.7% cases in our study. Conclusion: Efficacy of ultrasound was found to be 96.4% in the detection of ectopic pregnancy and hence plays a very important role in early diagnosis of ectopic pregnancy. (author)

  2. Risk Factors For Ectopic Pregnancy : A Case Control Study

    Directory of Open Access Journals (Sweden)

    Deshmukh J.S

    1999-01-01

    Full Text Available Research question: Which are the risk factors for ectopic pregnancy . Objective: To study the strength of association between hypothesised risk factors and ectopic pregnancy. Study design: Unmatched case- control study. Setting: Government Medical College, Hospital, Nagpur. Participants: 133 cases of ectopic pregnancy and equal number of controls (non pregnant women admitted to study hospital. Study variables : Pelvic inflammatory diseases, sexually transmitted diseases, IUD use at conception , past use of IUD, prior ectopic pregnancy, OC pills use at the time of conception, past use of OC pills, induced abortion, spontaneous abortion, infertility and pelvic and abdominal surgery. Statistical analysis: Odds ratios & their 95% CI, Pearson’s chi square test, unconditional logistic regression analysis and population attributable risk proportion. Results : Use of IUD at conception, prior ectopic pregnancy , pelvic inflammatory disease, sexually transmitted diseases, infertility, OC pills use at the time of conception, past use of IUD and induced abortion were found to be significantly associated with ectopic pregnancy. Conclusion: Identification of these risk factors for etopic pregnancy shall help in early detection and appropriate management in an individual case and it may help in devising a comprehensive preventive strategy for ectopic pregnancy

  3. Modern Technologies In Ectopic Pregnancy Diagnostics On Hospital Stage

    Directory of Open Access Journals (Sweden)

    L.V. Kaushanskaya

    2009-12-01

    Full Text Available The present research provides analysis of results of preoperative examination of 680 patients with ectopic pregnancy depending on the range of surgical treatment. It has been shown that in case of progressive ectopic pregnancy the diagnostic significance of concentrations of human chorionic gonadotropin, transvaginal examination and laparos-copy depends on the duration of pregnancy. When the term of ectopic pregnancy is 3-4 weeks monitoring of p chorionic gonadotropin in blood serum (99.5%, transvaginal examination (58% and laparoscopy (78.5% are more informative. When the term of ectopic pregnancy is more than 4 weeks there is a high diagnostic value of monitoring p-subunit of chorionic gonadotropin (99.5%, transvaginal examination (68% and laparoscopy (99,5%. The research has proved that pregnancy period of 3-4 weeks is optimal for laparoscopy and other operations

  4. Ectopic pregnancy experience in a tertiary health facility in South ...

    African Journals Online (AJOL)

    Celestine

    Methods: A retrospective study of all cases of ectopic pregnancies managed at the University of Port. Harcourt .... study was obtained from the ethics committee of the hospital. .... Business woman. 54. 15.7 .... Dewhurst`s Textbook of Obstetrics.

  5. Spontaneous unilateral Twin Ectopic Pregnancy: A case report

    Directory of Open Access Journals (Sweden)

    هادی اریا منش

    2017-03-01

    Full Text Available Abstract Aim & Objective: Twin pregnancy in the tube is a few and due to more frequent use of ovulatory medicine and increased maternal mortality rate. In this article, we report a case of  untitled twin ectopic pregnancy. Case study: The pregnant women was a 28 year-old  to had  a  history infertility, PCOD, Abortion and cortege,   too have one 5 years girl by CS and  Mild cramp pain in both abdominal lower quadrants and metroreghia . That have not treatment by projection. The ultra-sonography showed a twin pregnancy uterus with a moderate amount of fluid in pelvic cavity was seen. And do salpanjectimy surgery. Conclusion:  We report one Untitled Spontaneous Twin Ectopic Pregnancy,  is necessary any pregnant woman with  positive BhCG and metrorhoghia must be considered for Ectopic pregnancy. To decrease maternal mortality rate. Key words:

  6. Microsurgical tubal recanalization: A hope for the hopeless

    Directory of Open Access Journals (Sweden)

    Jain M

    2003-01-01

    Full Text Available Objective: To analyse the various factors affecting pregnancy rate after microsurgical tubal recanalisation. Design: Prospective study, follow-up of 5 years in patients treated with tubal microsurgery. Setting: Referral Tertiary Care Hospital. Patients: Fifty women underwent microsurgical tubal recanalisation procedure. Principles of microsurgery were followed throughout the procedure meticulously. Interventions: Microsurgical tubal recanalisation. Main outcome measure: Pregnancy rate. Results: With microsurgery, an overall 60% pregnancy rate was achieved. In these patients, pregnancy outcome was in form of intrauterine pregnancy (96.66%, ectopic pregnancy (3.33%, term viable pregnancy (96.55% and spontaneous abortion (3.45%. Conclusions: The important factors for determining the success of operation were age of the patient, time interval between sterilization and reversal, site of ligation, method used for previous ligation & the remaining length of the tube after recanalisation. The microsurgical technique should be available at specialized centres to improve the success of family planning services.

  7. Ectopic Pregnancy After Plan B Emergency Contraceptive Use.

    Science.gov (United States)

    Steele, Brianne Jo; Layman, Kerri

    2016-04-01

    Pregnancy outcomes after emergency contraceptive use has been debated over time, but review of the literature includes mechanisms by which these medications may increase the chance of an ectopic pregnancy. Such cases are infrequently reported, and many emergency providers may not readily consider this possibility when treating patients. This is a case presentation of ectopic pregnancy in a patient who had recently used Plan B (levonorgestrel) emergency contraceptive. She presented with abdominal pain and vaginal spotting, and was evaluated by serum testing and pelvic ultrasound. She was discovered to have a right adnexal pregnancy. She was treated initially with methotrexate, though she ultimately required surgery for definitive treatment. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This case report aims to bring a unique clinical case to the attention of emergency providers. The goal is to review research on the topic of levonorgestrel use and the incidence of ectopic pregnancies. The mechanism of action of this emergency contraceptive is addressed, and though no definite causal relationship is known between levonorgestrel and ectopic pregnancies, there is a pharmacologic explanation for how this event may occur after use of this medication. Ultimately, the emergency provider will be reminded of the importance of educating the patient on the possible outcomes after its use, including failure of an emergency contraceptive and the potential of ectopic pregnancy. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. Overview and guidelines of off-label use of methotrexate in ectopic pregnancy: report by CNGOF.

    Science.gov (United States)

    Marret, Henri; Fauconnier, Arnaud; Dubernard, Gil; Misme, Hélène; Lagarce, Laurence; Lesavre, Magali; Fernandez, Hervé; Mimoun, Camille; Tourette, Claire; Curinier, Sandra; Rabishong, Benoit; Agostini, Aubert

    2016-10-01

    Our objective is to describe off-label use of methotrexate in ectopic pregnancy treatment using evidence based medicine. The patient group includes all women with a pregnancy outside the usual endometrium, or of unknown location. Method used was a Medline search on ectopic pregnancy managed using methotrexate treatment; evidence synthesis was done based on this current literature analysis. Level of evidence (LE) were given according to the centre for evidence base medicine rules. Grade was proposed for guidelines but no recommendation was possible as misoprostol is off label use for all the indications studied. In the absence of any contraindication, the protocol recommended for medical treatment of ectopic pregnancy is a single intramuscular injection of methotrexate (MTX) at a dosage of 1mg/kg or 50mg/m(2) (Grade A). It can be repeated once at the same dose should the hCG concentration not fall sufficiently. Pretreatment laboratory results must include a complete blood count and kidney and liver function tests (in accordance with its marketing authorization). MTX is an alternative to conservative treatment such as laparoscopic salpingotomy for uncomplicated tubal pregnancy (Grade A) with pretreatment hCG levels≤5000IU/l (Grade B). Expectant management is preferred for hCG levelslocation persisting more than 10days in an asymptomatic woman who has an hCG level>2000IU/l, routine MTX treatment is an option. MTX is not indicated for combination with treatments such as mifepristone or potassium. Copyright © 2016. Published by Elsevier Ireland Ltd.

  9. Ectopic Pregnancy and Emergency Contraceptive Pills: A Systematic Review

    Science.gov (United States)

    Cleland, Kelly; Raymond, Elizabeth; Trussell, James; Cheng, Linan; Zhu, Haoping

    2014-01-01

    Objective To evaluate the existing data to estimate the rate of ectopic pregnancy among emergency contraceptive pill treatment failures. Data Sources Our initial reference list was generated from a 2008 Cochrane review of emergency contraception. In August 2009, we searched Biosys Previews, the Cochrane Database of Systematic Reviews, Medline, Global Health Database, Health Source: Popline, and Wanfang Data (a Chinese database). Methods of Study Selection This study included data from 136 studies which followed a defined population of women treated one time with emergency contraceptive pills (either mifepristone or levonorgestrel), and in which the number and location of pregnancies were ascertained. Results Data from each article were abstracted independently by two reviewers. In the studies of mifepristone, 3 out of 494 (0.6%) pregnancies were ectopic; in the levonorgestrel studies, 3 out of 307 (1%) were ectopic. Conclusion The rate of ectopic pregnancy when treatment with emergency contraceptive pills fails does not exceed the rate observed in the general population. Since emergency contraceptive pills are effective in lowering the risk of pregnancy, their use should reduce the chance that an act of intercourse will result in ectopic pregnancy. PMID:20502299

  10. Selective Uterine Artery Embolization for Management of Interstitial Ectopic Pregnancy

    International Nuclear Information System (INIS)

    Yang, Seung Boo; Lee, Sang Jin; Joe, Hwan Sung; Goo, Dong Erk; Chang, Yun Woo; Kim, Dong Hun

    2007-01-01

    Interstitial pregnancy is defined as any gestation that develops in the uterine portion of the fallopian tubes lateral to the round ligament. Interstitial pregnancies account for 2-4% of all ectopic pregnancies and have been reported to have an associated 2% to 2.5% maternal mortality rate. The traditional treatment for interstitial pregnancy using surgical cornual resection may cause infertility or uterine rupture in subsequent pregnancies. Recently, the early identification of intact interstitial pregnancy has been made possible in many cases with high resolution transvaginal ultrasound as well as more sensitive assays for betahuman chorionic gonadotropin (β-hCG). The treatment includes: hysteroscopic transcervical currettage, local and systemic methotrexate (MTX) therapy and prostaglandin or potassium chloride injection of the ectopic mass under sonographic guidance. We describe a case of successful treatment of interstitial pregnancy using uterine artery embolization, after failure of methotrexate treatment

  11. Selective Uterine Artery Embolization for Management of Interstitial Ectopic Pregnancy

    Energy Technology Data Exchange (ETDEWEB)

    Yang, Seung Boo; Lee, Sang Jin; Joe, Hwan Sung; Goo, Dong Erk; Chang, Yun Woo [Soonchunhyang University Gumi Hospital, Gumi (Korea, Republic of); Kim, Dong Hun [Chosun University Hospital, Gwangju (Korea, Republic of)

    2007-04-15

    Interstitial pregnancy is defined as any gestation that develops in the uterine portion of the fallopian tubes lateral to the round ligament. Interstitial pregnancies account for 2-4% of all ectopic pregnancies and have been reported to have an associated 2% to 2.5% maternal mortality rate. The traditional treatment for interstitial pregnancy using surgical cornual resection may cause infertility or uterine rupture in subsequent pregnancies. Recently, the early identification of intact interstitial pregnancy has been made possible in many cases with high resolution transvaginal ultrasound as well as more sensitive assays for betahuman chorionic gonadotropin ({beta}-hCG). The treatment includes: hysteroscopic transcervical currettage, local and systemic methotrexate (MTX) therapy and prostaglandin or potassium chloride injection of the ectopic mass under sonographic guidance. We describe a case of successful treatment of interstitial pregnancy using uterine artery embolization, after failure of methotrexate treatment.

  12. Comparison of the diagnostic values of circulating steroid hormones, VEGF-A, PIGF, and ADAM12 in women with ectopic pregnancy

    Directory of Open Access Journals (Sweden)

    Zou Shien

    2013-02-01

    Full Text Available Abstract Background Several peripheral proteins that might be useful for detecting the presence of ectopic pregnancy (EP have been evaluated, but none have been proven entirely useful in the clinic. We investigated the presence and the possible changes in circulating molecules that distinguish between normal intrauterine pregnancy (IUP and tubal ectopic pregnancy. Methods Non-pregnant women during the menstrual cycle, women with IUP, and women with tubal EP after informed consent. Serum levels of 17β-estradiol (E2, progesterone (P4, testosterone (T, beta-human chorionic gonadotropin (β-hCG, vascular endothelial growth factor-A (VEGF-A, placental growth factor (PIGF, and a distintegrin and metalloprotease protein 12 (ADAM12 were analyzed. Receiver operating characteristic analysis was used to assess the diagnostic discrimination of EP and gestational age-matched IUP. Results E2, P4, PIGF, and ADAM12 levels increased and β-hCG decreased throughout IUP. E2 and VEGF-A levels were significantly different between women with tubal EP and IUP. However, using a serum β-hCG cut-off of less than 1000 mIU/mL, P4 was significantly lower in women with tubal EP compared to IUP. Although E2 was inversely correlated with VEGF-A in women in the early stages of IUP, E2 was not correlated with VEGF-A in women with EP prior to tubal surgery. There were no significant differences in either PIGF or ADAM12 alone between women with tubal EP or IUP. Although no significant correlations were seen between E2 and PIGF or P4 and ADAM12 in women in the early stages of IUP, E2 was positively correlated with PIGF and P4 was positively correlated with ADAM12 in women with EP prior to tubal surgery. Our studies defined associations but not causality. Conclusions Individual measurements of serum E2 or VEGF-A levels are strongly related to early pregnancy outcomes for women with IUP and EP, and pregnancy-associated E2 and VEGF-A levels provide diagnostic accuracy for the

  13. Laparoscopic Surgery for the Treatment of Ectopic Pregnancy

    Directory of Open Access Journals (Sweden)

    Hulusi B ZEYNELOGLU

    2005-09-01

    Full Text Available OBJECTIVE: To evaluate the outcomes of laparoscopic surgery for the treatment of ectopic pregnancy Design: 43 women with ectopic pregnancy who underwent laparoscopic surgery in our department between 1996 and 2005 were included in this study.\tSetting: Department of Obstetrics and Gynecology, School of Medicine, Baskent University, Ankara Patients: 43 women with ectopic pregnancy who underwent laparoscopic surgery Interventions: Laparoscopic surgery was performed the treatment of ectopic pregnancy Main Outcome Measures: Patients characteristics such as age, parity, gestational age at the time of diagnosis, symptoms, preoperative and postoperative serum _-hCG and hemoglobin levels, sonographic findings, type of laparoscopic surgery, blood transfusion, additional treatments, endometrial sampling and postoperative fertility status were recorded. The size and the location of myomas were obtained from the surgeon’s findings in the operative note. Preoperative and postoperative hemoglobin values, change in hemoglobin values, hemorrhage, blood transfusion, postoperative fewer, duration of operation and length of postoperative hospital stay were the main outcomes. RESULTS: Forty-three women with ectopic pregnancy who underwent laparoscopic surgery were included in this study. Patients were submitted usually with pelvic pain and abnormal vaginal bleeding. Adnexal mass and hemoperitoneum were seen by sonographic evaluation. Ampuller pregnancy was the most common. Most of patients had conservative surgery and 38% of patients underwent salpingectomy. 12 patient had blood transfusion and two ones underwent re-laparoscopy. After treatment 5 intrauterine pregnancies were occurred. Endometrial samplings usually defined as decidual en Aria stella reactions. Serum _-hCG levels were in normal range at the end of the month after the laparoscopy. CONCLUSION: In conclusion according to these findings, laparoscopic surgery remains the definitive and universal

  14. Ectopic pregnancy: a life-threatening gynecological emergency

    Directory of Open Access Journals (Sweden)

    Lawani OL

    2013-08-01

    Full Text Available Osaheni L Lawani, Okechukwu B Anozie, Paul O Ezeonu Department of Obstetrics and Gynecology, Federal Teaching Hospital, Abakaliki, Nigeria Background: Ectopic pregnancy is a life-threatening gynecological emergency, and a significant cause of maternal morbidity and mortality in Nigeria. Objective: The aim of this work was to determine and evaluate the incidence, clinical presentation, risk factors, and management outcomes of ectopic pregnancies at Ebonyi State University Teaching Hospital (EBSUTH in Abakaliki. Methods: This was a retrospective, descriptive study of ectopic pregnancies managed in EBSUTH during the study period (June 1, 2002 to May 31, 2012. The medical records of the patients managed for ectopic pregnancy as well as the total birth record and gynecological admission records during the period under review were retrieved, and data were collected with the aid of data-entry forms designed for this purpose. There were 4,610 gynecological admissions and 9,828 deliveries, with 215 cases of ectopic pregnancies. A total of 205 cases were suitable for analysis after excluding cases with incomplete records. The relevant data collected were analyzed with SPSS version 15.0 for Windows. Results: Ectopic pregnancy constituted 4.5% of all gynecological admissions, and its incidence was 2.1%. The mean age of the patients was 27 ± 2 years, 196 of 205 (95.6% had ruptured ectopic pregnancies, and the remaining nine (4.4% were unruptured. The commonest (166 of 205, 80.0% clinical presentation was abdominal pain, and the commonest (105 of 205, 51.2% identified risk factor was a previous history of induced abortion. Three deaths were recorded, giving a case-fatality rate of 1.4% (three of 205. Conclusion: Ectopic pregnancy is a recognized cause of maternal morbidity and mortality and has remained a reproductive health challenge to Nigerian women, as well as a threat to efforts in achieving the UN's Millennium Development Goal 5 in sub-Saharan Africa

  15. RECURRENT CORNUAL ECTOPIC PREGNANCY – A CASE REPORT

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    Velayudam DA, Radha Bai Prabhu T, Dipenty Devi L, Meenalochani P, Isha Gutgutia

    2015-10-01

    Full Text Available Cornual ectopic gestation is one of the causes of “Maternal near miss” cases. In the modern era of IVF treatments and better imaging techniques, more number of cases of cornual ectopic pregnancies is being diagnosed and treated both by conservative and radical methods. Here, we report a case of a recurrent cornual ectopic pregnancy in the early second trimester, which was managed by hysterectomy due to uncontrolled haemorrhage. Thirty five year old Mrs. S, Gravida 4, para2, with one previous ectopic pregnancy presented to the obstetric casualty with acute abdominal pain at 15 weeks +2 days of gestation. On vaginal examination, there was right fornicial fullness and both the fornices were tender. Cervical motion tenderness was also present. On review of her previous records, dating scan done at 8 to 9 weeks showed normal intrauterine pregnancy. An emergency scan was carried out which revealed an empty uterine cavity with gestational sac measuring 3.6×4.4×4.6 cms seen outside the uterus just above the fundus with absent cardiac activity. There was evidence of haemoperitoneum, therefore she was diagnosed with recurrent ruptured ectopic pregnancy.

  16. Retrospective review of the medical management of ectopic ...

    African Journals Online (AJOL)

    condition is ranked among the top direct obstetric causes ... In Europe and North America, the incidence of ectopic pregnan- ... The reason for tubal implantation in an ectopic pregnancy is ... from assisted reproductive technologies, a pregnancy with current use of an intrauterine contraceptive device, and cigarette smoking.

  17. The association between smoking and ectopic pregnancy: why nicotine is BAD for your fallopian tube.

    Directory of Open Access Journals (Sweden)

    Andrew W Horne

    Full Text Available Epidemiological studies have shown that cigarette smoking is a major risk factor for tubal ectopic pregnancy but the reason for this remains unclear. Here, we set out to determine the effect of smoking on Fallopian tube gene expression. An oviductal epithelial cell line (OE-E6/E7 and explants of human Fallopian tubes from non-pregnant women (n = 6 were exposed to physiologically relevant concentrations of cotinine, the principle metabolite of nicotine, and changes in gene expression analyzed using the Illumina Human HT-12 array. Cotinine sensitive genes identified through this process were then localized and quantified in Fallopian tube biopsies from non-pregnant smokers (n = 10 and non-smokers (n = 11 using immunohistochemistry and TaqMan RT-PCR. The principle cotinine induced change in gene expression detected by the array analysis in both explants and the cell line was significant down regulation (P<0.05 of the pro-apoptotic gene BAD. We therefore assessed the effect of smoking on cell turnover in retrospectively collected human samples. Consistent with the array data, smoking was associated with decreased levels of BAD transcript (P<0.01 and increased levels of BCL2 transcript (P<0.05 in Fallopian tube biopsies. BAD and BCL2 specific immunolabelling was localized to Fallopian tube epithelium. Although no other significant differences in levels of apoptosis or cell cycle associated proteins were observed, smoking was associated with significant changes in the morphology of the Fallopian tube epithelium (P<0.05. These results suggest that smoking may alter tubal epithelial cell turnover and is associated with structural, as well as functional, changes that may contribute to the development of ectopic pregnancy.

  18. Intra-gestational sac injection for tubal pregnancy: an interventional approach

    International Nuclear Information System (INIS)

    Wang Yitang; Sun Xiaobo; Xu Xiaojun; Zhang Feiyue; Wu Ke; Song Yingxin; Han Mingjun

    2002-01-01

    Objective: It's an investigation of the procedure, effects and clinical application of the interventional intra-gestational sac injection as a treatment of tubal pregnancy. Methods: Under DSA guidance a selective salpingography was performed and MTX was injected into the gestational sac or oviduct. The procedure was performed in 13 cases with oviductal pregnancy before the gestational sac ruptured. Results: Technical success was obtained in all cases. The serum HCG began to fall in 7 days after the procedure, and dropped to normal level in 2-4 weeks of the procedure. Conclusion: Interventional selective salpingography and intra-gestational sac injection is a simple, safe and effective treatment of the un-ruptured tubal pregnancy

  19. Ruptured Ectopic in Heterotopic Pregnancy: Management and ...

    African Journals Online (AJOL)

    2018-05-22

    May 22, 2018 ... pregnancy (Heterotopic pregnancy) in a primigravida was made. She was ... baby weighed 3.0 kg and was exclusively breastfed. Puerperium was ... Some researchers ... Hence, Mrs. EC did not benefit from EPAU as such the.

  20. Acute Abdomen in Interstitial Ectopic Pregnancy, An Emergency Laparoscopic Treatment

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    E. Picardo

    2014-01-01

    Full Text Available The present case report demonstrates a laparoscopic approach to treat interstitial cornual pregnancy in emergency. Interstitial ectopic pregnancy develops in the uterine portion of the fallopian tube which accounts for 2–4% of all ectopic pregnancies and has the potential to cause life-threatening hemorrhage at rupture. The mortality rate for a woman diagnosed with such a pregnancy is 2–2.5%. Diagnosis of interstitial pregnancy is made by ultrasound. In this case a 32 year-old woman, Gravida 0 Parity 0 Living 0 Ectopic 1, presented to the emergency obstetrical room complaining acute abdominal pain. There was a history of 10 weeks of pregnancy but no pelvic ultrasound scan was performed before the access. A transvaginal ultrasound scan immediately performed demonstrated a gestational sac with viable fetus in the right interstitial region. Moreover there was an ultrasound evidence of hemoperitoneum. She was transferred to the operating room and an emergency laparoscopy surgery was performed. The postoperative course was uneventful and the patient was discharged two days after the surgery. Interstitial pregnancies present a difficult management problem with no absolute standard of care in literature. Laparoscopic technique is under study with favorable results. For our personal point of view a treatment via laparoscopy could be performed both in elective and in emergency cases.

  1. Cervical ectopic pregnancy: Mersilene tape in surgical management

    African Journals Online (AJOL)

    2 Division of Obstetrics and Gynaecology, Mediclinic Hospital, Nelspruit, Mpumalanga, South Africa. Corresponding author: A A ... case of cerv ical ectopic pregnancy that was managed using cervical cerclage with Mersilene tape as an interven tion to reduce intraoperative haemorrhage during evacuation. Case report.

  2. Transvaginal echography in the diagnose of the ectopic pregnancy

    International Nuclear Information System (INIS)

    Betancourt, Claudia; Rivera, Humberto

    1993-01-01

    The ultrasound findings in 21 patients with confirmed ectopic pregnancy were reviewed. The inclusion criteria were those of anatomopathologic confirmation of this diagnosis. All patients were examined with trans-vaginal ultrasound. The most important echographic finding was and an adnexial mass, of mix nature, associated with fluid at the posterior cul-de-sac, in 86% of our patients

  3. Risk factors for ectopic pregnancy in Germany: a retrospective study of 100,197 patients

    Directory of Open Access Journals (Sweden)

    Jacob, Louis

    2017-12-01

    Full Text Available Aim: The goal of this study was to identify potential risk factors for ectopic pregnancy in women followed in German gynecological practices.Methods: The present study included pregnant women diagnosed with ectopic pregnancy and pregnant women without ectopic pregnancy followed in 262 gynecological practices between January 2012 and December 2016. The effects of demographic and clinical variables on the risk of developing ectopic pregnancy were estimated using a multivariate logistic regression model. Results: This study included 3,003 women with ectopic pregnancy and 97,194 women without ectopic pregnancy. The mean age was 31.4 years (SD=5.9 years in ectopic pregnancy patients and 31.1 years (SD=5.6 years in non-ectopic pregnancy patients. Women aged 36–40 (OR=1.12 and 41–45 years (OR=1.46 were at a higher risk of ectopic pregnancy than women aged 31–35 years. Prior ectopic pregnancy was strongly associated with a risk of recurring ectopic pregnancy (OR=8.17. Prior genital surgery (OR=2.67, endometriosis (OR=1.51, and eight other gynecological diseases were also positively associated with ectopic pregnancy (ORs ranging from 1.19 to 2.06. Finally, there was a 1.80-fold increase in women previously diagnosed with psychiatric disorders.Conclusions: Prior ectopic pregnancy and prior genital surgery were strongly associated with ectopic pregnancy in women followed in German gynecological practices. Psychiatric diseases had an additional impact on the risk of ectopic pregnancy.

  4. Contraceptive Use and the Risk of Ectopic Pregnancy: A Multi-Center Case-Control Study.

    Science.gov (United States)

    Li, Cheng; Zhao, Wei-Hong; Meng, Chun-Xia; Ping, Hua; Qin, Guo-Juan; Cao, Shu-Jun; Xi, Xiaowei; Zhu, Qian; Li, Xiao-Cui; Zhang, Jian

    2014-01-01

    To evaluate the association between the risk of ectopic pregnancy (EP) and the use of common contraceptives during the previous and current conception/menstrual cycle. A multi-center case-control study was conducted in Shanghai. Women diagnosed with EP were recruited as the case group (n = 2,411). Women with intrauterine pregnancy (IUP) (n = 2,416) and non-pregnant women (n = 2,419) were matched as controls at a ratio of 1∶1. Information regarding the previous and current use of contraceptives was collected. Multivariate logistic regression analyses were performed to calculate odds ratios (ORs) and the corresponding 95% confidential intervals (CIs). Previous use of intrauterine devices (IUDs) was associated with a slight risk of ectopic pregnancy (AOR1 = 1.87 [95% CI: 1.48-2.37]; AOR2 = 1.84 [1.49-2.27]), and the risk increased with the duration of previous use (P1 for trend contraceptives reduced the risk of both unwanted IUP (condom: AOR = 0.04 [0.03-0.05]; withdrawal method: AOR = 0.10 [0.07-0.13]; calendar rhythm method: AOR = 0.54 [0.40-0.73]; oral contraceptive pills [OCPs]: AOR = 0.03 [0.02-0.08]; levonorgestrel emergency contraception [LNG-EC]: AOR = 0.22 [0.16-0.30]; IUDs: AOR = 0.01 [0.005-0.012]; tubal sterilization: AOR = 0.01 [0.001-0.022]) and unwanted EP (condom: AOR1 = 0.05 [0.04-0.06]; withdrawal method: AOR1 = 0.13 [0.09-0.19]; calendar rhythm method: AOR1 = 0.66 [0.48-0.91]; OCPs: AOR1 = 0.14 [0.07-0.26]; IUDs: AOR1 = 0.17 [0.13-0.22]; tubal sterilization: AOR1 = 0.04 [0.02-0.08]). However, when contraception failed and pregnancy occurred, current use of OCPs (AOR2 = 4.06 [1.64-10.07]), LNG-EC (AOR2 = 4.87 [3.88-6.10]), IUDs (AOR2 = 21.08 [13.44-33.07]), and tubal sterilization (AOR2 = 7.68 [1.69-34.80]) increased the risk of EP compared with the non-use of contraceptives. Current use of most contraceptives reduce the risk of both IUP and EP. However, if the

  5. Contraceptive Use and the Risk of Ectopic Pregnancy: A Multi-Center Case-Control Study.

    Directory of Open Access Journals (Sweden)

    Cheng Li

    Full Text Available To evaluate the association between the risk of ectopic pregnancy (EP and the use of common contraceptives during the previous and current conception/menstrual cycle.A multi-center case-control study was conducted in Shanghai. Women diagnosed with EP were recruited as the case group (n = 2,411. Women with intrauterine pregnancy (IUP (n = 2,416 and non-pregnant women (n = 2,419 were matched as controls at a ratio of 1∶1. Information regarding the previous and current use of contraceptives was collected. Multivariate logistic regression analyses were performed to calculate odds ratios (ORs and the corresponding 95% confidential intervals (CIs.Previous use of intrauterine devices (IUDs was associated with a slight risk of ectopic pregnancy (AOR1 = 1.87 [95% CI: 1.48-2.37]; AOR2 = 1.84 [1.49-2.27], and the risk increased with the duration of previous use (P1 for trend <10-4, P2 for trend <10-4. The current use of most contraceptives reduced the risk of both unwanted IUP (condom: AOR = 0.04 [0.03-0.05]; withdrawal method: AOR = 0.10 [0.07-0.13]; calendar rhythm method: AOR = 0.54 [0.40-0.73]; oral contraceptive pills [OCPs]: AOR = 0.03 [0.02-0.08]; levonorgestrel emergency contraception [LNG-EC]: AOR = 0.22 [0.16-0.30]; IUDs: AOR = 0.01 [0.005-0.012]; tubal sterilization: AOR = 0.01 [0.001-0.022] and unwanted EP (condom: AOR1 = 0.05 [0.04-0.06]; withdrawal method: AOR1 = 0.13 [0.09-0.19]; calendar rhythm method: AOR1 = 0.66 [0.48-0.91]; OCPs: AOR1 = 0.14 [0.07-0.26]; IUDs: AOR1 = 0.17 [0.13-0.22]; tubal sterilization: AOR1 = 0.04 [0.02-0.08]. However, when contraception failed and pregnancy occurred, current use of OCPs (AOR2 = 4.06 [1.64-10.07], LNG-EC (AOR2 = 4.87 [3.88-6.10], IUDs (AOR2 = 21.08 [13.44-33.07], and tubal sterilization (AOR2 = 7.68 [1.69-34.80] increased the risk of EP compared with the non-use of contraceptives.Current use of most

  6. Comparison of the Fertility Outcome of Salpingotomy and Salpingectomy in Women with Tubal Pregnancy: A Systematic Review and Meta-Analysis.

    Directory of Open Access Journals (Sweden)

    Xiaolin Cheng

    Full Text Available To compare the natural fertility outcomes of salpingotomy and salpingectomy among women treated for tubal pregnancy.An online database search including PubMed, Embase, CENTRAL and Web of Science was performed to identify studies comparing salpingotomy and salpingectomy to treat women with tubal pregnancy. The search included papers published after the databases were established until May 2015. Two reviewers independently screened literature according to the inclusion and exclusion criteria and then extracted data and assessed the methodological quality of all of the included studies. The meta-analysis was conducted using RevMan 5.3 software. The registration number is CRD42015017545 in PROSPERO.Two randomized controlled trials (RCTs and eight cohort studies, including a total of 1,229 patients, were znalyzed. The meta-analysis of the RCT subgroup indicated that there was no statistically significant difference in IUP rates (RR = 1.04, 95% CI = 0.89-1.21, P = 0.61 nor the repeat ectopic pregnancy (REP rate (RR = 1.30, 95% CI = 0.72-2.38, P = 0.39 between the salpingotomy and salpingectomy group. In contrast, the cohort study subgroup analysis revealed that the IUP rate was higher in the salpingotomy group compared with the salpingectomy group (RR = 1.24, 95% CI = 1.08-1.42, P = 0.002; Salpingotomy also increased the risk of REP rate (RR = 2.27, 95% CI = 1.12-4.58, P = 0.02. The persistent ectopic pregnancy (PEP occurred more frequently in the salpingotomy group than the salpingectomy group (RR = 11.61, 95% CI = 3.17-42.46, P = 0.0002. An IUP would be more likely to occur after salpingotomy than salpingectomy when the follow-up time was more than 36 months (RR = 1.16, 95% CI = 1.02-1.32, P = 0.03. The IUP rate (RR = 1.13, 95% CI = 1.01-1.26, P = 0.03, and the REP rate (RR = 1.62, 95% CI = 1.02-2.56, P = 0.04 was higher after salpingotomy than salpingectomy among patients from Europe compared with those from America.Based on the available evidence

  7. Ectopic pregnancy in a Caesarean section scar: a case study

    Directory of Open Access Journals (Sweden)

    Piotr Niziurski

    2013-08-01

    Full Text Available Implantation of a pregnancy in a scar after Caesarean section is one of the rarest locations of ectopic pregnancies. A diagnosis and/or treatment which is too late may lead to a uterine rupture, the necessity to remove the uterus and a significant increase in morbidity among mothers. The study presents a diagnostically difficult case of a 29-year-old woman, who was diagnosed with pregnancy in its seventh week, located in a scar after a Caesarean section, with highly increased values of human chorionic gonadotropin (β-HCG concentration in blood serum. The pregnancy was removed and the wound was stitched during laparotomy, without a need to remove the uterus.

  8. Ruptured tubal pregnancy: predictors of delays in seeking and obtaining care in a Nigerian population

    Directory of Open Access Journals (Sweden)

    Awoleke JO

    2015-01-01

    Full Text Available Jacob O Awoleke,1 Abiodun I Adanikin,1 Adeola O Awoleke2 1Department of Obstetrics and Gynaecology, Ekiti State University, 2School of Nursing, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria Purpose: Morbidity and mortality from ruptured tubal pregnancies (RTPs have been linked with delays in seeking and receiving care. Evaluation of the reasons for these delays and their contributions to maternal deaths is rarely done for women with RTPs in resource-constrained settings.Patients and methods: This was a 3-year retrospective review of the case records of women with tubal pregnancies managed at the Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria. Clinical and sociodemographic parameters were obtained, including information on onset of symptoms and intervals between the symptoms and when help was sought and obtained at the hospital.Results: There were 92 cases of tubal pregnancies, giving an incidence of 18 per 1,000 births. Most of the patients were married (74.7%, parous (64.9%, and urban dwellers (76.9%, and 11% were severely anemic on arrival. The case-fatality rate was 1.1% and 74.7% had delay in seeking care, while 82.4% of the women spent more than 2 hours after admission before surgical intervention. Rural dwellers (adjusted odds ratio 2.96, 95% confidence interval 1.08–8.36 and those without formal education (adjusted odds ratio 6.39, 95% confidence interval 1.06–67.30 had delays in seeking help, while problems with funds (χ2=7.354, P=0.005 and initial misdiagnosis (χ2=5.824, P=0.018 predicted delay in obtaining help at the hospital.Conclusion: RTPs are common gynecological emergencies in our environment that are often associated with delayed decisions to seek help and obtain care. Efforts should be geared toward women’s education and financial independence, improved hospital accessibility, and better diagnostic skills. Keywords: delay, ruptured tubal pregnancies, predictors, health care, Nigeria

  9. Fluoroscopically Guided Transcervical Fallopian Tube Recanalization of Post-Sterilization Reversal Mid-Tubal Obstructions

    International Nuclear Information System (INIS)

    Houston, J. Graeme; Anderson, David; Mills, John; Harrold, Anthony

    2000-01-01

    Purpose: To assess the technical success and early outcome of fluoroscopically guided transcervical fallopian tube recanalization (FTR) in mid-tubal occlusion following sterilization reversal surgery.Methods: From July 1995 to January 1998, patients with greater than 12 months secondary infertility underwent hysterosalpingography (HSG). FTR was performed in proximal or mid-tubal occlusion. Cases of FTR in mid-tubal occlusion were included in this study. Technical success (defined as complete tubal patency) using a standard guidewire and hydrophilic glidewire, the number of patients with at least one patent tube, and the intrauterine and ectopic pregnancy rates were determined.Results: Twenty-six infertile patients with previous sterilization reversal underwent HSG. Eight of 26 (31%) patients (mean age 32 years, range 23-37 years), had attempted FTR for mid-tubal occlusion at the site of surgical anastomosis. Fourteen tubes were attempted as there were two previous salpingectomies. Technical success was achieved in eight of 14 (57%) tubes attempted, resulting in five of eight (62%) patients having at least one patent tube. At follow-up (mean 18 months, range 12-28 months) in these five patients there was one intrauterine pregnancy. There were no ectopic pregnancies.Conclusions: FTR in mid-tubal obstruction in infertile patients following sterilization reversal surgery is technically feasible and may result in intrauterine pregnancy. In this small group there was a lower technical success rate and lower pregnancy rate than in unselected proximal tubal occlusion

  10. Risk of Ectopic Pregnancy in Women With Inflammatory Bowel Disease

    DEFF Research Database (Denmark)

    de Silva, Punyanganie S; Hansen, Helene H; Wehberg, Sonja

    2018-01-01

    BACKGROUND & AIMS: Few data are available on adverse events of pregnancy in women with inflammatory bowel diseases (IBDs), such as ectopic pregnancy. We assessed the risk of an ectopic pregnancy in pregnancies of women in Denmark with IBD compared with those without IBD over a 22-year period. We...... also examined the disease-specific risks of ectopic pregnancies in pregnancies of women with ulcerative colitis (UC) or Crohn's disease (CD) who underwent IBD-related surgical procedures. METHODS: We performed a retrospective study of all women of child-bearing age (ages, 15-50 y) registered...

  11. The echoic pseudogestational sac of ectopic pregnancy simulating early intrauterine pregnancy.

    Science.gov (United States)

    Schaffer, R M; Stein, K; Shih, Y H; Goodman, J D

    1983-05-01

    The sonographic features of ectopic pregnancy have been well documented. When an early intrauterine pregnancy is identified or an obvious extrauterine sac is visualized, diagnosis is not a problem; but often a sac is seen within the uterus that may contain a well-defined rind and even internal echoes simulating an early fetal pole. This has been mistaken for an early intrauterine pregnancy. In this review, four patients with pseudogestational sacs had internal echoes within the sac, and two of them ultimately underwent dilatation and curettage, which revealed blood clots. This supports the assertion that fetal cardiac activity and/or fetal motion should be demonstrated within a fetal pole before the diagnosis of ectopic pregnancy is excluded.

  12. Immunohistological demonstration of intermediate trophoblast in the diagnosis of uterine versus ectopic pregnancy

    DEFF Research Database (Denmark)

    Sørensen, Flemming Brandt; Marcussen, N; Daugaard, H O

    1991-01-01

    . The histological presence and distribution of hPL was investigated in endometrial curettings from 90 patients studied retrospectively (47 had ectopic pregnancies, 14 miscarriages, and 29 legal abortions), and a consecutive, prospective series of 50 patients (40 had miscarriages and 10 had ectopic pregnancies...

  13. Detection of chromosome abnormalities by quantitative fluorescent PCR in ectopic pregnancies

    NARCIS (Netherlands)

    Goddijn, Mariette; van Stralen, Marja; Schuring-Blom, Heleen; Redeker, Bert; van Leeuwen, Liesbeth; Repping, Sjoerd; Leschot, Nico; van der Veen, Fulco

    2005-01-01

    Objective: To evaluate the potential value of quantitative fluorescent polymerase chain reaction (QF-PCR) in the detection of chromosome abnormalities in ectopic pregnancies. Methods: Seventy chorionic villi samples of ectopic pregnancies were studied by QF-PCR. Primers for chromosomes 16, 21, X and

  14. 42 CFR 136a.55 - Drugs and devices and termination of ectopic pregnancies.

    Science.gov (United States)

    2010-10-01

    ... and devices and termination of ectopic pregnancies. Federal funds are available for drugs or devices... 42 Public Health 1 2010-10-01 2010-10-01 false Drugs and devices and termination of ectopic pregnancies. 136a.55 Section 136a.55 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN...

  15. 42 CFR 136.55 - Drugs and devices and termination of ectopic pregnancies.

    Science.gov (United States)

    2010-10-01

    ... devices and termination of ectopic pregnancies. Federal funds are available for drugs or devices to... 42 Public Health 1 2010-10-01 2010-10-01 false Drugs and devices and termination of ectopic pregnancies. 136.55 Section 136.55 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN...

  16. 42 CFR 441.207 - Drugs and devices and termination of ectopic pregnancies.

    Science.gov (United States)

    2010-10-01

    ... APPLICABLE TO SPECIFIC SERVICES Abortions § 441.207 Drugs and devices and termination of ectopic pregnancies... 42 Public Health 4 2010-10-01 2010-10-01 false Drugs and devices and termination of ectopic pregnancies. 441.207 Section 441.207 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF...

  17. Ectopic Pregnancy risk factors among the patients referred to Shariati hospital in Bandarabbas

    Directory of Open Access Journals (Sweden)

    Minoo Rajaee

    2011-08-01

    Full Text Available Background: Ectopic pregnancy (EP is the most common cause of death related to pregnancy during the first trimester and its' incidence is increasing. Knowledge about the risk factors of EP can be helpful in diagnosis and also in prevention of EP, because some of these risk factors are preventable. The aim of this study is to assess the EP patients and the prevalence of EP risk factors among them in Bandarabbas.Methods: Eighty two patients with EP referred to Shariati hospital in Bandarabbas in 2009 were included in our descriptive study. Study was conducted using a questionnaire about demographic characteristics, EP risk factors, and information about treatment and duration of hospital stay. Data was collected using interview with patients by educated personnel and patients' records during hospitalization. After data collection we analysed the data using SPSS 17.0 software using descriptive statistics (Mean, Standard Deviation, and frequency.Results: Mean age of the participants was 27.46±5.98. Sixty four (78% patients were households and 18(22% were employees. Sixteen (19.5% had low socioeconomic status, 62(75.6% had intermediate socioeconomic status and 4 (4.9% had high socioeconomic status.Twenty one (25.6% of patients were using withdrawal method for contraception at the time of conception. Condom, Oral Contraceptive Pills (OCP, DMPA, and IUD was reported in 7 (8.5%, 13 (15.9%, 8 (9.8%, and 2 (2.4% respectively. Other 31 (37.8% patients weren’t using any method for contraception. Six (7.3% patients had previous history of EP. Also 4 (4.9% had history of previous EP in their near family members. One (1.2% patient was undergone surgery for Tubal Ligation (TL.Four (4.9% patient were using tobacco. EP location was in fallopian tube in 62 (75.6% and in other places in 20 (24.4% of patients. Thirty four (41.5% received drug therapy, 35 (42.7% undergone surgery and 13 (15.9% received both drug and surgery treatment. Mean duration of hospital

  18. Clinical Significance of Monitoring Serum β-HCG in the Conservative Treatment of Ectopic Pregnancy

    International Nuclear Information System (INIS)

    Chen Xue

    2010-01-01

    To explore the clinical value of the serum β-HCG (human chorionic gonadotrophin) in the conservative treatment of ectopic pregnancy, the serum β-HCG levels in 118 patients with ectopic pregnancy were measured with RIA. The results showed that the serum β-HCG levels in patients with successful conservative treatment of ectopic pregnancy were all less than 200mIU/mL. The patients require a surgical treatment to reach <200mIU/mL serum β-HCG concentration were only 26.3%. There was significant difference between two groups (P<0.01). The monitoring of serum β-HCG was very useful in the diagnosis, the choice of treatment measures and the evaluation of conservative treatment effect of ectopic pregnancy. In the course of treatment of ectopic pregnancy, serum β-HCG is a good marker in determining the success or failure of treatment. (authors)

  19. A Rare Case of Chronic Ectopic Pregnancy Presenting as Large Hematosalpinx

    Directory of Open Access Journals (Sweden)

    Madhavi Nacharaju

    2014-01-01

    Full Text Available Ectopic pregnancy is defined as implantation and subsequent development of an embryo outside the uterine lining. It has wide range of presentation from acute hemoperitoneum to chronic ectopic pregnancy. This is an unusual case of chronic ectopic pregnancy with large hematosalpinx without classical symptoms. A 22-year-old South Indian woman reported to the outpatient clinic with irregular spotting for a duration of 2 months which was not associated with pain. There was no preceding amenorrhea and previous menstrual cycles were regular. Clinically, the patient was hemodynamically stable but severely anemic. The abdomen was soft on palpation, cervical movements were not tender, and human chorionic gonadotropin was absent in the urine. Ultrasound revealed a complex adnexal mass. Magnetic resonance imaging (MRI revealed a large hematosalpinx. Laparoscopic left salpingectomy was conducted and histopathology confirmed ectopic pregnancy. Ectopic pregnancy presents diagnostic dilemmas in the absence of classical symptoms. MRI and laparoscopy are important tools in such a diagnostic dilemma.

  20. The treatment of tubal pregnancy by MTX drug perfusion and vascular embolization

    International Nuclear Information System (INIS)

    Dan Jian; Ke Yaojun; Tan Wei; Jiang Ling

    2001-01-01

    Objective: To study the feasibility of the treatment of tubule pregnancy by interventional technique. Methods: By using Seldinger's method, 40 cases of tubule pregnancy received super selective angiography of uterine artery, followed by perfusion of methotrexate (MTX) through the catheter and embolization of uterine artery with gelatin sponge. The concentration of serum β-HCG, the change of pelvic cavity, and the open condition of oviduct were regularly monitored postoperatively. Results: Angiographic findings of tubule pregnancy were classified into 3 types. type I, no abnormal vascular appearance were found in 3 cases (7.5%). Type II, patchy vascular staining of villi in parauterine area was observed in 4 cases (10.0%). Type III, a round vacuolar staining of villi surrounded by small blood vessels in parauterine area occurred in 33 cases (82.5%). The cure rate in total 40 cases achieved 97.5% (39/40). After treatment, the mean time that the serum β-HCG concentration returned to normal was (7.66 +- 2.01) d and the mean time that the menstruation returned to normal was (29.78 +- 7.14) d. In 21 cases who hoped their fertility remaining intact, the oviduct were verified open by hysterosalpingography (HSG) in 20 cases, the open rate was 95.24%. Conclusion: The treatment of tubule pregnancy by interventional technique was proved no harmful effect to reproductive organs and would expect to preserve fertility. This method could resolve the difficult problem of celiac hemorrhage which making conservative treatment impossible and internal hemorrhage happened in the course of traditional conservative therapy leading to treatment failure finally. This method might be a new conception and a choice to treat tubal pregnancy through artery

  1. Point-of-care Ultrasound for the Diagnosis of Ectopic Pregnancy

    Directory of Open Access Journals (Sweden)

    Ahmed Farhat

    2017-09-01

    Full Text Available History of present illness: A 31-year-old female presented to the Emergency Department by ambulance with severe abdominal pain and presyncope. On exam, the patient was hypotensive with suprapubic tenderness. Though the patient denied being pregnant, her labs showed a beta human chorionic gonadotropin (hCG of 38,000 mIU/ml. A bedside transabdominal pelvic ultrasound revealed an ectopic pregnancy and the patient was taken to the operating room for an emergent right salpingectomy. Significant findings: The transabdominal pelvic ultrasound shows an empty uterus (annotated with free fluid and a right sided extrauterine gestational sac representing an ectopic pregnancy (red arrow. Discussion: Ectopic pregnancy is the leading cause of mortality in the first trimester of pregnancy making prompt diagnosis critical.1 Risk factors including history of previous ectopic pregnancy,2 pelvic inflammatory disease,2 increased age,3 and smoking4 can raise suspicion of an ectopic pregnancy. However, the absence of risk factors does not exclude ectopic pregnancy from the differential. Any sexually active female with abdominal pain following a period of amenorrhea should be suspected of an ectopic until proven otherwise. One third of all pregnant women experience abdominal pain and/or vaginal bleeding and 9% of women with an ectopic are asymptomatic. Thus, history alone is insufficient to make the diagnosis.5 In early pregnancy, ectopic pregnancies share the same symptoms as normal pregnancies, including a missed menstrual period, fatigue, and nausea. The first classical signs of an ectopic pregnancy are vaginal bleeding, dizziness, and lower abdominal and/or pelvic pain usually 6 to 8 weeks after a missed menstrual period.5 A meta-analysis of studies on pelvic ultrasonography demonstrated a sensitivity of 99.3% and a negative predictive value of 99.6% for diagnosing ectopic pregnancy and therefore should be utilized as a first-line diagnostic tool for emergency

  2. Clinical course of ectopic pregnancy: A single-center experience

    Directory of Open Access Journals (Sweden)

    Aqueela Ayaz

    2013-01-01

    Full Text Available Objectives: The objective was to highlight the frequency, clinical profile, and predisposing factors of ectopic pregnancy (EP in a general hospital. Materials and Methods: This descriptive study was conducted at the Obstetrics and Gynaecology department of Hera General hospital, Makkah, Saudi Arabia, from July 1, 2009 to December 29, 2010. Data were collected on chief medical complaints, sociodemographic characteristics, past obstetrics and gynecological history, management done, and outcome of management. Data were analyzed using Microsoft Office Excel (version 2007. Results: Out of total 7564 pregnancies, 44 (0.58% patients were diagnosed as EP. Out of 44, 22 (50% patients presented within 24 h of onset of symptoms. Mean age was 28 ± 7 years. Multigravida were predominant in 25 (57%, and 21 (48% had gestational age of 6-8 weeks at the time of presentation; the common presenting features were amenorrhea (41, 93.2%, abdominal pain (39, 88.6%, and tenderness (38, 86%. Previous pelvic surgery (13, 29.5%, infertility treatment (11, 25%, and pelvic inflammatory disease (10, 22.7% were the common predisposing factors. Twenty-five (57% presented with ruptured EP and were operated within 24 h, and the remaining were kept under observation till further diagnosis. After confirming the diagnosis, 12/19 underwent laparoscopy, whereas 7/19 received medical treatment. Surgery confirmed fallopian tube pregnancies in 35 (94.5%. No mortality was observed. Conclusion: Previous pelvic surgeries were the major etiological factor for EP. Other factors were infertility treatment and pelvic inflammatory disease. The most common site of EP was fallopian tubes.

  3. incidence of ectopic pregnancy in calabar, nigeria: two halves of the ...

    African Journals Online (AJOL)

    user

    Reports of a rising incidence of ectopic pregnancy (EP) in the country and beyond prompted ... O. Udofia, Dept. of Psychiatry, University of Calabar Teaching Hospital, Calabar, Nigeria .... on reproductive performance among EP patients.

  4. Ectopic Molar Pregnancy: Diagnostic Efficacy of Magnetic Resonance Imaging and Review of the Literature.

    Science.gov (United States)

    Yamada, Yasushi; Ohira, Satoshi; Yamazaki, Teruyuki; Shiozawa, Tanri

    2016-01-01

    Ectopic molar pregnancy is extremely rare, and preoperative diagnosis is difficult. Our literature search found only one report of molar pregnancy diagnosed preoperatively. Moreover, there is no English literature depicting magnetic resonance image (MRI) findings of ectopic molar pregnancy. We report a case of ectopic molar pregnancy preoperatively diagnosed using MRI. A literature review of 31 cases of ectopic molar pregnancy demonstrated that lesions have been found in the fallopian tube (19 cases, 61%), ovary (5 cases, 16%), cornu (3 cases, 10%), peritoneum (2 cases, 6%), uterine cervix (1 case, 3%), and cesarean scar (1 case, 3%). Abdominal pain and abnormal vaginal bleeding were reported in 70% and 61% of the patients, respectively. Twenty-one cases (67%) presented with rupture and hemoperitoneum. All patients underwent surgical resection or dilatation and curettage. Methotrexate therapy was performed in one case because residual trophoblastic tissue was suspected. A second operation was performed in one case of ovarian molar pregnancy because serum hCG levels increased again after primary focal ovarian resection. No patients developed metastatic disease or relapsed. These findings suggest the prognosis of ectopic molar pregnancy to be favorable.

  5. Ectopic Molar Pregnancy: Diagnostic Efficacy of Magnetic Resonance Imaging and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Yasushi Yamada

    2016-01-01

    Full Text Available Ectopic molar pregnancy is extremely rare, and preoperative diagnosis is difficult. Our literature search found only one report of molar pregnancy diagnosed preoperatively. Moreover, there is no English literature depicting magnetic resonance image (MRI findings of ectopic molar pregnancy. We report a case of ectopic molar pregnancy preoperatively diagnosed using MRI. A literature review of 31 cases of ectopic molar pregnancy demonstrated that lesions have been found in the fallopian tube (19 cases, 61%, ovary (5 cases, 16%, cornu (3 cases, 10%, peritoneum (2 cases, 6%, uterine cervix (1 case, 3%, and cesarean scar (1 case, 3%. Abdominal pain and abnormal vaginal bleeding were reported in 70% and 61% of the patients, respectively. Twenty-one cases (67% presented with rupture and hemoperitoneum. All patients underwent surgical resection or dilatation and curettage. Methotrexate therapy was performed in one case because residual trophoblastic tissue was suspected. A second operation was performed in one case of ovarian molar pregnancy because serum hCG levels increased again after primary focal ovarian resection. No patients developed metastatic disease or relapsed. These findings suggest the prognosis of ectopic molar pregnancy to be favorable.

  6. Ectopic pregnancy morbidity and mortality in low-income women, 2004-2008.

    Science.gov (United States)

    Stulberg, D B; Cain, L; Dahlquist, I H; Lauderdale, D S

    2016-03-01

    Does the risk of adverse outcomes at the time of ectopic pregnancy vary by race/ethnicity among women receiving Medicaid, the public health insurance program for low-income people in the USA? Among Medicaid beneficiaries with ectopic pregnancy, 11% experienced at least one complication, and women from all racial/ethnic minority groups were significantly more likely than whites to experience complications. In this population of Medicaid recipients, African American women are significantly more likely than whites to experience ectopic pregnancy, but the risk of adverse outcomes has not previously been assessed. We conducted a cross-sectional observational study of all women (n = 19 135 106) ages 15-44 enrolled in Medicaid for any amount of time during 2004-2008 who lived in one of the following 14 US states: Arizona; California; Colorado; Florida; Illinois; Indiana; Iowa; Louisiana; Massachusetts; Michigan; Minnesota; Mississippi; New York; and Texas. We analyzed Medicaid claims records for inpatient and outpatient encounters and identified ectopic pregnancies with a principal diagnosis code for ectopic pregnancy from 2004-2008. We calculated the ectopic pregnancy complication rate as the number of ectopic pregnancies with at least one complication (blood transfusion, hysterectomy, any sterilization, or length-of-stay (LOS) > 2 days) divided by the total number of ectopic pregnancies. We used Poisson regression to assess the risk of ectopic pregnancy complication by race/ethnicity. Secondary outcomes were each individual complication, and ectopic pregnancy-related death. We calculated the ectopic pregnancy mortality ratio as the number of deaths divided by live births. Ectopic pregnancy-associated complications occurred in 11% of cases. Controlling for age and state, the risk of any complication was significantly higher among women who were black (incidence risk ratio [IRR] 1.47, 95% CI 1.43-1.53, P American Indian/Alaskan Native (IRR 1.34 95% CI 1.16-1.55, P white

  7. Use of a radioreceptorassay of human chorionic gonadotropin for the diagnosis and management of ectopic pregnancy

    International Nuclear Information System (INIS)

    Saxena, B.B.; Landesman, R.

    1975-01-01

    The radioreceptorassay of human chorionic gonadotropin (hCG), with a sensitivity of 50 pg or 3 mIU/ml of plasma, has provided almost 100 percent reliability in detecting pregnancy after the first missed cycle. This test may be performed within 1 hour and is ideally suited to the clinical detection of ectopic pregnancy, especially in patients who require immediate surgical intervention. Thirteen patients with suspected ectopic pregnancy were evaluated by the radioreceptorassay, one of whom was followed with four separate determinations. The results of the assay were subsequently compared with those of hemagglutination pregnancy tests, clinical symptoms, and pathologic findings. All of the patients were diagnosed accurately by the radioreceptorassay, even when hemagglutination tests yielded a false indication of pregnancy. By this assay, the hCG levels during ectopic pregnancies are generally lower than those found during a normal intrauterine pregnancy; in addition, pregnancy may be detected much earlier (prior to the rupture) than is possible by hemagglutination tests. Furthermore, the diagnosis of ectopic pregnancy may be excluded for patients admitted to the hospital with acute abdominal emergencies

  8. 42 CFR 50.308 - Drugs and devices and termination of ectopic pregnancies.

    Science.gov (United States)

    2010-10-01

    ... pregnancies. Federal financial participation is available with respect to the cost of drugs or devices to... 42 Public Health 1 2010-10-01 2010-10-01 false Drugs and devices and termination of ectopic pregnancies. 50.308 Section 50.308 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN...

  9. Primary obturator foramen pregnancy: a case report and review of literature

    Institute of Scientific and Technical Information of China (English)

    LIN Jing-xian; LIU Qi; JU Yan; GUAN Qun; WU Yuan-zhe; ZHENG Ning

    2008-01-01

    @@ Ectopic pregnancy, in which the fertilized ovum implants on any tissue other than the endometrium, is the most common life-threatening emergency in the first trimester of pregnancy. The incidence of ectopic pregnancy is 0.25%-1.0% of all pregnancies, and has increased greatly in the last few decades, from 4.5 per 1000 pregnancies in 1970 to an estimated 19.7 per 1000 pregnancies in 1992.1 Generally more than 95% of ectopic gestations are tubal pregnancies; only 1.4% are abdominal pregnancy, of which very rare cases are retroperitoneal pregnancy.

  10. Post-traumatic stress, anxiety and depression following miscarriage or ectopic pregnancy: a prospective cohort study

    OpenAIRE

    Farren, Jessica; Jalmbrant, Maria; Ameye, Lieveke; Joash, Karen; Mitchell-Jones, Nicola; Tapp, Sophie; Timmerman, Dirk; Bourne, Tom

    2016-01-01

    Objectives This is a pilot study to investigate the type and severity of emotional distress in women after early pregnancy loss (EPL), compared with a control group with ongoing pregnancies. The secondary aim was to assess whether miscarriage or ectopic pregnancy impacted differently on the type and severity of psychological morbidity. Design This was a prospective survey study. Consecutive women were recruited between January 2012 and July 2013. We emailed women a link to a survey 1, 3 and 9...

  11. Use of ICSI in IVF cycles in women with tubal ligation does not improve pregnancy or live birth rates.

    Science.gov (United States)

    Grimstad, F W; Nangia, Ajay K; Luke, B; Stern, J E; Mak, W

    2016-12-01

    Does ICSI improve outcomes in ART cycles without male factor, specifically in couples with a history of tubal ligation as their infertility diagnosis? The use of ICSI showed no significant improvement in fertilization rate and resulted in lower pregnancy and live birth (LB) rates for women with the diagnosis of tubal ligation and no male factor. Prior studies have suggested that ICSI use does not improve fertilization, pregnancy or LB rates in couples with non-male factor infertility. However, it is unknown whether couples with tubal ligation only diagnosis and therefore iatrogenic infertility could benefit from the use of ICSI during their ART cycles. Longitudinal cohort of nationally reported cycles in the Society for Assisted Reproductive Technology Clinic Outcomes Reporting System (SART CORS) of ART cycles performed in the USA between 2004 and 2012. There was a total of 8102 first autologous fresh ART cycles from women with the diagnosis of tubal ligation only and no reported male factor in the SART database. Of these, 957 were canceled cycles and were excluded from the final analysis. The remaining cycles were categorized by the use of conventional IVF (IVF, n = 3956 cycles) or ICSI (n = 3189 cycles). The odds of fertilization, clinical intrauterine gestation (CIG) and LB were calculated by logistic regression modeling, and the adjusted odds ratios (AORs) with 95% confidence intervals were calculated by adjusting for the confounders of year of treatment, maternal age, race and ethnicity, gravidity, number of oocytes retrieved, day of embryo transfer and number of embryos transferred. The main outcome measures of the study were odds of fertilization (2PN/total oocytes), clinical intrauterine gestation (CIG/cycle) and live birth (LB/cycle). The fertilization rate was higher in the ICSI versus IVF group (57.5% vs 49.1%); however, after adjustment this trend was no longer significant (AOR 1.14, 0.97-1.35). Interestingly, both odds of CIG (AOR 0.78, 0

  12. Ectopic pregnancy: pictorial essay focusing on computed tomography and magnetic resonance imaging findings

    Energy Technology Data Exchange (ETDEWEB)

    Febronio, Eduardo Miguel; Rosas, George de Queiroz; D' Ippolito, Giuseppe [Escola Paulista de Medicina - Universidade Federal de Sao Paulo (EPM-Unifesp), Sao Paulo, SP (Brazil). Dept. of Imaging Diagnosis; Cardia, Patricia Prando, E-mail: giuseppe_dr@uol.com.br [Centro Radiologico Campinas, Campinas, SP (Brazil)

    2012-09-15

    The objective of the present study is to describe key computed tomography and magnetic resonance imaging findings in patients with acute abdominal pain caused by ectopic pregnancy. For this purpose, two radiologists consensually selected and analyzed computed tomography and magnetic resonance imaging studies performed in female patients with acute abdominal pain caused by proven ectopic pregnancy in the period between January 2010 and December 2011. The imaging diagnosis of ectopic pregnancy is usually obtained by ultrasonography, however, with the increasing use of computed tomography and magnetic resonance imaging in the assessment of patients with acute abdomen of gynecological origin it is necessary that the radiologist becomes familiar with the main findings observed at these diagnostic methods. (author)

  13. Ectopic pregnancy: pictorial essay focusing on computed tomography and magnetic resonance imaging findings

    International Nuclear Information System (INIS)

    Febronio, Eduardo Miguel; Rosas, George de Queiroz; D'Ippolito, Giuseppe

    2012-01-01

    The objective of the present study is to describe key computed tomography and magnetic resonance imaging findings in patients with acute abdominal pain caused by ectopic pregnancy. For this purpose, two radiologists consensually selected and analyzed computed tomography and magnetic resonance imaging studies performed in female patients with acute abdominal pain caused by proven ectopic pregnancy in the period between January 2010 and December 2011. The imaging diagnosis of ectopic pregnancy is usually obtained by ultrasonography, however, with the increasing use of computed tomography and magnetic resonance imaging in the assessment of patients with acute abdomen of gynecological origin it is necessary that the radiologist becomes familiar with the main findings observed at these diagnostic methods. (author)

  14. Value of intramuscular methotrexate and bilateral uterine artery embolization for treating cervical ectopic pregnancy

    International Nuclear Information System (INIS)

    Pan Feng; Xiong Bin

    2011-01-01

    Objective: To assess the clinical value of bilateral uterine artery chemotherapy embolization (UACE) for cervical ectopic pregnancy analyzed. Methods: Clinical records of 40 patients with cervical ectopic pregnancy treated using UACE were retrospectively analyzed. Results: 8 patients with severe active vaginal bleeding after curettage were treated urgently with UACE. The remaining 32 patients were treated with UACE combined with sequential ultrasound-guided curettage. Active vaginal bleeding was stopped after UACE. There was no recurrent hemorrhage with the sequential ultrasound-guided curettage procedure. The β-HCG levels of all patients were normalized after 1 month. Conclusion: Bilateral uterine artery chemotherapy embolization is valuable as emergency treatment for patients with severe vaginal bleeding from cervical ectopic pregnancy. UACE combined with sequential ultrasound-guided curettage may be more effective. (authors)

  15. Failure Rate of Single Dose Methotrexate in Managment of Ectopic Pregnancy

    Directory of Open Access Journals (Sweden)

    Feras Sendy

    2015-01-01

    Full Text Available Background. One of the treatment modalities for ectopic pregnancy is methotrexate. The purpose of this study is to identify the failure rate of methotrexate in treating patients with ectopic pregnancy as well as the risk factors leading to treatment failure. Methods. A retrospective chart review of 225 patients who received methotrexate as a primary management option for ectopic pregnancy. Failure of single dose of methotrexate was defined as drop of BHCG level less than or equal to 14% in the seventh day after administration of methotrexate. Results. 225 patients had methotrexate. Most of the patients (151 (67% received methotrexate based on the following formula: f 50 mg X body surface area. Single dose of methotrexate was successful in 72% (162/225 of the patients. 28% (63/225 were labeled as failure of single dose of methotrexate because of suboptimal drop in BhCG. 63% (40/63 of failure received a second dose of methotrexate, and 37% (23/63 underwent surgical treatment. Among patient who received initial dose of methotrexate, 71% had moderate or severe pain, and 58% had ectopic mass size of more than 4 cm on ultrasound. Conclusion. Liberal use of medical treatment of ectopic pregnancy results in 71% success rate.

  16. Failure rate of single dose methotrexate in managment of ectopic pregnancy.

    Science.gov (United States)

    Sendy, Feras; AlShehri, Eman; AlAjmi, Amani; Bamanie, Elham; Appani, Surekha; Shams, Taghreed

    2015-01-01

    Background. One of the treatment modalities for ectopic pregnancy is methotrexate. The purpose of this study is to identify the failure rate of methotrexate in treating patients with ectopic pregnancy as well as the risk factors leading to treatment failure. Methods. A retrospective chart review of 225 patients who received methotrexate as a primary management option for ectopic pregnancy. Failure of single dose of methotrexate was defined as drop of BHCG level less than or equal to 14% in the seventh day after administration of methotrexate. Results. 225 patients had methotrexate. Most of the patients (151 (67%)) received methotrexate based on the following formula: f 50 mg X body surface area. Single dose of methotrexate was successful in 72% (162/225) of the patients. 28% (63/225) were labeled as failure of single dose of methotrexate because of suboptimal drop in BhCG. 63% (40/63) of failure received a second dose of methotrexate, and 37% (23/63) underwent surgical treatment. Among patient who received initial dose of methotrexate, 71% had moderate or severe pain, and 58% had ectopic mass size of more than 4 cm on ultrasound. Conclusion. Liberal use of medical treatment of ectopic pregnancy results in 71% success rate.

  17. An appraisal of the management of ectopic pregnancy in a nigerian tertiary hospital.

    Science.gov (United States)

    Igwegbe, Ao; Eleje, Gu; Okpala, Bc

    2013-04-01

    Ectopic pregnancy has remained a significant cause of maternal morbidity and mortality especially in the sub Saharan Africa. A periodic appraisal of its management is paramount. To determine the incidence and associated risk factors, for ectopic pregnancy, review available treatment modalities and suggest interventions to reduce its prevalence, morbidity and mortality. A cross sectional study with retrolective data collection of all cases of ectopic pregnancy managed in Nnamdi Azikiwe University Teaching Hospital, Nnewi, south-east Nigeria between 1(st) January, 2002 and 31(st) December, 2011 was undertaken. Analysis was carried out using Epi-info 2008 version 3.5.1. During the study period, there were a total 98 cases of ectopic pregnancies out of 8,811 deliveries and 1884 gynecological admissions, giving an incidence of 0.9% of all attendants or 1 in 90 deliveries and 5.2% of all gynecological admissions. Only 94.9% (93/98) case files were retrieved and were used in the final analysis. The mean age of the patients was 30.1 (0.7) years while the mean gestational age at presentations was 7.4 weeks. Previous induced abortion, 37.5% (36/93) was the commonest associated risk factor, followed by pelvic infections, 35.5% (33/93). The recurrence rate was 6.5% (6/93). Majority, 80.6% (75/93) presented with abdominal pain and 35.8% (33/93) presented with vaginal bleeding. Up to 88.2% (82/93) had salpingectomy while only 2.5% (2/93) were successfully managed medically with methotrexate therapy following diagnosis with transvaginal ultrasound Missed diagnosis of ectopic pregnancy occurred in 16.1% (15/93). There was no maternal death. Ectopic pregnancy has remained an important gynecological condition in our center. The common identifiable risk factors were induced abortion and pelvic infection. Early first trimester transvaginal ultrasound should be offered to all women for early diagnosis.

  18. Analysis of tubal patency after essure placement.

    Science.gov (United States)

    Rodriguez, Ana M; Kilic, Gokhan S; Vu, Thao P; Kuo, Yong-Fang; Breitkopf, Daniel; Snyder, Russell R

    2013-01-01

    To evaluate tubal patency after hysteroscopic sterilization using the Essure microinsert (Conceptus Inc, San Carlos, CA). A retrospective longitudinal cohort study. II-3. Patients undergoing hysteroscopic sterilization in the outpatient clinic of a university-based hospital in Southeast Texas from July 2009 to November 2011. Two hundred twenty-nine women (ages 21-44 yrs, 71% Hispanic) desiring sterilization with a history of regular menses, demonstrated prior fertility (≥1 live birth), and the ability to use an alternative contraceptive method for at least 90 days after coil placement were included. Twenty six patients in this cohort were excluded because of failure to perform a hysterosalpingogram (HSG), tubal perforation, severe dyspareunia, a history of ectopic pregnancy, tubal surgery, or cervical intraepithelial neoplasia. Not applicable. HSGs were assessed for microinsert location and tubal occlusion. Two hundred three patients were included for analysis. After the successful bilateral hysteroscopic placement of Essure microinserts in fallopian tubes, all patients returned for the first follow-up HSG a mean of 103 ± 38 days after the procedure. Patients with fallopian tube patency at the initial HSG returned for second and/or third HSGs as needed at 192 ± 45 and 291 ± 97 days, respectively. Correct device placement was confirmed in 100% of cases at the first HSG. The tubal patency rates at the 90-day and 180-day HSGs were 16.1% (95% confidence interval, 7.4%-31.7%) and 5.8% (95% CI, 1.2%-24.4%), respectively. These rates were estimated by the accelerated failure time model with log normal distribution and interval censored time to event. The 16.1% 90-day tubal patency rate is significantly different from the 8% rate reported by Cooper et al in the 2003 multicenter phase III pivotal trial (p Essure results in a higher initial tubal patency rate than previously reported. Multivariate analyses are needed to identify factors associated with an increased

  19. Frozen-Thawed Embryo Transfer Cycles Have a Lower Incidence of Ectopic Pregnancy Compared With Fresh Embryo Transfer Cycles.

    Science.gov (United States)

    Zhang, Xinyu; Ma, Caihong; Wu, Zhangxin; Tao, Liyuan; Li, Rong; Liu, Ping; Qiao, Jie

    2017-01-01

    To evaluate the risk of ectopic pregnancy of embryo transfer. A retrospective cohort study on the incidence of ectopic pregnancy in fresh and frozen-thawed embryo transfer cycles from January 1 st , 2010, to January 1 st , 2015. Infertile women undergoing frozen-thawed transfer cycles or fresh transfer cycles. In-vitro fertilization, fresh embryo transfer, frozen-thawed embryo transfer, ectopic pregnancy. Ectopic pregnancy rate and clinical pregnancy rate. A total of 69 756 in vitro fertilization-embryo transfer cycles from 2010 to 2015 were analyzed, including 45 960 (65.9%) fresh and 23 796 (34.1%) frozen-thawed embryo transfer cycles. The clinical pregnancy rate per embryo transfer was slightly lower in fresh embryo transfer cycles compared with frozen-thawed embryo transfer cycles (40.8% vs 43.1%, P cycles, blastocyst transfer shows a significantly lower incidence of ectopic pregnancy (0.8% vs 1.8%, P = .002) in comparison with day 3 cleavage embryo transfer. The risk of ectopic pregnancy is lower in frozen-thawed embryo transfer cycles than fresh embryo transfer cycles, and blastocyst transfer could further decrease the ectopic pregnancy rate in frozen-thawed embryo transfer cycles.

  20. EVALUATION OF THE IMPORTANCE OF BIOCHEMICAL PARAMETERS IN RELATION TO ULTRASONOGRAPHIC FINDING IN ECTOPIC PREGNANCY DIAGNOSIS

    Directory of Open Access Journals (Sweden)

    Dragan Lončar

    2011-09-01

    Full Text Available The implantation of the fertilized egg outside the uterine cavity leads to the development of ectopic pregnancy. The incidence of ectopic pregnancy is 1/100 births. The most common place of ectopic implantation of the fertilized ovum is the oviduct (98% with predilection for the ampullar part of the Fallopian tube. The aim of this study was to determine the predictive importance of beta-hCG and progesterone concentration compared to ultrasonographic finding in the ectopic pregnancy diagnosis.We examined 24 patients with ectopic pregnancies which we divided according to the days of amenorrhea into two groups: the first group with the total of 28 patients from 16–42 days and another group of 8 patients with amenorrhea longer than 42 days. The control group was comprised of 20 patients with vital intrauterine pregnancy, gestational age of 42-52 days. Blood samples for quantitative determination of hormones were collected on three occasions after 48 hours in the forenoon time in the examined and control group of pregnant women. Ultrasonographic examinations of all pregnant women were carried out immediately after blood sampling, with the trans-vaginal approach using "make loop" option, and measurements with an accuracy of 0.1 mm.Mean values for beta-hCG range from 698-1774 mlU/ml in the first group of pregnant women, and in the second group of 1896 mlU/ml to 4410 mlU/ml with a statistically significant difference compared to the values in the control group (p <0.001. The concentration of progesterone in the first group of women ranging from 41-70 nmol/l, and in the second group of 76-94 nmol/l which is also the statistically significant difference compared to the control group (p<0.002. We have shown that ultrasonographic finding with its parameters reliably predicts the values of biochemical parameters both in normal intrauterine pregnancy and in the case of ectopic pregnancy.Embryo viability and implantation place condition the values of

  1. Successful Management of Cervical Ectopic Pregnancy with Bilateral Uterine Artery Embolization and Methotrexate

    Directory of Open Access Journals (Sweden)

    Keitaroh Takeda

    2018-01-01

    Full Text Available Cervical ectopic pregnancy (CEP is a rare form of ectopic pregnancy. Cases diagnosed early in pregnancy can be managed medically, but more advanced pregnancies often require hysterectomy. Uterine artery embolization (UAE is a novel approach to CEP for those who wish to preserve fertility. Here we present the case of a 44-year-old female with a 2-week history of vaginal bleeding and abdominal pain who was diagnosed with CEP and successfully treated with bilateral UAE (BUAE in combination with methotrexate. A 44-year-old female presented to the emergency department with a 2-week history of vaginal bleeding. Serum beta-hCG was 71,964 mIU/ml. The transvaginal ultrasound confirmed CEP. The patient was referred to obstetrics and interventional radiology and ultimately treated with BUAE and methotrexate. Symptoms resolved quickly and she was discharged after 3 days.

  2. Cesarean Scar Ectopic Pregnancy: Laparoscopic Resection and Total Scar Dehiscence Repair.

    Science.gov (United States)

    Mahgoub, Sara; Gabriele, Victor; Faller, Emilie; Langer, Bruno; Wattiez, Arnaud; Lecointre, Lise; Akladios, Cherif

    2018-02-01

    To illustrate a laparoscopic technique for the resection of cesarean scar ectopic pregnancy, associated with isthmocele repair. Case report (Canadian Task Force classification III). A tertiary referral center in Strasbourg, France. Cesarean scar pregnancy is a rare form of ectopic pregnancy. The major risk of this type of pregnancy is the early uterine rupture with massive, sometimes life-threatening, bleeding. Thus, active management of these pregnancies starting immediately after diagnosis is crucial. Therapeutic options can be medical, surgical, or a combination. Numerous case reports or case series can be found in the literature, but there are few clinical studies, which are difficult to conduct because of case rarity and inconclusiveness. A 2016 meta-analysis that included 194 articles published between 1978 and 2014 (126 case reports, 45 cases series, and 23 clinical studies) concluded that hysteroscopy or laparoscopic hysterotomy seems to be the best first-line approach to treating cesarean scar ectopic pregnancy, with uterine artery embolization reserved for significant bleeding and/or a high suspicion index for arteriovenous malformation [1]. There is no consensus on the treatment of reference, however. The case involves a 38-year-old primiparous women who underwent a cesarean section delivery in 2010 and who was diagnosed by ultrasound scan at 7 weeks gestation with cesarean scar ectopic pregnancy, which was confirmed by pelvic magnetic resonance imaging. The patient initially received medical treatment with 2 intramuscular injections of methotrexate and one local intragestational injection of KCl. Her initial human chorionic gonadotropin (hCG) level was 82 000 IU/L. Rigorous weekly biological and ultrasound monitoring revealed an involution of the ectopic pregnancy associated with decreasing hCG. No bleeding or infectious complications occurred during this period. After 10 weeks of monitoring, her hCG had stabilized at 300 IU/L, and a residual image

  3. Retroperitoneal ectopic pregnancy: a case report and review of the literature.

    Science.gov (United States)

    Yang, Man; Cidan, Lamu; Zhang, Dan

    2017-10-16

    Retroperitoneal ectopic pregnancy (REP) is an extremely rare type of ectopic pregnancy, with a total of less than 20 cases reported in the English literature. However, failure to recognize REP may result in severe consequences. We report a case of 32-year-old woman with REP. She had amenorrhea, left lower abdominal pain, but no vaginal bleeding. Her urine human chorionic gonadotropin (HCG) test was positive and blood HCG level was 1880 m-international units per milliliter (mIU/mL). Transvaginal ultrasound sonography showed a left adnexal mass. Laparoscopy found an enlarged uterus, normal right uterine tube and ovary, and normal left uterine tube. The left ovary was partly covered by a blood clot, but appeared normal after removing the clot. There was a 10-mm circular peritoneal defect located lateral to the left sacrocervical ligament, anterior to the left ovarian fossa, and next to the lower edge of the left broad ligament. The patient was diagnosed of having REP with the gestational tissues covered by the peritoneum. The REP was removed by laparoscopic surgery. Bleeding was stopped by bipolar coagulation and absorbable hemostatic cellulose. The patient recovered smoothly and was discharged on the next day after surgery. Her blood HCG returned to normal range 29 days after surgery. REP is very rare, but in any suspected case of ectopic pregnancy, caution must be paid to find signs of REP when the common sites of ectopic pregnancy do not have any positive findings.

  4. Clinical Study of Ectopic Pregnancy in a Tertiary Care Hospital in Nepal

    Directory of Open Access Journals (Sweden)

    Narinder Kaur

    2014-12-01

    seventh postoperative day. Conclusion: Ectopic pregnancy can be suspected clinically by history and associated risk factors. Women presenting with acute pain abdomen with a positive urine β-hCG test should be promptly diagnosed and treated without undue delay to reduce maternal morbidity and mortality.

  5. Ectopic Pregnancy: A 5 Year Review of Cases at Nnamdi Azikiwe ...

    African Journals Online (AJOL)

    Background: Ruptured ectopic pregnancy continues to be a common life threatening emergency in our environment as well as a public health problem. Objective: This is to study the incidence, clinical presentation, risk factors and the management of cases that presented in our centre over a five year period. Methods: This is ...

  6. RISK FACTOR EPIDEMIOLOGY OF ECTOPIC PREGNANCY AND SUCCESS OF NONSURGICAL MANAGEMENT

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    Vijayan C.P

    2016-10-01

    Full Text Available BACKGROUND Ectopic pregnancies are increasing in number and proportions. Real increase and better detection methods are contributing for this rise. All the cases diagnosed now are not surgical emergencies. Medical management and expectant line of management are possible. Revised clinical guidelines are there for the selection of cases for nonsurgical management. Knowledge about the risk factors is good for prophylaxis and to have a high suspicion about ectopic pregnancy in high-risk individuals. Knowing the success rate is absolutely essential for counselling before starting the therapy. Aim of the study- 1. To study the risk factor profile of ectopic pregnancies and to compare them with the old data of the study setting. 2. To follow up the cases receiving nonsurgical treatment and to assess the success rate. MATERIALS AND METHODS Study Setting- Department of Obstetrics and Gynaecology, Government Medical College, Kottayam. It is a tertiary care centre with 1500 beds and catering for the population of five districts of Kerala. Study Design- Observational Study Study Period- This study was completed by eighteen months from April 2014 to September 2015. RESULTS 219 cases of ectopic pregnancies were diagnosed during the study period. The ratio of this number with the total number of deliveries during that period is 3.48% and this is three times higher than that of the ratio twenty years ago (1.23%. Risk factor profile is also showing changes over this period. 15.1% had medical treatment and 11% had expectant line of therapy. Success rates are 87.87% and 95.65%, respectively. CONCLUSIONS Incidence and detection of ectopic pregnancies are increasing and the risk factor profile is changing. In properly selected cases, the success of nonsurgical management is excellent.

  7. Primary omental pregnancy

    International Nuclear Information System (INIS)

    Yildizhan, R.; Kurdoglu, M.; Kolusari, A.; Erten, R.

    2008-01-01

    Omental pregnancy is a rare form of ectopic pregnancy and can be seen primarily or secondary to a tubal pregnancy. A 25-yeal-old woman presented with abdominal distention with pain and anemia without vaginal bleeding. After a provisional diagnosis of ruptured ectopic pregnancy, laparotomy was performed. On surgical exploration, the bilateral tubes and ovaries were intact, however, an omental pregnancy was detected as the cause of hemoperitoneum. Partial omentectomy was performed. Although most cases are secondary, presented here is an additional case of primary omental pregnancy at 12 weeks according to Studdiford's criteria. Histological evidence of neovascularization into the supporting tissue confirmed our diagnosis. A primary omental pregnancy should always be considered as a possible explanation for severe hemoperitoneum in ectopic pregnancies presenting with acute abdomen and with intact adnexes on surgical exploration. (author)

  8. Management of interstitial ectopic pregnancies with a combined intra-amniotic and systemic approach.

    Science.gov (United States)

    Swank, Morgan L; Harken, Tabetha R; Porto, Manuel

    2013-08-01

    Approximately 2% of all pregnancies are ectopic; of these, 4% are interstitial or cervical. There exists no clear consensus as to whether surgical or medical management is superior. We present three cases of advanced nonfallopian tube ectopic pregnancies from 6 to 8 weeks of gestation. Our first two cases were managed with a combined intrafetal, intra-amniotic and systemic approach using methotrexate and potassium chloride, whereas our third case was managed with an intra-amniotic approach alone. Our combined approach cases were successful, with resolution of human chorionic gonadotropin in 50 and 34 days, whereas our single approach case re-presented with bleeding requiring uterine artery embolization and operative removal of products of conception. Patients presenting with advanced interstitial or cervical pregnancies who are clinically stable can be offered medical management with a combined approach.

  9. Superselective uterine arterial infusion and embolization in the treatment of ectopic pregnancies of 56 cases

    International Nuclear Information System (INIS)

    Han Chaolin; Li Changfu; Zhang Yanhua; Liu Feng; Guan Yafang; Liu Zhen; Wang Weibo; Niu Haijuan

    2008-01-01

    Objective: To probe a simple, safe, and minimally invasive method to treat ectopic pregnancy with preservation of the organs. Methods: Superselective catheterization of uterine artery through cannulation of right femoral artery was achieved in 56 patients with ectopic pregnancy. Location of the lesions involved, feeding arteries, and active bleeding were observed on angiography. 150 mg of methylamine neopterin diluted in 100 ml of saline water was infused slowly into the target artery. Small gelatin spongy particles with size of 0.5 mm in diameter were used to embolize the uterine artery until its branches were totally obliterated. Follow-up was undertaken to observe the results of the treatment. Results: Superselective uterine arterial infusion and embolization were successfully performed in all 56 patients without any related complications. Active bleeding in the peritoneum in 33 eases ceased soon after embolization. The embryos in 13 patients were confirmed to have died by ultrasound two days after the procedure. Beta-HCG value dropped to below 5 U/L within two to twelve days. Hemorrhage in the peritoneum dissolved after seven days in all cases. Mixed mass disappeared after one month. Histerosalpingography was performed three months after the procedure in 19 patients and patent fallopians were demonstrated in 11 patients. Conclusions: Superselective uterine arterial infusion and embolization is a minimally invasive procedure, which can be used to effectively treat ectopic pregnancy by disabling the ectopic embryo and embolizing leaking arteries with the advantages of preserving the fallopian tubes. (authors)

  10. A rare presentation of ruptured interstitial ectopic pregnancy with broad ligament hematoma: A case report

    Directory of Open Access Journals (Sweden)

    Ahmed M. Abbas

    2017-03-01

    Full Text Available Ectopic pregnancy is a major cause of maternal morbidity and mortality in the first trimester. Interstitial type is the most dangerous variety with a high risk of life-threatening internal hemorrhage. Obstetricians need a high index of suspicion to diagnose such rare type. We are reporting a rare case of ruptured interstitial ectopic pregnancy presented with a large broad ligament hematoma early in the first trimester. A 25-year-old woman was presented with gradual onset of increasing abdominal pain after 6 weeks of amenorrhea. She had a positive urinary pregnancy test. Abdominal ultrasound revealed bulky empty uterus and ill-defined mass at the right side of the uterus. On exploration, incision and drainage of broad ligament hematoma were performed in addition to right salpingectomy. Interstitial ectopic pregnancy represents a diagnostic and therapeutic challenge and frequently constitutes an obstetrical emergency. Its rupture early in the first trimester should be expected. Early diagnosis and proper management are the most important issues to avoid its catastrophic consequences.

  11. Vinorelbine Potently Induces Placental Cell Death, Does Not Harm Fertility and is a Potential Treatment for Ectopic Pregnancy

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    Roxanne Hastie

    2018-03-01

    Full Text Available Ectopic pregnancies complicate 1–2 pregnancies and are a leading cause of maternal death. An effective oral drug therapy that replaces surgery might make its treatment safer, cheaper, simpler and therefore more widely accessible. The only current medical treatment offered to women is intramuscular methotrexate, but this only reliably resolves smaller ectopic pregnancies. As such, many ectopic pregnancies require surgical excision. We show that vinorelbine, an orally available chemotherapeutic agent, potently induced placental cell death but did not harm fertility in mice. Vinorelbine was 100–1000 times more potent than methotrexate in inducing placental cell death in vitro, and more potent than combination methotrexate and gefitinib (another proposed treatment for ectopic pregnancy being evaluated in phase III trials. Mechanistically, it caused microtubule condensation, blocked mitosis and activated the apoptosis cascade in placental cells. Vinorelbine was more efficacious than methotrexate ± gefitinib in reducing the volume of placental cell tumors xenografted subcutaneously in SCID mice. Mice exposed to vinorelbine and allowed to breed, following a four week washout period, displayed normal fertility, however long-term fertility was not assessed. Human Fallopian tubes treated with vinorelbine did not exhibit up-regulation of apoptosis molecules. Our findings show that placental cells appear sensitive to vinorelbine and it has potential as a tablet-only approach to treat ectopic pregnancy. Keywords: Ectopic pregnancy, Vinorelbine, Methotrexate, Placenta, Treatment

  12. A Combination of Surgery And Methotrexate for Successful Treatment of a Caesarean Scar Ectopic Pregnancy.

    LENUS (Irish Health Repository)

    Tadesse, WG

    2018-06-01

    Caesarean scar ectopic pregnancy (CSEP) is one of the rarest forms of ectopic pregnancies. With rising caesarean delivery (CD) rates worldwide, there is an increase in the incidence of CSEP. Patients usually present with painless vaginal bleeding and often misdiagnosed as spontaneous miscarriage. The use of ultrasonography with colour flow Doppler helps in the differential diagnosis. Different treatment options are described in the literature, although there is insufficient evidence regarding the best approach. We report the diagnosis and management of a case of CSEP in a woman with four previous CD who presented with vaginal bleeding and lower abdominal cramps at six weeks of gestation. She was treated with laparoscopic and ultrasound guided aspiration of the gestational sac and local injection of methotrexate supplemented by intramuscular methotrexate injection.

  13. Clinical effectiveness of multiple-drug injection treatment in unruptured ectopic pregnancies: a retrospective study.

    Science.gov (United States)

    Dai, Quan; Wang, Lu-Lu; Shao, Xiao-Hui; Wang, Si-Ming; Dong, Xiao-Qiu

    2012-10-01

    To study the effect of local interventional treatment of unruptured ectopic pregnancies with multiple-drug injection guided by color Doppler sonography. In this retrospective analysis, 49 patients with an unruptured ectopic pregnancy were treated with two different local injection methods administered under sonographic guidance. The patients were divided into single-drug (n = 23) and multiple-drug (n = 26) injection groups, and they received a locally administered injection of methotrexate alone or a combination including methotrexate, hemocoagulase, antibiotics, and anti-inflammatory drugs, respectively. Overall, local injection treatment was successful in 44 patients. The 5 patients with failed treatment underwent laparotomy about 1 week after single-drug injection. Serum β-human chorionic gonadotropin (β-hCG ) levels, ectopic pregnancy mass sizes, blood flow at various points after treatment, the incidence of pelvic bleeding, and the time for serum β-hCG levels to return to normal and the mass to resolve were analyzed in the remaining 44 patients. Single-drug treatment was successful in 18 patients; 10 of 23 had low to moderate pelvic bleeding after treatment, and 5 were referred for surgery. All 26 patients were successfully treated by multiple-drug injection. Only 2 patients had a small amount of pelvic bleeding. Differences between groups were statistically significant (P injection under color Doppler guidance is a new, safe, and effective method for treating unruptured ectopic pregnancies. It accelerates the serum β-hCG decline and facilitates mass resolution. This regimen is associated with a very low rate of pelvic bleeding, improves the success rate of conservative treatment, and, therefore, has value as an important clinical application.

  14. Ectopic pregnancy among American Indian and Alaska Native women, 2002-2009.

    Science.gov (United States)

    de Ravello, Lori; Folkema, Arianne; Tulloch, Scott; Taylor, Melanie; Reilley, Brigg; Hoover, Karen; Holman, Robert; Creanga, Andreea

    2015-04-01

    To examine rates of ectopic pregnancy (EP) among American Indian and Alaska Native (AI/AN) women aged 15-44 years seeking care at Indian Health Service (IHS), Tribal, and urban Indian health facilities during 2002-2009. We used 2002-2009 inpatient and outpatient data from the IHS National Patient Information Reporting System to identify EP-associated visits and obtain the number of pregnancies among AI/AN women. Repeat visits for the same EP were determined by calculating the interval between visits; if more than 90 days between visits, the visit was considered related to a new EP. We identified 229,986 pregnancies among AI/AN women 15-44 years receiving care at IHS-affiliated facilities during 2002-2009. Of these, 2,406 (1.05 %) were coded as EPs, corresponding to an average annual rate of 10.5 per 1,000 pregnancies. The EP rate among AI/AN women was lowest in the 15-19 years age group (5.5 EPs per 1,000 pregnancies) and highest among 35-39 year olds (18.7 EPs per 1,000 pregnancies). EP rates varied by geographic region, ranging between 6.9 and 24.4 per 1,000 pregnancies in the Northern Plains East and the East region, respectively. The percentage of ectopic pregnancies found among AI/AN women is within the national 1-2 % range. We found relatively stable annual rates of EP among AI/AN women receiving care at IHS-affiliated facilities during 2002-2009, but considerable variation by age group and geographic region. Coupling timely diagnosis and management with public health interventions focused on tobacco use and sexually transmitted diseases may provide opportunities for reducing EP and EP-associated complications among AI/AN women.

  15. Ectopic Pregnancy Among American Indian and Alaska Native Women, 2002–2009

    Science.gov (United States)

    Folkema, Arianne; Tulloch, Scott; Taylor, Melanie; Reilley, Brigg; Hoover, Karen; Holman, Robert; Creanga, Andreea

    2015-01-01

    To examine rates of ectopic pregnancy (EP) among American Indian and Alaska Native (AI/AN) women aged 15–44 years seeking care at Indian Health Service (IHS), Tribal, and urban Indian health facilities during 2002–2009. We used 2002–2009 inpatient and outpatient data from the IHS National Patient Information Reporting System to identify EP-associated visits and obtain the number of pregnancies among AI/AN women. Repeat visits for the same EP were determined by calculating the interval between visits; if more than 90 days between visits, the visit was considered related to a new EP. We identified 229,986 pregnancies among AI/AN women 15–44 years receiving care at IHS-affiliated facilities during 2002–2009. Of these, 2,406 (1.05 %) were coded as EPs, corresponding to an average annual rate of 10.5 per 1,000 pregnancies. The EP rate among AI/AN women was lowest in the 15–19 years age group (5.5 EPs per 1,000 pregnancies) and highest among 35–39 year olds (18.7 EPs per 1,000 pregnancies). EP rates varied by geographic region, ranging between 6.9 and 24.4 per 1,000 pregnancies in the Northern Plains East and the East region, respectively. The percentage of ectopic pregnancies found among AI/AN women is within the national 1–2 % range. We found relatively stable annual rates of EP among AI/AN women receiving care at IHS-affiliated facilities during 2002–2009, but considerable variation by age group and geographic region. Coupling timely diagnosis and management with public health interventions focused on tobacco use and sexually transmitted diseases may provide opportunities for reducing EP and EP-associated complications among AI/AN women. PMID:25023759

  16. Laparoscopic Management of Sclerosing Stromal Tumors of the Ovary Combined with Ectopic Pregnancy.

    Science.gov (United States)

    Liu, Hua-Qian; Liu, Qiang; Sun, Xue-Bing; Chang, Wen-Min

    2015-01-01

    Like other stromal-derived gynecological tumors, a sclerosing stromal tumor of the ovary (SSTO) is a rare benign tumor that is difficult to distinguish from a malignant ovarian tumor in clinical practice. An SSTO is routinely treated with laparotomy. Here, we present two extremely rare cases of SSTO with contralateral and ipsilateral tubal pregnancies, in which laparoscopic surgery was performed to remove the tumors. After surgery, one patient (case 1) became pregnant twice within 29 months, and the other patient (case 2) did not become pregnant within 6 months postoperatively. These two cases suggest that laparoscopic management is not only useful in treating SSTO and complicating diseases, but it may also help to reduce unnecessary surgical injury to the ovary. © 2015 S. Karger AG, Basel.

  17. Bilateral Tubal Gestation Associated with Schistosomiasis in an African Woman

    Directory of Open Access Journals (Sweden)

    K. H. Odubamowo

    2014-01-01

    Full Text Available Background. The incidence of tubal ectopic gestation caused by schistosomiasis induced tubal pathology is undocumented in this environment, which may be due to rarity of this pathology. Bilateral tubal gestation is common in patients that have undergone in vitro fertilization. We report a hitherto undocumented case of spontaneous bilateral ectopic gestation following tubal schistosomiasis. Case Report. Mrs. OB was a 32-year-old G4P3+0 (3 alive woman who complained of abdominal pain and bleeding per vaginam of 4 and 2 days’ duration respectively following 8 weeks of amenorrhea. A clinical impression of ruptured ectopic gestation was confirmed by ultrasound scanning. She had bilateral salpingectomy with histology of specimens showing bilateral ectopic gestation with Schistosoma haematobium induced salpingitis (findings of Schistosoma haematobium ova noted on slide. Conclusion. Schistosoma induced salpingitis is a rare but possible cause of bilateral tubal gestation.

  18. Ruptured Tubal Triplet Heterotopic Pregnancy After in Vitro Fertilisation: A Case Report

    Directory of Open Access Journals (Sweden)

    Mehmet Osmanağaoğlu

    2011-12-01

    tube. A left total salpingectomy was performed. Postoperative recovery was uneventful and the patient was discharged on postoperative day 3 in good condition. She was following up in the antenatal unit and the twin pregnancy is progressing normally. Heterotopic pregnancies are rare but life-threatening conditions, therefore it should be kept it in mind when a pregnant woman who underwent IVF-ET, presents low abdominal pain.

  19. The value of combined detection of serum β-HCG and progesterone in diagnosis of early ectopic pregnancy

    International Nuclear Information System (INIS)

    Lu Yanting; Wang Taisong

    2011-01-01

    To explore the value of combined detection of serum β-HCG and P in diagnosis of early ectopic pregnancy and expectant therapeutic efficacy. Serum levels of β-HCG and P of 324 patients with early ectopic pregnancy and 146 normal early pregnant women were determined and compared by RIA, Serum β-HCG and P were compared between before and after treatment. The required time when serum β-HCG and P decreased to the normal rang of the patients treated successfully were observed respectively. The results showed that the serum β-HCG and P value in ectopic pregnancy group were significantly lower than those in intrauterine gestation group (P<0.05). The variation of P was significant between success and failure groups of drug conservative treatment, but β-HCG had no significant difference. The required time when serum P decreased to the normal was significantly less than the serum β-HCG dropped to normal. Combined detection of serum levels of β-HCG and P is an adjunctive method to diagnose early ectopic pregnancy, so it giants opportunity for treatment of early ectopic pregnancy and is of positive clinical application value for observation therapeutic effect and prognosis of the disease. P values may be one of the more important reference index to predict whether conservative treatment is successful or not than β-HCG. (authors)

  20. Implementation Study of Patient-Ready Syringes Containing 25 mg/mL Methotrexate Solution for Use in Treating Ectopic Pregnancy

    Directory of Open Access Journals (Sweden)

    R. Respaud

    2014-01-01

    Full Text Available Background. Ectopic pregnancy (EP is a significant cause of morbidity and mortality during the first trimester of pregnancy. Small unruptured tubal pregnancies can be treated medically with a single dose of methotrexate (MTX. Objective. The aim of this study was to evaluate the stability of a 25 mg/mL solution of MTX to devise a secure delivery circuit for the preparation and use of this medication in the management of EP. Method. MTX solutions were packaged in polypropylene syringes, stored over an 84-day period, and protected from light either at +2 to +8°C or at 23°C. We assessed the physical and chemical stability of the solutions at various time points over the storage period. A pharmaceutical delivery circuit was implemented that involved the batch preparation of MTX syringes. Results. We show that 25 mg/mL MTX solutions remain stable over an 84-day period under the storage conditions tested. Standard doses were prepared, ranging from 50 mg to 100 mg. The results of this study suggest that MTX syringes can be prepared in advance by the pharmacy, ready to be dispensed at any time that a diagnosis of EP is made. Conclusion. The high stability of a 25 mg/mL MTX solution in polypropylene syringes makes it possible to implement a flexible and cost-effective delivery circuit for ready-to-use preparations of this drug, providing 24-hour access and preventing treatment delays.

  1. Role of sonography in the recognition, assessment, and treatment of cesarean scar ectopic pregnancies.

    Science.gov (United States)

    McKenna, David A; Poder, Liina; Goldman, Mindy; Goldstein, Ruth B

    2008-05-01

    Cesarean scar ectopic pregnancies (CSEPs) are rare but may have serious adverse consequences and are therefore important to promptly recognize on sonography. We aim to describe the typical sonographic appearances. Potential treatments are discussed, including sonographic guidance for transcervical injection of methotrexate (MTX) into the gestational sac. Two patients with CSEPs were treated with systemic and intra-amniotic administration of MTX under sonographic guidance. Both patients were followed clinically after medical treatment, resulting in low maternal morbidity and mortality. Considering the increasing rate of cesarean delivery and the increased risk of CSEPs, sonologists should be familiar with the sonographic appearances of a pregnancy implanted into the cesarean scar. We show how to correctly diagnose scar implantation and describe how to perform sonographically guided transcervical injection of MTX.

  2. Gestational Tubal Choriocarcinoma Presenting as a Pregnancy of Unknown Location following Ovarian Induction

    Directory of Open Access Journals (Sweden)

    Lawrence Hsu Lin

    2018-01-01

    Full Text Available The management of pregnancy of unknown location (PUL can be a challenging situation, since it can present as several different conditions. Here we describe a rare case of gestational choriocarcinoma arising in the fallopian tube after ovarian induction in an infertile patient. The patient received clomiphene for ovarian induction and had rising levels of human chorionic gonadotropin (hCG over nine months without sign of pregnancy. After referral to our center, the patient was diagnosed with a paraovarian tumor, which revealed a gestational choriocarcinoma arising in the fallopian tube; the final diagnosis was supported by pathological and cytogenomic analysis. Malignancies, such as gestational trophoblastic disease, should be in the differential diagnosis of PUL; the early recognition of these conditions is key for the proper treatment and favorable outcome.

  3. The treatment of tubal pregnancy by interventional technique through uterine artery

    International Nuclear Information System (INIS)

    Li Lizhao; Zhang Yonghui; Chen Zhu; Ge Xiaobing; Li Jiehua

    2004-01-01

    Objective: To study the feasibility and the clinical effect of the treatment of tubule pregnancy by using interventional technique through selective uterine artery. Methods: By using seldinger's method, 48 cases received interventional treatment, followed by perfusion of methotrexate (MTX) 100 mg through Tube 4-5 F. The concentration of serum β-HCG, the changes of pelvic cavity, and the open condition of amnion by ultrasonic examination. Results: The cure rate of 47 cases was 97.92%. No serious reaction. After treatment, the mean time that the serum β-HCG concentration returned to normal was 14-28 days and the mean time was 18 days. Conclusion: The treatment of tubule pregnancy by interventional technique proved no harmful effect to reproductive organs and quick recovery. It is worth spreading

  4. Diagnostic accuracy of serum activin A in detection of ectopic pregnancy

    Directory of Open Access Journals (Sweden)

    Mohammad Ali Roghaei

    2012-01-01

    Full Text Available Background: Ectopic pregnancy (EP still remains a main cause of maternal mortalities. This study is designed to evaluate the accuracy of serum Activin A in detection of ectopic pregnancy. Methods : This prospective observational study was conducted from 2009 to 2010 at two main referral university hospitals, Isfahan University of Medical Sciences, Isfahan, Iran. Two hundred subjects who were under 10 week′s pregnancy with clinical presentations of abdominal pain and vaginal bleeding were enrolled. After sampling serum Activin A, patients underwent ultrasonography, titer of B-HCG and surgery (if indicated and were divided into two groups: EP (n = 100 and intrauterine pregnancy (IUP (n = 100. The mean of Activin A was compared between groups and by ROC curve, the optimal cut off with sensitivity, specificity, positive predictive value (PPV and negative predictive value (NPV were determined. Results : The mean age of women with IUP was 25.4 ± 4.3 years (15-40 years compared with 25.9 ± 4.1 years in women in EP group (P = 0.448. Statistical difference was not found between EP versus IUP groups in gestational age (6.32 ± 1.03 vs. 6.85 ± 1.82 weeks, P = 0.124. The mean of serum Activin A in EP group was 0.264 ± 0.0703 ng/ml versus 0.949 ± 0.5283 ng/ml in IUP group (P < 0.05. According to ROC curve (area under the curve = 0.981, P < 0.05, confidence interval: 0.961-1.000, the optimal cut off was estimated as 0.504 ng/ml with sensitivity of 97% and specificity of 93.5%. Conclusion : This study indicated that the mean of serum Activin A is lower in EP compared with IUP. The serum Activin A has a fair accuracy in detecting EP.

  5. Influence of embryo culture medium on incidence of ectopic pregnancy in in vitro fertilization.

    Science.gov (United States)

    Lin, Shengli; Li, Rong; Zheng, Xiaoying; Chi, Hongbin; Ren, Xiulian; Yang, Rui; Liu, Ping; Qiao, Jie

    2015-12-01

    To explore the effect of type of media used to culture embryos for IVF on the incidence of ectopic pregnancy (EP). Retrospective analysis. University-affiliated IVF center. The retrospective analysis involved 23,481 women who underwent IVF-ET cycles between 2011 and 2013. None. There was an association between EP and the culture medium. During 23,481 fresh transfer cycles, 364 patients were diagnosed with EP. The EP to clinical pregnancy rate was 3.01% in the G5 group, 3.89% in the G5 Plus group, and 4.04% in the Global group. The EP to clinical pregnancy rates were significantly higher in the G5 Plus and Global groups than in the G5 group. After adjusting for confounding factors, the incidence of EP was significantly associated with the G5 Plus and Global media. Our results showed that there is an association between incidence of EP and the culture medium. The rates of EP to clinical pregnancy were significantly higher in the G5 Plus and Global media than in the G5 medium. Copyright © 2015 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  6. [Ectopic pregnancy at the Ignace Deen University Hospital in Conakry: epidemiologic, social, demographic, therapeutic, and prognostic aspects].

    Science.gov (United States)

    Baldé, I S; Diallo, F B; Conté, I; Diallo, M H; Sylla, I; Diallo, B S; Diallo, T S; Sy, T

    2014-01-01

    The objectives of this study were to calculate the frequency of ectopic pregnancy in the department, define its epidemiological, diagnostic, therapeutic, and prognostic aspects, and determine a clear therapeutic approach appropriate to our setting. In this prospective study, we compiled all cases of ectopic pregnancy seen in 2011 and 2012 in the obstetrics-gynecology department at Ignace Deen University Hospital in Conakry. Ectopic pregnancies represented 1.3% of all deliveries over this period. In the 111 cases in this population, women aged 30-34 years accounted for 31.5%, those pregnant for the first time 40.5%, nulliparous women 35.1%, married women 72.1%, those without schooling 43.2%), and those with a history of sexually transmitted infection 57.6% (these categories are not exclusive, and the same women may be included in several). Secondary amenorrhea with abdominopelvic pain and metrorrhagia was the reason for admission in 56.5% of cases. Ultrasound in early pregnancy is infrequent in Conakry. Almost all of our patients underwent emergency surgery (80.2%) More than half of the ectopic pregnancies were located in the ampulla of the uterine tubes (73.0%). There were three abdominal pregnancies and 2 ovarian. In all cases the treatment was surgical, most often salpingectomy. Postoperative complications occurred in 35.1% of cases, most often anemia (27.9% of all cases) requiring blood transfusion in 11.7% of all cases before, during, or after surgery. The maternal death rate was 1.8%. Ectopic pregnancy remains a major concern at Ignace Deen CHU. Reduction of its frequency requires increased population awareness of sexually transmitted infections and illegal abortions. Management should be prompt and appropriate.

  7. Ovarian ectopic pregnancy: diagnosis, treatment, correlation to Carnegie stage 16 and review based on a clinical case.

    Science.gov (United States)

    Kraemer, Bernhard; Kraemer, Elizabeth; Guengoer, Ersin; Juhasz-Boess, Ingolf; Solomayer, Erich-Franz; Wallwiener, Diethelm; Rajab, Taufiek Konrad

    2009-07-01

    To present a case of a vital ectopic pregnancy after 8 weeks that was located in the right ovary. Case study and literature review. Hospital outpatient clinic. A 29-year-old primigravida presented with lower abdominal pain and mild vaginal bleeding at 8 weeks after her last menstrual period. Wedge resection of the ovary which did not affect subsequent fertility. Conservative treatment options and preservation of patient's reproductive capacity. The embryo was laparoscopically removed in toto and visualized. Therefore, macroscopic correlation to Carnegie stage 16 of development was possible. Approximately 3% of all ectopic pregnancies are located in the ovaries. Preoperative diagnosis of this extremely rare condition is challenging, because the ectopic tumor often resembles cysts of the corpus luteum. At surgery, the trophoblast tissue or the embryo can rarely be visualized completely.

  8. The Regulation of Nitric Oxide Synthase Isoform Expression in Mouse and Human Fallopian Tubes: Potential Insights for Ectopic Pregnancy

    Directory of Open Access Journals (Sweden)

    Junting Hu

    2014-12-01

    Full Text Available Nitric oxide (NO is highly unstable and has a half-life of seconds in buffer solutions. It is synthesized by NO-synthase (NOS, which has been found to exist in the following three isoforms: neuro nitric oxide synthase (nNOS, inducible nitric oxide synthase (iNOS, and endothelial nitric oxide synthase (eNOS. NOS activity is localized in the reproductive tracts of many species, although direct evidence for NOS isoforms in the Fallopian tubes of mice is still lacking. In the present study, we investigated the expression and regulation of NOS isoforms in the mouse and human Fallopian tubes during the estrous and menstrual cycles, respectively. We also measured isoform expression in humans with ectopic pregnancy and in mice treated with lipopolysaccharide (LPS. Our results confirmed the presence of different NOS isoforms in the mouse and human Fallopian tubes during different stages of the estrous and menstrual cycles and showed that iNOS expression increased in the Fallopian tubes of women with ectopic pregnancy and in LPS-treated mice. Elevated iNOS activity might influence ovulation, cilia beats, contractility, and embryo transportation in such a manner as to increase the risk of ectopic pregnancy. This study has provided morphological and molecular evidence that NOS isoforms are present and active in the human and mouse Fallopian tubes and suggests that iNOS might play an important role in both the reproductive cycle and infection-induced ectopic pregnancies.

  9. Face and Construct Validity of the SimSurgery SEP VR Simulator for Salpingectomy in Case of Ectopic Pregnancy

    NARCIS (Netherlands)

    Hessel, M.; Buzink, S.N.; Schoot, B.C.; Jakimowicz, J.J.

    2012-01-01

    Objective: To secure patient safety, skills needed for laparoscopy are preferably obtained in a non-patient setting. Therefore, we assessed face and construct validity of performance of a salpingectomy in case of ectopic pregnancy on the SimSurgery SEP VR simulator. Materials and Methods: Fifteen

  10. The METEX study: Methotrexate versus expectant management in women with ectopic pregnancy: A randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Visser Harry

    2008-06-01

    Full Text Available Abstract Background Patients with ectopic pregnancy (EP and low serum hCG concentrations and women with a pregnancy of unknown location (PUL and plateauing serum hCG levels are commonly treated with systemic methotrexate (MTX. However, there is no evidence that treatment in these particular subgroups of women is necessary as many of these early EPs may resolve spontaneously. The aim of this study is whether expectant management in women with EP or PUL and with low but plateauing serum hCG concentrations is an alternative to MTX treatment in terms of treatment success, future pregnancy, health related quality of life and costs. Methods/Design A multicentre randomised controlled trial in The Netherlands. Hemodynamically stable patients with an EP visible on transvaginal ultrasound and a plateauing serum hCG concentration Discussion This trial will provide guidance on the present management dilemmas in women with EPs and PULs with low and plateauing serum hCG concentrations. Trial registration Current Controlled Trials ISRCTN 48210491

  11. An evaluation of sodium hyaluronate in preventing recurrence of tubal obstruction after interventional recanalization

    International Nuclear Information System (INIS)

    Chen Hanwei; Cao Xiaoying; Hu Peiling; Liu Haiying; Tang Yukuan; Xiao Chengjiang

    2004-01-01

    Objective: To evaluate the efficacy and application of sodium hyaluronate in preventing the recurrence of tubal obstruction after interventional recanalization. Methods: In total 103 cases of the study group were injected sodium hyaluronate to prevent tubal adhering obstruction after successful recanalization, while in the control group 206 cases were injected desamethasone, alphacutanee, metronidazole and gentamycin for the same purpose. Both groups were followed up in 2-3 months after the initial intervention. The assessments included water insufflation, intrauterine pregnancy rate, ectopic pregnancy rate and the normal labor. Results: In the study group, 190 tubes in 103 cases were obstructed, 27 tubes missing, and 188 tubes were recanalized out of 190 (99%). In the control group 390 tubes were obstructed, 27 tubes missing, 385 tubes were successfully recanalized (99%). In the 2-3 month follow up water insufflation showed satisfying patency in 99 cases in the study group, and in 178 cases in the control group. Significant difference of recurrence rate of tubal obstruction was found between the two groups. Conclusion: Sodium hyaluronate is effective to prevent the recurrence of tubal obstruction after interventional recanalization

  12. Persistent ectopic pregnancy after linear salpingotomy: a non-predictable complication to conservative surgery for tubal gestation

    DEFF Research Database (Denmark)

    Lund, Claus Otto; Nilas, Lisbeth; Bangsgaard, Nannie

    2002-01-01

    CG levels had a low diagnostic sensitivity (0.38-0.66) and specificity (0.74-0.77) for predicting PEP. In multivariate logistic analysis, none of the following clinical variables were predictive of PEP: duration of surgery, laparoscopic approach, history of previous EP, history of previous lower abdominal...

  13. Effect of different ectopic pregnancy treatments on cryopreserved embryo transfer outcomes: A retrospective cohort study

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    Bingqian Zhang

    2017-08-01

    Conclusion: There was no significant difference among EP treatment methods with regard to their impacts on CET outcomes in women with EP histories. Bilateral tubal ligation or removal surgery can decrease the miscarriage rate after CET.

  14. risk factors for abnormal tubal hysterosalpingographic findings

    African Journals Online (AJOL)

    Administrator

    So many presumed risk factors for female tubal infertility are seen among. Nigerian women. ... strategies such as health awareness campaigns against unwanted pregnancy, promotion of responsible ..... of CT findings in acute pyogenic pelvic.

  15. Does methotrexate administration for ectopic pregnancy after in vitro fertilization impact ovarian reserve or ovarian responsiveness?

    Science.gov (United States)

    Boots, Christina E; Gustofson, Robert L; Feinberg, Eve C

    2013-12-01

    To evaluate the effects of methotrexate (MTX) on the future fertility of women undergoing IVF by comparing ovarian reserve and ovarian responsiveness in the IVF cycle before and after an ectopic pregnancy (EP) treated with MTX. Retrospective cohort study. Private reproductive endocrinology and infertility practice. Sixty-six women undergoing IVF before and after receiving MTX for an EP. Methotrexate administration and ovarian stimulation. Markers of ovarian reserve (day 3 FSH, antral follicle count), measures of ovarian responsiveness (duration of stimulation, peak E2 level, total dose of gonadotropins, number of oocytes retrieved, fertilization rate), and time from MTX administration to subsequent IVF cycle. There were no differences after MTX administration in body mass index (BMI), FSH, or antral follicle count. A greater dose of gonadotropins was used in the cycle after MTX, but there were no differences in numbers of oocytes retrieved or high quality embryos transferred. As expected, there was a slight increase in age in the subsequent IVF cycle. The pregnancy rates (PR) were comparable to the average PRs within the practice when combining all age groups. Methotrexate remains the first line of therapy for medical management of asymptomatic EP and does not compromise ovarian reserve, ovarian responsiveness, or IVF success in subsequent cycles. Copyright © 2013 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  16. Clinical usefulness of dynamic determination of serum progesterone and HCG levels in patients with threatened abortion, inevitable abortion and ectopic pregnancy

    International Nuclear Information System (INIS)

    Tu Fengjuan; Ding Jiefeng; Liu Qi

    2008-01-01

    Objective: To study the clinical differential diagnostic usefulness of dynamic determinations of serum progesterone and HCG levels in patients with abortion and ectopic pregnancy. Methods: Serum progesterone (with CLIA) and HCG (with RIA) levels were determined twice (48h apart) in 98 patients with threatened abortion, 75 patients with inevitable abortion, 52 patients with ectopic pregnancy, and 83 controls. Results: Among the three groups of patients, the serum progesterone levels were highest in the patients with threatened abortion, being significantly higher than those in the other two groups (P<0.05, P<0.01). The progesterone levels were lowest in the patients with ectopic pregnancy, being significantly less than those in other two groups (P<0.05, P<0.01). The serum HCG levels were also significantly higher in the patients with threatened abortion than those in the other two groups (P < 0.05 ), but there were no significant differences between the levels in patients with inevitable abortion and patients with ectopic pregnancy. The differences between the first and second determination HCG levels, either increased or decreased, in patients with ectopic pregnancy were significantly less than those in patients with inevitable abortion (P<0.05). Conclusion: Dynamic determination of serum progesterone and HCG levels might be of differential diagnostic help in patients with threatened abortion, inevitable abortion and ectopic pregnancy. (authors)

  17. Clinical value of detection of HPL-expressing intermediate trophoblasts in abortion or curettage-obtained specimens for diagnosis of intrauterine or ectopic pregnancies

    International Nuclear Information System (INIS)

    He Xiaomei; Wang Yuping; Wang Lisha; Yang Jingxiu; Gao Xueyan

    2005-01-01

    Objective: To investigate the value of detection of HPL-expressing intermediate trophoblasts in endometrial specimens for diagnosis of intrauterine and ectopic pregnancies. Methods: The examined specimens included: (1) Group I, 35 specimens with suspected intermediate trophoblast in decidua (2) Group II, 30 specimens with decidua-like plump endometrial stroma cells and/ or A-S phenomena in glandular epithelium (3) 30 specimens from proven intrauterine pregnancies serving as controls. Histochemistry (SP method) was used for HPL detection in all these specimens. Results: In the 30 proven intrauterine pregnancies, decidua and villa were present in all the specimens. Only 24 of the 30 were found to be HPL(+) with 6 HPL negatives (20%). In Group I , 28 of the 35 specimens were found to be HPL(+) and all of 28 were from intrauterine pregnancies: Of the 7 HPL negative cases, 5 were later confirmed as with ectopic pregnancy, the remaining 2 were with intrauterine pregnancy. In Group II, 22 of 30 specimens were HPL(+) and all were from intrauterine pregnancy. Of the 8 HPL negative cases, 6 were later confirmed as with ectopic pregnancy and 2 were with intrauterine pregnancy. Combining the data from Group I and II, we could see that in the total 15 HPL negative cases, 11 were with ectopic pregnancy (11/15=73.3%) and 4 were with intrauterine pregnancy (4/15=26.7%). Conclusion: In specimens of intrauterine contents, demonstration of HPL (+) cells could be regarded as confirmative evidence of intrauterine pregnancy. However, the reverse did not hold true. Many of the HPL negative specimens were from intrauterine pregnancies (in this study 4/15 or 26.7%). Therefore, in HPL negative cases, there was a high possibility of ectopic pregnancy but further examinations were required to ascertain the diagnosis. (authors)

  18. Systemic methotrexate to treat ectopic pregnancy does not affect ovarian reserve.

    Science.gov (United States)

    Oriol, Bárbara; Barrio, Ana; Pacheco, Alberto; Serna, José; Zuzuarregui, José Luis; Garcia-Velasco, Juan A

    2008-11-01

    To evaluate whether methotrexate (MTX) compromises ovarian reserve and future reproductive outcome in women undergoing assisted reproductive technology (ART), when it is used as first-line treatment for ectopic pregnancy (EP). Prospective, observational study. University-affiliated private IVF unit. Twenty-five women undergoing IVF-ICSI who were treated with MTX (1 mg/kg IM) for an EP after ART. Evaluation of reproductive outcome and serum anti-Müllerian hormone (AMH) levels. Serum AMH was evaluated before administering MTX and >or=1 week after the resolution of the EP. Reproductive outcome was evaluated by comparing subsequent IVF-ICSI cycles after EP resolution. Serum AMH levels, cycle length, gonadotropin dose required, peak serum E(2) level, oocytes collected, and embryos obtained. Serum AMH levels before MTX were not statistically significantly different from those after treatment (3.7 +/- 0.3 ng/mL vs. 3.9 +/- 0.3 ng/mL). Patients undergoing a subsequent cycle after systemic treatment for EP had similar cycle durations (10.3 vs. 10.8 d), gonadotropin requirements (2,775 vs. 2,630.3 IU), peak E(2) levels (1,884.3 vs. 1,523.6 pg/mL), number of oocytes retrieved (12.1 vs. 10.5), and total number of embryos obtained (7.1 vs. 6.5). Single-dose MTX is a safe first-treatment choice that does not compromise future reproductive outcomes in women who are diagnosed with EP after ART.

  19. Ciąża ektopowa – czynniki ryzyka, diagnostyka i leczenie = Ectopic pregnancy – risk factors, diagnostics and treatment

    Directory of Open Access Journals (Sweden)

    Magdalena Sowa

    2015-11-01

    4Katedra i Klinika Rehabilitacji, Uniwersytet Mikołaja Kopernika w Toruniu, Collegium Medicum im. L. Rydygiera w Bydgoszczy     Adres do korespondencji/ Address for correspondence: Magdalena Sowa Katedra i Zakład Laseroterapii i Fizjoterapii Uniwersytet Mikołaja Kopernika w Toruniu Collegium Medicum im. Ludwika Rydygiera w Bydgoszczy ul. Techników 3 85 – 801 Bydgoszcz           Streszczenie   Wprowadzenie: Ciąża ektopowa stanowi poważny problem kliniczny, w którym dochodzi do zagnieżdżenia komórki jajowej poza jamą macicy. Częstość jej występowania w ostatnich latach wykazuje tendencję wzrostową. Każde ektopowe zagnieżdżenie jaja płodowego stanowi stan zagrożenia życia dla kobiety ciężarnej. Mimo, iż znane są czynniki ryzyka nieprawidłowej implantacji blastocysty, nie ma skutecznych sposobów zapobiegania ciążom pozamacicznym. Cel pracy: Celem pracy była analiza czynników ryzyka, diagnostyki oraz współczesnych metod leczenia ciąży ekotopowej. Metodyka: W celu przedstawienia problemu posłużono się metodą analizy piśmiennictwa dostępnego w internetowych, medycznych bazach danych. Podsumowanie: Na przełomie ostatnich lat nastąpił rozwój zaawansowanych metod diagnostycznych, co przyczyniło się do wcześniejszego wykrywania patologii oraz umożliwiło wdrożenie odpowiedniego leczenia, dostosowanego do możliwości terapeutycznych zakładu opieki zdrowotnej oraz dalszych planów rozrodczych pacjentki. Obecnie trwają prace nad poznaniem czynników genetycznych, sprzyjających ektopii jaja płodowego.   Słowa kluczowe: ciąża ektopowa, diagnostyka, leczenie.         Summary   Ectopic pregnancy – risk factors, diagnostics and treatment Introduction: Ectopic pregnancy is a serious clinical problem, in which the egg cell is implanted outside the uterine cavity. Its incidence has been increasing in the last years. Each ectopic implantation of the ovum constitutes life-threatening condition for a pregnant

  20. Comparison of Levels of Antibodies against Chlamydia Trachomatis in Infertile Women Due to Tubal Factors and Fertile Women

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    F Ghalmbor

    2009-01-01

    Full Text Available Introduction: Chlamydia trachomatis infection is a common pathogen in sexual transmitted disease, but most of female patients with this infection are asymptomatic. Sequealae include pelvic inflammatory disease, infertility and ectopic pregnancy. The aim of the study was to determine the association between Chlamydia trachomatis and tubal factor infertility, if significant. Methods: This prospective, case -control study was done in April 2005-April2006. The study group consisted of 125 patients with tubal factor infertility and the control group included 125 fertile women. The level of antibodies to Chlamydia trachomatis was determined in both groups by ELIZA method. Results: Antibody to Chlamydia trachomatis was present in 29 women in the study group (23.2% and in15 women in the control group ( 12%, respectively, (P< 0.005. The mean level of antibody in both groups was 0.76 and 0.49, respectively (P<0.0005. Conclusion: The study showed that the level of antibody against Chlamydia is significantly more in tubal factor infertile women. We therefore suggest the screening of Chlamydia antibody testing is necessary for tubal factor infertility workup.

  1. Laparoscopic reconstructive tubal surgery in a tertiary referral centre ...

    African Journals Online (AJOL)

    Objectives. To establish the pregnancy rate (PR) following endoscopic reconstructive tubal surgery in patients with tubal disease presenting to the Reproductive Medicine Unit at Groote Schuur Hospital between January 1994 and December 1997. Design. A prospective descriptive study utilising the Hulka classification ...

  2. Heterotropic pregnancy: Rare occurrence of a 12- week ruptured right isthmo-cornual ectopic along with a viable intrauterine pregnancy

    Directory of Open Access Journals (Sweden)

    Priya Selvaraj

    2012-01-01

    Full Text Available Heterotropic pregnancy, although a rare condition, is associated with a greater frequency in assisted reproduction. It occurs in approximately 1 in 100 pregnancies conceived by in vitro fertilization (IVF particularly when multiple embryos are transferred into the uterus. We report a case of heterotropic pregnancy following IVF with the rupture of an isthmo-cornual pregnancy at 12 weeks of gestation with uneventful progression of the intrauterine pregnancy. Laparotomy was performed for the excision of the isthmo-cornual pregnancy. The intrauterine pregnancy continued uneventfully. A female baby was delivered by elective cesarean section at 33 weeks.

  3. Delayed Uterine Rupture After Fetal Reduction in a Case of Cornual Heterotopic Pregnancy

    OpenAIRE

    Su, Mei-Tsz; Kuo, Pao-Lin; Hsu, Keng-Fu

    2005-01-01

    Objective: Assisted reproductive technology has contributed to the rising rate of multiple and ectopic pregnancies. We report a case of heterotopic cornual pregnancy with delayed uterine rupture despite successful fetal reduction. To our knowledge, this has not been previously reported. Case Report: A 32-year-old woman, gravida 2, para 0, had secondary infertility. She had undergone laparoscopic tuboplasty for bilateral tubal obstruction and laparoscopic bilateral salpingectomy for hydrosa...

  4. Do host genetic traits in the bacterial sensing system play a role in the development of Chlamydia trachomatis-associated tubal pathology in subfertile women?

    Directory of Open Access Journals (Sweden)

    Ito James I

    2006-07-01

    Full Text Available Abstract Background In women, Chlamydia (C. trachomatis upper genital tract infection can cause distal tubal damage and occlusion, increasing the risk of tubal factor subfertility and ectopic pregnancy. Variations, like single nucleotide polymorphisms (SNPs, in immunologically important host genes are assumed to play a role in the course and outcome of a C. trachomatis infection. We studied whether genetic traits (carrying multiple SNPs in different genes in the bacterial sensing system are associated with an aberrant immune response and subsequently with tubal pathology following a C. trachomatis infection. The genes studied all encode for pattern recognition receptors (PRRs involved in sensing bacterial components. Methods Of 227 subfertile women, serum was available for C. trachomatis IgG antibody testing and genotyping (common versus rare allele of the PRR genes TLR9, TLR4, CD14 and CARD15/NOD2. In all women, a laparoscopy was performed to assess the grade of tubal pathology. Tubal pathology was defined as extensive peri-adnexal adhesions and/or distal occlusion of at least one tube. Results Following a C. trachomatis infection (i.e. C. trachomatis IgG positive, subfertile women carrying two or more SNPs in C. trachomatis PRR genes were at increased risk of tubal pathology compared to women carrying less than two SNPs (73% vs 33% risk. The differences were not statistically significant (P = 0.15, but a trend was observed. Conclusion Carrying multiple SNPs in C. trachomatis PRR genes tends to result in an aberrant immune response and a higher risk of tubal pathology following a C. trachomatis infection. Larger studies are needed to confirm our preliminary findings.

  5. CAN INITIAL βHCG VALUES PREDICT THE NEED FOR SECOND DOSE OF METHOTREXATE IN MEDICAL MANAGEMENT OF ECTOPIC PREGNANCY?

    Directory of Open Access Journals (Sweden)

    Priya Narayanan

    2016-09-01

    Full Text Available INTRODUCTION Prediction of requirement of second dose of methotrexate in patients treated with single dose would help in guiding treatment and counseling. The aim of this study is to determine whether pretreatment beta HCG values can predict the need for second dose of methotrexate in medically managed ectopic pregnancy. MATERIALS AND METHODS 46 women with ectopic pregnancies who were managed medically were included. The median of beta HCG titres on day 1, day 4 and day 7 was assessed in patients who responded to single dose methotrexate and those who required a second dose. RESULTS Out of the 46 patients studied, 41 responded to medical treatment (success 91%. 14 out of 41 required second dose of methotrexate (34%. Two patients required third dose of methotrexate. Five patients required surgery. DISCUSSION The median of day 1 and day 4 beta HCG values were not statistically different between those who responded to single dose methotrexate and those who required a second dose. Only day 7 values were found to be different. CONCLUSION The beta-hCG titre on day 1 and day 4 is not a predictor of requirement of second dose of methotrexate.

  6. Cesarean Section and Rate of Subsequent Stillbirth, Miscarriage, and Ectopic Pregnancy: A Danish Register-Based Cohort Study

    Science.gov (United States)

    O'Neill, Sinéad M.; Agerbo, Esben; Kenny, Louise C.; Henriksen, Tine B.; Kearney, Patricia M.; Greene, Richard A.; Mortensen, Preben Bo; Khashan, Ali S.

    2014-01-01

    Background With cesarean section rates increasing worldwide, clarity regarding negative effects is essential. This study aimed to investigate the rate of subsequent stillbirth, miscarriage, and ectopic pregnancy following primary cesarean section, controlling for confounding by indication. Methods and Findings We performed a population-based cohort study using Danish national registry data linking various registers. The cohort included primiparous women with a live birth between January 1, 1982, and December 31, 2010 (n = 832,996), with follow-up until the next event (stillbirth, miscarriage, or ectopic pregnancy) or censoring by live birth, death, emigration, or study end. Cox regression models for all types of cesarean sections, sub-group analyses by type of cesarean, and competing risks analyses for the causes of stillbirth were performed. An increased rate of stillbirth (hazard ratio [HR] 1.14, 95% CI 1.01, 1.28) was found in women with primary cesarean section compared to spontaneous vaginal delivery, giving a theoretical absolute risk increase (ARI) of 0.03% for stillbirth, and a number needed to harm (NNH) of 3,333 women. Analyses by type of cesarean section showed similarly increased rates for emergency (HR 1.15, 95% CI 1.01, 1.31) and elective cesarean (HR 1.11, 95% CI 0.91, 1.35), although not statistically significant in the latter case. An increased rate of ectopic pregnancy was found among women with primary cesarean overall (HR 1.09, 95% CI 1.04, 1.15) and by type (emergency cesarean, HR 1.09, 95% CI 1.03, 1.15, and elective cesarean, HR 1.12, 95% CI 1.03, 1.21), yielding an ARI of 0.1% and a NNH of 1,000 women for ectopic pregnancy. No increased rate of miscarriage was found among women with primary cesarean, with maternally requested cesarean section associated with a decreased rate of miscarriage (HR 0.72, 95% CI 0.60, 0.85). Limitations include incomplete data on maternal body mass index, maternal smoking, fertility treatment, causes of

  7. Hysteroscopic proximal tubal occlusion versus laparoscopic salpingectomy as a treatment for hydrosalpinges prior to IVF or ICSI: an RCT

    NARCIS (Netherlands)

    Dreyer, K.; Lier, M. C. I.; Emanuel, M. H.; Twisk, J. W. R.; Mol, B. W. J.; Schats, R.; Hompes, P. G. A.; Mijatovic, V.

    2016-01-01

    STUDY QUESTION Does hysteroscopic proximal tubal occlusion by intratubal devices as a treatment for hydrosalpinges result in comparable ongoing pregnancy rates following IVF/ICSI when compared with laparoscopic salpingectomy? SUMMARY ANSWER Hysteroscopic proximal tubal occlusion by intratubal

  8. Spontaneous Heterotopic Pregnancy: Dual Case Report and Review of Literature

    Directory of Open Access Journals (Sweden)

    Annika Chadee

    2016-01-01

    Full Text Available Introduction. Heterotopic pregnancy is a rare complication usually seen in populations at risk for ectopic pregnancy or those undergoing fertility treatments. It is a potentially dangerous condition occurring in only 1 in 30,000 spontaneous pregnancies. With the advent of Assisted Reproduction Techniques (ART and ovulation induction, the overall incidence of heterotopic pregnancy has risen to approximately 1 in 3,900 pregnancies. Other risk factors include a history of pelvic inflammatory disease (PID, tubal damage, pelvic surgery, uterine Mullerian abnormalities, and prior tubal surgery. Heterotopic pregnancy is a potentially fatal condition, rarely occurring in natural conception cycles. Most commonly, heterotopic pregnancy is diagnosed at the time of rupture when surgical management is required. Case. This paper represents two cases of heterotopic pregnancies as well as a literature review. Conclusion. Heterotopic pregnancy should be suspected in patients with an adnexal mass, even in the absence of risk factors. Clinicians must be alert to the fact that confirming an intrauterine pregnancy clinically or by ultrasound does not exclude the coexistence of an ectopic pregnancy. A high index of suspicion in women is needed for early and timely diagnosis, and management with laparotomy or laparoscopy can result in a favorable and successful obstetrical outcome.

  9. Laparoscopic tubal sterilization reversal and fertility outcomes

    Directory of Open Access Journals (Sweden)

    K Jayakrishnan

    2011-01-01

    Full Text Available Purpose: The purpose of the study was two-fold. Firstly it was to assess the suitability for tubal recanalization and factors predicting successful laparoscopic recanalization. Secondly, it was to analyze the fertility outcomes and factors affecting the pregnancy rate following laparoscopic tubal recanalization. Materials and Methods: A retrospective chart review of prospectively followed-up 29 women at a tertiary care center seeking tubal sterilization reversal between May 2005 and February 2010 were included. Results: In 14 (48.3% women unilateral tubes were suitable and in only 3 women (10.3% bilateral tubes were suitable. All cases with laparoscopic tubal sterilization were suitable, whereas all cases with fimbriectomy were unsuitable for recanalization. In 6 (20.7% cases salphingostomy was performed as an alternative procedure to tubal reanastomosis. The overall pregnancy rate was 58.8%. In cases with sterilization by Pomeroy′s method, 4 out of 10 (40% conceived, whereas for laparoscopic tubal ligation cases 6 out of 7 (85.7% conceived (P=0.32. None of the patients with final tubal length <5 cm conceived (P=0.03. Comparing the age at recanalization, in women ≤30 years, 71.4% conceived, as compared with 50% when age of women was more than 30 years (P=0.37. Conclusions: The important factors determining the success of recanalization are technique of sterilization and the remaining length of the tube after recanalization. The gynecologist must use an effective technique of sterilization to minimize the failure rates, but at the same time, which causes minimal trauma, and aim at preserving the length of the tube so that reversal is more likely to be successful, should the patient′s circumstances change.

  10. Cost and efficacy comparison of in vitro fertilization and tubal anastomosis for women after tubal ligation.

    Science.gov (United States)

    Messinger, Lauren B; Alford, Connie E; Csokmay, John M; Henne, Melinda B; Mumford, Sunni L; Segars, James H; Armstrong, Alicia Y

    2015-07-01

    To compare cost and efficacy of tubal anastomosis to in vitro fertilization (IVF) in women who desired fertility after a tubal ligation. Cost-effectiveness analysis. Not applicable. Not applicable. Not applicable. Cost per ongoing pregnancy. Cost per ongoing pregnancy for women after tubal anastomosis ranged from $16,446 to $223,482 (2014 USD), whereas IVF ranged from $32,902 to $111,679 (2014 USD). Across maternal age groups cost effective than IVF for ongoing pregnancy. Sensitivity analyses validated these findings across a wide range of ongoing pregnancy probabilities as well as costs per procedure. Tubal anastomosis was the most cost-effective approach for most women less than 41 years of age, whereas IVF was the most cost-effective approach for women aged ≥41 years who desired fertility after tubal ligation. A model was created that can be modified based on cost and success rates in individual clinics for improved patient counseling. Copyright © 2015 American Society for Reproductive Medicine. All rights reserved.

  11. ANAMNESIS AND CLINIC FINDINGS OF THE PATIENTS SUSPECTED OF HAVING ECTOPIC PREGNANCY

    Directory of Open Access Journals (Sweden)

    Stanoje Pesic

    2000-09-01

    Full Text Available An analysis has been done of a series of 573 patients suffering from extrauterinepregnancy, namely those found suspect upon entering the hospital. Thediagnosis of extra-uterine pregnancy was confirmed in 322 (56% patients. Theleading symptom of extra-uterine pregnancy is metrorrhagia (63,41%. As for theoperation time, 3 1% of them were immediately operated. The ultrasound techniqueadds to the diagnostic certainty. Our results show that carefully taken anamnesis inaddition to symptom recording and a careful clinic examination can make possiblethe extra-uterine pregnancy diagnosis.

  12. Recurrent pregnancy-related upper airway obstruction caused by intratracheal ectopic thyroid tissue

    DEFF Research Database (Denmark)

    Døssing, H; Jørgensen, K E; Oster-Jørgensen, E

    1999-01-01

    An unusual case of recurrent pregnancy-related thyroid growth stimulation is reported. A 27-year-old euthyroid woman had pulmonary symptoms, thought to be asthma during her first pregnancy, that improved postpartum. Bronchodilatators had no effect and symptoms recurred from gestational week 22...... during her second pregnancy. Her 58-mL multinodular goiter (by ultrasound) was not thought to be responsible for her upper airway symptoms. Therefore, fiber laryngoscopy and computed tomographic (CT) scan were performed and revealed a 20 x 15 x 10 mm intratracheal tumor. After tracheostomy...... developed normally. We believe that this case illustrates the recurrent effect of pregnancy-related thyroid tissue stimulation by a combination of increasing human chorionic gonadotropin (hCG) stimulation and iodine deficiency in a borderline iodine-deficient region. This is the first report on symptomatic...

  13. Gravidez ectópica na cicatriz uterina de cesárea: relato de caso Cesarean scar ectopic pregnancy: a case report

    Directory of Open Access Journals (Sweden)

    Maurício de Souza Arruda

    2008-10-01

    Full Text Available Gravidez ectópica na cicatriz de cesárea é a forma mais rara de gravidez ectópica e provavelmente uma das mais perigosas em função dos riscos de ruptura e hemorragia volumosa. Essa situação deve ser diferenciada da gravidez cervical e de abortamento em curso, para que o tratamento apropriado seja imediatamente oferecido. Desde o advento da ultra-sonografia transvaginal, a gravidez ectópica na cicatriz de cesárea pode ser diagnosticada precocemente na gestação e, para isso o ultra-sonografista deve estar familiarizado com e atento aos critérios diagnósticos, especialmente em mulheres com cicatriz de cesárea prévia. Descrevemos aqui um caso de gravidez ectópica em cicatriz de cesárea, cujo diagnóstico foi tardio, havendo apresentação de involução espontânea.Ectopic pregnancy in a cesarean scar is the rarest form of ectopic pregnancy and probably the most dangerous one because of the risk of uterine rupture and massive hemorrhage. This condition must be distinguished from cervical pregnancy and spontaneous abortion in progress, so that the appropriate treatment can be immediately offered. Since the advent of endovaginal ultrasonography, ectopic pregnancy in a cesarean scar can be diagnosed early in pregnancy if the sonographer is familiarized with the diagnostic criteria of this situation, especially in women with previous cesarean scar. Here we describe a case of ectopic pregnancy in a cesarean scar in which the diagnosis was considerably late, with presentation of spontaneous regression.

  14. Cornual pregnancy in a patient suffering from sickle cell anemia

    OpenAIRE

    Onilda Labrada Silva; Yamila del Carmen Castellanos Fernández; Jorge Luis Hernández Alfonso

    2015-01-01

    Nowadays, ectopic pregnancy is a pathological entity of great incidence, which is increased, among other things, by each time earlier sexual relations. Cornual pregnancy is as a result of the implantation of the blastocyte within the segment of the fallopian tube that goes into the uterus wall or between the tubal ostium and the proximal portion of the isthmus. This is a case of a cornual pregnancy in which the use of ultrasonography played an essential role for its diagnosis, since it is abo...

  15. Discordant relationship between Essure microinsert position and tubal occlusion.

    Science.gov (United States)

    Hou, Melody Y

    2016-07-27

    Hysteroscopic sterilisation with Essure requires confirmation of tubal occlusion by hysterosalpingogram or microinsert position by transvaginal sonography 3 months after placement before women can rely on the method for pregnancy prevention. A 39-year-old woman underwent hysteroscopic sterilisation via Essure, with successful bilateral tubal occlusion documented on hysterosalpingogram. She had a subsequent unintended pregnancy and termination, and presented with persistent pelvic pain and other non-specific symptoms. She underwent a laparoscopic-assisted vaginal hysterectomy with bilateral salpingectomy, with complete resolution of her symptoms. Pathological evaluation demonstrated a perforated Essure microinsert and ipsilateral tubal occlusion, and a correctly placed Essure microinsert with ipsilateral tubal patency. Clinicians should be cautious about the assumption that correctly placed microinserts based on ultrasonography, hysterosalpingogram or laparoscopic evaluation assures occlusion success. 2016 BMJ Publishing Group Ltd.

  16. A review of 33 years (1980-2013) of data indicating a rise in ectopic pregnancy in Saudi Arabia.

    Science.gov (United States)

    Al-Turki, Haifa A

    2015-01-01

    To assess the trend in ectopic pregnancy (EP) at a single center in Saudi Arabia and to compare the data with those from the rest of Saudi Arabia. In a retrospective study, data were analyzed from patients admitted to King Fahd Hospital of the University, Al Khobar, Saudi Arabia, with a diagnosis of EP between January 2011 and December 2013. The prevalence of EP was calculated as a percentage of the number of live births during the study period. A 30-year review of publications on EP in Saudi Arabia was done via search engines. During the study period, there were 58 EPs among 3818 deliveries, giving an overall incidence of 1.5% at the study center; the incidence of EP in the rest of the country during this period was 0.5%. Between 2002 and 2004, the country's incidence was 0.6% as compared with 1% at the study center. The incidence of EP in Saudi Arabia has increased in the past few decades. Copyright © 2014 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  17. The response of Islamic jurisprudence to ectopic pregnancies, frozen embryo implantation and euthanasia.

    Science.gov (United States)

    Ghanem, I

    1987-07-01

    The opinions of the Jurisconsult of Egypt on Islamic law regarding test tube fertilization, embryo transfer and abortion are explained. Test tube babies, if not derived from the husband's sperm, are by definition, "zina" or the result of illicit sexual intercourse. This type of quasi-adultery is punishable by mere disgracing, rather than lapidation, or stoning to death. Such children cannot inherit even from the mother. Possibly, a female child may marry the husband, to be legitimized in terms of inheritance. Under Islamic law, embryo transfer is illegal insofar as it involves artificial insemination of the donor by the husband; temporary maternity by the donor is a jural concept that has no place in Islamic family law. The egg of the donor, not the surrogate mother, places the issue in the thorny area of multiple suckling. There have been no pronouncements by Islamic legal experts on euthanasia or pregnancy by in vitro fertilization of orphaned embryos. Abortion law "ijhad" in Kuwait was amended in 1982 to permit abortion where either grievous bodily harm to the mother is imminent or it is proved that the baby will suffer incurable brain damage or severe mental retardation. The decision must be approved unanimously by 3 Muslim consultant physicians presided over by an obstetrician or gynecologist, parental consent is required, and the hospital must have an obstetric-gynecological wing. There is precedent in Islamic law for saving the life of the mother where there is a clear choice of allowing either the fetus or the mother to survive. Similarly in case of miscarriage or attempted miscarriage, damages for a fetus or stillborn are less than those paid for a live birth. Penalties for therapeutic abortion, for example after exposure to German measles, have been viewed as less serious before 120 days of gestation, when the Prophet indicated that the embryo is given a soul. These ethical interpretations are worth considering for Western jurists as a source of ideas.

  18. Papillary tubal hyperplasia

    DEFF Research Database (Denmark)

    Kurman, Robert J; Vang, Russell; Junge, Jette

    2011-01-01

    , designated "papillary tubal hyperplasia (PTH)," characterized by small rounded clusters of tubal epithelial cells and small papillae, with or without associated psammoma bodies, that are present within the tubal lumen and which are frequently associated with APSTs. Twenty-two cases in this study were...... with an ovarian tumor. PTH was found in 20 (91%) of the 22 cases in the Danish study. On the basis of this association of PTH with APSTs with implants and the close morphologic resemblance of PTH, not only to primary ovarian APSTs but also to noninvasive epithelial implants and endosalpingiosis, we speculate...... of ovarian and extraovarian low-grade serous proliferations (APST, noninvasive epithelial implants, and endosalpingiosis) that postulates that all of these lesions are derived from PTH, which appears to be induced by chronic inflammation. If this hypothesis is confirmed, it can be concluded that low...

  19. Tubal Factor Infertility and Perinatal Risk After Assisted Reproductive Technology

    Science.gov (United States)

    Kawwass, Jennifer F.; Crawford, Sara; Kissin, Dmitry M.; Session, Donna R.; Boulet, Sheree; Jamieson, Denise J.

    2014-01-01

    OBJECTIVE To assess trends of tubal factor infertility and to evaluate risk of miscarriage and delivery of preterm or low birth weight (LBW) neonates among women with tubal factor infertility using assisted reproductive technology (ART). METHODS We assessed trends of tubal factor infertility among all fresh and frozen, donor, and nondonor ART cycles performed annually in the United States between 2000 and 2010 (N=1,418,774) using the National ART Surveillance System. The data set was then limited to fresh, nondonor in vitro fertilization cycles resulting in pregnancy to compare perinatal outcomes for cycles associated with tubal compared with male factor infertility. We performed bivariate and multivariable analyses controlling for maternal characteristics and calculated adjusted risk ratios (RRs) and 95% confidence intervals (CI). RESULTS The percentage of ART cycles associated with tubal factor infertility diagnoses decreased from 2000 to 2010 (26.02–14.81%). Compared with male factor infertility, tubal factor portended an increased risk of miscarriage (14.0% compared with 12.7%, adjusted RR 1.08, 95% CI 1.04–1.12); risk was increased for both early and late miscarriage. Singleton neonates born to women with tubal factor infertility had an increased risk of pre-term birth (15.8% compared with 11.6%, adjusted RR 1.27, 95% CI 1.20–1.34) and LBW (10.9% compared with 8.5%, adjusted RR 1.28, 95% CI 1.20–1.36). Significant increases in risk persisted for early and late preterm delivery and very low and moderately LBW delivery. A significantly elevated risk was also detected for twin, but not triplet, pregnancies. CONCLUSION Tubal factor infertility, which is decreasing in prevalence in the United States, is associated with an increased risk of miscarriage, preterm birth, and LBW delivery as compared with couples with male factor infertility using ART. PMID:23812461

  20. The Unexpected Ovarian Pregnancy at Laparoscopy: A Review of Management

    Directory of Open Access Journals (Sweden)

    Meher Tabassum

    2017-01-01

    Full Text Available Ovarian ectopic pregnancies are a rare occurrence; however the incidence is on the rise. Preoperative diagnosis remains difficult due to nonspecific clinical symptoms and USS findings. Most patients undergo diagnostic laparoscopy with subsequent surgical management. We present the case of a 32-year-old female who presented with vaginal bleeding and an unsited pregnancy, with a BhCG of 24693. Formal USS described unruptured right tubal ectopic with ovarian pregnancy being diagnosed at laparoscopy. A wedge resection was conducted to preserve ovarian function. Postoperative recovery was uneventful and BhCG levels returned to zero (nonpregnant in an outpatient setting. Although laparoscopy remains the gold standard of diagnosis and treatment, in this case report we discuss benefits of early diagnosis for fertility conserving management, including nonsurgical options.

  1. The Unexpected Ovarian Pregnancy at Laparoscopy: A Review of Management.

    Science.gov (United States)

    Tabassum, Meher; Atmuri, Kiran

    2017-01-01

    Ovarian ectopic pregnancies are a rare occurrence; however the incidence is on the rise. Preoperative diagnosis remains difficult due to nonspecific clinical symptoms and USS findings. Most patients undergo diagnostic laparoscopy with subsequent surgical management. We present the case of a 32-year-old female who presented with vaginal bleeding and an unsited pregnancy, with a BhCG of 24693. Formal USS described unruptured right tubal ectopic with ovarian pregnancy being diagnosed at laparoscopy. A wedge resection was conducted to preserve ovarian function. Postoperative recovery was uneventful and BhCG levels returned to zero (nonpregnant) in an outpatient setting. Although laparoscopy remains the gold standard of diagnosis and treatment, in this case report we discuss benefits of early diagnosis for fertility conserving management, including nonsurgical options.

  2. Retained Intra-Abdominal Surgical Clamp Complicating Emergency Laparotomy: Incidental Finding on Hysterosalpingogram for Evaluation of Tubal Infertility

    Directory of Open Access Journals (Sweden)

    Adebiyi Gbadebo Adesiyun

    2014-01-01

    Full Text Available The finding of intraperitoneal foreign body complicating surgical intervention broadly remains as an issue of safety in the operative room, a source of emotive concern for the patient, and an upsetting but equally embarrassing situation to the surgeon and the team. However, in the media world, it is a source of sumptuous and captivating headline on the newspaper and to the legal profession, an attractive case to prosecute. A middle age teacher presented with secondary infertility. She had emergency laparotomy fifteen years ago for ruptured tubal ectopic pregnancy in a private hospital and postoperative period was uneventful. Amongst other investigations to find out the cause of infertility, she had hysterosalpingography and a radio-opaque clamp was visualized on the films. She was counselled and had laparotomy. A pair of surgical Kocher clamps was retrieved buried in the mesentery.

  3. Elevated dietary magnesium during pregnancy and postnatal life prevents ectopic mineralization in Enpp1asj mice, a model for generalized arterial calcification of infancy.

    Science.gov (United States)

    Kingman, Joshua; Uitto, Jouni; Li, Qiaoli

    2017-06-13

    Generalized arterial calcification of infancy (GACI) is an autosomal recessive disorder caused by mutations in the ENPP1 gene. It is characterized by mineralization of the arterial blood vessels, often diagnosed prenatally, and associated with death in early childhood. There is no effective treatment for this devastating disorder. We previously characterized the Enpp1asjmutant mouse as a model of GACI, and we have now explored the effect of elevated dietary magnesium (five-fold) in pregnant mothers and continuing for the first 14 weeks of postnatal life. The mothers were kept on either control diet or experimental diet supplemented with magnesium. Upon weaning at 4 weeks of age the pups were placed either on control diet or high magnesium diet. The degree of mineralization was assessed at 14 weeks of age by histopathology and a chemical calcium assay in muzzle skin, kidney and aorta. Mice placed on high magnesium diet showed little, if any, evidence of mineralization when their corresponding mothers were also placed on diet enriched with magnesium during pregnancy and nursing. The reduced ectopic mineralization in these mice was accompanied by increased calcium and magnesium content in the urine, suggesting that magnesium competes calcium-phosphate binding thereby preventing the mineral deposition. These results have implications for dietary management of pregnancies in which the fetus is suspected of having GACI. Moreover, augmenting a diet with high magnesium may be beneficial for other ectopic mineralization diseases, including nephrocalcinosis.

  4. Fallopian tube recanalisation using dedicated radiographic tubal assessment set in angiography suite

    International Nuclear Information System (INIS)

    Al-Omari, M.H; Rousan, L.; Al-balas, H.; Alawneh, K.; El-heis, M.; Al-mnayyis, A.; Obeidat, N.; Amarin, Z.; Zayed, F.; Omari, Z.; Hanania, R.

    2014-01-01

    Fallopian tube recanalisation (FTR) for proximal fallopian tube obstruction (PFTO) is considered a good treatment option for tubal infertility. The aim of this study was to assess the safety and the technical and clinical success rates of FTR using a dedicated radiographic tubal assessment set (FluoroSet®) in the angiography suite. This study is a retrospective analysis of data prospectively collected between February 2007 and June 2011 at King Abdullah University Hospital, Irbid, Jordan. During this period, 61 patients affected by PFTO underwent FTR using FluoroSet® at our institution. The mean age of patients was 34 years (range 20-45 years), and the mean duration of infertility was 4 years (range 2-14 years). The procedure was performed with conscious sedation under fluoroscopic guidance in the angiography suite. The obstructed tube was accessed with a 5-Fr multipurpose catheter, and the obstruction was crossed with a 0.35-Fr hydrophilic guide wire until the wire coiled freely into the peritoneal cavity. Patency of the tube was then confirmed by selective salpingiogram. Technical success rate was recorded, and patients were followed up for evidence of pregnancy over 12 months. The procedure was technically successful in all patients. Minor bleeding and postprocedural pain occurred in most patients; however, there were no major complications encountered. Twenty-five patients (41%) became pregnant. Successful deliveries of full-term infants were reported in 21 patients (84%). Miscarriage was reported in four patients (16%). No ectopic pregnancies were detected, and all deliveries were full-term. The technical success rate was 100% and the clinical success rate was 41%. Selective salpingography and FTR using FluoroSet® is a safe and effective method. FTR is recommended as the first intervention in patients with PFTO. In experienced hands with dedicated equipment and in an appropriate setting, the success rate is high, and this treatment should be offered to

  5. Induced Abortion and the Risk of Tubal Infertility

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    Objective To explore the association between induced abortion and tubal infertility in Chengdu, China.Methods A 1 :2 case-control study was designed. Infertile women with bilateral tubal occlusion in the case group compared with two control groups: infertile control group with bilateral tubal patency and pregnant control group with currently pregnancy. Data were collected using questionnaires through face-to-face interviews, covering the subjects' demographic details and histories of gynecology and obstetrics. Adjusted odds ratio was calculated as a measure of the association using stepwise multiple logistic regression analysis.Results Induced abortion was not found to be associated with tubal infertility in the analysis including either the infertile controls or the pregnant controls, but other risk factors were found, such as history of acute pelvic inflammatory disease (PID), lower abdominal surgeries, dysmenorrhea and pregnancy.Conclusion It is contended that facing an increasing trend of infertile cases with tubal occlusion in China, it is emphasized that special attention should paid to the long term impact of reproductive tract infection, especially, asymptomatic ones, rather than induced abortion.

  6. Laparoscopic tubal reanastomosis versus in vitro fertilization: cost-based decision analysis.

    Science.gov (United States)

    Hirshfeld-Cytron, Jennifer; Winter, Jordan

    2013-07-01

    Regret after tubal ligation continues to be a problem. After tubal ligation, couples have the option of tubal surgery or in vitro fertilization (IVF). Using decision analysis techniques, we compared cost-effectiveness of tubal reanastomosis by tubal type vs tubal surgery or in vitro fertilization (IVF) for 3 separate age groups of women: 40 years of age. Tubal techniques was divided into type A, those with more favorable prognosis because of the likelihood of having a more significant length tube at time of reanastomosis and type B, those with a worse prognosis of success. We incorporated delivery costs to address the impact of high order multiples in IVF. Data were extracted by studies available in the literature. All costs were adjusted to 2012 US dollars. One-way and 2-way sensitivity analyses were performed. The laparoscopic reanastomosis of type A dominated the other groups, because it was more effective and less costly then type B and IVF. However, when women were >40 years old with a history of type B, IVF was favored when its costs were at the lower limit. The most cost-effective choice for a woman desiring pregnancy after tubal ligation is laparoscopic reanastomosis after a prior clip or ring tubal ligation for women ≤40 years old. It is also the most cost-effective for the oldest cohort, assuming IVF costs are greater than $4500. Copyright © 2013 Mosby, Inc. All rights reserved.

  7. Female sterilization by tubal ligation at caesarean section in Makurdi ...

    African Journals Online (AJOL)

    Background: Female sterilization is an important tool in reducing unplanned pregnancy and maternal mortality in our environment. The aim of this study was to determine the incidence, sociodemographic characteristics, technique, effectiveness and complications associated with female sterilization by bilateral tubal ligation ...

  8. Ruptured Cornual Monochorionic Monoamniotic Twin Ectopic ...

    African Journals Online (AJOL)

    A high index of suspicion for ectopic pregnancy in women of reproductive age who presented with history of amenorrhea and lower abdominal pains could prove useful in making a diagnosis of ectopic pregnancy. The usefulness of ultrasonography has also been demonstrated. Key Words: Monochorionic monoamniotic, ...

  9. Secondary abdominal appendicular pregnancy: Case report

    Directory of Open Access Journals (Sweden)

    Rosso Mićo

    2014-01-01

    Full Text Available Introduction. The case report describes a 29-year-old nulliparous woman that was admitted at the Department of Gynecology and Obstetrics of the Clinical Hospital Osijek complaining of mild abdominal pain without vaginal discharge. Case Outline. The patient’s menstrual cycle was irregular, from 30-45 days. An ultrasound examination showed suspicion of an ectopic pregnancy with a βHCG level of 1358 IU/L. Due to the presence of liquid in the pouch of Douglas the patient underwent emergency laparoscopy, which showed the presence of tumor mass between the right Fallopian tube and the appendix. These two structures associated with adhesions corresponded to secondary implantation after spontaneous tubal abortion which was confirmed by histopathologic analysis. Conclusion. Laparoscopy has emerged as the “gold standard” in the diagnosis and treatment of ectopic pregnancy, in this case the secondary abdominal pregnancy. From the diagnostic point of view, all women of reproductive age should be considered pregnant until proven otherwise, also keeping in mind that ectopic pregnancies can have different locations and many clinical features.

  10. Successful pregnancy after office microlaparoscopic correction of tubal herneation for a very rare congenital fimbrial-ovarian relationship, a case report

    Directory of Open Access Journals (Sweden)

    Emad M. Siam

    2011-09-01

    Here, a case is described in which a very rare congenital tubo-ovarian relationship had been observed and assessed during routine laparoscopy to discover the cause of delayed conception after previous spontaneous pregnancy. This very rare tubo-ovarian relationship had been observed directly using a newly advanced fiber optic 2 mm microlaparoscopic set, in an office procedure under augmented local anesthesia in stead of the conventional 10 mm laparoscopy.

  11. Cornual pregnancy in a patient suffering from sickle cell anemia

    Directory of Open Access Journals (Sweden)

    Onilda Labrada Silva

    2015-10-01

    Full Text Available Nowadays, ectopic pregnancy is a pathological entity of great incidence, which is increased, among other things, by each time earlier sexual relations. Cornual pregnancy is as a result of the implantation of the blastocyte within the segment of the fallopian tube that goes into the uterus wall or between the tubal ostium and the proximal portion of the isthmus. This is a case of a cornual pregnancy in which the use of ultrasonography played an essential role for its diagnosis, since it is about a patient suffering from sickle cell anemia, where it was not possible to clinically eliminate the possibility of an occlusive vessel crisis as the cause of abdominal pain. Subtotal hysterectomy of the right tube was performed. The patient’s evolution is satisfactory.

  12. Gravidez ectópica após uso de contracepção de emergência: relato de caso Ectopic pregnancy after use of hormonal emergency contraception: a case report

    Directory of Open Access Journals (Sweden)

    Renato Monteiro Zucchi

    2004-10-01

    Full Text Available Gravidez ectópica é a implantação e o desenvolvimento do ovo fora da cavidade uterina; impõe diagnóstico precoce e assistência de urgência. Gravidez ectópica com corpo lúteo contralateral presume ocorrência de transmigração do zigoto para a tuba uterina do lado oposto, o que pode ser responsável pela sua ocorrência. Em 1994, o levonorgestrel teve sua eficácia comprovada como superior à dos outros métodos para contracepção de emergência. É relatado caso de paciente de 27 anos que apresentou gravidez ectópica, de localização tubária, com corpo lúteo contralateral, após uso de contracepção de emergência por falha do método anticoncepcional de escolha (preservativo masculino. Foi realizado tratamento cirúrgico conservador por videolaparoscopia, com boa evolução após a cirurgia.Ectopic pregnancy is the implantation and development of the ovum outside the uterine cavity; it needs a quick diagnosis and an urgent treatment. The presence of the corpus luteum in the ovary that is contralateral to the ectopic pregnancy is presumptive evidence for ovum transmigration, which may be the cause of ectopic pregnancy. In 1994, a multinational clinical trial proved the superiority of levonorgestrel over the existing emergency contraceptive products. In the present study, we describe the case of a 27-year-old woman with ectopic pregnancy and a contralateral corpus luteum after use of hormonal emergency contraception (levonorgestrel, because of failure of the used contraception method (condom. The patient was treated with laparoscopic surgery that was successful.

  13. Association between knowledge about levonorgestrel emergency contraception and the risk of ectopic pregnancy following levonorgestrel emergency contraception failure: a comparative survey.

    Science.gov (United States)

    Zhang, Duo; Yan, Ming-Xing; Ma, Jue; Xia, Wei; Xue, Rui-Hong; Sun, Jing; Zhang, Jian

    2016-08-01

    To study the association between knowledge about levonorgestrel emergency contraception (LNG-EC) and the risk of ectopic pregnancy (EP) following LNG-EC failure. This study included 600 women who had visited the hospital with LNG-EC failure. Of these, 300 with EP and 300 with intrauterine pregnancy (IUP) were recruited to the EP group and IUP group respectively. The participants were interviewed face-to-face using a standardized questionnaire. Pearson's chi-square tests and t-test were used to compare the sociodemographic characteristics, reproductive and gynecological history, surgical history, previous contraceptive experience, and answers to 10 questions concerning the knowledge about LNG-EC. Those who gave incorrect answers to the question regarding the basic mechanism and specific method of levonorgestrel emergency contraceptive pills (LNG-ECPs) were at a higher risk of EP after LNG-EC failure. Women who did not strictly follow instructions or advice from healthcare professionals were more likely to subsequently experience EP (p < 10(-4) ). Women with LNG-EC failure reported friends/peers, TV, and Internet as the main sources of information. No difference was observed with regard to the sources of knowledge on LNG-EC (p = 0.07). The results illustrate the importance of strictly following the doctor's guidance or drug instructions when using LNG-ECPs. The media should be used to disseminate information about responsible EC, and pharmacy staff should receive regular educational training sessions in this regard. © 2016 The Authors. Pharmacoepidemiology and Drug Safety published by John Wiley & Sons Ltd. © 2016 The Authors. Pharmacoepidemiology and Drug Safety published by John Wiley & Sons Ltd.

  14. Cirugía laparoscópica de urgencia en el embarazo ectópico Emergency laparoscopic surgery in ectopic pregnancy

    Directory of Open Access Journals (Sweden)

    Ernesto Manuel Luzardo Silveira

    2011-09-01

    Full Text Available Se realizó un estudio descriptivo y prospectivo de 32 pacientes con embarazo ectópico, tratadas por medio de cirugía laparoscópica en el Hospital Clinicoquirúrgico Docente "Dr. Joaquín Castillo Duany" de Santiago de Cuba desde enero de 2003 hasta diciembre de 2008. Esa gestación anormal prevaleció en mujeres de 15-31 años, en las trompas (tubárico y en la forma complicada (roto. La técnica quirúrgica fue radical en la totalidad de la serie, lo cual garantizó la pronta recuperación de sus integrantes y el alta hospitalaria precoz, sin aumentar el riesgo de complicaciones.A descriptive and prospective study of 32 patients with ectopic pregnancy treated through laparoscopic surgery at "Dr Joaquín Castillo Duany" Teaching Clinical Surgical Hospital in Santiago de Cuba was carried out from January, 2003 to December, 2008. The abnormal gestation, which prevailed in the Fallopian tubes (uterotubal and in the complicated form (broken, was observed in women aged 15-31 years. Surgical technique was radical in the whole series. This guaranteed to patients their soon recovery as well as their earlier discharge from hospital, without increasing complication risks.

  15. Mola hidatiforme en un embarazo ectópico. Presentación de un caso Hydatid mole in an ectopic pregnancy

    Directory of Open Access Journals (Sweden)

    Vladimir Díaz Noda

    2005-09-01

    Full Text Available La Mola Hidatiforme se caracteriza por la presencia de anormalidades de las vellosidades coriónicas que consisten en grados variables de proliferación trofoblásticas y de edema del estroma de las vellosidades.Su incidencia varia de manera importante en las diversas regiones del mundo, no ocurriendo así con el embarazo ectópico que ha tenido un aumento significativo en todo el planeta. Pero la asociación de estas dos entidades es muy rara. Presentamos un caso de 35 años de edad donde observamos esta rara asociación, en el que se realizó salpingectomia derecha con evolución favorable.The Hydatiform mole is characterized by the presence of abnormalities of chorionic vellus which consist of variables degrees of trophoblastic proliferation and edema of the vellus stroma. Its incidence varies very importantly in the varuopus regions all over the world, which is not the same for the ectopic pregnancy that has increased significantly around the globe. The association between these two entities is uncommon. We presented a case with a 35 year - old person and observed this uncommon association, and performed a right salpingectomy with favorable progress.

  16. Silicone rubber band for laparoscopic tubal sterilization.

    Science.gov (United States)

    Ansari, A H; Sealey, R M; Gay, J W; Kang, I

    1977-12-01

    In 1974, Yoon and associates (Am J Obstet Gynecol 120:132, 1974) described a new approach in which laparoscopic tubal occlusion was accomplished by utilizing the silicone rubber band technique. Recognizing the great advantages of the new technique in eliminating potential thermal injury associated with electrocoagulation, the authors have utilized the Yoon silicone rubber band technique in these institutions over the past 20 months. Thus far the procedure has been performed in 304 patients without any major complications. In the hope of eliminating and/or reducing possible pregnancy-failure rates, in 110 cases. In addition to application of the silicone band, the tube within the band was transected with non-electrical Seigler biopsy forceps. This, we believe, should provide an interesting long-term comparative study.

  17. Ectopic decidual reaction mimicking irritable bowel syndrome: a case report.

    Directory of Open Access Journals (Sweden)

    Soraya Salehgargari

    2014-01-01

    Full Text Available Ectopic decidualization with gross involvement of the peritoneum is one of the rare findings in pregnant women particularly when ectopic decidualization disseminated as an asymptomatic intra-abdominal nodule. We present here a case of an ectopic decidualization in a 33-year-old pregnant woman with symptoms of irritable bowel syndrome during pregnancy.

  18. Spectrum of menstrual problems after tubal ligation

    International Nuclear Information System (INIS)

    Naqvi, S.S.B.; Akthar, S.; Mubeen, A.; Noor, A.

    2014-01-01

    To determine the frequency of menstrual problems after tubal ligation. Study Design: Descriptive study. Place and Duration of Study: This study was carried out in gynae department of PAF Hospital Sargodha, Pakistan from September 2011 to September 2012. Patients and methods: Two hundred patients were included in the study with menstrual problems after tubal ligation. Results: Forty seven percent of patients presented with menorrhagia, 28% presented with metrorrhagia, 13% patients were having complaints of polymenorrhoea and 5% patients presented with dysmenorrhea and 7% had oligomenorrhoea after tubal ligation. Thirty one percent of patients ended up in hysterectomy and 37% of patients had improvement of symptoms with medical treatment. Conclusion: Menstrual problem is a common complaint in our gyn ecological patients. A large number of these patients had history of tubal ligation. Menorrhagia, metrorrhagia, polymenorrhoea and dysmenorrhoea can occur after tubal ligation. Patients giving the history of menstrual problems and wants tubal ligation should be counselled earlier for these symptoms. (author)

  19. Fatores associados ao futuro reprodutivo de mulheres desejosas de gestação após ligadura tubária Factors associated with the reproductive future of patients wishing pregnancy after being submitted to tubal ligation

    Directory of Open Access Journals (Sweden)

    Antônio Carlos Rodrigues da Cunha

    2007-05-01

    comprometer o futuro reprodutivo, uma vez que apenas uma minoria dessas pacientes alcançam os objetivos.PURPOSE: to analyze the factors associated with the reproductive future of patients wishing to become pregnant after having being submitted to tubal ligation (TL, attended at a public service. METHODS: a prospective study including 98 patients previously submitted to TL, who came to the Human Reproduction Center of the University Hospital of Brasilia (HUB, from January 1996 to January 2004, wishing to become pregnant again These patients were followed up from their first appointment till the end of the study, when they answered a structured questionnaire about the social demographic aspects at both the moment they asked for the TL and the reversion of the procedure. RESULTS: the patients’ average age at the TL procedure was 25 years old. Among them, 55.1% were younger than 25, 46.9% had three or more children, and ten of them had only one child. The most common reasons for the TL procedure were: contraception (48%, financial difficulties (25.5% and marital problems (15.3%. The major causes for wishing a new pregnancy were: a new relationship/marriage (80.6%, the desire of having another child with the same partner (8.2%, and the death of a child (6.1%. The regret time informed by most of the patients was between two and four years, and the search for reversion was between six and ten years. About 83.6% of the sample referred lack of information about the procedure and the difficulties of reversion. Twenty patients were submitted to TL reversal procedure; from the ten who became pregnant, only six delivered babies, after a full-term pregnancy. Eight patients were referred to in vitro fertilization treatment, four of them became pregnant and two delivered healthy babies. CONCLUSIONS: TL in young vulnerable women, not informed about the definitive condition of the method, may increase the search for attended reproduction services and impair their reproductive future, as far

  20. Selective transcervical tubal recanalisation using DSA

    International Nuclear Information System (INIS)

    Kelekis, D.; Fezoulidis, I.; Petsas, T.; Tsapalira, A.; Kelekis, N.

    1991-01-01

    The results of selective transcervical tubal recanalisation by means of a catheter in 20 patients with tubal occlusions are reported and discussed. The advantages of tubal recanalisation under DSA are stressed. In 18 (90%) of the 20 patients treated, it was possible to recanalise at least one tube. Nine of these 18 women (50%) became pregnant during the period of observation, averaging 12 months. Selective transcervical recanalisation of obstructive tubes is a rapid, reliable, cheap and hardly invasive treatment of sterility, when compared with laparoscopy or laparotomy. In the majority of patients it makes surgery unnecessary. (orig.) [de

  1. Heterotopic pregnancy - outcome and management

    International Nuclear Information System (INIS)

    Zahoor, S.; Hussain, M.; Yasmin, H.; Noorani, K.J.

    2004-01-01

    A case of heterotopic pregnancy is reported that presented with 7 weeks of amenorrhea, lower abdominal pain and spotting per vaginum. Ultrasound showed an intra-uterine gestational sac as well as right-sided ruptured tubal pregnancy. Emergency laparotomy and right salpingectomy was performed. Subsequent ongoing alive intra-uterine pregnancy was delivered by vaginal route at term. (author)

  2. Hysteroscopic tubal electrocoagulation versus laparoscopic tubal ligation for patients with hydrosalpinges undergoing in vitro fertilization.

    Science.gov (United States)

    El-Mazny, Akmal; Abou-Salem, Nermeen; Hammam, Mohamed; Saber, Walid

    2015-09-01

    To investigate the use and success rate of hysteroscopic tubal electrocoagulation for the treatment of hydrosalpinx-related infertility among patients undergoing in vitro fertilization (IVF) who have laparoscopic contraindications. A prospective study was conducted among patients who had unilateral or bilateral hydrosalpinges identified on hysterosalpingography and vaginal ultrasonography, and who were undergoing IVF at a center in Cairo, Egypt, between January 1, 2013, and October 30, 2014. All patients who had contraindications for laparoscopy were scheduled for hysteroscopic tubal electrocoagulation (group 1); the other patients underwent laparoscopic tubal ligation (group 2). For all patients, hysterosalpingography was performed 3 months after their procedure to evaluate proximal tubal occlusion. Among 85 enrolled patients, 22 underwent hysteroscopic tubal electrocoagulation and 63 underwent laparoscopic tubal ligation. The procedure was successful in terms of tubal occlusion for 25 (93%) of 27 hydrosalpinges in group 1, and 78 (96%) of 81 hydrosalpinges in group 2 (P=0.597). No intraoperative or postoperative complications were reported. Hysteroscopic tubal electrocoagulation was found to be a successful treatment for hydrosalpinges before IVF when laparoscopy is contraindicated. Copyright © 2015 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  3. Ovarian and tubal cancer in Denmark

    DEFF Research Database (Denmark)

    Gottschau, Mathilde; Mellemkjaer, Lene; Hannibal, Charlotte G

    2016-01-01

    INTRODUCTION: The Nordic countries are areas with a high-incidence of ovarian cancer; however, differences between the countries exist. MATERIAL AND METHODS: We used the Danish Cancer Registry to identify 11 264 cases of ovarian cancer and 363 cases of tubal cancer during 1993-2013. We calculated...... age-standardized (world standard population) incidence rates for overall and subtype-specific ovarian cancer, and for tubal cancer. We compared age-standardized incidence rates, and 1- and 5-year age-standardized relative survival rates, respectively, for ovarian and tubal cancer combined in four...... Nordic countries using the NORDCAN database. RESULTS: The incidence rate of ovarian cancer overall in Denmark decreased statistically significantly by approximately 2.3% per year among women aged

  4. Psychomotor skills and cognitive load training on a virtual reality laparoscopic simulator for tubal surgery is effective.

    Science.gov (United States)

    Bharathan, Rasiah; Vali, Saaliha; Setchell, Thomas; Miskry, Tariq; Darzi, Ara; Aggarwal, Rajesh

    2013-07-01

    Validation of a virtual reality (VR) simulator for the training and assessment of laparoscopic tubal surgery and mapping of cognitive load. Prospective cohort study conducted at the Imperial College Virtual Reality Surgical Skills laboratory amongst 25 trainees and nine senior gynaecologists. Participants performed two sessions of salpingectomy and salpingotomy procedures on a VR simulator to assess construct validity. Nine novices performed ten such sessions to enable assessment of the learning curve. The relationship between cognitive load and the dexterity parameters was assessed. Simulator fidelity was reported by experienced and intermediate level gynaecologists. Statistical analyses utilised non-parametric tests, Kruskall-Wallis and Mann-Whitney U tests. Learning curves were assessed using the Friedman test and Wilcoxon Signed Ranks test. Relationship between dexterity metrics and cognitive load was performed using Spearman's rank order correlation. Salpingectomy demonstrated construct validity for time taken by experienced, intermediate and novice gynaecologists (median 170 vs. 191 vs. 313s (P=0.003) respectively) and movements (median 200 vs. 267 vs. 376s, P=0.045). Salpingotomy demonstrated construct validity for time taken (median 183 vs. 191 vs. 306s, P=<0.001) and movements (median 210 vs. 233 vs. 328s, P=0.005). Learning curve analysis for salpingectomy displayed a plateau for time taken after the eighth session, and the fourth session for movements. Salpingotomy displayed a plateau after the eighth session for both time taken and movements. Cognitive load correlated significantly with dexterity parameters. The fidelity scores were not significantly different between the two procedures (P=0.619). The LAP Mentor VR laparoscopic simulator is a valid and effective tool for training novice surgeons in ectopic pregnancy surgery. Reduction in cognitive load significantly correlates with the learning curves. Copyright © 2013 Elsevier Ireland Ltd. All rights

  5. Cost-effectiveness of tubal patency tests.

    Science.gov (United States)

    Verhoeve, H R; Moolenaar, L M; Hompes, P; van der Veen, F; Mol, B W J

    2013-04-01

    Guidelines are not in agreement on the most effective diagnostic scenario for tubal patency testing; therefore, we evaluated the cost-effectiveness of invasive tubal testing in subfertile couples compared with no testing and treatment. Cost-effectiveness analysis. Decision analytic framework. Computer-simulated cohort of subfertile women. We evaluated six scenarios: (1) no tests and no treatment; (2) immediate treatment without tubal testing; (3) delayed treatment without tubal testing; (4) hysterosalpingogram (HSG), followed by immediate or delayed treatment, according to diagnosis (tailored treatment); (5) HSG and a diagnostic laparoscopy (DL) in case HSG does not prove tubal patency, followed by tailored treatment; and (6) DL followed by tailored treatment. Expected cumulative live births after 3 years. Secondary outcomes were cost per couple and the incremental cost-effectiveness ratio. For a 30-year-old woman with otherwise unexplained subfertility for 12 months, 3-year cumulative live birth rates were 51.8, 78.1, 78.4, 78.4, 78.6 and 78.4%, and costs per couple were €0, €6968, €5063, €5410, €5405 and €6163 for scenarios 1, 2, 3, 4, 5 and 6, respectively. The incremental cost-effectiveness ratios compared with scenario 1 (reference strategy), were €26,541, €19,046, €20,372, €20,150 and €23,184 for scenarios 2, 3, 4, 5 and 6, respectively. Sensitivity analysis showed the model to be robust over a wide range of values for the variables. The most cost-effective scenario is to perform no diagnostic tubal tests and to delay in vitro fertilisation (IVF) treatment for at least 12 months for women younger than 38 years old, and to perform no tubal tests and start immediate IVF treatment from the age of 39 years. If an invasive diagnostic test is planned, HSG followed by tailored treatment, or a DL if HSG shows no tubal patency, is more cost-effective than DL. © 2013 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2013

  6. Ectopic Oral Tonsillar Tissue: A Case Series with Bilateral and Solitary Presentations and a Review of the Literature

    Directory of Open Access Journals (Sweden)

    Masashi Kimura

    2015-01-01

    Full Text Available An ectopic tonsil is defined as tonsillar tissue that develops in areas outside of the four major tonsil groups: the palatine, lingual, pharyngeal, and tubal tonsils. The occurrence of tonsillar tissue in the oral cavity in ectopic locations, its prevalence, and its developmental mechanisms that belong to its formation remain unclear. In this report, we describe a rare case of bilateral symmetric ectopic oral tonsillar tissue located at the ventral surface of the tongue along with two solitary cases arising from the floor of the mouth. The role of immune system and its aberrant response leading to ectopic deposits desires further studies. As an ectopic tonsil may simulate a benign soft tissue tumor, this case series highlights the importance of this entity in our clinical differential diagnosis of oral soft tissue masses.

  7. Primary Intraorbital Ectopic Meningioma

    Science.gov (United States)

    Yokoyama, Tetsuo; Nishizawa, Shigeru; Sugiyama, Kenji; Yokota, Noki; Ohta, Seiji; Uemura, Kenichi; Hinokuma, Kaoru; Inenaga, Chikanori

    1999-01-01

    We report a case of intraorbital meningioma. Operative findings and histopathological examination revealed the tumoc to be meningothelial meningloma and to be located entirely outside the optic dura. This case demonstrates the occurrence of primary intraorbital ectopic meningioma, and the tumor was removed through a modified Dolenc approach. The primary intraorbital ectopic meningioma is discussed and the surgical approach to the orbital apex region is reviewed. ImagesFigure 1Figure 2Figure 4Figure 5 PMID:17171081

  8. Development of Some Organs Derived from the Three Embryonic Germ Layer in a Degus Ectopic Pregnancy and Presence of a Cytotrophoblast That Mimics Human Chorionic Placenta

    Directory of Open Access Journals (Sweden)

    C. Bosco

    2014-01-01

    Full Text Available This report describes a case of abdominal pregnancy in an adult female degu from which we recovered two large tissular masses from the peritoneal cavity. The bigger one showed a number of thin vascular connections to the serosa layer of the small intestine. It was also directly connected to the smaller mass by a thin membranous process. The surface of the bigger mass facing the small intestine wall showed the presence of chorionic villous that resembled a villous human chorionic placenta, rather than the hemomonochorial labyrinthine placenta, characteristic of this species. This unusual finding leads us to postulate that in the degu’s uterus the cytotrophoblast is exposed to a number of factors that will activate cascades of cellular and molecular events that ultimately will be signaling the cytotrophoblast to develop into a labyrinthine hemomonochorial placenta. In absence of the proper uterine environment, as is the case of the abdominal pregnancy in the peritoneal cavity reported here, the lack of signaling will lead the cytotrophoblast to develop into a villous chorionic placenta, similar to that observed in human.

  9. Radiologic fallopian tube catheterization for diagnosis and treatment of proximal tubal obstruction

    International Nuclear Information System (INIS)

    Thurmond, A.S.; Rosch, J.

    1988-01-01

    Seventy-five infertile women in whom proximal fallopian tube obstruction had been demonstrated by conventional hysterosalpingography were managed by means of fluoroscopic transcervical fallopian tube catheterization techniques. The procedure helped avoid surgery for diagnosis and/or treatment of proximal tubal obstruction in 71 women (95%). In 32 patients who had patent tube(s) following the procedure, 15 pregnancies have occurred, 14 intrauterine and one tubal (follow-up, 6 months). Fifteen patients had follow-up studies after recanalization, and 19 of 23 tubes remained patent (83%). Fluoroscopic fallopian tube catheterization improves diagnosis of fallopian tube disease and is a low-cost, nonsurgical treatment for infertility caused by proximal fallopian tube obstruction

  10. Heterotopic pregnancy in HIV women

    OpenAIRE

    Savasi, V.; Antonazzo, P.; Personeni, C.

    2016-01-01

    Heterotopic pregnancy occurs when intrauterine and ectopic pregnancy are concomitant; overall rate rises from 1/30.000 to 1.5/1000 in assisted reproductive technology pregnancies. HIV (human immunodeficiency virus) patients are at increased risk of heterotopic pregnancies due to the greater frequency of assisted reproductive technology and pelvic inflammatory disease. We report the first case of heterotopic pregnancy in HIV woman.

  11. Cost-effectiveness analysis comparing the essure tubal sterilization procedure and laparoscopic tubal sterilization.

    Science.gov (United States)

    Thiel, John A; Carson, George D

    2008-07-01

    To analyze the financial implications of establishing a hysteroscopic sterilization program using the Essure micro-insert tubal sterilization system in an ambulatory clinic. A retrospective cohort study (Canadian Task Force classification Type II-2), in an ambulatory women's health clinic in a tertiary hospital, of 108 women undergoing Essure coil insertion between 2005 and 2006, and 104 women undergoing laparoscopic tubal sterilization for permanent sterilization between 2001 and 2004. The Essure procedures used a 4 mm single channel operative hysteroscope and conscious sedation (fentanyl and midazolam); the laparoscopic tubal sterilizations were completed under general anaesthesia with a 7 mm laparoscope and either bipolar cautery or Filshie clips. Costs associated with the procedure, follow-up, and management of any complications (including nursing, hospital charges, equipment, and disposables) were tabulated. The Essure coils were successfully placed on the first attempt in 103 of 108 women (95%). Three patients required a second attempt to complete placement and two patients required laparoscopic tubal sterilization after an unsuccessful Essure. All 104 laparoscopic tubals were completed on the first attempt with no complications reported. The total cost for the 108 Essure procedures, including follow-up evaluation, was $138,996 or $1287 per case. The total cost associated with the 104 laparoscopic tubal sterilization procedures was $148,227 or $1398 per case. The incremental cost-effectiveness ratio was $111. The Essure procedure in an ambulatory setting resulted in a statistically significant cost saving of $111 per sterilization procedure. Carrying out the Essure procedure in an ambulatory setting frees space in the operating room for other types of cases, improving access to care for more patients.

  12. Pregnancy

    DEFF Research Database (Denmark)

    Palmer, Keith T; Bonzini, Matteo; Bonde, Jens Peter Ellekilde

    2013-01-01

    Most pregnant women are exposed to some physical activity at work. This Concise Guidance is aimed at doctors advising healthy women with uncomplicated singleton pregnancies about the risks arising from five common workplace exposures (prolonged working hours, shift work, lifting, standing and hea...... on pregnancy. Moreover, moderate physical exercise is thought to be healthy in pregnancy and most pregnant women undertake some physical work at home. The guidelines provide risk estimates and advice on counselling....

  13. Office hysteroscopic-guided selective tubal chromopertubation: acceptability, feasibility and diagnostic accuracy of this new diagnostic non-invasive technique in infertile women.

    Science.gov (United States)

    Carta, Gaspare; Palermo, Patrizia; Pasquale, Chiara; Conte, Valeria; Pulcinella, Ruggero; Necozione, Stefano; Cofini, Vincenza; Patacchiola, Felice

    2018-06-01

    The aim of this study was to evaluate accuracy, tolerability and side effects of office hysteroscopic-guided chromoperturbations in infertile women without anaesthesia. Forty-nine infertile women underwent the procedure to evaluate tubal patency and the uterine cavity. Women with unilateral or bilateral tubal stenosis at hysteroscopy with chromoperturbation, and women with bilateral tubal patency who did not conceive during the period of six months, underwent laparoscopy with chromoperturbation. The results obtained from hysteroscopy and laparoscopy in the assessment of tubal patency were compared. Sensitivity, specificity, accuracy, positive-predictive value and negative-predictive value were used to describe diagnostic performance. Pain and tolerance were assessed during procedure using a visual analogue scale (VAS). Side effects or late complications and pregnancy rate were also recorded three and six months after the procedure. The specificity was 87.8% (95% CI: 73.80-95.90), sensitivity was 85.7% (95% CI 57.20-98.20), positive and negative predictive values were 70.6% (95% CI: 44.00-89) and 94.7% (95% CI: 82.30-99.40), respectively. Pregnancy rate (PR) within six months after performance of hysteroscopy with chromoperturbation was 27%. Office hysteroscopy-guided selective chromoperturbation in infertile patients is a valid technique to evaluate tubal patency and uterine cavity.

  14. Psychosocial implications of tubal ligation in a rural health district: A phenomenological study

    Directory of Open Access Journals (Sweden)

    Lutala Prosper M

    2011-12-01

    Full Text Available Abstract Background Tubal ligation is the most popular family planning method worldwide. While its benefits, such as effectiveness in protecting against pregnancies, minimal need for long-term follow-up and low side-effects profile are well documented, it has many reported complications. However, to date, these complications have not been described by residents in Congo. Therefore, the study aimed at exploring the experience of women who had undergone tubal ligation, focusing on perceptions of physical, psychological and contextual experiences of participants. Methods This qualitative study used a semi-structured questionnaire in a phenomenological paradigm to collect data. Fifteen participants were purposefully selected among sterilized women who had a ligation procedure performed, were aged between 30 and 40 years, and were living within the catchment area of the district hospital. Data were collected by two registered nurses, tape-recorded, and transcribed verbatim. Reading and re-reading cut and paste techniques, and integration were used to establish codes, categories, themes, and description. Results Diverse and sometimes opposite changes in somatic symptoms, psychological symptoms, productivity, ecological relationships, doctor-client relationships, ethical issues, and change of life style were the major problem domains. Conclusions Clients reported conflicting experiences in several areas of their lives after tubal sterilization. Management, including awareness of the particular features of the client, is needed to decrease the likelihood of psychosocial morbidity and/or to select clients in need of sterilization.

  15. Prevalência de gestação ectópica de tratamento cirúrgico em hospital público de 1995-2000 Prevalence of ectopic pregnancy liable to surgical treatment in a public hospital from 1995 through 2000

    Directory of Open Access Journals (Sweden)

    Arlete Maria dos Santos Fernandes

    2004-12-01

    Full Text Available OBJETIVOS: Determinar a prevalência de gestação ectópica (GE em mulheres submetidas à laparotomia no Hospital e Maternidade Celso Pierro durante os anos de 1995 a 2000, avaliar as características e o tratamento realizado. MÉTODOS: Estudo retrospectivo. Os prontuários de mulheres submetidas à laparotomia foram revisados. As variáveis consideradas foram idade, procedência da mulher, trabalho, paridade, gravidez ectópica íntegra ou rôta, cirurgia realizada, complicações e tempo de internação. A análise de dados foi descritiva, seguida de regressão logística. RESULTADOS: Noventa e seis casos foram identificados, todos com GE tubária. A maioria das mulheres (65% tinha entre 25 e 35 anos e 30% estavam empregadas. A maior parte dos diagnósticos foi de gestação ectópica rôta (66% e realizou-se salpingectomia com ou sem ooforectomia em 79%. Houve 19% de casos complicados, com maior freqüência de anemia aguda, um óbito por CIVD e 12% das mulheres receberam transfusão. O tempo médio de internação foi de 3,63 dias (DP+0,8. A prevalência de gestações ectópicas manteve-se estável durante o período e correspondeu a 11% do total de laparotomias. CONCLUSÕES: O número de GE submetidas à cirurgia manteve-se estável durante o período estudado, o que requer medidas preventivas em vários níveis para o seu controle. Esta é patologia grave, cursa com alta morbidade e segue sendo desafio nos serviços de ginecologia.OBJECTIVES: To determine the prevalence of women with ectopic pregnancy submitted to surgical treatment at the HMCP from 1995 to 2000; as well as to evaluate some characteristics of these women and the treatment performed. METHODS: The study was retrospective. Data was obtained from medical register of women submitted to laparotomy with the diagnosis of ectopic pregnancy. Variables studied were: patient's age, place of birth and occupation, status of ectopic pregnancy (with or without rupture, type of surgery

  16. Non-surgical female sterilization with quinacrine-induced tubal occlusion: a clinical trial

    Directory of Open Access Journals (Sweden)

    Seifi

    2008-08-01

    Full Text Available Background: Over the last 35 years, quinacrine has been used to sterilize more than 150,000 women in 40 countries, first in the form of slurry and now in the form of cylindrical pellets. Some studies confirmed the tubal occlusion by hysterosalpyngo-graphy, but this method increases the chance of failure. Only a few studies on tubal occlusion have used transvaginal sonography for confirmation, and there were some doubts about the effect of quinacrine on the endometrium. We performed this study to evaluate the tubal scar and endometrial pattern by ultrasound and to determine the feasibility, acceptance, and side effects of quinacrine sterilization (QS in Iranian women. Methods: This prospective clinical trial was done at the Vali-e-Asr Reproductive Health Research Center of the Tehran University of Medical Sciences between April 2005 and July 2006. One hundred sexually active women ranging from 30 to 47 years of age, who had at least two children above two years old, requesting sterilization, were sterilized by this method. By the end of menstrual bleeding, seven pellets, each containing 36mg quinacrine, were inserted in the uterine fundal area via the cervical canal. The procedure was repeated one month later. Three cycles after the first step, transvaginal sonography was performed to visualize the tubal scar and determine the endometrial pattern. Patients were followed at one and three years after initiation of the procedure. Results: All women were satisfied with the procedure. There were no side effects. No pregnancies had occurred, nor were there endometrial thickness abnormalities. Scar formation was visible in the tubes. "nConclusion: Quinacrine sterilization is a useful method for women and can be recommended to family planning services as an ambulatory procedure due to its efficacy, simplicity, acceptance and cost effectiveness.

  17. Association between history of abdominopelvic surgery and tubal ...

    African Journals Online (AJOL)

    EB

    women. Reports on the relationship between these factors and tubal pathology seen on hysterosalpingography (HSG) from our .... (2) tubal dilatation with prolonged retention of ... irrespective of whether the patient has had single or .... women marry earlier in our culture. ... Münstedt K, Tinneberg HR, Hackethal A. Dtsch.

  18. Risk factors for abnormal tubal hysterosalpingographic findings in ...

    African Journals Online (AJOL)

    Background: Acquired structural abnormalities of the female reproductive tract contributes to the aetiology of female infertility. So many presumed risk factors for female tubal infertility are seen among Nigerian women. However, reports on the relationship between these factors and tubal pathology as seen on ...

  19. Tubal ligation and risk of ovarian cancer subtypes

    DEFF Research Database (Denmark)

    Sieh, Weiva; Salvador, Shannon; McGuire, Valerie

    2013-01-01

    Tubal ligation is a protective factor for ovarian cancer, but it is unknown whether this protection extends to all invasive histological subtypes or borderline tumors. We undertook an international collaborative study to examine the association between tubal ligation and ovarian cancer subtypes....

  20. Chlamydial Infection, Plasma Peroxidation and Obesity in Tubal ...

    African Journals Online (AJOL)

    Objective: This study aimed to investigate the association of Chlamydial infection, obesity and oxidative response with tubal infertility in Nigerian women. Methods: It was a case-control study of 40 women with tubal infertility and 32 fertile women, respectively, recruited from the Infertility and Family Planning Clinics ...

  1. Diagnostic methods of tubal factor in infertility

    International Nuclear Information System (INIS)

    Korzon, T.; Mielnik, J.; Gosciniak, W.

    1993-01-01

    The diagnostic methods of tubal factor in infertility have been presented. In details have been discussed PJ, PK HSG and pelviscopy. These examinations themselves constitute the basic ones in infertility. We turned our attention into technical details and possible mistakes which may occur at the time of performing them, these misinterpretations may lead to absolutely wrong conclusion and diagnosis. Authors have wide experience in performing the discussed examinations and this allows them to share their opinion. Over the years several thousand of PK and HSG examinations have been carried out and also 1000 laparoscopies. (author)

  2. Pregnancy

    Science.gov (United States)

    ... current.html ACOG Committee on Obstetric Practice and Society for Maternal-Fetal Medicine. (2013; Reaffirmed 2015). Committee Opinion No. 579. Definition of term pregnancy. Retrieved May 20, 2016, from ...

  3. Successful Intrauterine Pregnancy following salpingostomy; Case ...

    African Journals Online (AJOL)

    by salpingostomy, after which she had spontaneous abortion of the associated intrauterine pregnancy. Result: Initial marital disharmony, followed by an uneventful intrauterine pregnancy carried to term with caesarean delivery of a live female baby. Conclusion: In well-selected cases, conservative tubal surgeries should be ...

  4. Next Generation Sequencing of Tubal Intraepithelial Carcinomas

    Science.gov (United States)

    McDaniel, Andrew S.; Stall, Jennifer N.; Hovelson, Daniel H.; Cani, Andi K.; Liu, Chia-Jen; Tomlins, Scott A.; Cho, Kathleen R.

    2016-01-01

    Importance High-grade serous carcinoma (HGSC) is the most prevalent and lethal form of ovarian cancer. HGSCs frequently arise in the distal fallopian tubes rather than the ovary, developing from small precursor lesions called serous tubal intraepithelial carcinomas (TICs or more specifically STICs). While STICs have been reported to harbor TP53 mutations, detailed molecular characterizations of these lesions are lacking. Observations We performed targeted next generation sequencing (NGS) on formalin-fixed, paraffin- embedded tissue from four women, two with HGSC and two with uterine endometrioid carcinoma (UEC) who were diagnosed with synchronous STICs. We detected concordant mutations in both HGSCs with synchronous STICs, including TP53 mutations as well as assumed germline BRCA1/2 alterations, confirming a clonal relationship between these lesions. NGS confirmed the presence of a STIC clonally unrelated to one case of UEC. NGS of the other tubal lesion diagnosed as a STIC unexpectedly supported the lesion as a micrometastasis from the associated UEC. Conclusions and Relevance We demonstrate that targeted NGS can identify genetic lesions in minute lesions such as TICs, and confirm TP53 mutations as early driving events for HGSC. NGS also demonstrated unexpected relationships between presumed STICs and synchronous carcinomas, suggesting potential diagnostic and translational research applications. PMID:26181193

  5. Retrospective review of the medical management of ectopic ...

    African Journals Online (AJOL)

    Medical management of ectopic pregnancies is a safe and effective management option, as proven by international data, but at Tygerberg Hospital the safety of this treatment modality cannot be guaranteed because of poor follow-up. Improvement in patient selection with consideration of predictors of success and thorough ...

  6. Cervical Ectopic Pregnancy presenting as Cervical Fibroid

    African Journals Online (AJOL)

    Mubeen

    A free application to browse and search the journal's content is now available for iPhone/iPad. The application provides “Table of Contents” of the latest issues, which are stored on the device for future offline browsing. Internet connection is required to access the back issues and search facility. The application is Compatible ...

  7. Fibrocystic disease of vulvar ectopic breast tissue. Case report and review of the literature.

    Science.gov (United States)

    Baykal, C; Tulunay, G; Usubutun, A; Küçükali, T; Ozer, S; Demir, O F

    2004-01-01

    Mammary glands located in the vulvar region have been named as ectopic breast tissue or anogenital mammary glands by different authors. Literature on pathologies of ectopic breast tissue located in the vulvar region is rare. Most of the reports are about the malignancies arising from this ectopic tissue. We report a case of fibrocystic disease of the mammary glands in the vulva in a 25-year-old pregnant woman. Her disease was exaggerated during pregnancy. Ectopic breast tissue in the vulva is a rare entity and fibrocystic disease of this tissue has rarely been reported in the English literature. Copyright (c) 2004 S. Karger AG, Basel.

  8. Ectopic corticotroph syndrome

    Directory of Open Access Journals (Sweden)

    Penezić Zorana

    2004-01-01

    Full Text Available INTRODUCTION Endogenous Cushing's syndrome is a clinical state resulting from prolonged, inappropriate exposure to excessive endogenous secretion of Cortisol and hence excess circulating free cortisol, characterized by loss of the normal feedback mechanisms of the hypothalamo-pituitary-adrenal axis and the normal circadian rhythm of cortisol secretion [2]. The etiology of Cushing's syndrome may be excessive ACTH secretion from the pituitary gland, ectopic ACTH secretion by nonpituitary tumor, or excessive autonomous secretion of cortisol from a hyperfunctioning adrenal adenoma or carcinoma. Other than this broad ACTH-dependent and ACTH-independent categories, the syndrome may be caused by ectopic CRH secretion, PPNAD, MAH, ectopic action of GIP or catecholamines, and other adrenel-dependent processes associated with adrenocortical hyperfunction. CASE REPORT A 31 year-old men with b-month history of hyperpigmentation, weight gain and proximal myopathy was refereed to Institute of Endocrinology for evaluation of hypercortisolism. At admission, patient had classic cushingoid habit with plethoric face, dermal and muscle atrophy, abdominal strie rubrae and centripetal obesity. The standard laboratory data showed hyperglycaemia and hypokaliemia with high potassium excretion level. The circadian rhythm of cortisol secretion was blunted, with moderately elevated ACTH level, and without cortisol suppression after low-dose and high-dose dexamethason suppression test. Urinary 5HIAA was elevated. Abdominal and sellar region magnetic resonance imaging was negative. CRH stimulation resulted in ACTH increase of 87% of basal, but without significant increase of cortisol level, only 7%. Thoracal CT scan revealed 14 mm mass in right apical pulmonary segment. A wedge resection of anterior segment of right upper lobe was performed. Microscopic evaluation showed tumor tissue consisting of solid areas of uniform, oval cells with eosinophilic cytoplasm and centrally

  9. [Tubal reanastomosis: analysis of the results of 30 years of treatment].

    Science.gov (United States)

    Abelha, Melissa de Castro; Costa, Rosaly Rulli; Lopes, Vinicius Medina; Reis, Rachel Costa Vinhaes dos; Silva, Carla Maria Martins da

    2008-06-01

    to verify the ratio of intra-uterine gestation in patients submitted to recanalization in the Hospital Regional da Asa Sul in the last 30 years and to assess the rate of ectopic gestation of such procedures, the influence of age and time interval between salpingectomy and recanalization in the therapeutic success. medical files of 71 patients were analyzed, after exclusion of those presenting other alterations that could influence fertility prognosis, plus the cases when recanalization was impossible. Variables collected were: occurrence of intra-uterine gestation, coming to term or to abortion; occurrence of ectopic pregnancy after salpingectomy; no-conception after reversion, women's age at the recanalization, and time interval between salpingectomy and its reversion. there has been a pregnancy rate of 67.6%, 73.2% for bilateral recanalization and 46.6% for unilateral, as well as 5.6% of ectopic pregnancies. Concerning the patients' age group, it was observed a pregnancy rate of 33%, from 20 to 24; 60%, from 25 to 29; 69.2%, from 30 to 34; 65%, from 35 to 39, and 42.9%, from 40 to 44 years old. The number of cases was small for age the groups 20 to 24 and 40 to 44 years old. The time interval between salpingectomy and recanalization (TISR) has varied from one to 18 years. TISR has been divided in three groups presenting the following pregnancy rates: one to six year interval, 59%; seven to 12, 66.6%; 13 to 18, 57%. gestation rate has been 67.6%, 5.6% being ectopic. In the comparison of age groups, there has been no significant influence of age on the therapeutic success of patients from 25 to 39 years old. Sterility duration did not influence the reversion results.

  10. Primary ectopic frontotemporal extradural craniopharyngioma

    Directory of Open Access Journals (Sweden)

    Reza Pourkhalili

    2016-01-01

    Full Text Available We present a case of primary ectopic frontotemporal extradural craniopharyngioma. Primary ectopic craniopharyngiomas are very rare and have been reported involving the fourth ventricle, infrasellar region, lateral ventricle, temporal area, cerebellopontine angle, clivus, corpus callosum, and prepontine cistern. There was just 1 case of craniopharyngioma previously presented in the literature, with nearly same location as the presenting case.

  11. Heterotopic pregnancy in HIV women

    Directory of Open Access Journals (Sweden)

    Valeria Savasi

    2016-11-01

    Full Text Available Heterotopic pregnancy occurs when intrauterine and ectopic pregnancy are concomitant; overall rate rises from 1/30.000 to 1.5/1000 in assisted reproductive technology pregnancies. HIV (human immunodeficiency virus patients are at increased risk of heterotopic pregnancies due to the greater frequency of assisted reproductive technology and pelvic inflammatory disease. We report the first case of heterotopic pregnancy in HIV woman.

  12. Heterotopic pregnancy: Sonographic findings

    International Nuclear Information System (INIS)

    Kwon, Tae Hee

    1999-01-01

    To evaluate the sonographic findings of the heterotopic pregnancy which is increasing recently. Thirty-nine cases of heterotopic pregnancy after ovulation induction and IVF-ET (In Vitro Fertilization-Embryo Transfer) during the recent 3 years were analyzed. They were diagnosed by ultrasonography and proved surgically afterwards. Sonographic findings were analyzed focusing on gestational week of intrauterine pregnancy and location of ectopic pregnancy. In particular, adnexal mass was evaluated with regard to size and the characteristic findings such as ectopic gestational sac (echogenic ring). Also, overian cyst and fluid collection in cul-de-sac space were reviewed carefully. Heterotopic pregnancy was proved surgically by salpingectomy in 33 cases and by resection of cornus in six cases. Sonographic diagnosis using transvaginal ultrasound was made from five weeks to nine weeks two days (six weeks and four days in average) from last menstral period in all 39 cases. Ectopic pregnancy was identified in ampullary part in 29 cases, in the isthmic portion of tube in four cases and in the cornus of uterus in six cases. The intrauterine pregnancy was diagnosed by identifying the intrauterine gestational saccontaining a yolk sac in seven cases and the embryo with fetal heart beat in the remaining 32 cases. Adnexal masses of heterotopic pregnancy were less than 3 cm in diameter in 2 cases (57%), 3-4 cm in 11 cases (28%) and more than 4 cm in 6 cases (15%). A characteristic finding of ectopic mass was echogenic ring which was visible in 33 (84.6%) cases by transvaginal ultrasound. Six cases had pelvic hematosalpinx and two had pelvic hematoma. Of 10 cases (26%) which were identified to have ovarian hyperstimulation syndrome, eight (21%) had large amount of fluid collection in cul-de-sac and abdomen. Ultrasonographic identification of the intrauterine pregnancy and the ectopic chorion ring is effective for the early diagnosis of the heterotopic pregnancy.

  13. The optimal cutoff serum level of human chorionic gonadotropin for efficacy of methotrexate treatment in women with extrauterine pregnancy.

    Science.gov (United States)

    Sagiv, Ron; Debby, Abraham; Feit, Hagit; Cohen-Sacher, Bina; Keidar, Ran; Golan, Abraham

    2012-02-01

    To evaluate the efficacy of methotrexate treatment for extrauterine pregnancy and define criteria for prediction of success. Of 829 patients with an ectopic pregnancy admitted to E. Wolfson Medical Center, Holon, Israel, from January 1997 through December 2009, 238 had asymptomatic tubal pregnancies and increasing serum β-human chorionic gonadotropin (βhCG) levels. These patients were treated with a single intramuscular injection of 50mg of methotrexate (MTX) per square meter of body surface. Success was defined as undetectable βhCG levels without the need for a surgical intervention. The groups of patients successfully treated (n=167 [70%]) and unsuccessfully treated (n=71 [30%]) were compared. They were similar regarding age and gravidity. The initial serum βhCG level was significantly higher in the latter group than in the former (3798 mIU/mL vs. 1601 mIU/mL, Pinitial βhCG levels were less than 1000 mIU/mL, 71% when they were between 1000 and 2000 mIU/mL, and only 59% when they were between 2000 and 3000 mIU/mL. Methotrexate treatment is a safe and effective alternative to surgery. However, patients with initial βhCG levels higher than 2000 mIU/mL should only be offered the surgical approach. Copyright © 2011. Published by Elsevier Ireland Ltd.

  14. Isolated petrous apex ectopic craniopharyngioma

    Directory of Open Access Journals (Sweden)

    Julius July

    2015-12-01

    Full Text Available Primary ectopic craniopharyngioma is a rare entity. Isolated petrous apex bone location has not been reported previously. This study reports a case of 26-year-old male with right abducent nerve palsy. CT and MRI imaging reveal right petrous apex cystic lesion. No sellar or suprasellar region involvement was found. Endoscopic endonasal transphenoid approach has been successfully performed. Histopathology examination confirms the diagnosis of adamantinomatous craniopharyngioma. So far, it’s probably the first case report of primary ectopic craniopharyngioma isolated in the petrous apex. This case report supports the premise that primary ectopic craniopharyngioma is a multifactorial process that starts with an error from migrated embryological cells.

  15. Tubal risk markers for failure to place transcervical sterilization coils

    Science.gov (United States)

    Leyser-Whalen, Ophra; Rouhani, Mahta; Rahman, Mahbubur; Berenson, Abbey B

    2011-01-01

    Background There is a growing body of literature on placement rates of the Essure® procedure, yet prior studies have not attempted to identify tubal-associated risk factors for placement failures. The current study examines risk markers associated with the inability to deploy the Essure® coils into the tubal lumen using the new ESS305 design. Study Design We used electronic medical record data to assess risk markers associated with the inability to place the Essure coils in the tubal lumen using the new ESS305 design. A total of 310 attempted procedures between June 14, 2007, and April 29, 2011 were analyzed. Results There were 18 tubal failures (5.8%) out of the 310 attempted procedures. A history of a prior sexually transmitted infection (STI) was associated with tubal failure (OR 2.64, 95% confidence interval (CI) 1.01–6.90; p=.048). Conclusions We speculate that the observed association between a prior STI and an inability to place the coil was due to a past history of pelvic inflammatory disease. PMID:22036044

  16. The risk of menstrual abnormalities after tubal sterilization: a case control study

    OpenAIRE

    shobeiri, Mehri Jafari; AtashKhoii, Simin

    2005-01-01

    Abstract Background Tubal sterilization is the method of family planning most commonly used. The existence of the post-tubal-ligation syndrome of menstrual abnormalities has been the subject of debate for decades. Methods In a cross-sectional study, 112 women with the history of Pomeroy type of tubal ligation achieved by minilaparatomy as the case group and 288 women with no previous tubal ligation as the control group were assessed for menstrual abnormalities. Results Menstrual abnormalities...

  17. Initial experience with hysteroscopic tubal occlusion (Essure®).

    Science.gov (United States)

    Depes, Daniella De Batista; Pereira, Ana Maria Gomes; Lippi, Umberto Gazi; Martins, João Alfredo; Lopes, Reginaldo Guedes Coelho

    2016-01-01

    To evaluate results of early tubal occlusions performed by hysteroscopy (Essure®). This prospective study included 38 patients, 73.7% of them were white, mean age 34.5 years, they have had on average 3 pregnancies and 2.7 of deliveries. A total of 86.8% of patients previously prepared the endometrium. All procedures were carried out at outpatient unit without anesthesia. Insertion rate of the device was 100% at a mean time of 4 minutes and 50 seconds. Based on the analogical visual scale, average pain reported was three, and 55.3% of women did not report pain after the procedure. After 3 months, 89.5% of patients were very satisfied with the method. Simple radiographs of the pelvis showed 92.1% of topical devices, and one case of unilateral expulsion had occurred. A four years follow-up did not show failure in the method. Tubal occlusion through hysteroscopy at outpatient unit and without anesthesia was a quickly and well-tolerated procedure. No serious complications were seen, the success rate was high, and patients were satisfied. Avaliar os resultados das primeiras oclusões tubárias realizadas pela via histeroscópica (Essure®). Estudo prospectivo com 38 pacientes, sendo 73,7% caucasianas, com média de idade de 34,5 anos, e com 3 gestações e 2,7 partos em média. Do total, 86,8% das pacientes fizeram preparo prévio do endométrio. Todos os procedimentos foram ambulatoriais e sem anestesia. A taxa de inserção do dispositivo foi de 100%, com tempo médio de 4 minutos e 50 segundos. Segundo a Escala Visual Analógica, a dor média obtida foi de três, e 55,3% das mulheres não referiram qualquer dor após o método. Ocorreu um caso de reflexo vagal e 89,5% das pacientes retornaram às atividades normais no mesmo dia. Após 3 meses, 89,5% das pacientes encontravam-se muito satisfeitas com o método. A radiografia simples da pelve evidenciou 92,1% de dispositivos tópicos, ocorrendo um caso de expulsão unilateral. Após 4 anos de seguimento, não houve

  18. Ectopic lingual thyroid

    International Nuclear Information System (INIS)

    Amani, Mohammed El Amine; Benabadji, Nadjia; Benzian, Zakaria; Amani, Souad

    2012-01-01

    Thyroid ectopy is characterized by the presence of thyroid tissue outside its normal position resulting from a defect of the thyroid diverticulum migration from the base of the tongue until its final pre-tracheal position. One case is presented in a 12-year-old girl patient who consults for a failure to thrive estimated at less than three standard deviations (SD). Bone age was estimated at 8 years late compared to chronological age. The hormonal assessment showed hypothyroidism with negative thyroid antibodies. Cervical ultrasound was revealed thyroid parenchyma pre-dominantly left in place while sweeping the area under chin showed a nodular formation of the base of the tongue. Thyroid scan with technetium 99 m showed a selective uptake of radiotracer in sublingual position. Cervical computed tomography revealed a posterior median sublingual mass spontaneously hyperdense and enhancing sharply after injection of contrast. Treatment with thyroxine allowed obtaining euthyroidism. This case asks us to be careful before aetiological diagnosis of hypothyroidism in children, because although this is rare, the presence of a thyroid parenchyma up to the cervical ultrasound does not eliminate the presence of ectopic tissue

  19. Ectopic ureterocele and ectopic ureter in pediatric patients

    International Nuclear Information System (INIS)

    Lloret, M. T.; Ricart, V.; Muro, M. D.; Perez, D.; Martinez, I.; Brugger, S.; Romero, M. J.; Cortina, H.

    2000-01-01

    To describe the radiological findings associated with ectopic ureterocele and ectopic ureter in pediatric patients. To assess the role of ultrasound (US), serial micturating cystourethrography (SM-CU) and intravenous urography (IVU) in the diagnosis of these two entities. The authors performed a retrospective study of 132 patients, 73 with ectopic ureterocele and 59 with ectopic ureter. The imaging studies used were US, SMCU, IVU and methods to determine renal function (diuretic renography and renal scintigraphy). The findings were confirmed during surgery in every case. The most common radiological findings in ectopic ureterocele were renal duplication (86,3%). vesicoureteral reflux (VUR) to the lower half of the kidney (46.6%), dilatation of the lower pole of the kidney (38.4%) and contralateral duplication (30.1%). In boys, the ectopic ureter entered via bladder neck and posterior urethra (73.7%) or into seminal vesicles (15.8%); in girls, it went to vagina (32.5%), bladder neck (30%) or urethra (22.5%). Renal duplication was associated in 64.4%, with VUR to the ectopic ureter in 21% while there was a single renal system in 35.6%, with VUR to the ectopic ureter in 57.1% and contralateral renal agenesis in 19%. Eighteen patients (13.6%) presented a single, dy plastic, nonfunctioning renal system (6 cases of ureterocele and 12 of ectopic ureter). Knowledge of the embryological development of ureteral duplication is essential for the understanding of these two entities and helps to differentiate between them, thus facilitating a sometimes complicated diagnosis. Ectopic ureters and ureteroceles accompanied by a single, dysplastic renal system are associated with a greater incidence of congenital anomalies and a higher rate of complications than the duplicate systems. A prenatal US examination enables early diagnosis. The anatomical information provided by US is, on occasion, more valuable than that resulting from IVU or SMCU, However, IVU is indispensable in girls

  20. ECTOPIC ureters misdiagnosed as ureterocele

    International Nuclear Information System (INIS)

    Bader, I.; Akhter, N.; Anwar-ul-Haq; Chaudhary, A.; Khan, N.Z.

    2004-01-01

    Ectopic ureters may be difficult to diagnose unless there is high index of suspicion. Examination for continuous dribbling may be difficult in infants who are still using diapers. We are reporting a case of ectopic ureter which was erroneously diagnosed as ureterocele on a cystourethrogram. Further investigations for accurate diagnosis and emerging abnormalities during the course of management are presented in this case report. Review of literature to high- light the various forms of investigations and management are also presented. (author)

  1. Índice orientador do tratamento sistêmico da gravidez ectópica íntegra com dose única de metotrexato Index for the systemic treatment of unruptured ectopic pregnancy with a single dose of methotrexate

    Directory of Open Access Journals (Sweden)

    Julio Elito Junior

    1998-04-01

    iguais a cinco estiveram todas relacionadas com o fracasso do tratamento. O índice orientador ajuda-nos a indicar os melhores casos para o tratamento medicamentoso. Não o aconselhamos, portanto, quando a nota for inferior ou igual a cinco; por outro lado, podemos predizer boa evolução do tratamento, quando a nota for superior a cinco.A prospective study was performed with 42 patients with unruptured ectopic pregnancy, which intended to elaborate an index to orient the systemic treatment with the administration of a single intramuscular dose of methotrexate (50 mg/m². Patients were monitored with beta-hCG titers on days 1, 4 and 7 after the methotrexate. When the titers of beta-hCG declined more than 15%, between days 4 and 7 after methotrexate, the patients were discharged and had an outpatient follow-up monitored with beta-hCG titers weekly until the titers were less than 5 mIU/ml, which represents success of the treatment. We prepared an index for the systemic treatment with methotrexate, with five parameters: (1 initial titers of beta-hCG; (2 aspects of the image at ultrasound (hematosalpinx, gestational sac, live embryo; (3 size of the mass; (4 free fluid in cul-de-sac; (5 collor doppler. Each parameter received a grade from 0 to 2. Grade 0 represented bad prognosis, favorable parameters received grade 2 and borderline parameters received grade one. The success rate with a single dose of methotrexate was 69.0% (29/42. The color doppler was performed in 20 of the 42 patients; in this group of 20 patients the success rate was 75.0% (15/20. In the 22 patients who were not submitted to the color doppler, the average grade of the score in the successful cases was 6.6, and in the unsuccessful it was 3.1. In the group who underwent the doppler (20 patients the average was 7.9 in the successful cases and 4.2 in the cases that failed. In the present study the cut-off grade was 5, for most of the patients with grades above 5 had a successful treatment (15/16 - 93

  2. Single-dose systemic methotrexate vs expectant management for treatment of tubal ectopic pregnancy: a placebo-controlled randomized trial.

    Science.gov (United States)

    Jurkovic, D; Memtsa, M; Sawyer, E; Donaldson, A N A; Jamil, A; Schramm, K; Sana, Y; Otify, M; Farahani, L; Nunes, N; Ambler, G; Ross, J A

    2017-02-01

    Methotrexate is used routinely worldwide for the medical treatment of clinically stable women with a tubal ectopic pregnancy. This is despite the lack of robust evidence to show its superior effectiveness over expectant management. The aim of our multicenter randomized controlled trial was to compare success rates of methotrexate against placebo for the conservative treatment of tubal ectopic pregnancy. This study took place in two early-pregnancy units in the UK between August 2005 and June 2014. Inclusion criteria were clinically stable women with a conclusive ultrasound diagnosis of a tubal ectopic pregnancy, presenting with a low serum beta human chorionic gonadotropin (β-hCG) level of Women were assigned randomly to a single systemic injection of either 50 mg/m 2 methotrexate or placebo. The primary outcome was a binary indicator for success of conservative management, defined as resolution of clinical symptoms and decline of serum β-hCG to women, 42 of whom were assigned to methotrexate and 38 to placebo. The arms of the study were matched in terms of age, ethnicity, obstetric history, pregnancy characteristics and serum levels of β-hCG and progesterone. The rates of success were similar for the two study arms: 83% with methotrexate and 76% with placebo. On univariate analysis, this difference was not statistically significant (χ 2 (1 degree of freedom) = 0.53; P = 0.47). On multivariate logistic regression, the serum level of β-hCG was the only covariate found to be significantly associated with outcome. The odds of failure increased by 0.15% for each unit increase in β-hCG (odds ratio, 1.0015 (95% CI, 1.0002-1.003); P = 0.02). In 14 women presenting with serum β-hCG of 1000-1500 IU/L, the success rate was 33% in those managed expectantly compared with 62% in those receiving methotrexate. This difference was not statistically significant and a larger sample size would be needed to give sufficient power to detect a difference in the

  3. Evaluation of time lapse for establishing distal tubal occlusion diagnosis during hysterosalpingography procedure performed by using water soluble contrast media

    Directory of Open Access Journals (Sweden)

    Serkan Kahyaoglu

    2017-05-01

    Conclusion: Although a trend exists towards shorter time period intervals between the first uterine visualization and distal tubal filling graphy among patients with tubal patency, rather than patients with distal tubal occlusion confirmed by diagnostic laparoscopy, clinically reliable objective time period intervals for finalizing the HSG procedure and proceeding with diagnostic laparoscopy due to distal tubal occlusion diagnosis on HSG could not be detected.

  4. Identifying subfertile ovulatory women for timely tubal patency testing: a clinical decision rule based on medical history

    NARCIS (Netherlands)

    Coppus, S. F. P. J.; Verhoeve, H. R.; Opmeer, B. C.; van der Steeg, J. W.; Steures, P.; Eijkemans, M. J. C.; Hompes, P. G. A.; Bossuyt, P. M. M.; van der Veen, F.; Mol, B. W. J.

    2007-01-01

    BACKGROUND: The aim of tubal testing is to identify women with bilateral tubal pathology in a timely manner, so they can be treated with IVF or tubal surgery. At present, it is unclear for which women early tubal testing is indicated, and in whom it can be deferred. METHODS: Data on 3716 women who

  5. Identifying subfertile ovulatory women for timely tubal patency testing: A clinical decision rule based on medical history

    NARCIS (Netherlands)

    S.F.P.J. Coppus; H.R. Verhoeve (Harold); B.C. Opmeer (Brent); J.W. van der Steeg (Jan Willem); P. Steures (Pieternel); M.J.C. Eijkemans (René); P.G. Hompes (Peter); P.M.M. Bossuyt (Patrick); F. Veen (Fulco); B.W.J. Mol (Ben)

    2007-01-01

    textabstractBackground: The aim of tubal testing is to identify women with bilateral tubal pathology in a timely manner, so they can be treated with IVF or tubal surgery. At present, it is unclear for which women early tubal testing is indicated, and in whom it can be deferred. Methods: Data on 3716

  6. LEF1 is preferentially expressed in the tubal-peritoneal junctions and is a reliable marker of tubal intraepithelial lesions.

    Science.gov (United States)

    Schmoeckel, Elisa; Odai-Afotey, Ashley A; Schleißheimer, Michael; Rottmann, Miriam; Flesken-Nikitin, Andrea; Ellenson, Lora H; Kirchner, Thomas; Mayr, Doris; Nikitin, Alexander Yu

    2017-09-01

    Recently it has been reported that serous tubal intraepithelial carcinoma (STIC), the likely precursor of ovarian/extra-uterine high-grade serous carcinoma, are frequently located in the vicinity of tubal-peritoneal junctions, consistent with the cancer-prone features of many epithelial transitional regions. To test if p53 (aka TP53)-signatures and secretory cell outgrowths (SCOUTs) also localize to tubal-peritoneal junctions, we examined these lesions in the fallopian tubes of patients undergoing salpingo-oophorectomy for sporadic high-grade serous carcinomas or as a prophylactic procedure for carriers of familial BRCA1 or 2 mutations. STICs were located closest to the tubal-peritoneal junctions with an average distance of 1.31 mm, while SCOUTs were not detected in the fimbriated end of the fallopian tube. As many epithelial transitional regions contain stem cells, we also determined the expression of stem cell markers in the normal fallopian tube, tubal intraepithelial lesions and high-grade serous carcinomas. Of those, LEF1 was consistently expressed in the tubal-peritoneal junctions and all lesions, independent of p53 status. All SCOUTs demonstrated strong nuclear expression of β-catenin consistent with the LEF1 participation in the canonical WNT pathway. However, β-catenin was preferentially located in the cytoplasm of cells comprising STICs and p53 signatures, suggesting WNT-independent function of LEF1 in those lesions. Both frequency of LEF1 expression and β-catenin nuclear expression correlated with the worst 5-year patient survival, supporting important role of both proteins in high-grade serous carcinoma. Taken together, our findings suggest the existence of stem cell niche within the tubal-peritoneal junctions. Furthermore, they support the notion that the pathogenesis of SCOUTs is distinct from that of STICs and p53 signatures. The location and discrete patterns of LEF1 and β-catenin expression may serve as highly sensitive and reliable ancillary

  7. Genital tuberculosis is common among females with tubal factor ...

    African Journals Online (AJOL)

    Methods: We conducted a prospective observational study in Al Thawra General Hospital (from March 2012 to February 2014). Of a total 151 women who had tubal factor infertility, 61 cases were investigated for genital tuberculosis. Women who were found to have the disease were treated by antitubercular therapy and the ...

  8. Papillary Cystadenoma: An Incidental Finding in Tubal Ligation

    Directory of Open Access Journals (Sweden)

    Tabitha Lynn Ward

    2018-01-01

    Full Text Available von Hippel-Lindau disease (vHLD is a rare autosomal dominant disorder with multiple benign and malignant tumors of different organs. We report a papillary cystadenoma of the mesosalpinx found in close association with an adenomatoid tumor discovered incidentally following tubal ligation in a patient with vHLD.

  9. Serous tubal intraepithelial neoplasia : The concept and its application

    NARCIS (Netherlands)

    Meserve, Emily E. K.; Brouwer, Jan; Crum, Christopher P.

    In recent years it has become clear that many extra-uterine (pelvic) high-grade serous carcinomas (serous carcinomas) are preceded by a precursor lesion in the distal fallopian tube. Precursors range from small self-limited 'p53 signatures' to expansile serous tubal intraepithelial neoplasms that

  10. Genital tuberculosis is common among females with tubal factor ...

    African Journals Online (AJOL)

    Abdulhakim Ali Al eryani

    2015-01-02

    Jan 2, 2015 ... Of a total 151 women who had tubal factor infertility, 61 cases were ... This is an open access article under the CC BY-NC-ND license ... countries and as high as 19% in India.4 ... All patients were subjected to extensive work-up including complete .... such disadvantages of AFB culture limit its practical utility.

  11. Pregnancy after Essure placement: report of two cases.

    Science.gov (United States)

    Moses, A Whitney; Burgis, Judith T; Bacon, Janice L; Risinger, Jennifer

    2008-03-01

    To report two cases of pregnancy after placement of Essure micro-inserts. Case report. University-based Department of Obstetrics and Gynecology. Patient 1, a 38-year-old woman, presented with a positive pregnancy test 7 months after Essure hysteroscopic sterilization. Patient 2, a 35-year-old female, became pregnant approximately 1 year after undergoing the Essure procedure. Patient 1 received obstetric ultrasounds, a prophylactic cerclage, a cesarean section, and a tubal ligation. Patient 2 underwent a postprocedure hysterosalpingogram, an obstetric ultrasound, pregnancy termination, diagnostic pelvic ultrasound, and a hysterectomy. Documentation of normal progress of pregnancy after Essure placement. Patient 1 carried an uncomplicated pregnancy to term with an Essure micro-insert in place. Patient 2 became pregnant despite an hysterosalpingogram showing tubal occlusion and was ultimately found to have a micro-insert perforating the uterine wall. The presence of Essure micro-inserts in the fallopian tubes do not appear to interfere with implantation and pregnancy. Uterine perforation by an Essure micro-insert in proximity to the tubal ostia may mimic proper micro-insert placement and bilateral tubal occlusion on both hysterosalpingogram and saline infusion sonography.

  12. [Ectopic breast fibroadenoma. Case report].

    Science.gov (United States)

    Senatore, G; Zanotti, S; Cambrini, P; Montroni, I; Pellegrini, A; Montanari, E; Santini, D; Taffurelli, M

    2010-03-01

    Among the rare anomalies of the breast development, polythelia is the most common, between 1% and 5% of women and men present supernumerary nipples. Polymastia, usually presenting as ectopic breast tissue without areola-nipple complex, is seen mostly along the milk line, extending from the axilla to the pubic region. Ectopic breast tissue is functionally analogous to mammary gland and it is subjected to the same alterations and diseases, whether benign or malignant, that affect normal breast tissue. We report the case of a 21 years-old female evaluated by the medical staff after founding a solid nodular mass by suspect axillary lymphadenopathy. Differential diagnosis with lymphoma is the major problem in these cases. The mass was removed and the intraoperative histological examination showed fibroadenoma in axillary supernumerary breast. Presence of ectopic breast tissue is a rare condition; development of benign mass or malignant degeneration is possible, but it is very unusual. In case of polymastia diagnosis is simple; in case of isolated nodule, without local inflammation or infection, there are greater difficulties. Ultrasonography is diagnostic in case of breast fibroadenoma, but it might be inadequate in ectopic localizations owing to the shortage of mammary tissue around the mass. Preoperative diagnosis is important to plan an adequate surgical treatment; lumpectomy is indicated in case of benign tissue; in case of malignancy, therapy is based on the standard treatment used for breast cancer (surgery, chemotherapy and radiation therapy).

  13. The ectopic posterior pituitary gland

    African Journals Online (AJOL)

    2013-11-04

    Nov 4, 2013 ... crinology with short stature, delayed bone age and biochemical features suggestive of hypo pituitarism. Magnetic resonance imaging of the brain demonstrated a flattened anterior pituitary gland within the sella, associated with absence of the infundibular stalk and an ectopic posterior pituitary gland (Fig.

  14. The Flexibility of Ectopic Lipids

    Directory of Open Access Journals (Sweden)

    Hannah Loher

    2016-09-01

    Full Text Available In addition to the subcutaneous and the visceral fat tissue, lipids can also be stored in non-adipose tissue such as in hepatocytes (intrahepatocellular lipids; IHCL, skeletal (intramyocellular lipids; IMCL or cardiac muscle cells (intracardiomyocellular lipids; ICCL. Ectopic lipids are flexible fuel stores that can be depleted by physical exercise and repleted by diet. They are related to obesity and insulin resistance. Quantification of IMCL was initially performed invasively, using muscle biopsies with biochemical and/or histological analysis. 1H-magnetic resonance spectroscopy (1H-MRS is now a validated method that allows for not only quantifying IMCL non-invasively and repeatedly, but also assessing IHCL and ICCL. This review summarizes the current available knowledge on the flexibility of ectopic lipids. The available evidence suggests a complex interplay between quantitative and qualitative diet, fat availability (fat mass, insulin action, and physical exercise, all important factors that influence the flexibility of ectopic lipids. Furthermore, the time frame of the intervention on these parameters (short-term vs. long-term appears to be critical. Consequently, standardization of physical activity and diet are critical when assessing ectopic lipids in predefined clinical situations.

  15. Hysteroscopic proximal tubal occlusion versus laparoscopic salpingectomy as a treatment for hydrosalpinges prior to IVF or ICSI: an RCT.

    Science.gov (United States)

    Dreyer, K; Lier, M C I; Emanuel, M H; Twisk, J W R; Mol, B W J; Schats, R; Hompes, P G A; Mijatovic, V

    2016-09-01

    Does hysteroscopic proximal tubal occlusion by intratubal devices as a treatment for hydrosalpinges result in comparable ongoing pregnancy rates following IVF/ICSI when compared with laparoscopic salpingectomy? Hysteroscopic proximal tubal occlusion by intratubal devices is inferior to laparoscopic salpingectomy in the treatment of hydrosalpinges in women undergoing IVF/ICSI with respect to ongoing pregnancy rates. It is known that women with hydrosalpinges undergoing IVF have poorer pregnancy outcomes compared with women with other forms of tubal infertility. In these women, both laparoscopic salpingectomy and laparoscopic proximal tubal ligation are known to improve IVF outcomes. At present, it is unclear whether a less-invasive hysteroscopic treatment with intratubal devices leads to similar ongoing pregnancy rates following IVF when compared with laparoscopic salpingectomy. A two-centre, randomized, controlled, non-inferiority trial. Between October 2009 and December 2014 a total of 85 women were included in this study; of whom, 42 were randomized to hysteroscopic proximal occlusion by intratubal device placement and 43 were randomized to laparoscopic salpingectomy. Randomization was based on a computer-generated randomization list. The study was unblinded. The primary outcome was ongoing pregnancy rate, defined as a fetal heartbeat on ultrasound beyond 10-week gestation following one IVF/ICSI treatment (fresh and frozen-thawed embryo transfers). We studied women aged 18-41 years, with uni- or bilateral ultrasound visible hydrosalpinges who were scheduled for an IVF/ICSI treatment. The ongoing pregnancy rates per patient according to the intention-to-treat principle were 11/42 (26.2%) after hysteroscopic proximal occlusion by intratubal devices (intervention group) versus 24/43 (55.8%) after laparoscopic salpingectomy (control group) (P = 0.008) [absolute difference: 26.1%; 95% confidence interval (CI): 0.5-51.7, relative risk (RR): 0.56; 95% CI: 0.31-1.03, P

  16. Hysteroscopic tubal sterilization: a systematic review of the Essure system

    DEFF Research Database (Denmark)

    Hurskainen, Ritva; Hovi, Sirpa-Liisa; Gissler, Mika

    2010-01-01

    OBJECTIVE: To update the evidence of the efficacy and safety of the Essure system. Female sterilization has undergone changes in the last decade. Besides laparoscopic tubal occlusion, the Essure system is now a viable option, with about 200,000 women sterilized using this method. DESIGN: The review...... in ambulatory settings. However, sterilization is not immediate and women must use additional contraception for 3 months until permanent tubal occlusion is verified by transvaginal ultrasound, hysterosalpingosonography, hysterosalpingography, or pelvic radiography. The evidence on efficacy and safety is mainly...... sterilization, but more information on the total cost is needed. CONCLUSION(S): The Essure system appears to be safe, permanent, irreversible, and a less invasive method of contraception compared with laparoscopic sterilization. Copyright (c) 2010 American Society for Reproductive Medicine. Published...

  17. Hysteroscopic tubal sterilization: a health economic literature review.

    Science.gov (United States)

    2013-01-01

    Hysteroscopic sterilization is a minimally invasive alternative to laparoscopic tubal ligation for women who want permanent contraception. In contrast to the laparoscopic technique, a hysteroscope is used to pass permanent microinserts through the cervix and place them in the fallopian tubes. This procedure does not require local or general anesthesia and can be performed in an office setting. The objective of this analysis was to determine, based on published literature, the cost-effectiveness of hysteroscopic tubal sterilization (HS) compared with laparoscopic tubal ligation (LS) for permanent female sterilization. A systematic literature search was conducted for studies published between January 1, 2008, and December 11, 2012. Potentially relevant studies were identified based on the title and abstract. Cost-utility analyses (studies that report outcomes in terms of costs and quality-adjusted life-years) were prioritized for inclusion. When not available, cost-effectiveness, cost-benefit, and cost-consequence analyses were considered. Costing studies were considered in the absence of all other analyses. A total of 33 abstracts were identified. Three cost analyses were included. A retrospective chart review from Canada found that HS was $111 less costly than LS; a prospective activity-based cost management study from Italy reported that it was €337 less costly than LS; and the results of an American decision model showed that HS was $1,178 less costly than LS. All studies had limited applicability to the Ontario health care system due to differences in setting, resource use, and costs. Three cost analyses found that, although the HS procedure was more expensive due to the cost of the microinserts, HS was less costly than LS overall due to the shorter recovery time required. Hysteroscopic sterilization is a minimally invasive alternative to conventional tubal ligation for women who want a permanent method of contraception. Both approaches involve closing off the

  18. Expression of Stem Cell Markers in Preinvasive Tubal Lesions of Ovarian Carcinoma.

    Science.gov (United States)

    Chene, G; Ouellet, V; Rahimi, K; Barres, V; Meunier, L; De Ladurantaye, M; Provencher, D; Mes-Masson, A M

    2015-01-01

    In order to better understand the ovarian serous carcinogenic process with tubal origin, we investigated the expression of stem cell markers in premalignant tubal lesions (serous tubal intraepithelial carcinoma or STIC). We found an increased stem cell marker density in the normal fallopian tube followed by a high CD117 and a low ALDH and CD44 expression in STICs raising the question of the role of the stem cell markers in the serous carcinogenic process.

  19. Expression of Stem Cell Markers in Preinvasive Tubal Lesions of Ovarian Carcinoma

    Directory of Open Access Journals (Sweden)

    G. Chene

    2015-01-01

    Full Text Available In order to better understand the ovarian serous carcinogenic process with tubal origin, we investigated the expression of stem cell markers in premalignant tubal lesions (serous tubal intraepithelial carcinoma or STIC. We found an increased stem cell marker density in the normal fallopian tube followed by a high CD117 and a low ALDH and CD44 expression in STICs raising the question of the role of the stem cell markers in the serous carcinogenic process.

  20. Multimodality imaging of the Essure tubal occlusion device

    International Nuclear Information System (INIS)

    Simpson, W.L.; Beitia, L.

    2012-01-01

    The Essure device is a permanent birth-control device, which is gaining popularity. The micro-inserts are composed of metallic elements that can be seen on radiography, computed tomography, ultrasound, and magnetic resonance imaging. Knowledge of the normal location and appearance of the Essure device will ensure appropriate patient care. The purpose of this review is to describe the Essure tubal occlusion device and illustrate its normal and abnormal appearance using various imaging methods.

  1. 超声支架引导下双腔取卵针囊内注射MTX配合米非司酮及中药治疗罕见部位异位妊娠6例分析%Ultrasound-guided Oocyte Retrieval Needles Intracapsular Injection Dual Chamber Bracket MTX Treatment with Mifepristone and Medicine Rare Analysis of Six Cases of Ectopic Pregnancy

    Institute of Scientific and Technical Information of China (English)

    刘海瑛; 王妍; 阿艳妮

    2014-01-01

    Objective To investigate the stable condition of rare ectopic pregnancy, If indicators meet the drug treatment ,intracapsular injecting and taking orally drug for conservative treatment to avoid the impact of operation trauma on organization. Method In the abdominal ultrasonography or transvaginal ultrasound support guided,pregnancy intracapsular injection of MTX with double cavity needle for take eggs combined with mifepristone and Chinese medicine treatment of rare ectopic pregnancy, understand the chance of changing into the operation treatment, the serumβ-HCG fall time and drug side effect incidence. Results The ultrasound accurate guided pregnancy intracapsular injection of MTX combined with mifepristone in treatment of ectopic pregnancy stable rare position, the serumβ-HCG decreases faster, side effects lighter, no increased chance to operation, the residuing focus absorbed completely after chinese medicine treatment. Conclusion Ultrasound-guided injection drug stents rare ectopic pregnancy small patient trauma, pain, easy operation, without anesthesia, the treatment can be repeated, safety, efficacy, and to the maximum extent possible to ensure that the patients with normal structure or function of tissues and organs, there is further studies need to accumulate more data for the treatment of indications scope, application of drugs and on another pregnancy impacts.%目的:探讨罕见部位异位妊娠病情稳定,指标符合药物治疗者行囊内注射配合口服药物保守治疗以避免手术创伤对组织的影响。方法在腹部超声支架或阴道超声支架引导下,行双腔取卵针妊娠囊内注射MTX配合米非司酮口服及中药活血化瘀治疗罕见部位异位妊娠,了解其转手术治疗概率,血β-HCG下降时间及药物不良反应发生情况。结果超声准确引导下妊娠囊内注射MTX配合米非司酮口服治疗罕见部位稳定异位妊娠,血β-HCG下降时间快,不良反应轻,转手术

  2. Treatment of cervical pregnancy with ultrasound-guided local methotrexate injection.

    Science.gov (United States)

    Yamaguchi, M; Honda, R; Erdenebaatar, C; Monsur, M; Honda, T; Sakaguchi, I; Okamura, Y; Ohba, T; Katabuchi, H

    2017-12-01

    Cervical pregnancy (CP) is a rare type of ectopic pregnancy. While methotrexate (MTX) is generally the first-line method of choice for clinically stable women, there is still no consensus on the most appropriate treatment for this abnormal pregnancy. The aim of this study was to investigate the efficacy of a single local MTX injection under transvaginal ultrasound guidance for the initial treatment of CP and to assess post-treatment fertility. We reviewed retrospectively 15 patients with CP treated with local MTX injection under transvaginal ultrasound guidance. In all patients, the serum human chorionic gonadotropin (hCG) levels were monitored and the gestational sac was evaluated using ultrasonography after treatment. Magnetic resonance imaging (MRI) was performed as necessary. We evaluated the patients' clinical characteristics and clinical course after treatment, the efficacy of the treatment and the post-treatment fertility in patients desiring subsequent pregnancy. The median estimated gestational age at the time of MTX injection was 6 + 2 (range, 5 + 2 to 11 + 0) weeks. All 15 patients were treated successfully, without the need for blood transfusion or surgical procedures; however, three patients required an additional local MTX injection due to a poor decline in serum hCG level following the initial injection, while one patient required uterine artery embolization due to persistent vaginal bleeding and an enlarging gestational sac with blood vessels visible on contrast-enhanced MRI. The mean time following initial MTX injection for hCG normalization was 43.8 (95% CI, 33.3-54.3) days and for resumption of menses was 68.4 (95% CI, 51.9-84.9) days. Seven of the 10 women desiring subsequent pregnancy following treatment had uneventful pregnancy, one became pregnant but miscarried spontaneously at 8 weeks of gestation, one was treated by laparoscopic surgery after diagnosis of a tubal pregnancy and one did not conceive. A single, ultrasound

  3. Mechanisms of Ectopic Gene Conversion

    Directory of Open Access Journals (Sweden)

    P.J. Hastings

    2010-11-01

    Full Text Available Gene conversion (conversion, the unidirectional transfer of DNA sequence information, occurs as a byproduct of recombinational repair of broken or damaged DNA molecules. Whereas excision repair processes replace damaged DNA by copying the complementary sequence from the undamaged strand of duplex DNA, recombinational mechanisms copy similar sequence, usually in another molecule, to replace the damaged sequence. In mitotic cells the other molecule is usually a sister chromatid, and the repair does not lead to genetic change. Less often a homologous chromosome or homologous sequence in an ectopic position is used. Conversion results from repair in two ways. First, if there was a double-strand gap at the site of a break, homologous sequence will be used as the template for synthesis to fill the gap, thus transferring sequence information in both strands. Second, recombinational repair uses complementary base pairing, and the heteroduplex molecule so formed is a source of conversion, both as heteroduplex and when donor (undamaged template information is retained after correction of mismatched bases in heteroduplex. There are mechanisms that favour the use of sister molecules that must fail before ectopic homology can be used. Meiotic recombination events lead to the formation of crossovers required in meiosis for orderly segregation of pairs of homologous chromosomes. These events result from recombinational repair of programmed double-strand breaks, but in contrast with mitotic recombination, meiotic recombinational events occur predominantly between homologous chromosomes, so that transfer of sequence differences by conversion is very frequent. Transient recombination events that do not form crossovers form both between homologous chromosomes and between regions of ectopic homology, and leave their mark in the occurrence of frequent non-crossover conversion, including ectopic conversion.

  4. Ectopic intra-abdominal fascioliasis

    OpenAIRE

    ÖNGÖREN, Ali Ulvi

    2009-01-01

    Human fascioliasis, caused by Fasciola hepatica, is emerging as an important chronic zoonotic disease in many areas of the world, including Turkey. It primarily involves the liver and may also cause severe damage in the tissue. Herein we report on a patient with ectopic intra-abdominal fascioliasis that presented to our clinic with abdominal pain and distention. Physical and radiological examination as well as an exploratory laparotomy revealed a 10 × 10-cm mass in the splenic flexura of the ...

  5. Incidental heterotopic pregnancy demonstrated on magnetic resonance imaging

    International Nuclear Information System (INIS)

    Tan, P.L.; Ridley, L.J.

    2005-01-01

    We report a case of an assisted pregnancy in an asymptomatic woman who was found to have an extrauterine mass on ultrasound and MRI. This complex mass had equivocal imaging features and was found to be a ruptured ovarian ectopic pregnancy at surgery. This case illustrates that vigilance is required regarding the possibility of coexisting ectopic and intrauterine pregnancy following assisted conception, even in entirely asymptomatic cases. Copyright (2005) Blackwell Publishing Asia Pty Ltd

  6. Interstitial pregnancy: role of MRI

    International Nuclear Information System (INIS)

    Filhastre, M.; Lesnik, A.; Dechaud, H.; Taourel, P.

    2005-01-01

    We report the MRI features of two cases of interstitial pregnancy. In both cases, MRI was able to localize the ectopic pregnancy by showing a gestational structure surrounded by a thick wall in the upper part of the uterine wall separated from the endometrium by an uninterrupted junctional zone. Because US may confuse angular and interstitial pregnancies and because interstitial pregnancy has a particular evolutive course, MR imaging may play a key role in the diagnosis and management of women with interstitial pregnancy. (orig.)

  7. Successful Laparoscopically Assisted Transcervical Suction Evacuation of Interstitial Pregnancy following Failed Methotrexate Injection in a Community Hospital Setting

    Directory of Open Access Journals (Sweden)

    Rani B. Fritz

    2014-01-01

    Full Text Available We report on a case of a patient with an early diagnosed cornual ectopic pregnancy following failed methotrexate treatment. The patient was subsequently taken to the operating room for a laparoscopic guided transcervical suction curettage of the cornual ectopic. The surgery was successful and the patient was followed up until her urine pregnancy test was negative. We conclude that in properly selected patients, cornual ectopic pregnancy may be treated with transcervical suction curettage.

  8. Comparisons of Hysterosalpingography and Laparoscopy Results in the Diagnosis of Tubal Occlusion

    Directory of Open Access Journals (Sweden)

    Rafet Duraker

    2011-03-01

    Full Text Available Objective: The compliance rate between the hysterosalpingography (HSG and laparoscopy (L/S results in patients who diagnosed tubal occlusion on the HSG was investigated. Also, the incidence of endometriosis was evaluated in the study population. Material and Methods: Medical records of 139 women who were underwent L/S for the investigation of the tubal occlusion were reviewed retrospectively. The concordance rate between the HSG and L/S was investigated. The incidence of endometriosis in patients with no tubal pathology was compared with patients with unilaterally and bilaterally tubal occlusion. Results: Mean age of the women was 31.8±5.7years, mean BMI was measured as 24.6±4.6 kg/m2, and gravida 0 (0-5, mean infertility period was 30.7±3.7 months. Tubal occlusion was confirmed after the L/S in 38.8% of the patients (n=38 who has unilaterally tubal occlusion on the HSG. However, 58.8% (n=20 of the patients who were diagnosed as bilaterally tubal occlusion on the HSG was confirmed with the L/S. The misdiagnosis rate of the HSG was significantly high in women with unilaterally tubal occlusions compared with bilaterally tubal occlusions [(respectively, 61.2%, 51.2% (p: 0.001]. Endometriosis was observed in 28.4% of the patients who had patent tubes and in 13.9% of the patients in the unilaterally tubal occlusion group and and in 22.7% of the patients in the bilaterally tubal occlusion group. But the difference was not statistically significant when groups were compared according to the rate of endometriosis (p=0.24. Conclusion: HSG is the first step diagnostic test for the assessment of the fallopian tubes. Although L/S is more invasive technique than HSG, L/S with chromopertubation is the gold standard test for identifying periadnexal adhesive disease and endometriosis.

  9. Abdominal pregnancy - Case presentation.

    Science.gov (United States)

    Bohiltea, R; Radoi, V; Tufan, C; Horhoianu, I A; Bohiltea, C

    2015-01-01

    Abdominal pregnancy, a rare diagnosis, belongs to the ectopic pregnancy group, the leading cause of pregnancy related exitus. The positive diagnosis is very difficult to establish most often in an acute setting, leading to a staggering percent of feto-maternal morbidity and mortality. We present the case of 26-weeks-old abdominal pregnancy with partial feto-placental detachment in a patient, after hysteroscopy and in vitro fertilization, which until the acute symptoms that led to emergency laparotomy went unrecognized. The patient recovered completely and satisfactorily after surgery and, due to the high risk of uterine rupture with regard to a second pregnancy, opted for a surrogate mother. Abdominal pregnancy can be regarded as a difficult to establish diagnosis, with a greater chance in case of increased awareness. It is compulsory to be well informed in order not to be surprised by the diagnosis and to apply the correct treatment immediately as the morbidity and mortality rate is elevated.

  10. A Molar Pregnancy within the Fallopian Tube

    Directory of Open Access Journals (Sweden)

    Laura Allen

    2016-01-01

    Full Text Available Background. Discussion of the incidence of molar pregnancy and ectopic pregnancy. Role of salpingostomy and special considerations for postoperative care. Case. The patient is a 29-year-old G7P4 who presented with vaginal bleeding in the first trimester and was initially thought to have a spontaneous abortion. Ultrasound was performed due to ongoing symptoms and an adnexal mass was noted. She underwent uncomplicated salpingostomy and was later found to have a partial molar ectopic pregnancy. Conclusion. This case illustrates the rare occurrence of a molar ectopic pregnancy. There was no indication of molar pregnancy preoperatively and this case highlights the importance of submitting and reviewing pathological specimens.

  11. The risk of menstrual abnormalities after tubal sterilization: a case control study

    Directory of Open Access Journals (Sweden)

    AtashKhoii Simin

    2005-05-01

    Full Text Available Abstract Background Tubal sterilization is the method of family planning most commonly used. The existence of the post-tubal-ligation syndrome of menstrual abnormalities has been the subject of debate for decades. Methods In a cross-sectional study, 112 women with the history of Pomeroy type of tubal ligation achieved by minilaparatomy as the case group and 288 women with no previous tubal ligation as the control group were assessed for menstrual abnormalities. Results Menstrual abnormalities were not significantly different between the case and control groups (p = 0.824. The abnormal uterine bleeding frequency differences in two different age groups (30–39 and 40–45 years old were statistically significant (p = 0.0176. Conclusion Tubal sterilization does not cause menstrual irregularities.

  12. STUDIES ON HUMAN FALLOPIAN TUBAL EPITHELIUM IN DIFFERENT AGE GROUPS

    Directory of Open Access Journals (Sweden)

    Jayasri

    2016-02-01

    Full Text Available BACKGROUND AND AIMS The “fallopian tubes” (oviducts or uterine tubes are long paired flexuous reproductive organ which transports ova, spermatozoa, zygotes, the pre-implantation morulae and blastocyst. It has major role during reproductive period, but it remains as if vestigial organ before puberty and after menopause. Due to increasing rate of tubal block and infertility, oviducts and their structures gaining importance and have become a subject of research in present days particularly epithelium. The aim of the study is to ascertain any histological difference of tubal epithelium in different age groups and the research work could be utilized for investigation and management of infertility. MATERIALS AND METHODS Seven samples of each group i.e., prereproductive, reproductive & postmenopausal were collected from fresh unembalmed human cadavers received in the department of Anatomy, FAA Medical College, Barpeta, Assam. The slides were prepared using the standard laboratory procedure. Under low and high power objectives the type of cells were observed and epithelial height was measured in the different segments. Stress was given for any significant difference of epithelial height between the different age groups. RESULTS Study revealed that among the groups within the same segment, epithelial height was recorded highest (33.57µm in reproductive group as against the lowest (22.91µm in post-menopausal group. Epithelial structures of the prereproductive and reproductive groups were significantly differed (p<0.01 from the postmenopausal group. CONCLUSIONS From the findings of the present study it can be concluded that: 1. In all the groups fallopian tubal epithelium is of simple columnar type and contains three types of cells. Cells are ciliated, secretory & peg (intercalary cells. 2. In all the groups same type of increasing trend of epithelial height from intramural segment to ampullary segment was recorded. 3. In intergroup comparison of

  13. Serous tubal intraepithelial neoplasia: the concept and its application.

    Science.gov (United States)

    Meserve, Emily E K; Brouwer, Jan; Crum, Christopher P

    2017-05-01

    In recent years it has become clear that many extra-uterine (pelvic) high-grade serous carcinomas (serous carcinomas) are preceded by a precursor lesion in the distal fallopian tube. Precursors range from small self-limited 'p53 signatures' to expansile serous tubal intraepithelial neoplasms that include both serous tubal epithelial proliferations (or lesions) of uncertain significance and serous tubal intraepithelial carcinomas. These precursors can be considered from three perspectives. The first is biologic underpinnings, which are multifactorial, and include the intersection of DNA damage with Tp53 mutations and disturbances in transcriptional regulation that increase with age. The second perspective is the morphologic discovery and classification of intraepithelial neoplasms that are intercepted early in their natural history, either incidentally or in risk-reduction surgeries for germline mutations. For the practicing pathologist, as well as the investigators, a distinction between a primary intraepithelial neoplasm and an intramucosal carcinoma must be made to avoid misinterpreting (or underestimating) the significance of these proliferations. The third perspective is the application of this information to intervention, devising strategies that will actually lower the ovarian cancer death rate by opportunistic salpingectomy, widespread comprehensive genetic screening and early detection. Central to this issue are the questions of (1) whether some STICs are metastatic, (2) whether lower-grade epithelial proliferations can invade prior to evolving into intraepithelial carcinoma, or (3) metastasize and become malignant elsewhere ('precursor escape'). An important caveat is the persistent and unsettling reality that many high-grade serous carcinomas are not associated with an obvious point of initiation in the fallopian tube. The pathologist sits squarely in the midst of all of these issues, and has a pivotal role in managing expectations for stemming the death

  14. Hysteroscopic tubal sterilization: a systematic review of the Essure system.

    Science.gov (United States)

    Hurskainen, Ritva; Hovi, Sirpa-Liisa; Gissler, Mika; Grahn, Riitta; Kukkonen-Harjula, Katriina; Nord-Saari, Merja; Mäkelä, Marjukka

    2010-06-01

    To update the evidence of the efficacy and safety of the Essure system. Female sterilization has undergone changes in the last decade. Besides laparoscopic tubal occlusion, the Essure system is now a viable option, with about 200,000 women sterilized using this method. The review is based on the report of the Alberta Heritage Foundation for Medical Research and completed with systematic literature searches up to April 8, 2008. The Managed Uptake of Medical Methods program of the Finnish National Research and Development Center for Health and Welfare. Women over 30 years, who had been sterilized by the Essure method. Hysteroscopic tubal sterilization using Essure system. Efficacy/effectiveness, adverse events, costs. Sterilization by Essure can be performed under local anesthesia or with oral analgesics in ambulatory settings. However, sterilization is not immediate and women must use additional contraception for 3 months until permanent tubal occlusion is verified by transvaginal ultrasound, hysterosalpingosonography, hysterosalpingography, or pelvic radiography. The evidence on efficacy and safety is mainly available from short follow-up case series but shows good efficacy and safety of the Essure system. Only a few small risks are associated with the procedure. Two economic studies, one of which implemented Essure as an in-office procedure, suggest that Essure could be more cost-effective than laparoscopic sterilization, but more information on the total cost is needed. The Essure system appears to be safe, permanent, irreversible, and a less invasive method of contraception compared with laparoscopic sterilization. Copyright (c) 2010 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  15. Menstrual Pattern following Tubal Ligation: A Historical Cohort Study

    Directory of Open Access Journals (Sweden)

    Shahideh Jahanian Sadatmahalleh

    2016-12-01

    Full Text Available Background: Tubal ligation (TL is recommended for women who have completed their family planning. The existence of the menstrual disorders following this procedure has been the subject of debate for decades. This study was conducted to identify the relationship between tubal ligation and menstrual disorders. Materials and Methods: A historical cohort study was carried out on 140 women undergoing tubal ligation (TL group and on 140 women using condom as the main contraceptive method (Non-TL group. They aged between 20 and 40 years and were selected from a health care center in Rudsar, Guilan Province, Iran, during 2013-2014. The two groups were comparable in demographic characteristics, obstetrical features and menstrual bleeding pattern using a routine questionnaire. A validated pictorial blood loss assessment chart (PBLAC was also used to measure the menstrual blood loss. Results: Women with TL had more menstrual irregularity than those without TL (24.3 vs. 10%, P=0.002. Women with TL had more polymenorrhea (9.3 vs. 1.4%, P=0.006, hypermenorrhea (12.1 vs. 2.1%, P=0.002, menorrhagia (62.9 vs. 22.1%, P<0.0001 and menometrorrhagia (15.7 vs. 3.6%, P=0.001 than those without TL. There is a significant difference in the PBLAC score between women with and without TL (P<0.0001. According to logistic regression, age odds ratio [(OR=1.08, confidence interval (CI:1.07-1.17, P=0.03], TL (OR=5.95, CI:3.45-10.26, P<0.0001 and cesarean section (OR=2.72, CI:1.49-4.97, P=0.001 were significantly associated with menorrhagia. Conclusion: We found significant differences in menstrual disorders between women with and without TL. Therefore, women should be informed by the health providers regarding the advantages and disadvantages of TL before the procedures.

  16. Multimodality imaging of the Essure tubal occlusion device.

    Science.gov (United States)

    Simpson, W L; Beitia, L

    2012-12-01

    The Essure device is a permanent birth-control device, which is gaining popularity. The micro-inserts are composed of metallic elements that can be seen on radiography, computed tomography, ultrasound, and magnetic resonance imaging. Knowledge of the normal location and appearance of the Essure device will ensure appropriate patient care. The purpose of this review is to describe the Essure tubal occlusion device and illustrate its normal and abnormal appearance using various imaging methods. Copyright © 2012 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

  17. Ectopic decidua of the greater omentum: a case report

    Directory of Open Access Journals (Sweden)

    Biserka Pigac

    2016-04-01

    Full Text Available Ectopic decidua is defined as extrauterine deposits of decidual stromal cells. It occurs in 85-100% of pregnancies. Focal sites can be present in various locations, yet a peritoneal location is rare. A 24- year- old woman underwent a cesarean section in 39th week of her first pregnancy, during which adhesions of the omentum to the fundus, entire left side of the uterus, and a part of the right front abdominal wall were found. An operative specimen was taken for a pathohistological analysis under the assumption of being fibrous adhesive tissue. The analysis revealed ectopic decidual tissue composed of large, polygonal cells with eosinophilic cytoplasm, and large nuclei with conspicuous nucleoli infiltrated with mature fatty cells and lymphocytes. Strong staining for vimentin was observed in the decidual cell cytoplasm and for a progesterone- receptor in the cell nuclei, medium staining was detected for S-100, and negative staining for CK 5/ 6, HMB-45, desmin, smooth muscle actin, estrogen and androgen- receptors. We present this case in order to educate clinicians and pathologists about the phenomenon of ectopic deciduosis. Although it can exist as asymptomatic condition, we point out the importance of considering this condition since it can result in serious pathology, like intraperitoneal hemorrhage and labour obstruction, if remains unrecognized. Another pitfall is possible confusion of this entity with other conditions. A resemblance to adhesions of the omentum and malignant neoplastic lesions, like squamous cell and metastatic carcinoma, metastatic melanoma, malignant decidual mesothelioma, metastatic mucin -producing adenocarcinoma, can be deceiving. These obstacles may present a pitfall to clinicians and pathologists, with a negative impact on patient treatment and outcome.

  18. Ectopic pancreas with pseudocyst and pseudoaneurysm formation

    International Nuclear Information System (INIS)

    Surov, A.; Hainz, M.; Hinz, L.; Holzhausen, H.-J.; Finke, R.; Spielmann, R.-P.; Kunze, C.

    2009-01-01

    Ectopic pancreas is a rare congenital anomaly. It is usually asymptomatic, or presents with non specific gastrointestinal symptoms. We describe here a case of ectopic pancreas in the gastric antrum, with pseudocyst and pseudoaneurysm formation. This entity has not been reported previously in the literature.

  19. Ectopic pancreas in a giant mediastinal cyst

    NARCIS (Netherlands)

    Li, Wilson W.; van Boven, Wim Jan; Jurhill, Roy R.; Bonta, Peter I.; Annema, Jouke T.; de Mol, Bas A.

    2016-01-01

    Ectopic pancreas located in the mediastium is an extremely rare anomaly. We present a case of an ectopic pancreas located in a giant mediastinal cyst in an 18-year-old man. He presented with symptoms of dyspnea due to external compression of the cyst on the left main bronchus. Complete surgical

  20. Minimally Invasive Management of Ectopic Pancreas.

    Science.gov (United States)

    Vitiello, Gerardo A; Cavnar, Michael J; Hajdu, Cristina; Khaykis, Inessa; Newman, Elliot; Melis, Marcovalerio; Pachter, H Leon; Cohen, Steven M

    2017-03-01

    The management of ectopic pancreas is not well defined. This study aims to determine the prevalence of symptomatic ectopic pancreas and identify those who may benefit from treatment, with a particular focus on robotically assisted surgical management. Our institutional pathology database was queried to identify a cohort of ectopic pancreas specimens. Additional clinical data regarding clinical symptomatology, diagnostic studies, and treatment were obtained through chart review. Nineteen cases of ectopic pancreas were found incidentally during surgery for another condition or found incidentally in a pathologic specimen (65.5%). Eleven patients (37.9%) reported prior symptoms, notably abdominal pain and/or gastrointestinal bleeding. The most common locations for ectopic pancreas were the duodenum and small bowel (31% and 27.6%, respectively). Three out of 29 cases (10.3%) had no symptoms, but had evidence of preneoplastic changes on pathology, while one harbored pancreatic cancer. Over the years, treatment of ectopic pancreas has shifted from open to laparoscopic and more recently to robotic surgery. Our experience is in line with existing evidence supporting surgical treatment of symptomatic or complicated ectopic pancreas. In the current era, minimally invasive and robotic surgery can be used safely and successfully for treatment of ectopic pancreas.

  1. Localization of ectopic gastric mucosa by scintigraphy

    International Nuclear Information System (INIS)

    D'Alonzo, W.A. Jr.

    1988-01-01

    When gastric mucosal tissue occurs outside of the confines of the stomach, it is termed ectopic or heterotopic. Ectopic gastric mucosa may be found within Meckel's diverticulum, duplications of the alimentary tract, and Barrett's esophagus. In addition, a surgeon may inadvertently leave behind antral gastric mucosa while performing a partial gastrectomy for peptic ulcer disease (i.e., retained gastric antrum). It is important to detect the presence and location of ectopic mucosa because acid and pepsin secretion may cause ulceration in the adjacent tissue resulting in serious complications. The only currently available specific diagnostic technique for detecting ectopic gastric mucosa is pertechnetate Tc 99m (TcO 4- ) scintigraphy. This chapter reviews the functional anatomy of gastric mucosa, the mechanism of TcO 4 - localization, the various entities containing ectopic gastric mucosa, and the methods and results of TcO 4 - scanning for these disorders

  2. Next-Generation Sequencing of Tubal Intraepithelial Carcinomas.

    Science.gov (United States)

    McDaniel, Andrew S; Stall, Jennifer N; Hovelson, Daniel H; Cani, Andi K; Liu, Chia-Jen; Tomlins, Scott A; Cho, Kathleen R

    2015-11-01

    High-grade serous carcinoma (HGSC) is the most prevalent and lethal form of ovarian cancer. HGSCs frequently arise in the distal fallopian tubes rather than the ovary, developing from small precursor lesions called serous tubal intraepithelial carcinomas (TICs, or more specifically, STICs). While STICs have been reported to harbor TP53 mutations, detailed molecular characterizations of these lesions are lacking. We performed targeted next-generation sequencing (NGS) on formalin-fixed, paraffin-embedded tissue from 4 women, 2 with HGSC and 2 with uterine endometrioid carcinoma (UEC) who were diagnosed as having synchronous STICs. We detected concordant mutations in both HGSCs with synchronous STICs, including TP53 mutations as well as assumed germline BRCA1/2 alterations, confirming a clonal association between these lesions. Next-generation sequencing confirmed the presence of a STIC clonally unrelated to 1 case of UEC, and NGS of the other tubal lesion diagnosed as a STIC unexpectedly supported the lesion as a micrometastasis from the associated UEC. We demonstrate that targeted NGS can identify genetic alterations in minute lesions, such as TICs, and confirm TP53 mutations as early driving events for HGSC. Next-generation sequencing also demonstrated unexpected associations between presumed STICs and synchronous carcinomas, providing evidence that some TICs are actually metastases rather than HGSC precursors.

  3. Laparoscopic evaluation of tubal pathology in cases of infertility

    Directory of Open Access Journals (Sweden)

    Maherunnessa

    2013-07-01

    Full Text Available Infertility is a public health problem in developed and developing countries. Diagnostic laparoscopy is a generally accepted procedure to detect pelvic organ pathologies affecting fertility. This study was undertaken to find out the tubal pathology contributing to primary and secondary infertility by laparoscopic examination. The study was carried out in the department of Gynaecology and Obstetrics, BIRDEM during the period of January 2001 to December 2001. The study group comprised of 100 cases of infertile patients of age between 20 to 40 years. Sixty seven percent patients had primary infertility and 33% patients had secondary infertility. Size and shape of the uterus was normal in 69% cases and bicornuate uterus was found in 2% cases. Out of total cases, 71% and 69% had normal right and left fallopian tubes respectively. Patency of right and left fallopian tube was normal in 90% and 89% cases respectively while 11% and 10% had peritubal adhesions. Laparoscopy examination is an important tool for evaluation of tubal pathology contributing to infertility and might play a major role in infertility management. Ibrahim Med. Coll. J. 2013; 7(2: 38-40

  4. Are all pelvic (nonuterine) serous carcinomas of tubal origin?

    Science.gov (United States)

    Przybycin, Christopher G; Kurman, Robert J; Ronnett, Brigitte M; Shih, Ie-Ming; Vang, Russell

    2010-10-01

    It has been proposed that the presence of tubal intraepithelial carcinoma (TIC), in association with one-third to nearly half of pelvic serous carcinomas, is evidence of fallopian tube origin for high-grade serous carcinomas that would have been otherwise classified as primary ovarian or peritoneal. To address this hypothesis, we evaluated a series of 114 consecutive pelvic (nonuterine) gynecologic carcinomas at our institution (2006 to 2008) to determine the frequency of TIC in 52 cases in which all the resected fallopian tube tissue was examined microscopically. These 52 cases were classified as ovarian (n=37), peritoneal (n=8), or fallopian tube (n=7) in origin as per conventional criteria based on disease distribution. The presence of TIC and its location and relationship to invasive carcinoma in the fallopian tubes and ovaries were assessed. Among the 45 cases of ovarian/peritoneal origin, carcinoma subtypes included 41 high-grade serous, 1 endometrioid, 1 mucinous, 1 high-grade, not otherwise specified, and 1 malignant mesodermal mixed tumor. TIC was identified in 24 cases (59%) of high-grade serous carcinoma but not among any of the other subtypes; therefore, the term serous TIC (STIC) is a more specific appellation. STICs were located in the fimbriated end of the tube in 22 cases (92%) and in the ampulla in 2 (8%); they were unilateral in 21 (88%) and bilateral in 3 (13%). STICs in the absence of an associated invasive carcinoma in the same tube were detected in 7 cases (30%) and with invasive carcinoma in the same tube in 17 (71%). Unilateral STICs were associated with bilateral ovarian involvement in 15 cases and unilateral (ipsilateral) ovarian involvement in 5 (the remaining case with a unilateral STIC had a primary peritoneal tumor with no ovarian involvement); the bilateral STICs were all associated with bilateral ovarian involvement. Six of the 7 primary tubal tumors were high-grade serous carcinomas, and 4 of these 6 (67%) had STICs. Based on

  5. Clinical pattern of gynaecological / early pregnancy complaints and ...

    African Journals Online (AJOL)

    complaints of vaginal bleeding with or without pains, history of amenorrhea or infertility ; clinical and ultrasound impressions of early pregnancy complaints including ectopic pregnancies and pelvic inflammatory diseases (PID) with exclusion of uro-genital and gastrointestinal complaints/ cases. Pregnancies greater than 12 ...

  6. Clinical pattern of gynecological/early pregnancy complaints and the ...

    African Journals Online (AJOL)

    ... complaints of vaginal bleeding, with or without pain, history of amenorrhea or infertility, clinical and ultrasound impression of early pregnancy complaints, including ectopic pregnancies and pelvic inflammatory diseases (PID), with exclusion of urogenital and gastrointestinal complaints/cases. Pregnancies greater than 12 ...

  7. Ruptured heterotopic pregnancy and subsequent vaginal delivery at ...

    African Journals Online (AJOL)

    Background: Heterotopic pregnancy is the co- existence of intrauterine and extrauterine gestation at the same time. The condition is life threatening when the ectopic pregnancy ruptures and it is unrecognized. Objective: To report the first successfully managed case of heterotopic pregnancy in a woman without obvious risk ...

  8. Misdiagnosed Ovarian Pregnancy to Threatened Abortion: A Case Report

    Directory of Open Access Journals (Sweden)

    Roghaieh Rahmani Beilondi

    2017-10-01

    Full Text Available This study is about a patient with a history of infertility and polycystic ovarian disease who was admitted with spotting and severe abdominal pain, There was one misdiagnosis about this patient and progesterone was prescribed for treating of threatened abortion, following transvaginal ultrasound, one heterogeneous echogenic mass with dimensions of 5.8 × 18 in the vicinity of the left ovary was reported in favor of ectopic pregnancy. The patient was hospitalized and treated with methotrexate with diagnosis of an ovarian ectopic pregnancy. Pregnant women with complaints of bleeding and spotting in early pregnancy should be evaluated in terms of ectopic pregnancy in addition of abortion and molar pregnancy. The aim of this study was to introduce a new case of misdiagnosed ovarian pregnancy instead of threatened abortion.

  9. Infertility caused by tubal blockage: An ayurvedic appraisal

    Science.gov (United States)

    Shukla (Upadhyaya), Kamayani; Karunagoda, Kaumadi; Dei, L. P.

    2010-01-01

    Tubal blockage is one of the most important factors for female infertility. This condition is not described in Ayurvedic classics, as the fallopian tube itself is not mentioned directly there. The present study is an effort to understand the disease according to Ayurvedic principles. Correlating fallopian tubes with the Artavavaha (Artava-bija-vaha) Srotas, its block is compared with the Sanga Srotodushti of this Srotas. Charak's opinion that the diseases are innumerable and newly discovered ones should be understood in terms of Prakriti, Adhishthana, Linga, and Aayatana, is followed, to describe this disease. An effort has been made to evaluate the role of all the three Doshas in producing blockage, with classification of the disease done as per the Dasha Roganika. PMID:22131704

  10. Serous tubal intraepithelial carcinoma: diagnostic reproducibility and its implications.

    Science.gov (United States)

    Carlson, Joseph W; Jarboe, Elke A; Kindelberger, David; Nucci, Marisa R; Hirsch, Michelle S; Crum, Christopher P

    2010-07-01

    Serous tubal intraepithelial carcinoma (STIC) is detected in between 5% and 7% of women undergoing risk-reduction salpingooophorectomy for mutations in the BRCA1 or 2 genes (BRCA+), and seems to play a role in the pathogenesis of many ovarian and "primary peritoneal" serous carcinomas. The recognition of STIC is germane to the management of BRCA+ women; however, the diagnostic reproducibility of STIC is unknown. Twenty-one cases were selected and classified as STIC or benign, using both hematoxylin and eosin and immunohistochemical stains for p53 and MIB-1. Digital images of 30 hematoxylin and eosin-stained STICs (n=14) or benign tubal epithelium (n=16) were photographed and randomized for blind digital review in a Powerpoint format by 6 experienced gynecologic pathologists and 6 pathology trainees. A generalized kappa statistic for multiple raters was calculated for all groups. For all reviewers, the kappa was 0.333, indicating poor reproducibility; kappa was 0.453 for the experienced gynecologic pathologists (fair-to-good reproducibility), and kappa=0.253 for the pathology residents (poor reproducibility). In the experienced group, 3 of 14 STICs were diagnosed by all 6 reviewers, and 9 of 14 by a majority of the reviewers. These results show that interobserver concordance in the recognition of STIC in high-quality digital images is at best fair-to-good for even experienced gynecologic pathologists, and a proportion cannot be consistently identified even among experienced observers. In view of these findings, a diagnosis of STIC should be corroborated by a second pathologist, if feasible.

  11. Ectopic cervical thymoma in a patient with Myasthenia gravis

    Directory of Open Access Journals (Sweden)

    Chang Hung

    2011-07-01

    Full Text Available Abstract Ectopic cervical thymoma is rare and is often misdiagnosed as a thyroid tumor or other malignancy. Ectopic thymic tissue can be found along the entire thymic descent path during embryogenesis. However, a thymoma arising from such ectopic thymic tissue is extremely rare. Herein we report a patient with ectopic cervical thymoma and myasthenia gravis (MG and discuss the management.

  12. Ectopic Axillary Breast during Systemic Lupus

    Directory of Open Access Journals (Sweden)

    Besma Ben Dhaou

    2012-01-01

    Full Text Available Many breast changes may occur in systemic lupus erythematosus. We report a 41-year-old woman with lupus who presented three years after the onset of lupus an ectopic mammary gland confirmed by histological study.

  13. Pseudocarcinomatous hyperplasia of the fallopian tube mimicking tubal cancer: a radiological and pathological diagnostic challenge.

    Science.gov (United States)

    Lee, Nam Kyung; Choi, Kyung Un; Han, Ga Jin; Kwon, Byung Su; Song, Yong Jung; Suh, Dong Soo; Kim, Ki Hyung

    2016-11-14

    Pseudocarcinomatous hyperplasia of the fallopian tube is a rare, benign disease characterized by florid epithelial hyperplasia. The authors present the history and details of a 22-year-old woman with bilateral pelvic masses and a highly elevated serum CA-125 level (1,056 U/ml). Ultrasonography and magnetic resonance imaging (MRI) of the pelvis showed bilateral adnexal complex cystic masses with a fusiform or sausage-like shape. Contrast-enhanced fat-suppressed T1-weighted images showed enhancement of papillary projections of the right adnexal mass and enhancement of an irregular thick wall on the left adnexal mass, suggestive of tubal cancer. Based on MRI and laboratory findings, laparotomy was performed under a putative preoperative diagnosis of tubal cancer. The final pathologic diagnosis was pseudocarcinomatous hyperplasia of tubal epithelium associated with acute and chronic salpingitis in both tubes. The authors report a rare case of pseudocarcinomatous hyperplasia of the fallopian tubes mimicking tubal cancer.

  14. Tubal epithelial lesions in salpingo-oophorectomy specimens of BRCA-mutation carriers and controls.

    NARCIS (Netherlands)

    Mingels, M.J.J.M.; Roelofsen, T.; Laak, J.A.W.M. van der; Hullu, J.A. de; Ham, M.A.P.C. van; Massuger, L.F.A.G.; Bulten, J.; Bol, M.

    2012-01-01

    OBJECTIVE: A precursor lesion for ovarian carcinoma, tubal intraepithelial carcinoma (TIC), has been identified in BRCA-mutation carriers undergoing prophylactic bilateral salpingo-oophorectomy (pBSO). Other lesions were also identified in fallopian tubes, but different terminology, interpretation,

  15. Relationship between serum Chlamydia trachomatis antibody titer and tubal block in infertile Egyptian women

    Directory of Open Access Journals (Sweden)

    Ahmed Khairy Makled

    2013-03-01

    Conclusion: ELISA can be used as a simple, noninvasive screening test for C. trachomatis IgG antibodies, with a high predictive value for tubal occlusion in infertile Egyptian women, however larger studies are needed to confirm our results.

  16. The comparison of interventional tubal recanalization and drug irrigation recanalization in the management of oviduct obstruction

    International Nuclear Information System (INIS)

    Zhang Xiaomin; Li Yuzhi

    2002-01-01

    Objective: To explore and compare the efficacy of the interventional and drags irrigation tube recanalization for infertile women with fallopian tube obstruction. Methods: Eighteen patients with 36 tubal obstructions in the research group were treated with interventional tube recanalization and drugs infusion into tube through catheter. Other 10 cases with 20 tubal obstructions in the comparison group were treated only with drugs irrigation. All cases received followed up examination in 6 mouths. Results: The successful rates of recanalization were 61.1% (22/36) in the research group and 30.0% (6/20) in the comparison group, respectively. There was significant difference between the two groups (P < 0.05). The recurrence was 4 tube in the research group, 1 tube in the comparison group six months. Conclusion: The interventional tubal recanalization is a simple, sate and more effective treatment method of choice compared with the tubal recanalization with the traditional drag irrigation for fallopian tube obstruction

  17. Isolated tubal torsion: Successful preoperative diagnosis of five cases using ultrasound and management with laparoscopy

    Directory of Open Access Journals (Sweden)

    Erdem Fadıloğlu

    2017-09-01

    Full Text Available Our aim was to evaluate the presentation and diagnostic evaluation of patients with isolated tubal torsion and to evaluate the surgical approach to these patients. We also aimed to define the ultrasonographic diagnostic criteria. Five patients with isolated tubal torsion who were admitted to our gynecology department between January 2014 and January 2017 were evaluated and included in this study. All cases were diagnosed through ultrasonographic imaging alone. The preoperative findings of the patients were similar to those described in the literature. No further imaging modality was used for diagnosis and all patients were managed with laparoscopy. The clinical findings and ultrasonographic findings were consistent with literature. It may be difficult to preoperatively diagnose isolated tubal torsion, which is a rare clinical entity. Evaluation of these patients by an experienced sonographer and knowledge of the ultrasonographic findings of isolated tubal torsion may have vital preventive measures.

  18. Dual ectopic thyroid associated with thyroid hemiagenesis.

    Science.gov (United States)

    Nakamura, Shigenori; Masuda, Teruyuki; Ishimori, Masatoshi

    2018-01-01

    We report a case of a 15-year-old girl with a midline neck mass that was first noted 2 or 3 years previously. She had been treated with levothyroxine (L-T4) for congenital hypothyroidism until 11 years of age. Ultrasonography revealed an atrophic right thyroid (1.0 × 1.6 × 2.6 cm in size) and a mass (2.3 × 1.0 × 3.5 cm in size) in the upper part of the neck. No left lobe of the thyroid was detected. On further evaluation, Tc-99m pertechnetate thyroid scintigraphy and CT showed ectopic thyroid tissue in the lingual region and infrahyoid region. Thus, she was diagnosed as having dual ectopic thyroid and thyroid hemiagenesis. The atrophic right thyroid was thought be non-functional. Treatment with L-T4 was started to reduce the size of the dual ectopic thyroid tissue. This may be the first reported case of dual ectopic thyroid associated with hemiagenesis detected only by ultrasonography. Ultrasonography can confirm the presence or absence of orthotopic thyroid tissue in patients with ectopic thyroid.The cause of congenital hypothyroidism should be examined.Clinical manifestation of ectopic thyroid may appear when the treatment with L-T4 is discontinued.Annual follow-up is needed in all children when their thyroid hormone replacement is stopped.

  19. Sonographic Diagnosis of Tubal Cancer with IOTA Simple Rules Plus Pattern Recognition

    Science.gov (United States)

    Tongsong, Theera; Wanapirak, Chanane; Tantipalakorn, Charuwan; Tinnangwattana, Dangcheewan

    2017-11-26

    Objective: To evaluate diagnostic performance of IOTA simple rules plus pattern recognition in predicting tubal cancer. Methods: Secondary analysis was performed on prospective database of our IOTA project. The patients recruited in the project were those who were scheduled for pelvic surgery due to adnexal masses. The patients underwent ultrasound examinations within 24 hours before surgery. On ultrasound examination, the masses were evaluated using the well-established IOTA simple rules plus pattern recognition (sausage-shaped appearance, incomplete septum, visible ipsilateral ovaries) to predict tubal cancer. The gold standard diagnosis was based on histological findings or operative findings. Results: A total of 482 patients, including 15 cases of tubal cancer, were evaluated by ultrasound preoperatively. The IOTA simple rules plus pattern recognition gave a sensitivity of 86.7% (13 in 15) and specificity of 97.4%. Sausage-shaped appearance was identified in nearly all cases (14 in 15). Incomplete septa and normal ovaries could be identified in 33.3% and 40%, respectively. Conclusion: IOTA simple rules plus pattern recognition is relatively effective in predicting tubal cancer. Thus, we propose the simple scheme in diagnosis of tubal cancer as follows. First of all, the adnexal masses are evaluated with IOTA simple rules. If the B-rules could be applied, tubal cancer is reliably excluded. If the M-rules could be applied or the result is inconclusive, careful delineation of the mass with pattern recognition should be performed. Creative Commons Attribution License

  20. Pregnancy chances on an IVF/ICSI waiting list: a national prospective cohort study.

    NARCIS (Netherlands)

    Eijkemans, M.J.; Lintsen, A.M.E.; Hunault, C.C.; Bouwmans, C.A.; Hakkaart, L.; Braat, D.D.M.; Habbema, J.D.F.

    2008-01-01

    BACKGROUND: The effectiveness of IVF over expectant management has been proven only for bilateral tubal occlusion. We aimed to estimate the chance of pregnancy without treatment for IVF patients, using data on the waiting period before the start of IVF. METHODS: A prospective cohort study included

  1. Consideraciones éticas sobre el uso de metotrexate en el embarazo tubario (ET Consideraciones éticas sobre o uso de metotrexate na gravidez tubária (GT Ethical considerations about the use of metotrexate in ectopic pregnancy (TP

    Directory of Open Access Journals (Sweden)

    María de la Luz Casas M.

    , em apreciação da invulnerabilidade da vida humana, um ato antiético. Porém, a argumentação ética sobre o objetivo desta intervenção pode ser postulada sob o princípio do duplo efeito.Ectopic pregnancy (EP consists in the implantation of a fertilized ovule in the fallopian tube. The fact is that EP will continue to appear many times to physicians in the form of an urgent clinical episode of intra abdominal bleeding. The physician may consider then as certain the death of the embryo and he/she will intervene to extirpate the embryo remains and the bleeding and perforated fallopian tube. In this way he/she will revert the serious immediate threat to the life of the mother. The medical treatment with metotrexate (MTX is a safe and effective procedure in the treatment of ectopic pregnancy, without the potential risks of surgery. The act of the physician will never be to attempt directly against the embryo, but on the cause of the pathology, that may provoke the death of the embryo. The medical intervention in these cases has been considered by some as a type of indirect abortion and, therefore, an act contrary to ethics, considering the invulnerability of human life. But the ethical argumentation about the objective of this intervention may be posed under the principle of double effect.

  2. Aspectos epidemiológicos e clínicos das gestações ectópicas em serviço universitário no período de 2000 a 2004 Epidemiological and clinical aspects of ectopic pregnancies at a university service between 2000 and 2004

    Directory of Open Access Journals (Sweden)

    Arlete Maria dos Santos Fernandes

    2007-06-01

    Full Text Available OBJETIVOS: Comparar a freqüência de gestações ectópicas (GE internadas anualmente em relação às inserções de DIU e o número de nascidos vivos, avaliar possíveis variáveis associadas e características do diagnóstico e tratamento. MÉTODOS: Estudo de coorte transversal; foram utilizados dados de 151 mulheres com GE internadas entre 2000 e 2004, relacionou-se o número de GE com o de nascidos vivos e inserções de DIU, anualmente. As variáveis analisadas foram idade, escolaridade, estado marital, uso atual e antecedente de uso de DIU, antecedentes de aborto, esterilidade e GE, tratamento e cirurgia realizada, sítio de inserção, GE íntegra/ rota, tempo de internação, transfusão sangüínea e complicações. Realizou-se análise de freqüências e regressão linear múltipla para as variáveis que poderiam estar associadas à variação nas razões estudadas a cada ano. O estudo teve a aprovação do Comitê de Ética em Pesquisa. RESULTADOS: A freqüência de GE não cresceu significativamente nos cinco anos estudados e somente a percentagem de mulheres com GE anterior esteve associada à prevalência de GE. A idade de 80% das mulheres foi 20 a 34 anos, 61% não utilizavam MAC, 4,6% utilizavam e 10% haviam utilizado DIU, 42% referiram aborto, 18% esterilidade e 15% GE anterior. Foram internadas 69,5% com GE rota, o tratamento foi conservador para 20% e cirúrgico ablativo para 80%, 47% permaneceram internadas por > 4 dias. Houve 20,5% de transfusões e cinco complicações. CONCLUSÃO: A freqüência de GE manteve-se estável no período estudado e somente a percentagem de antecedente de GE foi associada à freqüência de GE.OBJECTIVE: To compare the frequency of ectopic pregnancies (EP in women hospitalized yearly in relation to IUD insertions and number of live births, evaluating possible associated variables and characteristics of diagnosis and treatment. METHODS: In a cohort cross-sectional study, data was obtained from

  3. Severe Acute Pancreatitis in Pregnancy

    Directory of Open Access Journals (Sweden)

    Bahiyah Abdullah

    2015-01-01

    Full Text Available This is a case of a pregnant lady at 8 weeks of gestation, who presented with acute abdomen. She was initially diagnosed with ruptured ectopic pregnancy and ruptured corpus luteal cyst as the differential diagnosis. However she then, was finally diagnosed as acute hemorrhagic pancreatitis with spontaneous complete miscarriage. This is followed by review of literature on this topic. Acute pancreatitis in pregnancy is not uncommon. The emphasis on high index of suspicion of acute pancreatitis in women who presented with acute abdomen in pregnancy is highlighted. Early diagnosis and good supportive care by multidisciplinary team are crucial to ensure good maternal and fetal outcomes.

  4. An unusual case of ectopic ACTH syndrome.

    Science.gov (United States)

    Willhauck, M J; Pöpperl, G; Rachinger, W; Giese, A; Auernhammer, C J; Spitzweg, C

    2012-02-01

    Ectopic ACTH-syndrome is a rare cause of Cushing's disease. Despite extensive diagnostic procedures the source of ACTH secretion often remains occult. This case describes a 45-year old woman with an ectopic Cushing's syndrome. Extensive imaging procedures including CT scan of chest and abdomen, octreotide scan and MRI of the chest and pituitary did not reveal the source of ACTH secretion. In consideration of an occult source of ACTH secretion we started a therapeutic trial with cabergoline (0.5 mg/d), a dopamine receptor agonist, which has been shown to be effective in ectopic Cushing's syndrome. 2 months after cabergoline treatment had been initiated, ACTH and cortisol levels normalized in association with significant improvement of the clinical symptoms. During follow-up a [(68)Ga-DOTA-dPhe(1), Tyr(3)]-octreotate ([(68)Ga-DOTA]-TATE) PET-CT was performed revealing a somatostatin receptor positive lesion in the right sphenoidal sinus suggesting the source of ACTH secretion. The patient was cured by transnasal resection of the polypoid lesion, which was immunohistochemically characterized as an ACTH-positive neuroendocrine tumor. This case report demonstrates the management of ectopic ACTH-syndrome by molecularly -targeted therapy with dopamine receptor -agonists as well as improved detection of the ectopic ACTH source by novel imaging modalities, such as [(68)Ga-DOTA]-TATE PET specifically targeting somatostatin receptor subtype-2 with high affinity. © J. A. Barth Verlag in Georg Thieme Verlag KG Stuttgart · New York.

  5. Surgical treatment for ectopic atrial tachycardia.

    Science.gov (United States)

    Graffigna, A; Vigano, M; Pagani, F; Salerno, G

    1992-08-01

    Atrial tachycardia is an infrequent but potentially dangerous arrhythmia which often determines cardiac enlargement. Surgical ablation of the arrhythmia is effective and safe, provided a careful atrial mapping is performed and the surgical technique is tailored to the individual focus location. Eight patients underwent surgical ablation of ectopic atrial tachycardia between 1977 and 1990. Different techniques were adopted for each patient according to the anatomical location of the focus and possibly associated arrhythmias. Whenever possible, a closed heart procedure was chosen. In 1 patient a double focal origin was found and treated by separate procedures. In 1 patient with ostium secundum atrial septal defect and atrial flutter, surgical isolation of the right appendage and the ectopic focus was performed. In all patients ectopic atrial tachycardia was ablated with maintenance of the sinoatrial and atrioventricular nodal function as well as internodal conduction. In follow-up up to December 1991, no recurrency was recorded.

  6. Corpus luteum blood flow in normal and abnormal early pregnancy: evaluation and analysis with transvaginal color and pulsed doppler sonography

    International Nuclear Information System (INIS)

    Tang Xiaoyi; Lin Meifang; Zheng Meirong; Liang Xiaoxian; Liu Jianfeng

    2005-01-01

    Objective: Detecting and assessment the corpus luteum blood flow in normal and abnormal early pregnancy. Methods: Using transvaginal color and pulse Doppler sonography, we detected 215 pregnant women including 150 normal intrauterine pregnancies, 25 abortion, 29 ectopic pregnancies, and then recorded corpus luteum blood flow feature and the blood flow indexes (Vmax, RI and PI). Results: 1) Corpus luteum was successfully identified in 148 cases out of 150 of normal early pregnancies, 25 cases out of 26 of threatened abortion; 22 cases out of 29 of ectopic pregnancy. 2) Three groups shared the same feature of Color Doppler imaging: a circumferential rim around the entire corpus luteum. 3) The flow index revealed mean PVS, RI and PI had no statistical difference in normal and abnormal early pregnancy; The mean PVS was lower in ectopic pregnancy than in normal pregnancy (P<0.05), while PI and PR had no characteristic in ectopic pregnancy group compared with the indexes obtained in normal pregnancy group. Conclusion: The corpus luteum can be precisely identified in most pregnancy using transvaginal color Doppler and manifests a characterized rim Doppler imaging. PVS may help in differentiating the ectopic pregnancy from normal early pregnancy. (authors)

  7. Treatment of ectopic first permanent molar teeth.

    LENUS (Irish Health Repository)

    Hennessy, Joe

    2012-11-01

    Ectopic eruption of the first permanent molar is a relatively common occurence in the developing dentition. A range of treatment options are available to the clinician provided that diagnosis is made early. Non-treatment can result in premature exfoliation of the second primary molar, space loss and impaction of the second premolar. This paper will describe the management of ectopic first permanent molars, using clinical examples to illustrate the available treatment options. CLINICAL RELEVANCE: This paper is relevant to every general dental practitioner who treats patients in mixed dentition.

  8. Simple ectopic kidney in three dogs.

    Science.gov (United States)

    Choi, Jiyoung; Lee, Heechun; Lee, Youngwon; Choi, Hojung

    2012-10-01

    Simple ectopic kidney was diagnosed in three dogs by means of radiography and ultrasonography. A 2-year-old castrated male Schnauzer, a 13-year-old female Schnauzer and a 9-year-old male Jindo were referred with vomiting, hematuria and ocular discharge, respectively. In all three dogs, oval-shaped masses with soft tissue density were observed in the mid to caudal abdomen bilaterally or unilaterally, and kidney silhouettes were not identified at the proper anatomic places on abdominal radiographs. Ultrasonography confirmed the masses were malpositioned kidney. The ectopic kidneys had relatively small size, irregular shape and short ureter but showed normal function on excretory urography.

  9. Treatment of ectopic first permanent molar teeth.

    Science.gov (United States)

    Hennessy, Joe; Al-Awadhi, E A; Dwyer, Lian O; Leith, Rona

    2012-11-01

    Ectopic eruption of the first permanent molar is a relatively common occurence in the developing dentition. A range of treatment options are available to the clinician provided that diagnosis is made early. Non-treatment can result in premature exfoliation of the second primary molar, space loss and impaction of the second premolar. This paper will describe the management of ectopic first permanent molars, using clinical examples to illustrate the available treatment options. This paper is relevant to every general dental practitioner who treats patients in mixed dentition.

  10. Isolated torsion of fallopian tube during pregnancy; report of two cases.

    Science.gov (United States)

    Yalcin, O T; Hassa, H; Zeytinoglu, S; Isiksoy, S

    1997-08-01

    Isolated torsion of fallopian tube is very uncommon during pregnancy. Predisposing factors for torsion are hydrosalpinx, prior tubal operation, pelvic congestion, ovarian and paraovarian masses and trauma. Although the most important clinical symptom is abdominal pain in lower quadrants, the diagnosis is usually established during the operation performed for acute abdomen and salpingectomy is almost always necessary. Two cases of torsion of fallopian tube during pregnancy, one with hydrosalpinx, the other with paratubal cyst are presented and symptoms and predisposing factors are discussed.

  11. Role Of Hysteroscopy In The Evaluation Of Tubal Patency In Infertile Women

    International Nuclear Information System (INIS)

    Rashed, A.M.; Sweedan, Kh.H.; ElBishry, G.A.; Serag, I.F.; Ahmed, W.E.

    2012-01-01

    Purpose: To evaluate the effectiveness of hysteroscopy as a method for the diagnosis of tubal patency using saline distention media. Methods: In this prospective study, 64 infertile women underwent hysteroscopy (HSC) and hysterosalpingography (HSG) on two consecutive days. Transvaginal ultrasonography (TVS) carried out before and after hysteroscopy in order to measure the fluid in the cul-de-sac.The difference between the two methods in diagnosis of tubal patency was compared using laparoscopy/chromotubationas a gold standard. Fluid volume measurements were used to determine a cut off value for tubal patency. Pain was recorded at the end of the processes. Results: According to the laparoscopy, the sensitivity and specificity of HSC and HSG in detecting tubal patency were (94.6% and 100% vs 92.8% and 50%, respectively). The best cut off point of the fluid volume in the cul-de-sac at which both tubes are patent is 6 ml. All of the patients reported significantly less pain during hysteroscopy in response to HSG. Conclusions: office HSC combined with TVS may be used as an alternative to HSG in the diagnosis of tubal patency in an easy, rapid, safe way with minimal pain.

  12. Retrospective cost analysis comparing Essure hysteroscopic sterilization and laparoscopic bilateral tubal coagulation.

    Science.gov (United States)

    Hopkins, Matthew R; Creedon, Douglas J; Wagie, Amy E; Williams, Arthur R; Famuyide, Abimbola O

    2007-01-01

    To compare the institutional cost of permanent female sterilization by Essure hysteroscopic sterilization and laparoscopic bilateral coagulation. Retrospective cohort study (Canadian Task Force classification II-2). Midwestern academic medical center. Women of reproductive age who elected for permanent contraception by the Essure method (n = 43) or by laparoscopic tubal coagulation (n = 44) during the time frame studied. Placement of the Essure inserts according to the manufacturer's instructions or laparoscopic tubal sterilization using bipolar forceps according to standard techniques of open or closed laparoscopy. Cost-center data for the institutional cost of the procedure was abstracted for each patient included in the study. In addition, demographic data and procedural information were obtained and compared for the patient populations. The Essure system of hysteroscopic sterilization had a significantly decreased cost compared with laparoscopic tubal sterilization when both procedures were performed in an operating room setting. The decrease per patient in institutional cost was 180 dollars (p = .038). This included the cost of the confirmatory hysterosalpingogram 3 months after Essure placement and the cost of laparoscopic tubal occlusion by Filshie clip if the Essure micro-inserts could not be placed. The majority of the cost was related to hospital costs as opposed to physician costs. The Essure procedure had higher costs for disposable equipment (p Essure hysteroscopic sterilization had significant cost savings compared with laparoscopic tubal sterilization (p = .038). We believe that our data represent the minimum of potential savings using this approach, and future developments will only increase the cost difference found in our study.

  13. Application of pregnancy specific β1 glycoprotein-radioimmunoassay (SP1-ria) in obstetrics and gynecology

    International Nuclear Information System (INIS)

    Zhang Weiyuan

    1988-01-01

    Serum SP 1 values of 395 patients were determined by radioimmunoassay. It was found that SP 1 was apparently absent from the blood of normal men and nonpregnant women, increased with gestational stage in pregnant women, and was highest in late pregnancy. In high-risk pregnancy, SP 1 was lower than normal pregnamey group (PC0.01) could also be detected in ectopic pregnancy. In patients with benign and malignant hydatidiform mole, and choriocarcinoma, AP 1 level decreased with malignant degree. The authors suggest that measurement of SP 1 levels is a valuable index for monitoring high-risk pregnancy, diagnosing ectopic pregnancy and following-up trophoblastic cell diseases

  14. Chlamydia trachomatis IgG seropositivity is associated with lower natural conception rates in ovulatory subfertile women without visible tubal pathology

    NARCIS (Netherlands)

    Coppus, S. F. P. J.; Land, J. A.; Opmeer, B. C.; Steures, P.; Eijkemans, M. J. C.; Hompes, P. G. A.; Bossuyt, P. M. M.; van der Veen, F.; Mol, B. W. J.; van der Steeg, J. W.

    2011-01-01

    The relation between Chlamydia trachomatis infection and subsequent tubal damage is widely recognized. As such, C. trachomatis antibody (CAT) testing can be used to triage women for immediate tubal testing with hysterosalpingography (HSG) or laparoscopy. However, once invasive tubal testing has

  15. Heterotopic pregnancy following induction of ovulation with clomiphene citrate.

    Science.gov (United States)

    Ghandi, Sedigheh; Ahmadi, Raheleh; Fazel, Mahmoud

    2011-01-01

    Although heterotopic gestation is common in assisted reproductive techniques, it is very rare in natural conception and clomiphene induced pregnancy. Diagnosis and appropriate intervention of heterotopic pregnancy requires a high index of suspicious. In this paper a case of heterotopic pregnancy in a 30-year old woman with hemoperitoneum from ruptured tubal pregnancy with live intrauterine gestation at 9 weeks of gestation is reported. This case suggests that a heterotopic pregnancy must always be considered particularly after the induction of ovulation by clomiphene citrate or assisted reproductive technology. Every clinician treating women of reproductive age should keep this diagnosis in mind. It also demonstrates that early diagnosis is essential in order to salvage the intrauterine pregnancy and avoid maternal morbidity and mortality.

  16. Heterotopic pregnancy following induction of ovulation with clomiphene citrate

    Directory of Open Access Journals (Sweden)

    Sedigheh Ghandi

    2011-01-01

    Full Text Available Background: Although heterotopic gestation is common in assisted reproductive techniques, it is very rare in natural conception and clomiphene induced pregnancy. Diagnosis and appropriate intervention of heterotopic pregnancy requires a high index of suspicious.Case: In this paper a case of heterotopic pregnancy in a 30-year old woman with hemoperitoneum from ruptured tubal pregnancy with live intrauterine gestation at 9 weeks of gestation is reported.Conclusion: This case suggests that a heterotopic pregnancy must always be considered particularly after the induction of ovulation by clomiphene citrate or assisted reproductive technology. Every clinician treating women of reproductive age should keep this diagnosis in mind. It also demonstrates that early diagnosis is essential in order to salvage the intrauterine pregnancy and avoid maternal morbidity and mortality

  17. Perineal Ectopic Testis in an Adult

    African Journals Online (AJOL)

    in an ectopic site outside the scrotum; such as the perineum, pubic region, dorsum of the penis, femoral region, anterior abdominal wall and the contralateral scrotum. Management is orchidopexy through an inguinal crease incision as the length of the spermatic cord is normal. We report a 26 year old man with a left perineal ...

  18. Ectopic gastric mucosa in the duodenal bulb

    International Nuclear Information System (INIS)

    Schnell, H.; Oehler, G.; Schulz, A.; Rau, W.S.; Giessen Univ.; Giessen Univ.

    1989-01-01

    The radiological and clinical findings of 12 patients with ectopic gastric mucosa in the duodenal bulb are presented. This is a defined disease with characteristic radiological features: multiple small nodular defects of the contrast medium of 1-3 mm diameter. Histology shows complete heterotopia. Pathogenesis and clinical significance are discussed with reference to the literature on this subject. (orig.) [de

  19. Grieving after early pregnancy loss--a common reality.

    LENUS (Irish Health Repository)

    Purandare, N

    2013-05-24

    A miscarriage can be very traumatic for a couple and their immediate family. The aim of this study was to assess, using the Perinatal Grief Scale (PGS), whether the type of early pregnancy loss influences the severity of grief and whether the presence of living children influences the severity of grief. Over a period of 6 months in 2008, seventy five patients were recruited for the study, of which 7 (9.3%) had molar pregnancies, 20 (26.7%) had ectopic pregnancies, 43 (573%) had a miscarriage and 5 (6.7%) had recurrent miscarriages. In this study there was no significant difference in severity of grief, between women that had a miscarriage and ectopic pregnancy (p = 0.14) or, between women that had a miscarriage and a molar pregnancy (p = 0.85). Women who had experienced a ectopic pregnancy did not have a higher grief intensity than the women that had a molar pregnancy (p = 0.75). However, for women with a child, the grief intensity significantly increases with the number of miscarriages (p = 0.015). Women with no children with an ectopic pregnancy grieve significantly more than those with a child (p = 0.019). An appointment for the \\'Miscarriage Clinic\\' should be offered to all of these women but special attention should be paid to those in the categories most at risk

  20. Ectopic decidual reaction mimicking inguinal lymphoma on ultrasound

    DEFF Research Database (Denmark)

    Lorentzen, C.; Prangsgaard, Tina; Lorentzen, Torben

    2014-01-01

    Ectopic decidual reaction has been described in various intraperitoneal locations. We present a case of unusual ectopic decidual reaction in the groin mimicking inguinal lymphoma on ultrasound in a pregnant woman. This case contributes evidence illustrating the variability of the clinical...... presentation of ectopic decidual reaction....

  1. Clinical and psychological repercussions of videolaparoscopic tubal ligation: observational, single cohort, retrospective study

    Directory of Open Access Journals (Sweden)

    Daniel Spadoto Dias

    Full Text Available CONTEXT AND OBJECTIVE: Tubal ligation is one of the most commonly used contraceptive methods worldwide. Since the controversy over the potential effects of tubal sterilization still continues, this study aimed to evaluate the clinical and psychological repercussions of videolaparoscopic tubal ligation.DESIGN AND SETTING: Observational, single cohort, retrospective study, conducted in a tertiary public hospital.METHODS: A questionnaire was applied to 130 women aged 21-46 years who underwent videolaparoscopic tubal ligation by means of tubal ring insertion or bipolar electrocoagulation and sectioning, between January 1999 and December 2007. Menstrual cycle interval, intensity and duration of bleeding, premenstrual symptoms, dysmenorrhea, dyspareunia, noncyclic pelvic pain and degree of sexual satisfaction were assessed in this questionnaire. Each woman served as her own control, and comparisons were made between before and after the surgical procedure and between the two techniques used.RESULTS: The clinical and psychological repercussions were significant, with increases in bleeding (P = 0.001, premenstrual symptoms (P < 0.001, dysmenorrhea (P = 0.019 and noncyclic pelvic pain (P = 0.001; and reductions in the number of sexual intercourse occurrences per week (P = 0.001 and in libido (P = 0.001. Women aged ≤ 35 years at the time of sterilization were more likely to develop menstrual abnormalities. The bipolar electrocoagulation method showed greater clinical and psychological repercussions.CONCLUSION: Regardless of the technique used, videolaparoscopic tubal ligation had repercussions consisting of increased menstrual flow and premenstrual symptoms, especially in women aged ≤ 35 years, and also had a negative influence on sexual activity.

  2. PRIMARY OVARIAN PREGNANCY: A CASE REPORT

    Directory of Open Access Journals (Sweden)

    Amulya

    2015-04-01

    Full Text Available Primary ovarian pregnancy is a rare entity and usually occurs in young women using intra uterine device. Preoperative diagnosis is difficult and is a challenge to the clinicians. A diagnostic delay may lead to rupture, secondary implantation or operative difficulties. Here w e present a case of a 30 year old primiparous woman who presented with lower abdominal pain and was diagnosed as ectopic pregnanc y and was managed with right ovariectomy.

  3. Ectopic ureterocele and ectopic ureter in pediatric patients; Ureterocele ectopico y ectopia ureteral en pacientes pediatricos

    Energy Technology Data Exchange (ETDEWEB)

    Lloret, M. T.; Ricart, V.; Muro, M. D.; Perez, D.; Martinez, I.; Brugger, S.; Romero, M. J.; Cortina, H. [hospital General Universitario La Fe. Valencia (Spain)

    2000-07-01

    To describe the radiological findings associated with ectopic ureterocele and ectopic ureter in pediatric patients. To assess the role of ultrasound (US), serial micturating cystourethrography (SM-CU) and intravenous urography (IVU) in the diagnosis of these two entities. The authors performed a retrospective study of 132 patients, 73 with ectopic ureterocele and 59 with ectopic ureter. The imaging studies used were US, SMCU, IVU and methods to determine renal function (diuretic renography and renal scintigraphy). The findings were confirmed during surgery in every case. The most common radiological findings in ectopic ureterocele were renal duplication (86,3%). vesicoureteral reflux (VUR) to the lower half of the kidney (46.6%), dilatation of the lower pole of the kidney (38.4%) and contralateral duplication (30.1%). In boys, the ectopic ureter entered via bladder neck and posterior urethra (73.7%) or into seminal vesicles (15.8%); in girls, it went to vagina (32.5%), bladder neck (30%) or urethra (22.5%). Renal duplication was associated in 64.4%, with VUR to the ectopic ureter in 21% while there was a single renal system in 35.6%, with VUR to the ectopic ureter in 57.1% and contralateral renal agenesis in 19%. Eighteen patients (13.6%) presented a single, dy plastic, nonfunctioning renal system (6 cases of ureterocele and 12 of ectopic ureter). Knowledge of the embryological development of ureteral duplication is essential for the understanding of these two entities and helps to differentiate between them, thus facilitating a sometimes complicated diagnosis. Ectopic ureters and ureteroceles accompanied by a single, dysplastic renal system are associated with a greater incidence of congenital anomalies and a higher rate of complications than the duplicate systems. A prenatal US examination enables early diagnosis. The anatomical information provided by US is, on occasion, more valuable than that resulting from IVU or SMCU, However, IVU is indispensable in girls

  4. Pregnancy Loss

    Science.gov (United States)

    ... To receive Pregnancy email updates Enter email Submit Pregnancy loss Pregnancy loss is a harsh reality faced ... have successful pregnancies. Expand all | Collapse all Why pregnancy loss happens As many as 10 to 15 ...

  5. Salpingitis isthmica nodosa in female infertility and tubal diseases

    DEFF Research Database (Denmark)

    Skibsted, L; Sperling, Lene; Hansen, U

    1991-01-01

    -examination, it was found in 24 patients. Ten women with SIN were bilaterally salpingectomized. Only one woman had SIN in both tubes. Women with SIN gave birth to as many children as women without SIN. After SIN had been diagnosed, no children were born, but this was not statistically different from the frequency of births...... with infertility, pregnancies, outcome of pregnancies, births, pelvic inflammatory disease and salpingitis. Sections from the isthmus were present in the specimens from 223 tubes from 193 patients and were analysed by the same pathologist. Originally, SIN was found in 12 patients but on re...

  6. Ectopic Varices in Colonic Stoma: MDCT Findings

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Jae Woong; Lee, Chang Hee; Kim, Kyeong Ah; Park, Cheol Min; Kim, Jin Yong [Guro Hospital of Korea University, Seoul (Korea, Republic of)

    2006-12-15

    We describe the 2D reformatted and 3D volume rendered images by MDCT in a patient with an episode of acute bleeding from the colonic stoma. This case indicates that the 2D reformatted and 3D volume rendered images are useful to detect this rare complication of portal hypertension, and they help to tailor adequate treatment for the patients with bleeding from stomal varices. Ectopic varices are an uncommon cause of gastrointestinal hemorrhage, but they account for up to 5% of all variceal bleedings (1). Bleeding from stomal varices has been reported in up to 20% of the patients suffering with chronic liver failure with permanent stoma (2). However, the diagnosis of stomal varices is difficult because bleeding from stoma may also be associated with lower gastrointestinal bleeding. To the best of our knowledge, the 2D reformatted and 3D volume rendered images by MDCT for visualization of ectopic stomal varices have not been previously reported in the medical literature.

  7. Ectopic ureterocele in the male infant

    International Nuclear Information System (INIS)

    Ekloef, O.; Loehr, G.; Ringertz, H.; Thomasson, B.

    1978-01-01

    An account is given of a series of ectopic ureterocele present in 14 male infants. The malformation is found to be more complex than in the female. The ipsilateral renal function is severely impaired or abolished and obstruction to the bladder outflow common. Associated dilatation and elongation of the posterior urethra during micturition may result in a valvelike appearance. Eversion of the male ureterocele is common and possible mechanisms to account for this event are discussed. (Auth.)

  8. Does vitamin E prevent tubal damage caused by smoking? A light microscopy and animal study.

    Science.gov (United States)

    Duran, Muzeyyen; Ustunyurt, Emin; Kosus, Aydin; Kosus, Nermin; Turhan, Nilgun; Hızlı, Deniz; Sarac, Gulce Naz; Erdogan, Deniz

    2014-04-01

    To assess the histomorphological effects of smoking on the cilia of fallopian tubes in mice and the effect of vitamin E on the negative effects of smoke. Eighteen 12-14 week-old Swiss albino type female mice were randomly divided into three groups, each consisting of six mice: Group A: control group; Group B: mice exposed to cigarette smoke; Group C: mice exposed to cigarette smoke together with vitamin E. Groups B and C were exposed to cigarette smoke for 10 weeks. After 10 weeks, tubal excision was performed in all animals. Histopathologic examination of excised tubal tissue was conducted under light microscopy. The number of cilia was significantly lower in Group B. Although not statistically significant, the median number of cilia in Group C was measured to be higher than in Group B but lower than in Group A. Based on the results, it can be concluded that smoking decreases tubal cilia numbers. Supplementation by vitamin E may treat or at least help to slow down the decrease in number of cilia caused by smoking; therefore it could be used therapeutically in the treatment of smoking-related tubal damage. Crown Copyright © 2014. Published by Elsevier Ireland Ltd. All rights reserved.

  9. Bearing capacity and rigidity of short plastic-concrete-tubal vertical columns under transverse load

    Science.gov (United States)

    Dolzhenko, A. V.; Naumov, A. E.; Shevchenko, A. E.

    2018-03-01

    The results of mathematical modeling in determining strain-stress distribution parameters of a short plastic-concrete-tubal vertical column under horizontal load as those in vertical constructions are described. Quantitative parameters of strain-stress distribution during vertical and horizontal loads and horizontal stiffness were determined by finite element modeling. The internal stress in the concrete column core was analyzed according to equivalent stress in Mohr theory of failure. It was determined that the bearing capacity of a short plastic- concrete-tubal vertical column is 25% higher in resistibility and 15% higher in rigidness than those of the caseless concrete columns equal in size. Cracks formation in the core of a short plastic-concrete-tubal vertical column happens under significantly bigger horizontal loads with less amount of concrete spent than that in caseless concrete columns. The significant increase of bearing capacity and cracking resistance of a short plastic-concrete-tubal vertical column under vertical and horizontal loads allows recommending them as highly effective and highly reliable structural wall elements in civil engineering.

  10. Bilateral tubal ligation in a rural hospital in the Niger Delta, Nigeria ...

    African Journals Online (AJOL)

    Background and Objective: To document bilateral tubal ligation (BTL) rate and highlight the need to improve on the rates. Materials and Methods: A retrospective review of BTLs done in a five-year period from January 2000 to December 2004 constituted the study group. Results: There were a total of 103 BTLs, 58 were ...

  11. Effect of menstrual cycle phase and hormonal treatments on evaluation of tubal patency in baboons.

    Science.gov (United States)

    Jensen, Jeffrey T; Hanna, Carol; Mishler, Emily; Lim, Jeong Y; Slayden, Ov D

    2018-02-01

    We evaluated whether menstrual cycle phase influences the assessment of tubal patency by hysterosalpingography (HSG) in baboons. Retrospective analysis of baseline tubal patency studies and serum estradiol (E 2 ) and progesterone (P4) values obtained from female baboons used as models for development of non-surgical permanent contraception in women. The main outcome measure was bilateral tubal patency (BTP) in relationship with estradiol level. Female baboons (n = 110) underwent a single (n = 81), two (n = 26), or three (n = 3) HSG examinations. In 33/142 (23%) HSG examinations, one or both tubes showed functional occlusion (FO). The median E 2 in studies with BTP (49 pg/mL) was significantly higher than in those studies with FO (32 pg/mL, P = .005). Among 18 animals with repeat examinations where serum E 2 changed from <60 to ≥ 60 pg/mL, 13 results changed from FO to BTP (P = .0001). No sets showed a change from BTP to FO with an increase in estradiol. In baboons, functional occlusion of the fallopian tube is associated with low estradiol levels, supporting a role for estrogen-mediated relaxation of the utero-tubal junction. © 2017 The Authors. Journal of Medical Primatology Published by John Wiley & Sons Ltd.

  12. Factors Promoting Tubal Ligation in Females Presenting to Tertiary Care Centers

    Directory of Open Access Journals (Sweden)

    Hammad Ali Qazi

    2009-09-01

    Full Text Available Objective: Despite development of new contraceptive methods, sterilization remained the most widely used method. Our objective was to determine the factors contributing to decision making for tubal ligation in females.Materials and methods: A cross sectional study was conducted in Jinnah Post graduate Medical Centre (JPMC between March - November 2008. About 505 Females using contraceptive measures were consecutively included. Those having any severe debilitating disease and unfamiliar with “urdu” language were excluded. Three trained co researchers conducted structured interviews to determine the frequency and factors associated with tubal ligation.Results: The final multiple logistic regression showed illiteracy [AOR 2.91 95% CI 1.53-5.53], number of children < 3 [AOR 6.15 95% CI 2.61-14.50], age of women < 30 [AOR 0.12 95% CI 0.06-0.22] years and information gained through health worker [AOR 3.04 95% CI 1.60-5.80] to be statistically significant.Conclusion: This highlights tubal ligation was more common in uneducated women of age > 35 years having <3 children. The most common means of promoting tubal ligation was information gained through health workers.

  13. Learning curve of hysteroscopic placement of tubal sterilization microinserts in 15 gynecologists in the Netherlands.

    Science.gov (United States)

    Janse, Juliënne A; Pattij, Thyrza O S; Eijkemans, Marinus J C; Broekmans, Frank J; Veersema, Sebastiaan; Schreuder, Henk W R

    2013-09-01

    To evaluate the learning curve of hysteroscopic placement of tubal sterilization microinserts by gynecologists in the Netherlands. Prospective multicenter study (Canadian Task Force II-2). Ten community (teaching) hospitals in the Netherlands. A total of 631 women who underwent permanent sterilization by tubal microinserts. Hysteroscopic placement of tubal sterilization microinserts performed by 15 gynecologists experienced in performing operative hysteroscopy, starting from their very first placement. Effect of increasing experience in time on procedure time, pain score, successful bilateral placement, and complications. Bilateral successful placement with confirmation of adequate positioning at follow-up evaluation was achieved in 480 (76.1%) patients at first attempt and in 44 (7.0%) at second attempt. Median procedure time was 8.0 minutes (range: 3-40), and 31 (4.9%) patients were lost to follow-up evaluation. Gravidity showed to be a confounding factor and was consequently adjusted for. A learning curve was seen in a statistically significant decrease of procedure time with increasing experience. The decrease in procedure time extended to 11 to 15 cases and was followed by a plateau phase of the subsequent 60 cases. In contrast, pain scores, successful placement, and complication rate appeared not to improve with increasing experience. A learning curve for hysteroscopic tubal sterilization was seen for procedure time, but successful placement, pain score, and complication rate were not clearly influenced by increasing experience. Copyright © 2013 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  14. chlamydial infection, plasma peroxidation and obesity in tubal

    African Journals Online (AJOL)

    INTRODUCTION. Human reproductive failure is as old as mankind. This public health problem involves all regions of the world and its prevalence worldwide varies from 10-15%1;. 10-32% in Africa2 and 31.5% in Nigeria3. The various categories of human reproductive failure include: infertility, recurrent pregnancy loss ( ...

  15. Ectopic hepatocellular carcinoma in a dog.

    Science.gov (United States)

    Burton, I R; Limpus, K; Thompson, K G; Owen, M C; Worth, A J

    2005-12-01

    A 14-year-old neutered male Bearded Collie was presented with a history of recurrent, intermittent urinary incontinence of 7 years duration. A large, firm, non-painful mass was found in the mid-abdominal region on palpation. Ultrasonography of the mass revealed a compartmentalised structure with mixed echogenicity, and which did not appear to be associated with any of the abdominal organs. Ultrasound-guided fine needle aspirates contained several clusters of epithelial cells with cytological features of hepatocytes. At exploratory laparotomy, the mass was found in the gastrosplenic ligament within the greater omentum. PATHOLOGICAL FINDINGS AND DIAGNOSIS: Histopathologically, the mass consisted of sheets of hepatocytes, but without the characteristic hepatic architecture. The cells showed moderate variation in nuclear size and were sometimes binucleate. A diagnosis of hepatocellular carcinoma (HCC) in the mesentery was made. The presence of ectopic hepatic tissue has been reported rarely in man and cats, but not in the dog. Neoplastic transformation of ectopic hepatic tissue is seen in man. This is the first report of the presentation, clinical findings and treatment of a dog with ectopic HCC.

  16. CT diagnosis of abdominal ectopic pheochromocytoma

    International Nuclear Information System (INIS)

    Zhang Yuping; Zhao Zhiying

    2010-01-01

    Objective: To discuss the value of CT in diagnosis of abdominal ectopic pheochromocytoma. Methods: CT findings of 5 cases surgically and pathologically proved with ectopic pheochromocytoma were retrospectively analyzed. Results: Soft tissue mass with light asymmetry enhancement was found between the abdominal aorta and the inferior vena ca-va in one case. 1 case was completely cystic with light enhancement of the cystwall located in front of the left side of the abdominal aorta. 1 case of large solid mass occurred between the renal hilum and the tail of pancreas, with irregular shape, unclear boundary, central necrosis, calcification and obviously enhancement at the solid part. 2 cases showed as oval soft lump with even density, moderate strengthening located before the abdominal aorta. Paroxysmal hypertension occurred in 3 cases and didn't in 2 cases. Hypertension happened in 1 case during the operation because of stimulation. Blood pressure appeared in 1 case during and after operation. Blood and urinary catecholamine increased significantly in 4 cases. Conclusion: Ectopic pheochromocytoma mainly located surround the abdominal aorta with diverse CT performance. It is helpful for diagnosing when finding a lesion locates at the specified sites combined with typical clinical presentation. CT can not only depict small tumor, but also can show the relationship with surrounding structure, and it provides important information for the operation and prognosis. (authors)

  17. Zoonotic ectopic fascioliasis: review and discussion.

    Science.gov (United States)

    Rashed, Amr A; Khalil, Hazem H M; Morsy, Ayman T A

    2010-12-01

    Ectopic fascioliasis (EF) has direct and indirect effects on both humans and animals. The phenomenon of EF was individual cases in the period from 1950 up to the end of last century. From the period of 2000 up to 2006, plenty of researches were on EF in the developed and undeveloped countries. Nineteen EF cases infected with the immature and few with the mature worms were 13 females and 6 males. Three cases of lymphatic, pleural and breast fascioliasis reached the adults and laid their eggs in a lymph node in the cervical region pleural cavity and breast tissues. Until recent, knowledge about the ectopic fascioliasis pathway is little. Fasciola hepatica was the commonest species in most cases. The effect of fascioliasis might be direct to liver as ectopic foci or indirect on other organs due to the metabolites and secretory excretory products. All ages and both sexes were EF infected. Watercress topped the list of water plants born encysted metacercariae followed by lettuce, mint, and alfalfa. Nearly 24 million Egyptians at risk and about 800,000 were infected. On the global scale, about 180 million are at risk of infection.

  18. Splenic Pregnancy: A New Minimally Invasive Approach to Treatment

    Energy Technology Data Exchange (ETDEWEB)

    Klang, Eyal, E-mail: eyalkla@hotmail.com; Keddel, Nicholas; Inbar, Yael; Rimon, Uri; Amitai, Michal [Tel Hashomer Hospital, The Chaim Sheba Medical Center, Department of Radiology (Israel)

    2016-09-15

    The spleen is a rare site of abdominal ectopic pregnancy. In a review of the literature, we found 16 published cases of primary splenic pregnancies. Of the cases identified, all received surgical intervention, with one case successfully treated with laparoscopic methotrexate injection, and the rest underwent splenectomy. We would like to present a case of primary splenic pregnancy in a 35-year-old woman successfully treated with percutaneous image-guided injection of methotrexate and KCl.

  19. Splenic Pregnancy: A New Minimally Invasive Approach to Treatment

    International Nuclear Information System (INIS)

    Klang, Eyal; Keddel, Nicholas; Inbar, Yael; Rimon, Uri; Amitai, Michal

    2016-01-01

    The spleen is a rare site of abdominal ectopic pregnancy. In a review of the literature, we found 16 published cases of primary splenic pregnancies. Of the cases identified, all received surgical intervention, with one case successfully treated with laparoscopic methotrexate injection, and the rest underwent splenectomy. We would like to present a case of primary splenic pregnancy in a 35-year-old woman successfully treated with percutaneous image-guided injection of methotrexate and KCl.

  20. Influence of mare uterine tubal fluids on the metabolism of stallion sperm.

    Science.gov (United States)

    Engle, C E; Foley, C W; Witherspoon, D M; Scarth, R D; Goetsch, D D

    1975-08-01

    Three experiments were conducted on the metabolism of stallion sperm. In experiment 1, whole and washed sperm were incubated under aerobic and anaerobic enviroments and analyzed before and after controlled incubation for motility, pH, lactic acid, glucose, fructose, and O2 comsumption. In experiment 2, whole and washed sperm were incubated aerobically and anaerobically with and without uterine tubal fluids. Experiment 3 was the same as experiment 2, except added substrates of glucose and lactic acid were studied. The same examinations were made in experiments 2 and 3 as for experiment 1. Motility decreased significantly during incubation for all treatments, with the greatest decrease occurring for whole semen where only trace amounts of substrate (fructose) were present. Exogenous glucose plus uterine tubal fluid maintained sperm motility better than did added lactate. However, sperm respiration rates were highest when exogenous lactate was the only substrate in the incubation medium. The mean pH values for gel-free stallion semen at the start of controlled aerobic and anaerobic incubation were 7.08 and 7.34. Lactic acid accummulation for 1 hour increased from 0.05 mg to 0.09 mg/10(9) sperm when uterine tubal fluid was added to the incubation medium. Washed spermatozoa incubated in 0.03 M glucose plus uterine tubal fluid utilized less glucose than did sperm incubated in the glucose medium. These results, along with the increased oxygen utilization (ZO2) values produced by adding uterine tubal fluid to the incubation mediums, might indicate utilization of a uterine tubal substrate. Added uterine tubal fluid resulted in increased ZO2 values (expressed in mul of O2 utilized by 10(8) sperm in 1 hour at 37 C) for whole semen from 10.45 to 12.63. Washed spermatozoa also respired at a significantly greater rate than whole sperm. Respiration rates were greater for sperm incubated with 0.01 M lactic acid than for any other substrate or experiment.

  1. A Case Report of Ruptured Spontaneous Heterotopic Pregnancy

    Directory of Open Access Journals (Sweden)

    F Seidoshohadaei

    2008-04-01

    Full Text Available ABSTRACT: Introduction & Objective: Heterotopic pregnancy refers to the simultaneous occurrence of pregnancy intrauterine and outside of uterine corpus. It is most often manifested in women who have undergone artificial reproductive technology (ART but rarely occurs spontaneously. Heterotopic pregnancy still remains as a diagnostic and therapeutic challenge to practitioners. In this situation physicians should have high suspicion for diagnosis and intrauterine pregnancy protection. This study reported a case of ruptured spontaneous heterotopic pregnancy. Case: A 32 year-old woman with abdominal pain, nausea, vomiting and hypovolumic shock in 1386 referred to emergency department in Sanandaj hospital. She reported one previous cesarean section. On examination, the patient's abdomen was distended. She had generalized tenderness and rebound tenderness in abdomen. The ultrasonographic examination revealed large amount of fluid in pelvic and abdominal cavity with a large hematoma in right adnex but there was intrauterine pregnancy at 7 weeks with normal fetal heart activity. She underwent laparotomy for heterotopic pregnancy and ruptured tube with tubal pregnancy removed. Intrauterine pregnancy continued without problem and led to birth of a healthy female neonate. Conclusion: Physicians should be quite cautious of heterotopic pregnancy in woman at reproductive age. Any abnormality on physical examination or ultrasonography of a patient with intrauterine pregnancy and abdominal pain should heighten the clinician's suspicion for heterotopic pregnancy

  2. Imaging in gynecological disease (9): clinical and ultrasound characteristics of tubal cancer.

    Science.gov (United States)

    Ludovisi, M; De Blasis, I; Virgilio, B; Fischerova, D; Franchi, D; Pascual, M A; Savelli, L; Epstein, E; Van Holsbeke, C; Guerriero, S; Czekierdowski, A; Zannoni, G; Scambia, G; Jurkovic, D; Rossi, A; Timmerman, D; Valentin, L; Testa, A C

    2014-03-01

    To describe clinical history and ultrasound findings in patients with tubal carcinoma. Patients with a histological diagnosis of tubal cancer who had undergone preoperative ultrasound examination were identified from the databases of 13 ultrasound centers. The tumors were described by the principal investigator at each contributing center on the basis of ultrasound images, ultrasound reports and research protocols (when applicable) using the terms and definitions of the International Ovarian Tumor Analysis (IOTA) group. In addition, three authors reviewed together all available digital ultrasound images and described them using subjective evaluation of gray-scale and color Doppler ultrasound findings. We identified 79 women with a histological diagnosis of primary tubal cancer, 70 of whom (89%) had serous carcinomas and 46 (58%) of whom presented at FIGO stage III. Forty-nine (62%) women were asymptomatic (incidental finding), whilst the remaining 30 complained of abdominal bloating or pain. Fifty-three (67%) tumors were described as solid at ultrasound examination, 14 (18%) as multilocular solid, 10 (13%) as unilocular solid and two (3%) as unilocular. No tumor was described as a multilocular mass. Most tumors (70/79, 89%) were moderately or very well vascularized on color or power Doppler ultrasound. Normal ovarian tissue was identified adjacent to the tumor in 51% (39/77) of cases. Three types of ultrasound appearance were identified as being typical of tubal carcinoma using pattern recognition: a sausage-shaped cystic structure with solid tissue protruding into it like a papillary projection (11/62, 18%); a sausage-shaped cystic structure with a large solid component filling part of the cyst cavity (13/62, 21%); an ovoid or oblong completely solid mass (36/62, 58%). A well vascularized ovoid or sausage-shaped structure, either completely solid or with large solid component(s) in the pelvis, should raise the suspicion of tubal cancer, especially if normal

  3. Tubal origin of ovarian cancer - the double-edged sword of haemoglobin.

    Science.gov (United States)

    Lin, Shiou-Fu; Gerry, Emily; Shih, Ie-Ming

    2017-05-01

    Ovarian high-grade serous carcinoma (HGSC) is the most malignant neoplasm of the gynaecological tract. While the origins of many human malignant neoplasms are clear, the origin of HGSC remains poorly understood. This lack of knowledge limits our understanding of its pathogenesis and compromises efforts devoted to developing better early detection tools and effective preventative interventions. The paradigm of the tubal origin of HGSC has been advanced since the initial report of dysplastic lesions (now known as serous tubal intraepithelial carcinomas or STICs) that morphologically resemble HGSC in the Fallopian tube. These were observed in a group of patients with a genetic predisposition to ovarian cancer who were undergoing risk-reducing salpingo-oophorectomy. Since then, a series of clinico-pathological and molecular studies have characterized STICs and their concurrent HGSCs, and the results support the new paradigm of a tubal origin of many 'ovarian' HGSCs. Reactive oxygen species-containing ovulatory follicular fluid has been thought to be the major culprit behind DNA damage in tubal epithelial cells, leading to either cell death or, if the cells survive, mutagenesis. A recent report from this journal demonstrates that ferryl haemoglobin (Hb) in peritoneal fluid could prevent cell death from DNA-damaged fimbrial epithelial cells, facilitating ovulation-induced carcinogenesis of tubal epithelium. This timely study provides new insight into the tumour initiation event in HGSC. Copyright © 2017 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd. Copyright © 2017 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.

  4. Serous tubal intraepithelial carcinoma: its potential role in primary peritoneal serous carcinoma and serous cancer prevention.

    Science.gov (United States)

    Carlson, Joseph W; Miron, Alexander; Jarboe, Elke A; Parast, Mana M; Hirsch, Michelle S; Lee, Yonghee; Muto, Michael G; Kindelberger, David; Crum, Christopher P

    2008-09-01

    A diagnosis of primary peritoneal serous carcinoma (PPSC) requires exclusion of a source in other reproductive organs. Serous tubal intraepithelial carcinoma (STIC; stage 0) has been described in asymptomatic women with BRCA mutations and linked to a serous cancer precursor in the fimbria. This study examined the frequency of STIC in PPSC and its clinical outcome in BRCA-positive women. Presence or absence of STIC was recorded in consecutive cases meeting the 2001 WHO criteria for PPSC, including 26 patients with nonuniform sampling of the fallopian tubes (group 1) and 19 patients with complete tubal examination (group 2; sectioning and extensively examining the fimbriated end, or SEE-FIM protocol). In selected cases, STIC or its putative precursor and the peritoneal tumor were analyzed for p53 mutations (exons 1 to 11). Outcome of STIC was ascertained by literature review. Thirteen (50%) of 26 PPSCs in group 1 involved the endosalpinx, with nine STICs (35%). Fifteen (79%) of 19 cases in group 2 contained endosalpingeal involvement, with nine STICs (47%). STIC was typically fimbrial and unifocal, with variable invasion of the tubal wall. In five of five cases, the peritoneal and tubal lesion shared an identical p53 mutation. Of 10 reported STICs in BRCA-positive women, all patients were without disease on follow-up. The fimbria is the source of nearly one half of PPSCs, suggesting serous malignancy originates in the tubal mucosa but grows preferentially at a remote peritoneal site. The generally low risk of recurrence in stage 0 (STIC) disease further underscores STIC as a possible target for early serous cancer detection and prevention.

  5. The secretory endometrial protein, placental protein 14, in women with ectopic gestation

    DEFF Research Database (Denmark)

    Ruge, S; Sørensen, Steen; Vejtorp, M

    1992-01-01

    OBJECTIVE: To determine the serum level of the secretory endometrial protein, placental protein 14 (PP14) and progesterone (P) in women with ectopic gestation. DESIGN: Blood samples were collected prospectively and preoperatively. Reference range was determined from a prospective population of 98...... observing the low serum levels of PP14 and P, a correlation analysis was made and compared with the findings in normally pregnant women. RESULTS: A significant positive correlation was found between the level of PP14 and P (P less than 0.00002), not found in normal intrauterine pregnancies. CONCLUSIONS...

  6. Outpatient endometrial aspiration: an alternative to methotrexate for pregnancy of unknown location.

    Science.gov (United States)

    Insogna, Iris G; Farland, Leslie V; Missmer, Stacey A; Ginsburg, Elizabeth S; Brady, Paula C

    2017-08-01

    Pregnancies of unknown location with abnormal beta-human chorionic gonadotropin trends are frequently treated as presumed ectopic pregnancies with methotrexate. Preliminary data suggest that outpatient endometrial aspiration may be an effective tool to diagnose pregnancy location, while also sparing women exposure to methotrexate. The purpose of this study was to evaluate the utility of an endometrial sampling protocol for the diagnosis of pregnancies of unknown location after in vitro fertilization. A retrospective cohort study of 14,505 autologous fresh and frozen in vitro fertilization cycles from October 2007 to September 2015 was performed; 110 patients were diagnosed with pregnancy of unknown location, defined as a positive beta-human chorionic gonadotropin without ultrasound evidence of intrauterine or ectopic pregnancy and an abnormal beta-human chorionic gonadotropin trend (location, failed intrauterine pregnancy was diagnosed in 46 patients (42%), and ectopic pregnancy was diagnosed in 64 patients (58%). Clinical variables that included fresh or frozen embryo transfer, day of embryo transfer, serum beta-human chorionic gonadotropin at the time of sampling, endometrial thickness, and presence of an adnexal mass were not significantly different between patients with failed intrauterine pregnancy or ectopic pregnancy. In patients with failed intrauterine pregnancy, 100% demonstrated adequate postsampling beta-human chorionic gonadotropin declines; villi were identified in just 46% (n=21 patients). Patients with failed intrauterine pregnancy had significantly shorter time to resolution (negative serum beta-human chorionic gonadotropin) after sampling compared with patients with ectopic pregnancy (12.6 vs 26.3 days; Plocation are spared methotrexate, with a shorter time to pregnancy resolution than those who receive methotrexate. Copyright © 2017 Elsevier Inc. All rights reserved.

  7. Pregnancy outcome following myomectomy.

    Science.gov (United States)

    Begum, N; Anwary, S A; Alfazzaman, M; Sultana, P; Banu, J; Deeba, F; Mahzabin, Z; Nahar, K N

    2015-01-01

    In developing countries, abdominal myomectomy is still a modality of treatment for large and symptomatic uterine fibroid in women who wish to retain their fertility and preserve uterus. In order to assess the outcome of pregnancies after myomectomy, a prospective observational study was carried out in the Department of Obstetrics and Gynaecology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, from July 1999 and June 2011. Study included 40 married women of reproductive age, suffering either from primary or secondary subfertility, and who had uterine fibroid and strongly wished to conceive shortly after myomectomy using microsurgical procedure with no existence of other male and female subfertility factor. These women were followed up at 3, 6, 12 and 24 month intervals over telephone and outdoor visits. Data were recorded on preformed questionnaires. Post myomectomy hysterosalpingography was done at about 16 weeks after myomectomy. Patients were advised to try for pregnancy after 16 weeks of operation. Maximum number of women belonged to age group 31-35 years (n=14, 35%); primary subfertility was 67.5% and secondary 32.5%; in maximum number of cases duration of subfertility was 2-5 years (n=22, 55%); type of fibroid were solitary (52.5%) and multiple (47.5%); type of myoma were intramural (75%), submucous (2.5%) and combined (22.5%); location of myoma were fundal (5%), anterior wall (25%), posterior wall (20%) and combined (50%); diameter of removed myoma were 8-10(20%) and >10cm (10%); uterine size before myomectomy were (in weeks) 25 (2.5%). Hysterosalpingography was done in 16(40%) cases, and the findings were both tube patent (62.5%), unilateral tubal block (31.2%) and bilateral tubal block (6.2%). Menorrhagia after myomectomy was present only in 5% cases. After uterine myomectomy, 14(35%) women conceived, common time interval between myomectomy and conception was 1-2 years (42.9%), conception was spontaneous in 71.4%. Out of 14 who

  8. Diagnostic accuracy of the ultrasonography in complicated pregnancy

    International Nuclear Information System (INIS)

    Cha, Kyung Soo; Kim, Kun Sang; Park, Soo Soung

    1983-01-01

    Ultrasonography is an invaluable diagnostic method in Obstetrics. It provides safe, speedy and repeatable way to obtain image of normal and abnormal pregnancy. The ultrasonograms of 167 patients with suspicion of complicated pregnancy were analyzed. The results were as follows. 1. 86 patients showed normal ultrasonogram(50.9%). 100% in intrauterine fetal death and gross fetal anomaly, 100% in abnormal fetal position and number, 95% in pregnancy with pelvic mass, 83% in ectopic pregnancy, 81% in abortion, 78% in molar pregnancy, 74% in plancenta previa. 3. Ultrasonic diagnosis of abrupto placenta was difficult. 4. Diagnostic accuracy was 80% in bicornuate uterus and double vagina

  9. Dual ectopic thyroid: A case report with review of literature

    International Nuclear Information System (INIS)

    Sood, A.; Seam, R. K.; Gupta, M.; Raj Sharma, D.; Bhardwaj, P.

    2011-01-01

    The ectopic thyroid gland is a rare entity which is mostly found along the line of descent of the thyroid gland. Most of the patients present with midline swelling and usually seek medical attention. Dual ectopic thyroid gland is even rarer. The clinical examination and different imaging modalities establish its diagnosis. Radionuclide studies are highly sensitive and specific in demonstrating the functional tissues in patients with ectopic thyroid, thereby guiding further management. The authors reported a case of ectopic thyroid gland in a girl with midline neck swelling initially, subsequently lost to follow-up. She again presented with enlarged swelling after a period of three years with dual ectopic thyroid in the neck region on thyroid scan. Thyroid scintigraphy demonstrated that progression in the size of ectopic glands was due to neglect in treatment.

  10. Clinicopathological Features and Treatment of Ectopic Varices with Portal Hypertension

    Directory of Open Access Journals (Sweden)

    Takahiro Sato

    2011-01-01

    Full Text Available Bleeding from ectopic varices, which is rare in patients with portal hypertension, is generally massive and life-threatening. Forty-three patients were hospitalized in our ward for gastrointestinal bleeding from ectopic varices. The frequency of ectopic varices was 43/1218 (3.5% among portal hypertensive patients in our ward. The locations of the ectopic varices were rectal in thirty-two, duodenal in three, intestinal in two, vesical in three, stomal in one, and colonic in two patients. Endoscopic or interventional radiologic treatment was performed successfully for ectopic varices. Hemorrhage from ectopic varices should be kept in mind in patients with portal hypertension presenting with lower gastrointestinal bleeding.

  11. Ectopic recurrence of craniopharyngioma: Reporting three new cases.

    Science.gov (United States)

    Yang, Yang; Shrestha, David; Shi, Xiang-En; Zhou, Zhongqing; Qi, Xueling; Qian, Hai

    2015-04-01

    Ectopic recurrence of craniopharyngioma is extremely rare following transcranial procedures of primary tumour. Here we describe 3 new cases of ectopic recurrence along the surgical route after transcranial gross total resection of primary tumour. All 3 cases are male adults--2 of them had papillary-type tumour with the other being adamantinomatous. All ectopic tumours were safely resected via repeated craniotomy. Long-term surveillance of patients with resected craniopharyngioma is essential.

  12. Ectopic Neurohypophysis in Patient with Pituitary Dwarfism: A Case Report

    OpenAIRE

    İlhan Kılınç; Deniz Gökalp; Cihan Akgül Özmen

    2008-01-01

    Ectopic neurohypophysis is an anomaly of the Pituitary gland whichmay be associated with short stature due to Growth hormone deficiency.MRI is the modality of choice in diagnosing this condition. We present acase of pituitary dwarfism and ectopic neurohypophysis with clinical andradiological findings. 21 year-old male admitted with short stature. Allhormones, except prolactin, of anterior hypophysis were low. Bright spotwas ectopically located at level of median eminence on enhanced MRI ofhyp...

  13. Molar Pregnancy

    Science.gov (United States)

    ... weeks of pregnancy Ovarian cysts Anemia Overactive thyroid (hyperthyroidism) Causes A molar pregnancy is caused by an ... have this complication than a partial molar pregnancy. Prevention If you've had a molar pregnancy, talk ...

  14. Pregnancy after hydrosalpinx treatment with Essure

    Science.gov (United States)

    Inocêncio, Gonçalo; Coutinho, Lúcia; Maciel, Raquel; Barreiro, Márcia

    2013-01-01

    We present a case of a 29-year-old woman, with a history of ectopic pregnancy, which required left salpingectomy, and with a tortuous and impermeable right fallopian tube, compatible with hydrosalpinx. As hydrosalpinx itself can compromise a future pregnancy, treatment with Essure was proposed before passing to medically assisted procreation techniques. Five months after placement of Essure in the right fallopian tube, an in vitro fertilisation cycle was successfully completed and the woman had a singleton pregnancy and vaginal delivery without intercurrences. PMID:23536627

  15. Widespread ectopic expression of olfactory receptor genes

    Directory of Open Access Journals (Sweden)

    Yanai Itai

    2006-05-01

    Full Text Available Abstract Background Olfactory receptors (ORs are the largest gene family in the human genome. Although they are expected to be expressed specifically in olfactory tissues, some ectopic expression has been reported, with special emphasis on sperm and testis. The present study systematically explores the expression patterns of OR genes in a large number of tissues and assesses the potential functional implication of such ectopic expression. Results We analyzed the expression of hundreds of human and mouse OR transcripts, via EST and microarray data, in several dozens of human and mouse tissues. Different tissues had specific, relatively small OR gene subsets which had particularly high expression levels. In testis, average expression was not particularly high, and very few highly expressed genes were found, none corresponding to ORs previously implicated in sperm chemotaxis. Higher expression levels were more common for genes with a non-OR genomic neighbor. Importantly, no correlation in expression levels was detected for human-mouse orthologous pairs. Also, no significant difference in expression levels was seen between intact and pseudogenized ORs, except for the pseudogenes of subfamily 7E which has undergone a human-specific expansion. Conclusion The OR superfamily as a whole, show widespread, locus-dependent and heterogeneous expression, in agreement with a neutral or near neutral evolutionary model for transcription control. These results cannot reject the possibility that small OR subsets might play functional roles in different tissues, however considerable care should be exerted when offering a functional interpretation for ectopic OR expression based only on transcription information.

  16. Ultrasound pregnancy

    Science.gov (United States)

    Pregnancy sonogram; Obstetric ultrasonography; Obstetric sonogram; Ultrasound - pregnancy; IUGR - ultrasound; Intrauterine growth - ultrasound; Polyhydramnios - ultrasound; Oligohydramnios - ultrasound; ...

  17. Treatment of Ectopic Mandibular Second Permanent Molar with Elastic Separators

    Directory of Open Access Journals (Sweden)

    R. Rajesh

    2014-01-01

    Full Text Available Ectopic eruption is a developmental disturbance in which the tooth fails to follow its normal eruption pathway. Ectopic eruption of the second molar is relatively rare. This paper presents the case of thirteen-year-old male with an ectopic mandibular second permanent molar. The condition was corrected with surgical exposure and placement of elastic separators. This case report lays emphasis on the practice of basic methods to obtain acceptable results rather than extensive surgical or orthodontic corrections. It is advised that ectopic teeth should not be neglected especially when it concerns developing caries and malocclusion.

  18. Endotracheal ectopic parathyroid adenoma mimicking asthma

    Directory of Open Access Journals (Sweden)

    M. Akif Özgül

    2014-01-01

    Full Text Available Primary benign tumors of the trachea are uncommon. These tumors may cause tracheal occlusion and lead to a misdiagnosis of asthma. Ectopic parathyroid adenoma (EPA can be seen anywhere between the mandibular angle and the mediastinum. The distal part of the trachea is a rare location for EPA, and EPA obstructing the endotracheal lumen has not been reported in the literature. We herein describe a 52-year-old female with a several-year history of asthma treatment who presented with progressive dyspnea. Computed tomography revealed a mass that was obstructing the tracheal lumen. Total mass excision was performed via endobronchial treatment, and pathologic examination revealed EPA.

  19. Is Previous Tubal Ligation a Risk Factor for Hysterectomy because of Abnormal Uterine Bleeding?

    Directory of Open Access Journals (Sweden)

    Sanam Moradan

    2012-07-01

    Full Text Available Objectives: Post tubal ligation syndrome (PTLS is a term used to describe a variety of post tubal ligation side effects or symptoms. These include increased menstrual bleeding and hysterectomy. Whether or not post tubal syndrome is a real entity, it has been a subject of controversy in the medical literature for decades. Numerous studies have reported conflicting conclusions about these symptoms. In this study the incidence of hysterectomy for bleeding disorders among sterilized women was compared with the incidence of hysterectomy for bleeding disorders among non-sterilized female population of the same age.Methods: This study was carried out on 160 women, 38-52 years, who underwent hysterectomy in Amir University Hospital, Semnan, Iran, from September 2008 to September 2011. After gathering of data from medical records, in this study, the incidence of hysterectomy for bleeding disorders among sterilized women was compared with the incidence of hysterectomy for bleeding disorders among nonsterilized female population for the same age.Results: The mean age of the study group was 44/4±5/7 and the mean age of the control group was 45/2±5/3, (p=0.424.The mean parity of the study group was 3/8±1/8 and the mean parity of the control group was 3/5±1/4, (p=0.220. So, in regard to age and parity, two groups were matched. Hysterectomies were performed for 160 cases and abnormal uterine bleeding was the cause of hysterectomy in 67 cases. Among 67 cases, 19 cases (37.3% had previous tubal sterilization + hysterectomy (study group and 48 cases (44% were not undergoing tubal sterilization but had hysterectomy for abnormal bleeding causes (control group. Statistical analyses showed that there were not significant differences between two groups, (RR=0.85; 95% CI: 0.56-1.28; p=0.418.Conclusion: The result of this study showed that previous tubal sterilization is not a risk factor for undergoing hysterectomy because of abnormal uterine bleeding.

  20. Histology and scanning electron microscopy of the tubal tonsil of goats

    Directory of Open Access Journals (Sweden)

    V. R. Indu

    2015-08-01

    Full Text Available Aim: To observe the light and scanning electron microscopy (SEM of the caprine tubal tonsil. Materials and Methods: The study was conducted on six crossbred male goats of 6 months of age. From the median sections of the head, tissue pieces from the nasopharynx around the auditory tube were collected and fixed for histology and SEM. Results: Tonsillar lymphoid tissue was located in the nasopharynx ventral to the auditory tube opening in the lateral wall of the pharynx. The height of the surface epithelium of the tubal tonsil measured 80.17±1.08 μm and was a pseudostratified ciliated columnar type with basal, supporting, and goblet cells. Above the dome of lymphoid nodules, the epithelium was modified into a follicle associated epithelium (FAE, also called lympho-epithelium or reticular epithelium and was characterized by the absence of goblet cells and cilia, reduced number of cell layers, and a large number of lymphoid cells due to interrupted basement membrane. The height of FAE was smaller than that of the surface epithelium and measured 34.33±0.92 μm. The surface of tubal tonsil showed folds and invaginations, which formed crypts. The lamina propria-submucosa underneath the epithelium was formed by the meshwork of reticular and, thin and loose collagen fibers with dome-like accumulation of lymphoid nodules. In the secondary lymphoid nodules, a corona, parafollicular area, and interfnodular area were observed. The average number of lymphoid nodules counted per field under low power magnification of microscope was 1.17±0.17, and the internodular distance was 34.00±4.37 μm. The mean diameter of lymphoid nodules was 566.67±11.45 μm and the lymphocyte count per nodule was 14741.67±174.36. The number of plasma cells counted per field under low power was 44.38±2.90 below the surface epithelium. The tubal tonsil was not encapsulated. In SEM, the surface epithelium of the tubal tonsils presented ciliated cells, microvillus (MV cells, and

  1. Histology and scanning electron microscopy of the tubal tonsil of goats

    Science.gov (United States)

    Indu, V. R.; Lucy, K. M.; Chungath, J. J.; Ashok, N.; Maya, S.

    2015-01-01

    Aim: To observe the light and scanning electron microscopy (SEM) of the caprine tubal tonsil. Materials and Methods: The study was conducted on six crossbred male goats of 6 months of age. From the median sections of the head, tissue pieces from the nasopharynx around the auditory tube were collected and fixed for histology and SEM. Results: Tonsillar lymphoid tissue was located in the nasopharynx ventral to the auditory tube opening in the lateral wall of the pharynx. The height of the surface epithelium of the tubal tonsil measured 80.17±1.08 µm and was a pseudostratified ciliated columnar type with basal, supporting, and goblet cells. Above the dome of lymphoid nodules, the epithelium was modified into a follicle associated epithelium (FAE), also called lympho-epithelium or reticular epithelium and was characterized by the absence of goblet cells and cilia, reduced number of cell layers, and a large number of lymphoid cells due to interrupted basement membrane. The height of FAE was smaller than that of the surface epithelium and measured 34.33±0.92 µm. The surface of tubal tonsil showed folds and invaginations, which formed crypts. The lamina propria-submucosa underneath the epithelium was formed by the meshwork of reticular and, thin and loose collagen fibers with dome-like accumulation of lymphoid nodules. In the secondary lymphoid nodules, a corona, parafollicular area, and interfnodular area were observed. The average number of lymphoid nodules counted per field under low power magnification of microscope was 1.17±0.17, and the internodular distance was 34.00±4.37 µm. The mean diameter of lymphoid nodules was 566.67±11.45 µm and the lymphocyte count per nodule was 14741.67±174.36. The number of plasma cells counted per field under low power was 44.38±2.90 below the surface epithelium. The tubal tonsil was not encapsulated. In SEM, the surface epithelium of the tubal tonsils presented ciliated cells, microvillus (MV) cells, and goblet cells. The

  2. Ectopic abdominal pregnancy due to uterine perforation after an attempt to terminate pregnancy: a case presentation

    OpenAIRE

    Alexander Abreu; Ndivhuwo Michael Ndwambi; Fermín Luis Martínez

    2017-01-01

    Resumen El embarazo ectópico abdominal secundario tiene una baja frecuencia de presentación en la práctica clínica, pero puede llevar al incremento de la mortalidad materna. Se presenta el caso de una paciente con embarazo abdominal secundario a una perforación uterina, causada por una interrupción voluntaria del embarazo. Este evolucionó durante nueve semanas con dolor abdominal y sangramiento vaginal escaso. A la paciente se le realizaron diagnósticos como enfermedad inflamatoria pélvica...

  3. Ectopic abdominal pregnancy due to uterine perforation after an attempt to terminate pregnancy: a case presentation

    Directory of Open Access Journals (Sweden)

    Alexander Abreu

    2017-07-01

    Full Text Available Resumen El embarazo ectópico abdominal secundario tiene una baja frecuencia de presentación en la práctica clínica, pero puede llevar al incremento de la mortalidad materna. Se presenta el caso de una paciente con embarazo abdominal secundario a una perforación uterina, causada por una interrupción voluntaria del embarazo. Este evolucionó durante nueve semanas con dolor abdominal y sangramiento vaginal escaso. A la paciente se le realizaron diagnósticos como enfermedad inflamatoria pélvica aguda, infección del tracto urinario, restos ovulares post aborto y definitivamente se concluyó como embarazo ectópico abdominal mediante ecografía abdominal. Se le realizó laparotomía exploradora y se extrajo el feto y la placenta sin dificultades con una evolución postoperatoria favorable hacia la curación. Se concluyó que la perforación uterina durante el curetaje de la cavidad pudo pasar inadvertida, llevando a implantación abdominal secundaria del embarazo con un cuadro clínico variable. En dicho cuadro, el ultrasonido juega un papel fundamental para su diagnóstico, siendo el manejo laparotómico el más apropiado en estos casos.

  4. A Comparison of Pattern of Pregnancy Loss in Women with Infertility Undergoing IVF and Women with Unexplained Recurrent Miscarriages Who Conceive Spontaneously

    Directory of Open Access Journals (Sweden)

    Vidya A. Tamhankar

    2015-01-01

    Full Text Available Objective. Women with infertility and recurrent miscarriages may have an overlapping etiology. The aim of this study was to compare the pregnancy loss in pregnancies after IVF treatment with spontaneous pregnancies in women with recurrent miscarriages and to assess differences related to cause of infertility. Methods. The outcome from 1220 IVF pregnancies (Group I was compared with 611 spontaneous pregnancies (Group II in women with recurrent miscarriages. Subgroup analysis was performed in Group I based on cause of infertility: tubal factor (392 pregnancies; male factor (610 pregnancies; and unexplained infertility (218 pregnancies. Results. The clinical pregnancy loss rate in Group I (14.3% was significantly lower than that of Group II (25.8%, p<0.001 and this was independent of the cause of infertility. However the timing of pregnancy loss was similar between Groups I and II. The clinical pregnancy loss rate in Group I was similar in different causes of infertility. Conclusions. The clinical pregnancy loss rate following IVF treatment is lower than that of women with unexplained recurrent miscarriages who conceived spontaneously. This difference persists whether the infertility is secondary to tubal factors, male factors, or unexplained cause.

  5. [Rare complication following oesophagectomy: early peptic ulcer perforation of the tubal stomach].

    Science.gov (United States)

    Géczi, Tibor; Paszt, Attila; Simonka, Zsolt; Furák, József; Lázár, György

    2011-10-01

    We report the case of a 45-year-old male patient who developed an acute peptic ulcer perforation of the tubal stomach on the second postoperative day after oesophagectomy. The patient underwent emergency surgery (perforation was closed with a Graham patch) followed by treatment in intensive care, and was finally discharged on the 19th postoperative day. Gastric pull-up is a surgical technique that is widely used to re-establish the continuity of the gastrointestinal tract after oesophagectomy. Various early and late complications of reconstruction with the tubal stomach are well-known, such as gastric necrosis, gastritis, gastric ulcer, as well as benign and malignant tumors. The precise etiology of gastric tube ulceration is not known yet, however, it can develop not only in the late, but also in the early postoperative period, as well.

  6. Tubal ligation and salpingectomy and the risk of epithelial ovarian cancer and borderline ovarian tumors

    DEFF Research Database (Denmark)

    Madsen, C; Baandrup, Louise; Dehlendorff, Christian

    2015-01-01

    OBJECTIVE: According to the recent theories on the ovarian cancer origin, any protective effect of tubal ligation may vary with histologic subtype of ovarian cancer. Furthermore, bilateral salpingectomy may represent an opportunity for surgical prevention of serous ovarian cancer. DESIGN: Nationw......OBJECTIVE: According to the recent theories on the ovarian cancer origin, any protective effect of tubal ligation may vary with histologic subtype of ovarian cancer. Furthermore, bilateral salpingectomy may represent an opportunity for surgical prevention of serous ovarian cancer. DESIGN...... sampling. We required that cases and controls have no previous cancer and that controls have no previous bilateral oophorectomy. METHODS: Conditional logistic regression was used to estimate odds ratios and 95% confidence intervals, adjusting for potential confounders. MAIN OUTCOME MEASURES: Epithelial...

  7. A rare cause of acute abdominal pain in children: Isolated tubal torsion; a case series

    Directory of Open Access Journals (Sweden)

    Yasemin Dere Gunal

    2017-06-01

    Full Text Available Isolated tubal torsion -a rare cause of acute abdomen in children-is usually difficult to diagnose because of non-specific findings. Surgical salphingectomy is required in delayed diagnosis in most cases. Three sexual inactive adolescents diagnosed in isolated tubal torsion (ITT were discussed for its diagnostic features and surgical management. Laboratory tests and radiological studies including ultrasonography (US, color doppler ultrasound were performed in all patients after evaluation for acute lower abdominal pain in emergency department and they underwent surgical intervention with laparotomy (n:2 and laparoscopy (n:1. One of the patients in this study had salpingectomy. Detorsion of the fallopian tube and cyst excision were performed in the remaining two patients who also had paratubal cysts. There was no recurrence in these patients during the follow-up for 3 and 2 years. The isolated tubal torsion should be kept in mind and early surgical management is essential in order to preserve fallopian tube because of its importance in fertility. Keywords: Fallopian tube, Torsion, Paratubal cyst, Adolescent, Acute abdomen

  8. Can hysterosalpingocontrast-sonography replace hysterosalpingography in the assessment of tubal subfertility?

    Science.gov (United States)

    Dijkman, A B; Mol, B W; van der Veen, F; Bossuyt, P M; Hogerzeil, H V

    2000-07-01

    Hysterosalpingo-contrastsonography (HyCoSy) is a new method for assessing tubal patency using transvaginal ultrasound. It is thought to have several advantages over conventional hysterosalpingography (HSG). We prospectively evaluated the performance of HyCoSy and HSG in the diagnosis of tubal pathology. One-hundred consecutive subfertile women underwent both HyCoSy and HSG in randomised order. Results of both tests were related to findings at laparoscopy with dye, which was used as the reference test. Each woman was asked to score the pain exsperienced at both procedures on a visual analogue scale. When laparoscopy with dye was used as reference test, the likelihood ratios of HyCoSy were slightly inferior to those obtained for HSG. Since the performance of HyCoSy was dependent on experience, the results were recalculated omitting the 50 initial procedures from the analysis. In that calculation, results of HyCoSy and HSG were comparable. There were no differences in pain experienced during the procedure, as there appeared also to be no differences in patient preferences. There appear to be no strong arguments either to replace HSG by HyCoSy, or to reject the use of HyCoSy. Both procedures can be used in the evaluation of tubal pathology.

  9. Can hysterosalpingocontrast-sonography replace hysterosalpingography in the assessment of tubal subfertility?

    Energy Technology Data Exchange (ETDEWEB)

    Dijkman, Antonius B.; Mol, Ben W.J.; Veen, Fulco van der; Bossuyt, P.M.M.; Hogerzeil, Hendricus V

    2000-07-01

    Introduction: Hysterosalpingo-contrastsonography (HyCoSy) is a new method for assessing tubal patency using transvaginal ultrasound. It is thought to have several advantages over conventional hysterosalpingography (HSG). We prospectively evaluated the performance of HyCoSy and HSG in the diagnosis of tubal pathology. Methods and patients: One-hundred consecutive subfertile women underwent both HyCoSy and HSG in randomised order. Results of both tests were related to findings at laparoscopy with dye, which was used as the reference test. Each woman was asked to score the pain exsperienced at both procedures on a visual analogue scale. Results: When laparoscopy with dye was used as reference test, the likelihood ratios of HyCoSy were slightly inferior to those obtained for HSG. Since the performance of HyCoSy was dependent on experience, the results were recalculated omitting the 50 initial procedures from the analysis. In that calculation, results of HyCoSy and HSG were comparable. There were no differences in pain experienced during the procedure, as there appeared also to be no differences in patient preferences. Conclusion: There appear to be no strong arguments either to replace HSG by HyCoSy, or to reject the use of HyCoSy. Both procedures can be used in the evaluation of tubal pathology.

  10. Can hysterosalpingocontrast-sonography replace hysterosalpingography in the assessment of tubal subfertility?

    International Nuclear Information System (INIS)

    Dijkman, Antonius B.; Mol, Ben W.J.; Veen, Fulco van der; Bossuyt, P.M.M.; Hogerzeil, Hendricus V.

    2000-01-01

    Introduction: Hysterosalpingo-contrastsonography (HyCoSy) is a new method for assessing tubal patency using transvaginal ultrasound. It is thought to have several advantages over conventional hysterosalpingography (HSG). We prospectively evaluated the performance of HyCoSy and HSG in the diagnosis of tubal pathology. Methods and patients: One-hundred consecutive subfertile women underwent both HyCoSy and HSG in randomised order. Results of both tests were related to findings at laparoscopy with dye, which was used as the reference test. Each woman was asked to score the pain exsperienced at both procedures on a visual analogue scale. Results: When laparoscopy with dye was used as reference test, the likelihood ratios of HyCoSy were slightly inferior to those obtained for HSG. Since the performance of HyCoSy was dependent on experience, the results were recalculated omitting the 50 initial procedures from the analysis. In that calculation, results of HyCoSy and HSG were comparable. There were no differences in pain experienced during the procedure, as there appeared also to be no differences in patient preferences. Conclusion: There appear to be no strong arguments either to replace HSG by HyCoSy, or to reject the use of HyCoSy. Both procedures can be used in the evaluation of tubal pathology

  11. Serous tubal intraepithelial carcinoma, chronic fallopian tube injury, and serous carcinoma development.

    Science.gov (United States)

    Malmberg, Karin; Klynning, Charlotta; Flöter-Rådestad, Angelique; Carlson, Joseph W

    2016-06-01

    Ovarian carcinoma is the deadliest gynecological malignancy. Previous studies have suggested that the fallopian tube may be the primary site for high-grade serous carcinoma. In prophylactic salpingo-oophorectomies from women with hereditary high risk for ovarian cancer, precursors can be assessed prior to onset and studied as a model for serous cancer precursor lesions. Epidemiologic studies indicate that carcinogenesis may be a result of chronic fallopian tube injury. The aims of this study were to (1) to examine the incidence of serous tubal intraepithelial carcinoma (STIC) in relation to other clinical parameters and (2) to evaluate whether chronic fallopian tube injury was related to cancer development. This study enrolled 101 women, comprising the following three groups: hereditary (n = 60), sporadic serous cancer (n = 18; endometrial cancers were excluded), and control (n = 23). The cases were histologically examined and clinical risk factors were collected. The histological changes were compared between different patients and correlated to clinical risk factors. STICs were identified primarily on the fallopian tube fimbria. The incidence of STIC was 3 % in the hereditary patients. In sporadic serous cancer cases, 61 % were associated with STIC and tubal carcinoma (p STIC and invasive cancer were seen more often in the older patients than in the younger patients (p = 0.528). This small study, no correlation with chronic tubal injury or inflammation was identified.

  12. Ectopic pancreas causing partial gastric outlet obstruction: a case ...

    African Journals Online (AJOL)

    Ectopic pancreas causing partial gastric outlet obstruction: a case report and review of literature. ... Nigerian Journal of Surgery ... Gastric outlet obstruction resulting from ectopic pancreas in an adult is the first of its kind in our center; we, therefore, present this case to describe the challenges faced with diagnosis, treatment, ...

  13. Ultrasonographic findings in 14 dogs with ectopic ureter

    International Nuclear Information System (INIS)

    Lamb, C.R.; Gregory, S.P.

    1998-01-01

    To evaluate ultrasonography as an alternative to contrast radiographyfor diagnosis of ectopic ureter in dogs, ultrasonography of the urinary tract was performed prospectively in a series of urinary incontinent dogs anesthetized for contrast radiography, Fourteen dogs had ectopic ureter based ore surgical, necropsy or unequivocal contrast radiographic findings, There were eight females and six males of a variety of breeds; five were Labrador retrievers, Mean (range) age at the time ofdiagnosis was 1.2 (0.2-4) years for females and 3.5 (0.3-5) for males(p < 0.05). Ectopic ureters were unilateral in five dogs (2 left; 3 right) find bilateral in nine dogs. Both ultrasound images and contrastradiographs were positive for 21 (91%) ectopic ureters; the same two ectopic ureters were not defected using either modality, The termination of each of the five normal ureters was visible on ultrasound images; two (40%) were visible on radiographs, Other ultrasonographic findings included dilatation of the ectopic ureter and/or ipsilateral renal pelvis ill ten (43%) instances, evidence of pyelonephritis in two dogs(with enlargement of the contralateral kidney in one dog), and urethral diverticuli in one dog, Ultrasonography is a practical diagnostic Best for ectopic ureter in clogs. In this series these was close correlation between the ultrasonographic and contrast radiographic findings for each ectopic meter, but ultrasonography enabled more accurate determination of normal ureteral anatomy

  14. Inferior ectopic pupil and typical ocular coloboma in RCS rats.

    Science.gov (United States)

    Tsuji, Naho; Ozaki, Kiyokazu; Narama, Isao; Matsuura, Tetsuro

    2011-08-01

    Ocular coloboma is sometimes accompanied by corectopia in humans and therefore ectopic pupil may indicate ocular coloboma in experimental animals. The RCS strain of rats has a low incidence of microphthalmia. We found that inferior ectopic pupil is associated exclusively with small-sized eyes in this strain. The objective of the current study was to evaluate whether inferior ectopic pupil is associated with iridal coloboma and other types of ocular coloboma in RCS rats. Both eyes of RCS rats were examined clinically, and those with inferior ectopic pupils underwent morphologic and morphometric examinations. In a prenatal study, coronal serial sections of eyeballs from fetuses at gestational day 16.5 were examined by using light microscopy. Ectopic pupils in RCS rats were found exclusively in an inferior position, where the iris was shortened. Fundic examination revealed severe chorioretinal coloboma in all cases of inferior ectopic pupil. The morphologic characteristics closely resembled those of chorioretinal coloboma in humans. Histopathologic examination of primordia showed incomplete closure of the optic fissure in 4 eyeballs of RCS fetuses. Neither F(1) rats nor N(2) (progeny of RCS × BN matings) displayed any ocular anomalies, including ectopic pupils. The RCS strain is a suitable model for human ocular coloboma, and inferior ectopic pupil appears to be a strong indicator of ocular coloboma.

  15. Anterior abdominal wall ectopic testes: A report of two cases ...

    African Journals Online (AJOL)

    Undescended testis (UDT) is a common anomaly of the male reproductive system affecting about 2% to 4% of male infants more commonly preterms. If the testis remains in the line of normal descent, it is classified as an UDT. If it is not in the line of normal descent, it is termed an ectopic testis. Common sites of ectopic testes ...

  16. Ectopic Pancreas Causing Partial Gastric Outlet Obstruction: A Case ...

    African Journals Online (AJOL)

    Ectopic pancreas is a rare cause of gastric outlet obstruction, perhaps rarer still among Africans. Although the entity is known, the diagnostic challenges are enormous, especially in the poor‑resource environment. Gastric outlet obstruction resulting from ectopic pancreas in an adult is the first of its kind in our center;.

  17. Serous tubal intraepithelial carcinoma localizes to the tubal-peritoneal junction: a pivotal clue to the site of origin of extrauterine high-grade serous carcinoma (ovarian cancer).

    Science.gov (United States)

    Seidman, Jeffrey D

    2015-03-01

    Recent data suggest that intraepithelial carcinoma of the fallopian tube [serous tubal intraepithelial carcinoma (STIC)] is the precursor of high-grade extrauterine serous carcinoma. A more specific location for the origin of this lesion is suggested by the recently described junction between the fallopian tubal epithelium and the peritoneum [tubal-peritoneal junction (TPJ)]. Fallopian tubes from 202 patients with advanced-stage high-grade extrauterine serous carcinoma or carcinosarcoma were evaluated histologically as were 124 prophylactic salpingo-oophorectomy specimens. These included 54 patients with BRCA or other high-risk mutation or a family history of BRCA mutation and 70 with a personal or family history of breast carcinoma. STIC was found in 81 of 202 patients with serous carcinoma (40.1%). STIC was present in 73 of 141 (52%) cases in which the fimbriae were present and in 62 of 100 (62%) cases in which the TPJ was present (P not significant). In comparison with these groups, when fimbriae and TPJ were absent, STIC was found in 8 of 61 (13%) cases (PSTIC. The mean size of STIC was 1.7 mm. In 32 cases (39.5%), the lesion was flat and in 49 (60.5%), papillary. The mean size of flat STICs was 0.8 mm as compared with 2.3 mm for papillary STICs (P=0.00005). STIC was identified in the same tissue fragment as the junction in 48 cases. The mean distance of STIC to the junction was 1.8 mm. In 11 cases, STIC was flanked by peritoneal mesothelium on one side and tubal epithelium on the opposite side. In 51 patients, the mean distance of invasive carcinoma from the TPJ was 1.8 mm. This distance was 1.9 mm when STIC was present (37 cases) in comparison with 1.5 mm when STIC was absent (14 cases) (P not significant). In 27 of 42 cases (64%), STIC was contiguous with invasive carcinoma. Lamina propria invasion was present in 71% of cases in which STIC was present as compared with 26% of cases in which STIC was absent (PSTIC was present as compared with 26% of cases in

  18. Heterotopic pregnancy after in vitro fertilization and embryo transfer: the role of routine transvaginal ultrasonography

    International Nuclear Information System (INIS)

    Lee, Eun Ju

    1994-01-01

    Spontaneous heterotopic pregnancy (HP) is a rare condition, however, the rising incidence after in-vitro fertilization and embryo transfer (IVF-ET) may present serious problems as the diagnosis of this potentially fatal condition is often missed. The purposes of this study were to investigate the frequency of HP after IVF-ET, to analyze the clinical presentation and the outcome of coincidental intrauterine pregnancy, and to evaluate the value of routine transvaginal ultrasonography in early diagnosis and treatment of HP. There were 11 cases of HP among 484 pregnancies after IVF-ET (The incidence was 2.3%) in recent 2 years. We evaluated the clinical findings and the findings of transvaginal sonography in those 11 patients. The combined extrauterine pregnancies were tubal (n = 9), cornual (n = 1), and both the tubal and cornual (n = 1). Vaginal bleeding was absent in 4 cases and one of them was asymptomatic. HP may be suspected if there was an elevated serum hCG in the absence of intrauterine multiple gestations. In all cases, the condition was diagnosed by transvaginal sonography performed prior to surgical intervention. The coincidental intrauterine pregnancies were ended in successful full-term delivery in 7 cases, while one pregnancy was ongoing at that time. The incidence of HP was evidently higher in IVF-ET than in spontaneous pregnancies. Transvaginal sonography was useful in accurate diagnosis in clinically suspected cases and even in asymptomatic cases. Routine transvaginal sonography played an important role in early diagnosis and prompt management of HP

  19. Bilateral cervical ectopic thymic nodules with accessory thyroid tissue and an ectopic parathyroid in the neck region

    Directory of Open Access Journals (Sweden)

    Wea-Lung Lin

    2011-03-01

    Full Text Available Some remnants of thymic tissue may be deposited along the pathway of the descent of the neck during embryologic development of the thymus. Ectopic thymic tissue is usually deposited along the pathway from the mandibular angle to the manubrium of the sternum. Most reported cases of an ectopic thymus occurred in children, and cases are less common in adults. We report a 26-year-old woman, who was incidentally found to have 2 neck nodules on the posterior side of the bilateral upper pole of the thyroid gland while undergoing a subtotal thyroidectomy. The left-side neck nodule showed accessory thyroid follicles intermixed with ectopic thymic tissue, and the right-side neck nodule was ectopic parathyroid tissue together with ectopic thymic tissue.

  20. Ectopic Neurohypophysis in Patient with Pituitary Dwarfism: A Case Report

    Directory of Open Access Journals (Sweden)

    İlhan Kılınç

    2008-09-01

    Full Text Available Ectopic neurohypophysis is an anomaly of the Pituitary gland whichmay be associated with short stature due to Growth hormone deficiency.MRI is the modality of choice in diagnosing this condition. We present acase of pituitary dwarfism and ectopic neurohypophysis with clinical andradiological findings. 21 year-old male admitted with short stature. Allhormones, except prolactin, of anterior hypophysis were low. Bright spotwas ectopically located at level of median eminence on enhanced MRI ofhypophysis and stalk of hypophysis was not observed. Ectopicneurohypophysis may be present with pituitary dwarfism. Cranial MRI maybe useful to investigate related pathologies in such cases.

  1. Twenty cases of ectopic thyroid gland detected by thyroid scintigraphy

    International Nuclear Information System (INIS)

    Hashimoto, Teisuke; Kubo, Atsushi; Hashimoto, Shozo

    1988-01-01

    20 cases of ectopic thyroid gland were detected out of 5,261 thyroid scintigraphy from 1973. Except for 1 case, all cases were female. Considering of thyroid function, 11 cases were euthyroid and rest of 9 cases were hypothyroid function. Clinical symptom of hypothyroid cases were mainly retarded linear growth and high value of serum TSH and in case of euthyroid cases were sublingual tumor and fullness or tightness in throat. Thyroid scintigraphy is very useful to diagnose the sublingual tumor whether it is ectopic thyroid gland or not. In case of congenital hypothyroidism children, ectopic thyroid gland causing hypothyroidism is definitely diagnosed by thyroid scintigraphy. (author)

  2. Papillary carcinoma in median aberrant thyroid (ectopic) - case report.

    Science.gov (United States)

    Hebbar K, Ashwin; K, Shashidhar; Deshmane, Vijaya Laxmi; Kumar, Veerendra; Arjunan, Ravi

    2014-06-01

    Median ectopic thyroid may be encountered anywhere from the foramen caecum to the diaphragm. Non lingual median aberrant thyroid (incomplete descent) usually found in the infrahyoid region and malignant transformation in this ectopic thyroid tissue is very rare. We report an extremely rare case of papillary carcinoma in non lingual median aberrant thyroid in a 25-year-old female. The differentiation between a carcinoma arising in the median ectopic thyroid tissue and a metastatic papillary carcinoma from an occult primary in the main thyroid gland is also discussed.

  3. Heterotopic pregnancy in an assisted reproduction conception; case ...

    African Journals Online (AJOL)

    Infertility management by assisted reproduction techniques has had rapid increase. While there is robust evidence supporting the efficacy and safety of assisted reproduction technique (ART), complications are encountered. Heterotopic pregnancy, defined as the presence of both an intrauterine and an ectopic gestation, ...

  4. Pregnancy planning and acceptance among Danish pregnant women

    DEFF Research Database (Denmark)

    Rasch, V; Knudsen, L B; Wielandt, H

    2001-01-01

    OBJECTIVE: To study how living conditions influence pregnancy planning and acceptance among Danish women. METHOD: A cross-sectional questionnaire study performed among 3516 pregnant women attending Odense University Hospital, Denmark. The study population consisted of women with spontaneous...... abortion, women with ectopic pregnancies, women attending antenatal care and women with induced abortion. They were divided into four groups: women with planned and accepted pregnancies (accepting planners, n=2137), women who accepted an initially unplanned pregnancy (accepting non-planners, n=1006), women...... who rejected an initially planned pregnancy (rejecting planners, n=31), and women with unplanned and rejected pregnancies (rejecting non-planners, n=342). The association between socio-economic characteristics and pregnancy planning and acceptance was evaluated by comparing accepting non...

  5. Power Doppler flow mapping and four-dimensional ultrasound for evaluating tubal patency compared with laparoscopy.

    Science.gov (United States)

    Soliman, Amr A; Shaalan, Waleed; Abdel-Dayem, Tamer; Awad, Elsayed Elbadawy; Elkassar, Yasser; Lüdders, Dörte; Malik, Eduard; Sallam, Hassan N

    2015-12-01

    To study the accuracy of four-dimensional (4D) ultrasound and power Doppler flow mapping in detecting tubal patency in women with sub-/infertility, and compare it with laparoscopy and chromopertubation. A prospective study. The study was performed in the outpatient clinic and infertility unit of a university hospital. The sonographic team and laparoscopic team were blinded to the results of each other. Women aged younger than 43 years seeking medical advice due to primary or secondary infertility and who planned to have a diagnostic laparoscopy performed, were recruited to the study after signing an informed consent. All of the recruited patients had power Doppler flow mapping and 4D hysterosalpingo-sonography by injecting sterile saline into the fallopian tubes 1 day before surgery. Registering Doppler signals, while using power Doppler, both at the tubal ostia and fimbrial end and the ability to demonstrate the course of the tube especially the isthmus and fimbrial end, while using 4D mode, was considered a patent tube. Out of 50 recruited patients, 33 women had bilateral patent tubes and five had unilateral patent tubes as shown by chromopertubation during diagnostic laparoscopy. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy for two-dimensional power Doppler hysterosalpingography were 94.4%, 100%, 100%, 89.2%, and 96.2%, respectively and for 4D ultrasound were 70.4%, 100%, 100%, 70.4%, and 82.6%, respectively. Four-dimensional saline hysterosalpingography has acceptable accuracy in detecting tubal patency, but is surpassed by power Doppler saline hysterosalpingography. Power Doppler saline hysterosalpingography could be incorporated into the routine sub-/infertility workup. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  6. Patch Grafting Using an Ologen Collagen Matrix to Manage Tubal Exposure in Glaucoma Tube Shunt Surgery

    Directory of Open Access Journals (Sweden)

    Masaki Tanito

    2018-01-01

    Full Text Available Purpose: To report the results using an ologen Collagen Matrix as a patch graft in eyes with tubal exposure after tube shunt surgery. Case Reports: Case 1 was an 82-year-old man with tubal exposure in his right eye 26 months after receiving a Baerveldt glaucoma implant. The tube was covered by surrounding conjunctival tissue combined with subconjunctival placement of an ologen Collagen Matrix as a patch graft. Two years after implantation, the tube was not exposed. Anterior-segment optical coherence tomography (AS-OCT showed dense conjunctival tissue over the tube. Case 2 was an 82-year-old man with peripheral keratitis, anterior scleritis, and secondary glaucoma in the right eye who underwent tube shunt surgery using an Ahmed glaucoma valve and cataract surgery. Intraoperatively, scleritis-related scleral thinning prevented the tube from being covered fully by an autologous scleral flap. An ologen Collagen Matrix was placed over the scleral flap as a patch graft. Seventeen months after implantation, the tube was not exposed. Case 3 was a 52-year-old man with diabetic maculopathy and steroid-induced glaucoma in the right eye who underwent tube shunt surgery using an Ahmed glaucoma valve. Intraoperatively, a flap defect prevented the tube from being covered fully by an autologous scleral flap. An ologen Collagen Matrix was placed over the scleral flap as a patch graft. Three weeks postoperatively, AS-OCT showed thick subconjunctival tissue over the tube. Three months after implantation, the tube was not exposed. Conclusions: The ologen Collagen Matrix can be used successfully as a patch graft to prevent and treat tubal exposure after tube shunt surgery.

  7. Morphological and immunohistochemical pattern of tubo-ovarian dysplasia and serous tubal intraepithelial carcinoma.

    Science.gov (United States)

    Chene, Gautier; Cayre, Anne; Raoelfils, Ines; Lagarde, Nicole; Dauplat, Jacques; Penault-Llorca, Frederique

    2014-12-01

    Histopathological examination of material from prophylactic salpingo-oophorectomies performed in patients at genetic risk of ovarian cancer can reveal abnormalities interpreted as possible pre-cancerous "ovarian dysplasia" and tubal precursors lesions. We sought to study the morphological features and immunohistochemical expression patterns of neoplasia-associated markers in prophylactically removed ovaries and fallopian tubes (pBSO) in comparison with a group of serous tubal intraepithelial carcinoma (STIC) and non-cancerous controls. Morphological features and immunohistochemical expression patterns of Ki-67 (for proliferation biomarker), p53 (key pathway of mullerian serous tumorogenesis), Bcl2 (anti-apoptotic), γH2AX (a double-strand breaks marker) and ALDH1 (a stem cell marker significantly associated with early-stage ovarian cancer) were blindly evaluated by two pathologists in 111 pBSO, 12 STICs and 116 non-cancerous salpingo-oophorectomies (control group) (nBSO). Morphological ovarian and tubal dysplasia scores were significantly higher in the pBSO than in controls (respectively, 8.8 vs 3.12, pSTICs compared with the controls whereas expression patterns of Ki67, p53 and bcl2 were low to moderate in the pBSO group. STICs overexpressed Ki67 and p53 while bcl2 expression was low; Interestingly, ALDH1 expression was low in non dysplastic epithelium, high in dysplasia and constantly low in STICs. The morphological and immunohistochemical profile of tubo-ovarian dysplasia and STICs might be consistent with progression toward neoplastic transformation in the Serous Carcinogenesis Sequence. These changes may be pre-malignant and could represent an important phase in early neoplasia. ALDH1 activation in pBSO samples and its extinction in STICs should be considered as a target for prevention. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  8. Intraoperative complications of outpatient interval tubal sterilization at a teaching hospital in Turkey

    International Nuclear Information System (INIS)

    Dilbaz, B.; Akdag, D.; Cengiz, H.; Akyunak, A.; Dilbaz, S.; Haberal, A.

    2008-01-01

    Objective was to evaluate the intra-operative complications of outpatient interval tubal sterilization at a teaching hospital. The data of 461 patients who underwent interval tubal ligation ITL at the Family Planning Clinic of Ankara Etlik Maternity and Women's Health Teaching and Research Hospital, Ankara, Turkey between January 2002 and December 2005 were reviewed from a computerized database. The demographic characteristics, operative technique and intra- and early postoperative complications of patients were evaluated. Only 11 patients had minilaparotomy for ITL. Laparoscopic ITL was performed using bipolar cautery. The cases who were hospitalized or had a complication and/or an unplanned laparotomy were analyzed. The mean age of patients was 35.1 range: 21-51, gravidity was 4.6 range: 2-9, parity was 3.2 range: 2-7 and number of living children was 3.1 range 2-6. Out of 461 patients, only 20.4% had complications related with general anesthesia. Two cases 0.4% had bleeding from the port-site, 3 cases 0.6% had meso-salpingeal and meso-ovarian bleeding, one had omental bleeding 0.2% from vagina wall. There was only one 0.2% intestinal burn that required a laparotomy and segmental resection followed by end-to-end anastomosis. The mortality was nil, whilst the morbidity was found to be 2.1% and all the complications were encountered in patients who had laparoscopic surgery. Outpatient tubal ligation is a convenient and safe procedure and implementing endoscopic surgical techniques is necessary for correction of the complications. (author)

  9. Cesarean scar pregnancy treated by curettage and aspiration guided by laparoscopy

    Directory of Open Access Journals (Sweden)

    Shu S

    2015-08-01

    Full Text Available Shan-rong Shu, Xin Luo, Zhi-xin Wang, Yu-hong Yao Department of Obstetrics and Gynecology, The First Affiliated Hospital of JiNan University, HuangPu Road West, Guangzhou, People’s Republic of China Abstract: Pregnancy in a cesarean scar is the rarest form of an ectopic pregnancy. The treatment for cesarean scar pregnancy mainly includes systemic methotrexate and uterine artery embolization. Here, we reported a case of cesarean scar pregnancy treated by curettage and aspiration guided by laparoscopy. The treatment plan included two phases. Three days after a combination of methotrexate and mifepristone was administered, the gestational sac was removed under laparoscopy, which enabled a successful treatment for the unruptured ectopic pregnancy in a previous cesarean scar and made it possible to preserve the reproductive capability of the patient. Keywords: cesarean scar pregnancy, laparoscopy, curettage and aspiration 

  10. Ectopic pituitary adenoma presenting as midline nasopharyngeal mass.

    LENUS (Irish Health Repository)

    Ali, R

    2012-02-01

    INTRODUCTION: Ectopic pituitary adenomas are extremely rare. We report a case of ectopic pituitary adenoma in the midline of the nasopharynx. This adenoma probably arose from the pharyngeal remnant of Rathke\\'s pouch. METHODS: We discuss a case of a lady who presented to our unit with 2 months history of dryness and sensation of lump in her throat and a long standing history of hypothyroidism. Examination of nasopharynx revealed a smooth and fluctuant midline mass. CT scan of nose and paranasal sinuses confirmed the midline mass with small defect communicating with the sphenoid sinus. An initial diagnosis of Thornwaldt\\'s cyst was made and she underwent upper aerodigestive tract endoscopy and marsupialization of the mass. Histopathological examination revealed ectopic pituitary adenoma. CONCLUSION: Ectopic pituitary adenoma is an important differential diagnosis for a midline nasopharyngeal mass. It is recommended that prior to surgical resection of midline nasopharyngeal mass biopsy is taken and MRI is performed.

  11. Ectopic third molar in maxillary sinus: A rare case report

    Directory of Open Access Journals (Sweden)

    Abhishek Sinha

    2017-01-01

    Full Text Available Ectopic tooth eruption in a non-dental area is a rare entity, and is most common in oral cavity. There have been a few case reports of teeth erupting in mandibular condyle, chin, palate, coronoid process, and maxillary sinus. Ectopic tooth in the maxillary sinus are found incidentally on routine radiological examination, same time they can be symptomatic and associated with pathologies usually dentigerous cyst or odontogenic keratocyst. Facial pain, purulent rhinorrhoea, epistaxis, headache, swelling, and epiphora-related naso-lacrimal duct obstruction can also be seen. By Caldwell-Luc procedure the ectopic teeth within the maxillary sinus are often removed. In this study, a case of ectopic maxillary third molar tooth on right maxillary sinus is presented.

  12. Dentigerous Cyst Associated with Ectopic Canine and a ...

    African Journals Online (AJOL)

    ankylosis, cystic or neoplastic lesion or trauma may be the local factors ... After clinical and radiographic examination, a provisional diagnosis of ... bone along with the impacted teeth (permanent ectopic canine ... [7] Panoramic radiograph and ...

  13. Repair of osteochondral defects in rabbits with ectopically produced cartilage

    NARCIS (Netherlands)

    Emans, PJ; Hulsbosch, M; Wetzels, GMR; Bulstra, SK; Kuijer, R

    2005-01-01

    Cartilage has poor regenerative capacity. Donor site morbidity and interference with joint homeostasis should be considered when applying the autologous chondrocyte transplantation technique. The use of ectopically produced cartilage, derived from periosteum, might be a novel method to heal

  14. Dysfunctional ectopic thyroid gland: A case report

    Directory of Open Access Journals (Sweden)

    Stokić Edita

    2014-01-01

    Full Text Available Introduction. Lingual thyroid gland is a rare anomaly of thyroid gland development, occurring more frequently in females. If it causes local symptomatology such as dysphagia, dysphonia or dyspnea it is diagnosed in childhood, however, if it is asymptomatic it is usually diagnosed in adulthood. Case Outline. We present a 23-year-old female patient in whom we diagnosed lingual thyroid gland coincidentally during diagnostic procedures of a concomitant disease. The application of 131I scintigraphy showed an oval field of intensive accumulation of radio markers in the zone of medial face line, around tongue base, with the absence of thyroid gland in its physiological position. Functional testing proved primary hypothyroidism and we started the application of substitution therapy. The application of levothyroxine resulted in reaching euthyroid state and the reduction of thyroid gland size. Conclusion. We present a very rare anomaly of the thyroid gland, and so far there have been no clear attitudes about further treatment. The general condition of the patient, age, the size of ectopic thyroid gland and the existence of local symptomatology or complications represent the factors that have influence on the choice of treatment method.

  15. Health care justice and its implications for current policy of a mandatory waiting period for elective tubal sterilization.

    Science.gov (United States)

    Moaddab, Amirhossein; McCullough, Laurence B; Chervenak, Frank A; Fox, Karin A; Aagaard, Kjersti Marie; Salmanian, Bahram; Raine, Susan P; Shamshirsaz, Alireza A

    2015-06-01

    Tubal sterilization during the immediate postpartum period is 1 of the most common forms of contraception in the United States. This time of the procedure has the advantage of 1-time hospitalization, which results in ease and convenience for the woman. The US Collaborative Review of Sterilization Study indicates the high efficacy and effectiveness of postpartum tubal sterilization. Oral and written informed consent is the ethical and legal standard for the performance of elective tubal sterilization for permanent contraception for all patients, regardless of source of payment. Current health care policy and practice regarding elective tubal sterilization for Medicaid beneficiaries places a unique requirement on these patients and their obstetricians: a mandatory waiting period. This requirement originates in decades-old legislation, which we briefly describe. We then introduce the concept of health care justice in professional obstetric ethics and explain how it originates in the ethical concepts of medicine as a profession and of being a patient and its deontologic and consequentialist dimensions. We next identify the implications of health care justice for the current policy of a mandatory 30-day waiting period. We conclude that Medicaid policy allocates access to elective tubal sterilization differently, based on source of payment and gender, which violates health care justice in both its deontologic and consequentialist dimensions. Obstetricians should invoke health care justice in women's health care as the basis for advocacy for needed change in law and health policy, to eliminate health care injustice in women's access to elective tubal sterilization. Copyright © 2015 Elsevier Inc. All rights reserved.

  16. Inadvertent intrathecal injection of labetalol in a patient undergoing post-partum tubal ligation.

    Science.gov (United States)

    Balestrieri, P J; Hamza, M S; Ting, P H; Blank, R S; Grubb, C T

    2005-10-01

    After receiving a continuous spinal anesthetic for labor following an inadvertent dural puncture with a 17-gauge epidural needle, a morbidly obese parturient underwent post-partum tubal ligation 12 h after vaginal delivery. The patient received a total of 2 mL of 0.75% hyperbaric bupivacaine for the surgery. In response to moderate hypertension the patient received intravenous labetalol hydrochloride 20 mg. She subsequently was inadvertently administered approximately 15 mg of labetalol through the spinal catheter. The spinal catheter was removed immediately after the procedure. She suffered no apparent adverse neurologic effects.

  17. Essure hysteroscopic sterilization versus interval laparoscopic bilateral tubal ligation: a comparative effectiveness review.

    Science.gov (United States)

    Ouzounelli, Myrsini; Reaven, Nancy L

    2015-01-01

    A comparative effectiveness analysis was performed to examine the risks and benefits of laparoscopic bilateral tubal ligation compared with hysteroscopic sterilization using the Essure Permanent Birth Control System (Bayer HealthCare AG, Whippany, NJ). Existing evidence shows that both LBTL and Essure are safe and effective methods of female sterilization. Both have high rates of efficacy and low rates of complications although when complications do occur, those related to the Essure procedure are more likely to be minor in nature. The analysis was limited by the restricted number of studies involving head-to-head comparisons of the 2 approaches. Copyright © 2015 AAGL. Published by Elsevier Inc. All rights reserved.

  18. Compliance with Papanicolaou smear screening following tubal ligation in women with cervical cancer.

    Science.gov (United States)

    Winkler, H A; Anderson, P S; Fields, A L; Runowicz, C D; DeVictoria, C; Goldberg, G L

    1999-01-01

    To evaluate patient compliance with Papanicolaou (Pap) smear screening after tubal ligation compared with other methods of birth control in patients who develop cervical cancer, a retrospective review of 262 women with cervical cancer diagnosed at age Albert Einstein College of Medicine from January 1987 to December 1995. Demographic data, stage of the disease, histologic type, history of smoking, history of sexually transmitted disease (STD), and birth control use were recorded. The Pap screening history was obtained from all the patients. Women who had a bilateral tubal ligation (BTL) were compared with those who did not have this form of birth control. The date and result of their last Pap test prior to their diagnosis of cervical cancer was noted. Two hundred fourteen women with cervical cancer were evaluable. The clinical stage, mean age, history of smoking, and history of STD were similar for both groups. Gravidity among the BTL group was higher than in the non-BTL group (p < 0.01). Forty-eight (22.4%) women had a previous BTL. Twenty-seven of these 48 patients (56.3%) did not have a Pap smear within 3 years prior to the diagnosis of cervical cancer. Of the 166 patients, 61 (36.7%) did not have a Pap test within 3 years (p < 0.05). Fourteen women (29.2%) in the tubal ligation group never returned for a Pap test following the BTL. An average of 6.2+/-5.9 years elapsed since the last Pap test in the BTL group, with 4.0+/-5.1 years in the nontubal ligation group (p < 0.05). There was a correlation between the number of years since BTL (14.2+/-7.7) to the number of years since the last Pap test (6.2+/-5.9) (p < 0.05). Women who have had a BTL should be considered high risk because of poor screening compliance. A Pap test every 3 years is not adequate in this high-risk population group. We advocate improved counseling regarding the importance of continued annual Pap screening for women who are considering tubal ligation.

  19. NEW APPROACHES TO REHABILITATION AFTER ECTOPIC PREGNANCY Новые подходы к реабилитации после эктопической беременности

    OpenAIRE

    Lebedenko E. Y.; Rymashevsky �. N.; Mikhelson �. �.; Makarenko Y. M.

    2012-01-01

    The work includes the clinical comparative analysis of ectopic pregnancy’s mortality cases caused by he-morrhagic shock and near miss. Current results contain morphological changes in the adenohypophysis which depend on the amount of hemorrhage and determine the direction of rehabilitation measures in a group of patients who experienced hemorrhage shock

  20. Magnetic resonance urography in duplex kidney with ectopic ureteral insertion

    Directory of Open Access Journals (Sweden)

    Conjeevaram Rajendrarao Thambidorai

    2011-01-01

    Full Text Available This is a report on the use of magnetic resonance urography (MRU in a 6-year-old girl who presented with urinary incontinence. She had a left duplex kidney with poorly functioning upper moiety and ectopic insertion of the dilated upper pole ureter. MRU has been shown to be superior to conventional imaging techniques in delineating poorly functioning moieties of duplex kidneys and ectopic ureters.

  1. Endosonographic Features of Histologically Proven Gastric Ectopic Pancreas

    Directory of Open Access Journals (Sweden)

    Jen-Wei Chou

    2014-01-01

    Full Text Available Gastric ectopic pancreas is an uncommon developmental anomaly and its histological diagnosis is usually difficult by using a conventional biopsy forceps. In the literature, most cases of gastric ectopic pancreas were usually diagnosed by gross pattern during endoscopic examination or features of endoscopic ultrasound. In contrast, this disease was seldom diagnosed by histology in clinical practice. Although the typical endoscopic ultrasonographic features of ectopic pancreas include heterogeneous echogenicity, indistinct borders, and a location within 2 or more layers, it can also exhibit hypoechoic homogeneous echogenicity and a distinct border within the fourth sonographic layer (muscularis propria similar to the endoscopic ultrasonographic features of gastrointestinal stromal tumors. In our study, we found that 53% of gastric ectopic pancreas originated within the fourth sonographic layer, demonstrating hypoechoic, homogeneous echogenicity, and distinct borders. Therefore, recognizing endoscopic ultrasonographic features, combining with deep biopsy, endoscopic ultrasound-guided fine needle aspiration/core needle biopsy can prevent conducting unnecessary resection. Surgical resection is the mainstay treatment for symptomatic gastric ectopic pancreas, but endoscopic resection using endoscopic mucosal resection or endoscopic submucosal dissection technique provides an alternative method of removing superficial-type and deep-type gastric ectopic pancreas.

  2. Ectopic Pelvic Kidney With Urinary Tract Infection Presenting as Lower Abdominal Pain in a Child

    OpenAIRE

    Chung-Ching Lu; You-Lin Tain; Kwok-Wan Yeung; Mao-Meng Tiao

    2011-01-01

    Ectopic pelvic kidney is a rare developmental anomaly. Ectopic pelvic kidney can present without the characteristic symptoms associated with the urinary tract pathology. Ectopic pelvic kidney is usually unknown, and nonspecific vague abdominal comfort maybe the only symptom. Early detection and recognition of an ectopic kidney can prevent long-term complications. We report a 3-year-5-month-old girl with ectopic pelvic kidney who experienced intermittent episodes of lower abdominal pain for ab...

  3. Non-communicating Rudimentary Uterine Horn Pregnancy

    Directory of Open Access Journals (Sweden)

    I Upadhyaya

    2011-12-01

    Full Text Available Pregnancy in a non-communicating rudimentary horn is an extremely rare form of ectopic gestation. The rudimentary horn may or may not communicate with the uterine cavity with the majority of cases being non-communicating. The patient exhibits features of acute abdomen and carries a high risk of maternal death. Even modern scans remain elusive whereas laparatomy remains the confi rmatory procedure for the diagnosis. Because of the varied muscular constitution in the thickness and distensibility of the wall of the rudimentary horn, pregnancy is accommodated for a variable period of gestation. Here, we report three cases of pregnancy in a non-communicating rudimentary horn of the uterus in different periods of gestation, their outcome and a review of the available literature. Keywords: Mullerian anomalies, non-communicating rudimentary horn pregnancy, surgical management.

  4. ICSI pregnancy outcomes following hysteroscopic placement of Essure devices for hydrosalpinx in laparoscopic contraindicated patients.

    Science.gov (United States)

    Ozgur, Kemal; Bulut, Hasan; Berkkanoglu, Murat; Coetzee, Kevin; Kaya, Gamze

    2014-07-01

    This study investigated the use of hysteroscopic Essure device placement for the treatment of hydrosalpinx-related infertility in patients with laparoscopic contraindications and compared their pregnancy outcomes following assisted conception treatment with those of patients having had laparoscopic tubal ligation. A total of 102 infertile patients were diagnosed with unilateral or bilateral hydrosalpinges: 26 patients had laparoscopic contraindications and were treated hysterscopically and 76 patients were treated laparoscopically. In total, 66 intracytoplasmic sperm injection (ICSI) and 39 frozen embryo transfer (FET) procedures were performed. In the hysteroscopy group, 13 ICSI and eight FET in 16 patients resulted in 10 pregnancies (pregnancy rates 47.6% per transfer and 62.5% per patient), and in the laparoscopy group, 53 ICSI and 31 FET embryo transfers in 54 patients resulted in 36 pregnancies (pregnancy rates 42.9% per transfer and 66.7% per patient). Live birth rates per assisted reproduction procedure were 23.8% (5/21) in the hysteroscopy group and 32.1% (27/84) for the laparoscopy group. The hysteroscopic placement of Essure devices to isolate hydrosalpinx prior to assisted conception treatment produced pregnancy outcomes comparable to those produced following laparoscopic tubal ligation. The live birth rates indicate that a larger, more comparative, prospectively randomized study is required. Infertile patients with tubal disease require surgical treatment before they can continue with fertility treatment. There are two main surgical methods that can be used, hysteroscopic and laparoscopic, the latter being the standard surgical method. However, some patients have disease that makes the use of laparoscopy inappropriate. For these patients the placement of Essure® devices by hysteroscopic surgery maybe the most suitable treatment method. One hundred and two patients were diagnosed with unilateral or bilateral hydrosalpinges - tubal disease. Twenty six

  5. [Hysteroscopic tubal sterilization with Essure® devices: a retrospective descriptive study and evaluation of hypnosis].

    Science.gov (United States)

    Gauchotte, E; Masias, C; Bogusz, N; Koebele, A

    2011-06-01

    The Essure(®) system is a hysteroscopic sterilization method. The aim of our study is to retrospectively evaluate the sterilization procedure with Essure(®) devices, with and without anesthesia, and in particular with hypnosis. The descriptive study includes all tubal sterilization with Essure(®) performed during the year 2009 at the Maternité régionale de Nancy. Hypnosis efficiency is retrospectively evaluated with Verbal Numeric Rating Scale (VNRS) for peroperative pain, and analgesic medication use for postoperative pain. Ninety-four sterilizations are performed, 85% (85/94) of them without anesthesia. The mean VNRS is 3.0. The mean operative time is 8.7 minutes, positively correlated with the VNRS (P=0.0005). The rate of successful insertion is 94%. At 3 months, 91% of the implants have a correct location. Inadequate locations are more frequent when anesthesia have been performed (37% vs 4%, P=0.016). There is no significant difference between groups with and without hypnosis for the VNRS, the failure rate and the use of analgesic medication. Tubal sterilization with the Essure(®) system is a quick and efficient method. Our study does not demonstrate efficiency of hypnosis in pain control. This remains to be explored with a prospective study, including others parameters, such as anxiety. Copyright © 2011 Elsevier Masson SAS. All rights reserved.

  6. Número ideal de filhos como fator de risco para laqueadura tubária Ideal number of children as a risk factor for tubal ligation

    Directory of Open Access Journals (Sweden)

    Luiz Eduardo Campos de Carvalho

    2004-12-01

    Full Text Available O objetivo deste artigo é avaliar a associação entre o número ideal de filhos (NIF e a realização da laqueadura. Foi feito um estudo de caso-controle aninhado, com base em uma análise secundária de dados obtidos em um estudo de coorte sobre a saúde reprodutiva de mulheres em Campinas, São Paulo, Brasil, que teve como sujeitos 3.878 mulheres, das quais 1.012 eram laqueadas (casos. A relação entre NIF e o número de nascidos vivos (NV foi dividida em duas categorias (NIF > NV e NIF ¾ NV. Foram calculados os riscos relativos estimados (odds ratio para a realização de laqueadura e seus respectivos intervalos de confiança (IC 95% para a relação NIF/NV, estratificando-se para outras dez variáveis. Todas as variáveis preditoras foram incluídas em um modelo de regressão logística para identificar os fatores independentemente associados à esterilização definitiva. Observou-se que o risco de laqueadura foi maior entre as mulheres com NIF The purpose of this paper was to evaluate the association between ideal number of children (INC and female sterilization. A nested case-control study was performed through a secondary analysis of data from a cohort study on the reproductive health of women in Campinas, São Paulo, Brazil. A total of 3,878 women were included, 1,012 being sterilized (cases. The relationship between INC and number of live births (LB was divided in two categories (INC > LB and INC ¾ LB. The relative risks of performing tubal ligation were calculated (odds ratio with their respective 95% confidence intervals for the relation INC/LB and all control variables. All predictor variables were included in a logistic regression model in order to identify the factors independently associated with female sterilization. The results showed that the risks of tubal ligation were higher among women with INC < LB, higher age, with partners, higher family income, more than two previous pregnancies, more deliveries, fewer abortions

  7. Report of a Case of Primary Abdominal Pregnancy

    Directory of Open Access Journals (Sweden)

    Sh Beigi

    2006-01-01

    Full Text Available Ectopic pregnancy (EP is a potentially life-threatening condition in which the embryo implants outside the uterine endometrial cavity. Abdominal pregnancy is an atypical site wherein the product of conception lies totally outside the reproductive tract. Primary abdominal pregnancy is a very rare condition with a high mortality rate. Diagnosis is often late or misdiagnosed. The aim of introducing this case report is to present a new case of early primary abdominal pregnancy. Despite regular menstrual bleeding and contraception with IUD (intrauterine device, this pregnancy occurred in a 24-year old woman. Emergency laparotomy was performed because of abdominal pain, unstable condition and positive urine pregnancy test. It revealed more than 1500 ml of blood in the abdominal cavity. The uterus, both fallopian tubes and ovaries were completely intact. A 3X4 cm mass lateral to the left utersacral ligament was observed and resected. Since IUD strings could not be identified, endometrial currettage was performed and then the IUD was removed. Histological report of the mass and tissue of uterine cavity was placental villi and secretory endometrium, respectively, which according to Studdifords criteria is a new case of early primary abdominal pregnancy. To reduce maternal mortality and morbidity, early recognition of ectopic pregnancy is critical. According to review of the literature and the case report, a high index of suspicion is vital for the early diagnosis of ectopic pregnancy because the signs and symptoms of EP overlap with many surgical and gynecologic conditions. With early diagnosis of EP, we can suggest many therapeutic options and also retain fertility (if desired by patient, while minimizing disease and treatment-related morbidity.

  8. High Lifetime Pregnancy and Low Contraceptive Usage Among Sex Workers Who Use Drugs- An Unmet Reproductive Health Need

    Directory of Open Access Journals (Sweden)

    Alexson Debbie

    2011-08-01

    Full Text Available Abstract Background The objective of this study was to describe levels of pregnancy and contraceptive usage among a cohort of street-based female sex workers (FSWs in Vancouver. Methods The study sample was obtained from a community-based prospective cohort study (2006-2008 of 211 women in street-based sex work who use drugs, 176 of whom had reported at least one prior pregnancy. Descriptive statistics were used to estimate lifetime pregnancy prevalence, pregnancy outcomes (miscarriage, abortion, adoption, child apprehension, child custody, and contraceptive usage. In secondary analyses, associations between contraceptive usage, individual and interpersonal risk factors and high number of lifetime pregnancies (defined as greater than the sample mean of 4 were examined. Results Among our sample, 84% reported a prior pregnancy, with a mean of 4 lifetime pregnancies (median = 3; IQR: 2-5. The median age of women reporting 5+ pregnancies was 38 years old [interquartile range (IQR: 25.0-39.0] compared to 34 years [IQR: 25.0-39.0] among women reporting 4 or fewer prior pregnancies. 45% were Caucasian and 47% were of Aboriginal ancestry. We observed high rates of previous abortion (median = 1;IQR:1-3, apprehension (median = 2; IQR:1-4 and adoption (median = 1; IQR:1-2 among FSWs who reported prior pregnancy. The use of hormonal and insertive contraceptives was limited. In bivariate analysis, tubal ligation (OR = 2.49; [95%CI = 1.14-5.45], and permanent contraceptives (e.g., tubal ligation and hysterectomy (OR = 2.76; [95%CI = 1.36-5.59] were both significantly associated with having five or more pregnancies. Conclusion These findings demonstrate high levels of unwanted pregnancy in the context of low utilization of effective contraceptives and suggest a need to improve the accessibility and utilization of reproductive health services, including family planning, which are appropriately targeted and tailored for FSWs in Vancouver.

  9. Serous Tubal Intraepithelial Carcinoma or Not? Metastases to Fallopian Tube Mucosa Can Masquerade as In Situ Lesions.

    Science.gov (United States)

    Singh, Reena; Cho, Kathleen R

    2017-10-01

    - Nonuterine high-grade serous carcinomas (HGSCs) are believed to arise most often from precursors in the fallopian tube referred to as serous tubal intraepithelial carcinomas (STICs). A designation of tubal origin has been suggested for all cases of nonuterine HGSC if a STIC is identified. - To highlight that many different types of nongynecologic and gynecologic carcinomas, including HGSC, can metastasize to the tubal mucosa and mimic de novo STIC. - A mini-review of several recently published studies that collectively examine STIC-like lesions of the fallopian tube. - The fallopian tube mucosa can be a site of metastasis from carcinomas arising elsewhere, and pathologists should exercise caution in diagnosing STIC without first considering the possibility of metastasis. Routinely used immunohistochemical stains can often be used to determine if a STIC-like lesion is tubal or nongynecologic in origin. In the context of uterine and nonuterine HGSC, STIC may represent a metastasis rather than the site of origin, particularly when widespread disease is present.

  10. South Asian women with polycystic ovary syndrome exhibit greater sensitivity to gonadotropin stimulation with reduced fertilization and ongoing pregnancy rates than their Caucasian counterparts.

    Science.gov (United States)

    Palep-Singh, M; Picton, H M; Vrotsou, K; Maruthini, D; Balen, A H

    2007-10-01

    Polycystic ovary syndrome (PCOS) is a heterogeneous syndrome. In vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) is required for PCOS cases that are refractory to standard ovulation induction or have co-existing infertility factors in women with PCOS and Tubal factor subfertility. Assess ethnic variations in response to IVF/ICSI treatment. Observational Comparative study in a University hospital fertility clinic in women with PCOS and Tubal factor subfertility. Women with PCOS (Asians: AP=104; Caucasians: CP=220) and those with tubal factor infertility seeking fertility treatment were assessed (Asians: AC=84; Caucasians: CC=200). Six hundred and eight fresh IVF or ICSI cycles using long protocol of GnRHa suppression and resulting in a fresh embryo transfer were compared. The primary endpoint was to assess the dose of gonadotropins used in the cycles. The secondary outcomes were: total number of oocytes retrieved, fertilization and ongoing clinical pregnancy rates. We found that the South Asian women presented at a younger age for the management of sub-fertility. An extended stimulation phase and Caucasian ethnicity showed an inverse correlation with the number of oocytes retrieved in the PCOS subgroup. Caucasian ethnicity was associated with a higher fertilization rate however increase in body mass index (BMI) and the laboratory technique of IVF appeared to have a negative impact on fertilization rates in the PCOS subgroup. Commencing down regulation on day 1 of the cycles was negatively associated with fertilization rates in the tubal group. In terms of clinical pregnancy rates, the Caucasian PCOS had a 2.5 times (95% CI: 1.25-5) higher chance of an ongoing clinical pregnancy as compared with their Asian counterpart. Also, a unit increase in the basal FSH concentration reduced the odds of pregnancy by 18.6% (95% CI: 1.8-32.6%) in the PCOS group. The Asian PCOS have a greater sensitivity to gonadotropin stimulation with lower fertilization and

  11. Teenage pregnancy

    Science.gov (United States)

    ... or family member, your partner, or your labor coach with you. Stay Healthy During Your Pregnancy You ... Pregnancy Browse the Encyclopedia A.D.A.M., Inc. is accredited by URAC, also known as the ...

  12. ISSN 2073 ISSN 2073 9990 East Cent. Afr. J. s 9990 East Cent. Afr ...

    African Journals Online (AJOL)

    Hp 630 Dual Core

    woman should be counselled to report at the earliest in next pregnancy to rule out ectopic gestation as delay can be disastrous for fertility and her life. References. 1. Tulandi T. Reproductive performance of women after two tubal ectopic pregnancies. ЗФЦЛО ХЦЗФЛО 1988; 50:164. 2. Adelusi B, AL Meshari A, Akande EO, ...

  13. Intrauterine adhesions as a risk factor for failed first-trimester pregnancy termination.

    Science.gov (United States)

    Luk, Janelle; Allen, Rebecca H; Schantz-Dunn, Julianna; Goldberg, Alisa B

    2007-10-01

    Risk factors for failed first-trimester surgical abortion include endometrial distortion caused by leiomyomas, uterine anomalies and malposition and cervical stenosis. This report introduces intrauterine adhesions as an additional risk factor. A multiparous woman presented for pregnancy termination at 6 weeks' gestation. Three suction-curettage attempts failed to remove what appeared to be an intrauterine pregnancy. Rising beta-hCG levels and concern for an interstitial ectopic pregnancy prompted a diagnostic laparoscopy and exploratory laparotomy without the identification of an ectopic pregnancy. After methotrexate treatment failed, the patient underwent ultrasound-guided hysteroscopy and suction curettage using a cannula with a whistle-cut aperture for the successful removal of a pregnancy implanted behind intrauterine adhesions. Intrauterine adhesions are a cause of failed surgical abortion. Ultrasound-guided hysteroscopy may be required for diagnosis.

  14. Diagnostic accuracy of hysterosalpingo-foam-sonography to confirm tubal occlusion after Essure® placement as treatment for hydrosalpinges.

    Science.gov (United States)

    Dreyer, Kim; Hompes, Peter G A; Mijatovic, Velja

    2015-04-01

    Consensus globally is that hydrosalpinges need to be treated before IVF owing to their negative influence on outcomes. The current standard treatment is laparoscopic salpingectomy. A potential less invasive treatment is proximal occlusion of a hydrosalpinx by hysteroscopic placement of an Essure® device. Tubal occlusion after Essure® placement needs to be verified by hysterosalpingography (HSG). However, this is a painful examination, that exposes patients to radiation. Hysterosalpingo-foam sonography (HyFoSy) is a less invasive alternative test to confirm proximal tubal occlusion. This prospective diagnostic accuracy study evaluated if HyFoSy is as accurate as HSG to confirm proximal tubal occlusion after placement of an Essure® device as treatment for a hydrosalpinx before IVF. Thirty-eight treated hydrosalpinges in 26 women were evaluated. Proximal occlusion was verified by HyFoSy (index test) and HSG (standard reference). The accuracy of HyFoSy was 97.4% (95% CI 92.3% to 100.0%). Sensitivity and specificity were 97.1% (95% CI.84.6% to 99.5%) and 100.0% (95% CI 40.2% to 100.0%), respectively. After an Essure® device is placed as treatment for a hydrosalpinx before IVF, HyFoSy is as able as HSG to confirm proximal tubal occlusion. If HyFoSy demonstrates tubal patency, a subsequent HSG needs to be carried out to validate this finding. Copyright © 2014 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

  15. Clinicopathologic study of serous tubal intraepithelial carcinoma with invasive carcinoma: is serous tubal intraepithelial carcinoma a reliable feature for determining the organ of origin?

    Science.gov (United States)

    Gao, Faye F; Bhargava, Rohit; Yang, Huaitao; Li, Zaibo; Zhao, Chengquan

    2013-08-01

    In the past several decades, the concept of serous ovarian carcinoma has been revised repeatedly. However, the exact pathogenesis remains controversial. The most popular current concept is origin from the epithelium of the fimbriated ends of the fallopian tubes. The objective of our study was to evaluate the characteristic clinical and morphologic features of serous tubal intraepithelial carcinoma (STIC) and associated invasive carcinomas. One hundred sixteen consecutive cases of STIC seen from 2007 to 2011 were included in this study. High-grade serous carcinoma (HGSC) with or without a mixed component was identified in 107 cases (92.2%), non-HGSC in 5 cases, and STICs without invasive carcinoma in 4 cases. Using conventional criteria, HGSCs were classified as fallopian tube in origin in 65 cases (60.7%), as ovarian in 30 (28.0%), as peritoneal in 9 (8.4%), and as endometrial in 3 (2.8%). Among the 107 cases with HGSCs, most STICs (86; 80%) were present unilaterally, whereas invasive tumors more commonly involved the ovaries bilaterally (79%; 84 cases). These findings support the hypothesis that STIC acts as a precursor lesion for most fallopian tube, ovarian, and peritoneal HGSCs, but not for endometrial HGSC. Copyright © 2013 Elsevier Inc. All rights reserved.

  16. Pregnancy & Motherhood >

    Science.gov (United States)

    Smoking when pregnant; Pregnancy and smoking; Smoking during pregnancy; Pregnant women smoking; Smoking when pregnant effects; Pregnancy and smoking effects; Pregnant quit smoking; Pregnant stop smoking; How to quit smoking when pregnant; Smoking and fertility; Smoking and infertility; Mom smoking; Smoking around children; Second hand smoke and children

  17. Diphenhydramine and hyaluronic acid derivatives reduce adnexal adhesions and prevent tubal obstructions in rats.

    Science.gov (United States)

    Avsar, Ayse Filiz; Avsar, Fatih Mehmet; Sahin, Mustafa; Topaloglu, Serdar; Vatansev, Husamettin; Belviranli, Metin

    2003-01-10

    The purpose of this study is to investigate the effects of diphenhydramine-HCl and Na-hyaluronate derivatives on the development of postoperative peritoneal adhesion and tubal obstruction. Forty female rats of Sprague-Dawley type were used in the study. The rats were divided into four groups, each comprising 10 subjects. After all the rats were anaesthetized with 50mg/kg ketamine HCl, their abdomens were opened with a lower midline incision. Injury was induced on the right pelvic peritoneum and on the peritoneal surface of left uterine tube. No additional procedure was applied to the first group. 10 mg/kg diphenhydramine-HCl was given to the second group intravenously. In the third group, 0.25 mg/kg Orthovisc, a Na-hyaluronate derivative was diluted with 2 ml physiological saline and poured into the abdomen. For the fourth group, Seprafilm, a Na-hyaluronate derivative was covered in a layer of 0.7 cm x 3 cm over the left uterine tube. After 14 days, the rats were anaesthetized with ketamine HCl again, and 5 cm(3) blood sample was taken with cardiac puncture. The abdomen was opened with an incision transverse to the upper end of the midline incision, and the presence of adhesions was investigated. Detected adhesions were staged according to the Mazuji classification. Tubal patencies were inspected by injecting methylene blue from the uterine corpus into the lumen using an injector. A piece of abdominal wall of 4 cm x 4 cm was removed by extending the incision in the reverse U shape. The tensile strength and bursting pressure of the suture line were determined using the Peacock method. One gram of tissue was taken from the incision line, and hydroxyproline levels were determined by the Bergman-Loxley method. Aspartate aminotransferase (AST) levels were measured. All of the rats completed the study. AST levels, tissue hydroxyproline levels and tensile strength and bursting pressure test results were found to be similar in all groups. While adhesion rates in the groups

  18. Synchronous Ectopic Pancreases in the Cardia and Antrum of the Stomach: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Yie, Mi yeon; Kim, Min Jeong; Lee, In Jae; Yang, Dae Hyun; Jun, Sun Young; Min, Kwang seon [Hallym University Medical Center, Anyang (Korea, Republic of); Jang, Kyung Mi [Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of)

    2010-04-15

    Ectopic pancreas is most commonly found in the antrum of the stomach, duodenum, or proximal jejunum. Rarely ectopic pancreas in the proximal stomach has been reported. Moreover, the coexistence of two ectopic pancreases at gastric cardia and antrum in a patient has not been reported. Ectopic pancreas usually appears as a submucosal mass, and it is difficult to differentiate between ectopic pancreas and other common submucosal tumors, such as a gastrointestinal stromal tumor (GIST) or leiomyoma. Here, we present a case of the coexistence of two ectopic pancreases at cardia and antrum of the stomach in a 60-year-old man, which was preoperatively misdiagnosed as GIST

  19. Synchronous Ectopic Pancreases in the Cardia and Antrum of the Stomach: A Case Report

    International Nuclear Information System (INIS)

    Yie, Mi yeon; Kim, Min Jeong; Lee, In Jae; Yang, Dae Hyun; Jun, Sun Young; Min, Kwang seon; Jang, Kyung Mi

    2010-01-01

    Ectopic pancreas is most commonly found in the antrum of the stomach, duodenum, or proximal jejunum. Rarely ectopic pancreas in the proximal stomach has been reported. Moreover, the coexistence of two ectopic pancreases at gastric cardia and antrum in a patient has not been reported. Ectopic pancreas usually appears as a submucosal mass, and it is difficult to differentiate between ectopic pancreas and other common submucosal tumors, such as a gastrointestinal stromal tumor (GIST) or leiomyoma. Here, we present a case of the coexistence of two ectopic pancreases at cardia and antrum of the stomach in a 60-year-old man, which was preoperatively misdiagnosed as GIST

  20. Tubal Sterilization

    Science.gov (United States)

    ... me? Are there other forms of permanent birth control? What if I want to reverse the procedure later ... time for me to have the procedure done? What are the risks involved with the ... Birth Control Methods U.S. Food and Drug Administration, Birth Control: ...

  1. Full-term extrauterine abdominal pregnancy: a case report

    Directory of Open Access Journals (Sweden)

    Babgi Reem

    2011-10-01

    Full Text Available Abstract Introduction Extrauterine abdominal pregnancy is extremely rare and is frequently missed during antenatal care. This is a report of a full-term extrauterine abdominal pregnancy in a primigravida who likely had a ruptured ectopic pregnancy with secondary implantation and subsequently delivered a healthy baby. Case presentation A 23-year-old, Middle Eastern, primigravida presented at 14 weeks gestation with intermittent suprapubic pain and dysuria. An abdominal ultrasound examination showed a single viable fetus with free fluid in her abdomen. A follow-up examination at term showed a breech presentation and the possibility of a bicornute uterus with the fetus present in the left horn of her uterus. Our patient underwent Cesarean delivery under general anesthesia and was found to have a small intact uterus with the fetus lying in her abdomen and surrounded by an amniotic fluid-filled sac. The baby was extracted uneventfully, but the placenta was implanted in the left broad ligament and its removal resulted in massive intraoperative bleeding that necessitated blood and blood products transfusion and the administration of Factor VII to control the bleeding. Both the mother and newborn were discharged home in good condition. Conclusions An extrauterine abdominal pregnancy secondary to a ruptured ectopic pregnancy with secondary implantation could be missed during antenatal care and continue to term with good maternal and fetal outcome. An advanced extrauterine pregnancy should not result in the automatic termination of the pregnancy.

  2. Ectopic Intratracheal Thyroid: A Rare Cause of Airway Obstruction

    Directory of Open Access Journals (Sweden)

    Waheed Rahman

    2018-01-01

    Full Text Available Ectopic intratracheal thyroid tissue (EITT is a rare abnormality with only limited cases reported so far. The presenting symptoms can be very similar to those of bronchial asthma. We discuss the case of a 29-year-old man with subglottic ectopic thyroid, with a history of thyroid surgery for goiter, which has been managed with laser-assisted endoscopic approach. We have also included presenting symptoms, pathophysiology, diagnosis, and management of EITT. We aim to include EITT in the differentials of airway obstruction, particularly in those patients who have goiter or previous thyroid surgeries.

  3. MDCT findings of right circumaortic renal vein with ectopic kidney

    International Nuclear Information System (INIS)

    Kim, Min Kyun; Ku, Young Mi; Chun, Chang Woo; Lee, Su Lim

    2013-01-01

    Anomalies of renal vasculature combined with ectopic kidneys were found on a multi-detector CT scan. Knowledge of renal vascular variation is very important for surgical exploration, radiologic intervention and staging for urologic cancer. We present an extremely rare case of a right circumaortic renal vein combined with a right ectopic kidney. The right kidney was located at the level between the third and fifth lumbar vertebra. The right circumaortic renal vein crossed the aorta and returned to the inferior vena cava behind the aorta.

  4. A case of ectopic intraabdominal fascioliasis presented with acute abdomen.

    Science.gov (United States)

    Tanir, Gönül; Karaman, Ayşe; Tüfekçı, Sehra Birgül; Erdoğan, Duygu; Tuygun, Nilden; Ozkan, Ayşegül Taylan

    2011-06-01

    Human fascioliasis with Fasciola species occurs worldwide and is most common among rural people who tend sheep and eat uncooked water vegetables, particularly watercress. The natural history of the acute phase begins with ingestion of metacercariae encysted on various kinds of aquatic vegetation such as watercress. Fascioliasis primarily involves the liver, bile ducts, gallbladder, and occasionally ectopic sites. We describe herein a case of ectopic fascioliasis. This uncommon form of disease was peritonitis; both visceral and parietal peritoneal layers were affected with the formation of multiple nodules and ascites.

  5. Tubal endometriosis diagnosed within one month after menarche: a case report.

    Science.gov (United States)

    Yamamoto, K; Mitsuhashi, Y; Takaike, T; Takase, K; Hoshiai, H; Noda, K

    1997-03-01

    A 13-year-old nulligravida girl, 158.5 cm in height and 76.0 kg in body weight, came to our department complaining of continuous right lower abdominal pain. One month earlier, an ovarian cyst in the right ovary, about 3 cm in diameter, was found when she underwent appendectomy at another hospital, but was left untreated. Menarche occurred at the age of 13 years and 1 month, which was after the appendectomy and 24 days before the present operation. Right hematosalpinx with peripheral obstruction and a para-ovarian serous cyst on the same side were diagnosed, and therefore right salpingectomy with para-ovarian cyst resection was performed. The bilateral ovaries and uterus were completely normal by inspection. The post operative histological examination confirmed hematosalpinx and revealed tubal endometriosis.

  6. Essure transcervical tubal sterilization: a 5-year x-ray follow up.

    Science.gov (United States)

    Franchini, Mario; Boeri, Cecilia; Calzolari, Stefano; Imperatore, Alberto; Cianferoni, Luciano; Litta, Pietro; Giarrè, Giovanna; Zerbetto, Irene; Moncini, Irene; Florio, Pasquale

    2011-05-01

    To evaluate the x-ray appearance of Essure microinserts 5 years after their insertion. Prospective controlled study. Tertiary referral centers for gynecologic care. Forty-five consecutive women with successful hysteroscopic bilateral placement of the Essure devices and postprocedure satisfactory hysterosalpingography confirmation test. Pelvic anteroposterior x-ray. Stability and and symmetric appearance of Essure microinsert positions; measurement of the intrauterine distance between the two devices. After 5 years from their placement, no detachment nor fracture of devices was observed. x-Ray recognition of the device after 5 years showed findings similar to those recorded at 3 months' follow-through hysterosalpingography. x-Ray evaluation of findings related to stability of position, symmetric appearance, and distance between the two Essure microinserts corroborates the irreversibility and the reliability of the fibrotic reaction that ensured tubal occlusion after devices placement. Copyright © 2011 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  7. Prediction of post-operative pain after a laparoscopic tubal ligation procedure

    DEFF Research Database (Denmark)

    Rudin, A.; Wolner-Hanssen, P.; Hellbom, M.

    2008-01-01

    ligation procedure. METHODS: Assessments of anxiety, mood, psychological vulnerability and pre-operative pain were made before surgery using the State-Trait Anxiety Inventory (STAI), the Hospital Anxiety Depression Scale (HADS), a psychological vulnerability test and the Short-Form McGill Pain......BACKGROUND: Pre-operative identification of reliable predictors of post-operative pain may lead to improved pain management strategies. We investigated the correlation between pre-operative pain, psychometric variables, response to heat stimuli and post-operative pain following a laparoscopic tubal...... Questionnaire (SF-MPQ), respectively. Pre-operative assessments of thermal thresholds and pain response to randomized series of heat stimuli (1 s, 44-48 degrees C) were made with quantitative sensory testing technique. Post-operative pain intensity was evaluated daily by a visual analogue scale during rest...

  8. Uterine and tubal anatomical abnormalities in infertile women: diagnosis with routine hysterosalpingography prior to selective laparoscopy

    Directory of Open Access Journals (Sweden)

    Mwaffaq Heis

    2011-12-01

    Full Text Available Objective: To assess the findings and usefulness of hysterosalpingography as a routine investigation in the fertility workup prior to selective laparoscopy. Design: Descriptive retrospective study. Setting: A university hospital in the north of Jordan. Subjects: All hysterosalpingographies performed in the period between 1st January and 31 December 2008. Outcome measures: Detection of uterine and fallopian tube abnormalities and their correlation with laparoscopic findings. Results: During the study period, 281 infertile women underwent hysterosalpingography with no post procedural complications. The mean (SD age was 31.5 (5.91 years. Mean (SD duration of infertility was 4 (3.44 years. Infertility was reported as primary and secondary by 119 (42.3 % and 162 (57.6 %, respectively. Altogether 281 patients and 562 tubes were examined. Of those, 402 were patent and 160 occluded. There was only one woman in whom peritubal adhesions were diagnosed. Because of hysterosalpingographically diagnosed tubal occlusion, 46 women (16.4 % were referred for laparoscopy. Eight (17.3% of them were treated with unilateral salpingectomy and 28 (60.8% with bilateral salpingectomy. Salpingolysis was performed for 7 (15.2% women, and 3 (6.7% women had untreatable adhesions. The concordance was 71.7%. The sensitivity of HSG was 80%, the specificity 50%, the negative predictive value 61% and the positive predictive value 71%. Of the total of 281 women, 30 (10.7% conceived within 1 - 11 months after the hysterosalpingography. Conclusions: The very high abnormal predictive value of hysterosalpingography in the diagnosis of tubal occlusion suggests that this procedure could be performed as a screening examination.

  9. Anti-Müllerian hormone levels in salpingectomized compared with nonsalpingectomized women with tubal factor infertility and women with unexplained infertility

    DEFF Research Database (Denmark)

    Grynnerup, Anna Garcia-Alix Haugen; Lindhard, Anette; Sørensen, Steen

    2013-01-01

    To investigate the consequence of salpingectomy on ovarian reserve by measuring anti-Müllerian hormone (AMH) levels before in vitro fertilization (IVF) treatment in salpingectomized women compared with nonsalpingectomized women with tubal factor infertility, women with unexplained infertility and...

  10. Unplanned pregnancies in the United States.

    Science.gov (United States)

    Grimes, D A

    1986-03-01

    Unplanned pregnancies constitute an epidemic in the United States. Over 3 million unplanned pregnancies occur, and over 1.5 million induced abortions are performed each year. Women of minority races and those with less than 12 years of education are at high risk of having unwanted children. Fear of complications (not the complications themselves) is the most powerful deterrent to women's use of contraception. Much of this fear is due to bad press. Recent good news about contraception, such as protection against ovarian and endometrial cancer, protection against ectopic pregnancy, and absence of teratogenic effects, has not received appropriate media coverage. For healthy women younger than 35 years, failure to use fertility control is more dangerous than use of any method.

  11. Ectopic Splenic Tissue in the Testis: A Case Report

    African Journals Online (AJOL)

    Ectopic SplENic tiSSUE iN thE tEStiS associated with bilateral cryptorchidism and hypospadias4. Brasch et al. reported a case involving the right testis5. Ultrasonography, scintigraphy (with technetium-99m) and single positron emission computerized tomography are considered the best diagnostic tools for this condition2,3.

  12. Early Ectopic Recurrence of Craniopharyngioma in the Cerebellopontine Angle.

    Science.gov (United States)

    Mahdi, Mohamad-Motaz Al; Krauss, Joachim K; Nakamura, Makoto; Brandis, Almuth; Hong, Bujung

    2018-01-01

    Ectopic recurrence of craniopharyngioma in the cerebellopontine angle after surgical resection of a suprasellar craniopharyngioma is rare. Thus, only 5 cases were reported with a delay ranging between 4 and 26 years after removal of the primary tumor. We report a unique case of ectopic recurrence of craniopharyngioma in the cerebellopontine angle, which occurred at only 4 months after surgical resection of the primary tumor. A 24-year-old man underwent resection of a suprasellar craniopharyngioma via a right pterional approach four months earlier. During follow-up, cerebral magnetic resonance imaging (MRI) showed a round homogeneous contrast-enhancing tumor in the right cerebellopontine angle with neither relation to the internal auditory canal nor to the dura mater. After microsurgical resection, histopathological findings revealed ectopic recurrence of craniopharyngioma with similar tumors like the primary tumor. Although infrequent, craniopharyngioma may disseminate via the cerebrospinal fluid during surgical resection and grow in an ectopic place. Early follow-up and MRI scan following resection of a craniopharyngioma is recommended.

  13. Ectopic ACTH syndrome: a clinical challenge | Tsabedze | Journal of ...

    African Journals Online (AJOL)

    A patient was managed in our endocrinology unit with ectopic Cushing's syndrome from an adrenocorticotropic hormoneproducing neuroendocrine carcinoma of the anal canal. There was limited response to standard therapy, which made it difficult to correct the electrolyte and metabolic derangements associated with the ...

  14. Damage-induced ectopic recombination in the yeast Saccharomyces cerevisiae.

    Science.gov (United States)

    Kupiec, M; Steinlauf, R

    1997-06-09

    Mitotic recombination in the yeast Saccharomyces cerevisiae is induced when cells are irradiated with UV or X-rays, reflecting the efficient repair of damage by recombinational repair mechanisms. We have used multiply marked haploid strains that allow the simultaneous detection of several types of ectopic recombination events. We show that inter-chromosomal ectopic conversion of lys2 heteroalleles and, to a lesser extent, direct repeat recombination (DRR) between non-tandem repeats, are increased by DNA-damaging agents; in contrast, ectopic recombination of the naturally occurring Ty element is not induced. We have tested several hypotheses that could explain the preferential lack of induction of Ty recombination by DNA-damaging agents. We have found that the lack of induction cannot be explained by a cell cycle control or by an effect of the mating-type genes. We also found no role for the flanking long terminal repeats (LTRs) of the Ty in preventing the induction. Ectopic conversion, DRR, and forward mutation of artificial repeats show different kinetics of induction at various positions of the cell cycle, reflecting different mechanisms of recombination. We discuss the mechanistic and evolutionary aspects of these results.

  15. Junctional ectopic tachycardia following repair of congenital heart ...

    African Journals Online (AJOL)

    Background: Postoperative junctional ectopic tachycardia (JET) is a rare and transient phenomenon occurring after repair of congenital heart defects. Report on this arrhythmia in the subregion is rare. We set out to determine the incidence of this arrhythmia and review the treatment and outcomes of treatment in our centre.

  16. Epidemiological Studies Persian Gulf War Illnesses Persian Gulf Women’s Health Linkage Study.

    Science.gov (United States)

    1997-07-01

    Ectopic/Tubal Pregnancy Amenorrhea Abnormal Uterine Bleeding 33 Have you ever been pregnant? Yes No GO to QUESTION 38 34. What was you age at your...pregnancy. MATERNAL COMPLICATIONS Pregl Preg2 Preg3 Preg4 Preg5 Preg6 Preg7 Preg8 Infection during pregnancy Gestational Diabetes Pregnancy- induced ...Cigarettes Use Illegal Drugs Abuse Prescription Drugs Drink Caffeinated Beverages Exercise Regularly SECTION SEVEN: HUSBAND or PARTNER HEALTH 49

  17. Primary Follicular Carcinoma Arising in Ectopic Thyroid Tissue of the Lateral Neck: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Oh, Se Won; Park, Dong Woo; Kim, Soo Yeon; Hahm, Chang Kok; Lee, Young Jun; Lee, Seung Ro; Pyo, Ju Yeon; Oh, Young Ha; Park, Yong Wook [Hanyang University College of Medicine, Guri Hospital, Guri (Korea, Republic of)

    2010-11-15

    Ectopic thyroid tissue in the lateral neck is an uncommon congenital anomaly, and the occurrence of primary follicular carcinoma in this ectopic thyroid tissue is very rare. We report here on such a case of follicular carcinoma arising in ectopic thyroid tissue of the left lateral neck without any evidence of primary carcinoma in the original thyroid gland

  18. Primary Follicular Carcinoma Arising in Ectopic Thyroid Tissue of the Lateral Neck: A Case Report

    International Nuclear Information System (INIS)

    Oh, Se Won; Park, Dong Woo; Kim, Soo Yeon; Hahm, Chang Kok; Lee, Young Jun; Lee, Seung Ro; Pyo, Ju Yeon; Oh, Young Ha; Park, Yong Wook

    2010-01-01

    Ectopic thyroid tissue in the lateral neck is an uncommon congenital anomaly, and the occurrence of primary follicular carcinoma in this ectopic thyroid tissue is very rare. We report here on such a case of follicular carcinoma arising in ectopic thyroid tissue of the left lateral neck without any evidence of primary carcinoma in the original thyroid gland

  19. Serum Beta-hCG of 11 Days after Embryo Transfer to Predict Pregnancy Outcome

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    Objective To assess the clinic value of a single maternal serum beta-human chorionic gonadotropin (β-hCG) assay 11 d after embryo transfer in ART pregnancies and to predict pregnancy outcome.Methods A total of 384 pregnancies after embryo transfer were included.Inviable pregnancies were defined as biochemical pregnancies,ectopic pregnancies and first trimester abortions.Ongoing pregnancies were defined as singleton pregnancies and multiple pregnancies whose gestation were achieved more than 12 weeks.Serum β-hCG concentrations were compared among different groups.Results On the post embryo transfer d 11,the mean β-hCG concentration of the ongoing pregnancy group (323.7±285.2 mIU/ml) was significantly higher than that of the inviable pregnancy group(81.4±68.1 mmIU/ml)(P<0.001).In multiple gestations,the levels of β-hCG were significantly higher compared with singleton pregnancies.If the β-hCG level was between 10 mIU/ml and 50 mIU/ml,the positive predictive value of biochemical pregnancies and ectopic pregnancies was 81.8%,the negative predictive value was 94.4%.If the level was less than 100 mIU/ml,the positive predictive value of first trimester abortions was 80.8% the negative predictive value was 77.8%.If the level was greater than 250 mIU/ml,the positive predictive value of multiple pregnancies was 83.3%.the negative predictive value was 74.4%.Conclusions A single serum β-hCG level on d 11 after embryo transfer has good predictive valuefor clinical pregnancy outcome in controlled ovarian stimulation cycles and helps to plan the subsequent follow-up.

  20. Intrahepatic pregnancy: A unique opportunity for evaluation with sonography, computed tomography, and magnetic resonance imaging

    International Nuclear Information System (INIS)

    Harris, G.J.; Al-Jurf, A.S.; Yuh, W.T.C.; Abu-Yousef, M.M.

    1989-01-01

    The incidence of ectopic pregnancy ranges from one in 84 to one in 357 live births. The most common site of implantation is within the fallopian tubes; abdominal pregnancies are unusual, and primary hepatic pregnancies are extremely rare. A computer search revealed only six case of placental attachment to the liver in the English-language literature since Cornell and Lash reported eight cases in 1933. Newer imaging techniques have a greater ability to define tissue planes, thus allowing more accurate diagnosis and preoperative planning by the surgical team. The authors take this opportunity to present radiological and other images, obtained by ultrasonography, CT, and MR to demonstrate a primary hepatic pregnancy

  1. Vocal local versus pharmacological treatments for pain management in tubal ligation procedures in rural Kenya: a non-inferiority trial.

    Science.gov (United States)

    Keogh, Sarah C; Fry, Kenzo; Mbugua, Edwin; Ayallo, Mark; Quinn, Heidi; Otieno, George; Ngo, Thoai D

    2014-02-04

    Vocal local (VL) is a non-pharmacological pain management technique for gynecological procedures. In Africa, it is usually used in combination with pharmacological analgesics. However, analgesics are associated with side-effects, and can be costly and subject to frequent stock-outs, particularly in remote rural settings. We compared the effectiveness of VL + local anesthesia + analgesics (the standard approach), versus VL + local anesthesia without analgesics, on pain and satisfaction levels for women undergoing tubal ligations in rural Kenya. We conducted a site-randomised non-inferiority trial of 884 women receiving TLs from 40 Marie Stopes mobile outreach sites in Kisii and Machakos Districts. Twenty sites provided VL + local anesthesia + analgesics (control), while 20 offered VL + local anesthesia without additional analgesics (intervention). Pain was measured using a validated 11-point Numeric Rating Scale; satisfaction was measured using 11-point scales. A total of 461 women underwent tubal ligations with VL + local anesthesia, while 423 received tubal ligations with VL + local anesthesia + analgesics. The majority were aged ≥30 years (78%), and had >3 children (99%). In a multivariate analysis, pain during the procedure was not significantly different between the two groups. The pain score after the procedure was significantly lower in the intervention group versus the control group (by 0.40 points; p = 0.041). Satisfaction scores were equally high in both groups; 96% would recommend the procedure to a friend. VL + local anesthesia is as effective as VL + local anesthesia + analgesics for pain management during tubal ligation in rural Kenya. Avoiding analgesics is associated with numerous benefits including cost savings and fewer issues related to the maintenance, procurement and monitoring of restricted opioid drugs, particularly in remote low-resource settings where these systems are weak. Pan-African Clinical Trials Registry PACTR201304000495942.

  2. Shortened telomeres in serous tubal intraepithelial carcinoma: an early event in ovarian high-grade serous carcinogenesis.

    Science.gov (United States)

    Kuhn, Elisabetta; Meeker, Alan; Wang, Tian-Li; Sehdev, Ann Smith; Kurman, Robert J; Shih, Ie-Ming

    2010-06-01

    Short telomeres are one of the main genetic manifestations in human cancer, as they have been shown to play an important role in inducing chromosomal instability and in contributing to tumor progression. The purpose of this study was to determine if changes in telomere length occur in serous tubal intraepithelial carcinoma (STIC), the putative precursor of "ovarian" high-grade serous carcinoma (HGSC). Twenty-two STICs from 15 patients with concurrent but discrete HGSCs were analyzed for telomere length on formalin-fixed, paraffin-embedded sections by conducting p53 immunofluorescence to assist in identifying STICs and telomere-specific FISH. Telomere length (short, long, or no change) in STICs was compared with HGSCs using normal fallopian tube epithelium and stromal cells as controls. We found that STICs had the shortest telomeres, as 18 (82%) of 22 STICs had short telomeres, whereas only 2 (9%) showed no change and 2 (9%) had long telomeres compared with the normal-looking tubal epithelium. In contrast, among 12 paired HGSCs and STICs, 6 HGSCs showed an increase in telomere length, one showed a decrease in length and 5 did not show any change when compared with their matched STICs, although, such as STICs, the majority of HGSCs had shorter telomeres than the associated normal tubal epithelial cells. These differences in telomere length between normal tubal epithelial cells and STICs, and between STICs and HGSCs were statisticaly significant (PSTICs provides further support to the proposal that STICs are precursors of HGSC and opens new areas of research in elucidating the early events of ovarian high-grade serous carcinogenesis.

  3. The attitudes of Dutch fertility specialists towards the addition of genetic testing in screening of tubal factor infertility.

    Science.gov (United States)

    Malogajski, Jelena; Jansen, Marleen E; Ouburg, Sander; Ambrosino, Elena; Terwee, Caroline B; Morré, Servaas A

    2017-06-01

    This study aims to identify elements perceived by Dutch fertility specialists as barriers and facilitators for the introduction of genetic testing, and their attitudes towards the use of genetic information. The genetic test would be implemented in routine screening for tubal pathology and identifies SNPs relevant for the immune response causing tubal pathology. Experienced reproductive specialists working in Dutch Academic Hospitals were interviewed. Based on the results of four interviews a questionnaire was developed and used to survey medical doctors in six out of eight Dutch Academic hospitals. 60.4% (n=91) stated that the addition of genetic markers to the Chlamydia trachomatis antibody test (CAT) in screening for tubal pathology would increase screening accuracy. 68.2% (n=90) agreed they would require additional training on clinical genetics. Clinical utility (91.2%, n=91) and cost-effectiveness (95.6%, n=91) were recognized by the respondents as important factors in gaining support for the new screening strategy. In summary, respondents showed a positive attitude towards the implementation of a genetic test combined with CAT for tubal factor infertility (TFI) screening. To gain their support the majority of respondents agreed that clinical utility, specifically cost-effectiveness, is an important factor. Comprehensive research about economic implications and utility regarding the introduction of genomic markers should be the next step in the implementation strategy. Furthermore, education and training would need to be developed and offered to fertility care professionals about genetic markers, their interpretation, and implications for clinical decision-making. Copyright © 2017 Elsevier B.V. All rights reserved.

  4. Advanced intraligamentary pregnancy: case report; Gravidez abdominal intraligamentar avancada: relato de caso

    Energy Technology Data Exchange (ETDEWEB)

    Holzhacker, Suzane; Elito Junior, Julio; Santana, Renato Martins; Hisaba, Wagner [Universidade Federal de Sao Paulo (UNIFESP/EPM), SP (Brazil). Escola Paulista de Medicina. Dept. de Obstetricia

    2008-09-15

    Intraligamentary pregnancy is an ectopic pregnancy developing within the broad ligament of the uterus. A case of a 20-year-old primigestation primipara woman is reported. The patient at 10 weeks of gestation, presented acute and continuous hypo gastric pain and was referred to ultrasonography examination, showing ectopic pregnancy and oligamnios. Another exam revealed right para-uterine abdominal pregnancy, fetal biometry of 16 weeks, placenta attached to mesosalpinx and severe oligamnios. Considering the fetal prognostics and the proximity of the placenta to iliac blood vessels, artheriographic examination was performed for evaluation of placenta insertion. Surgical procedures as salpingo-oophorectomy at the right side, appendectomy and removal of the fetus were performed.

  5. An Investigation into the Use of Stimulant Therapy during Pregnancy

    Directory of Open Access Journals (Sweden)

    Natalie Shields

    2012-01-01

    Full Text Available Introduction. A lack of documentation of stimulant use during pregnancy means that doctors have difficulty advising narcoleptic and hypersomnolent patients. Objectives. To investigate the use of stimulant therapy in narcoleptic and hypersomnolent patients during pregnancy. Method. A search of clinic letters at a tertiary sleep clinic identified women who became pregnant whilst receiving stimulant therapy between 01/09/1999 and 18/11/2010. Fifteen patients were included in a telephone survey. Results. There were 20 pregnancies. The reported advice received with regards to stimulant use was variable. In 7 pregnancies, medication was stopped preconceptually: 1 had a cleft palate and an extra digit 6 had good foetal outcomes. In 8 pregnancies, medication was stopped postconceptually: 1 had autism and attention-deficit hyperactivity disorder; 7 had good foetal outcomes. In 5 pregnancies, medication was continued throughout pregnancy: 2 ended in miscarriage; 1 was ectopic; 2 had good foetal outcomes. The most common symptom experienced was debilitating hypersomnolence. Conclusion. There are no standardised guidelines for use of stimulants during pregnancy. Women have significant symptoms during pregnancy for which there is an unmet clinical need. More research is needed into whether medication can be safely continued during pregnancy, and if not, when it should be discontinued. Better standardized advice should be made available.

  6. Teenage Pregnancy.

    Science.gov (United States)

    McClellan, Mary C.

    1987-01-01

    Reviews the problems of teenage pregnancy, including the costs to society, the challenge to educators, and the types of preventive programs developing across the country. Programs dealing strictly with reproduction and contraception are the least effective deterrents to teenage pregnancy. (MD)

  7. Twin pregnancy

    DEFF Research Database (Denmark)

    Sperling, Lene; Tabor, A

    2001-01-01

    Determination of chorionicity is one of the most important issues in the management of twin pregnancy. Modern ultrasound equipment has made it possible to accurately assess placentation already in the first trimester with the lambda sign. With regard to prenatal diagnosis, it is important to know...... for clinicians caring for twin pregnancies....

  8. Ki-67 labeling index as an adjunct in the diagnosis of serous tubal intraepithelial carcinoma.

    Science.gov (United States)

    Kuhn, Elisabetta; Kurman, Robert J; Sehdev, Ann Smith; Shih, Ie-Ming

    2012-09-01

    There is mounting evidence that serous tubal intraepithelial carcinoma (STIC) may be the immediate precursor of ovarian high-grade serous carcinoma (HGSC) but the criteria for its diagnosis are not well established as highlighted in a recent study showing that interobserver reproducibility, even among expert gynecologic pathologists, was moderate at best. Given the clinical significance of a diagnosis of STIC in a patient who has no other evidence of ovarian carcinoma, this is a serious issue that we felt needed to be addressed. Although it is not clear, at this time, whether such a patient should or should not be treated, the importance of an accurate and reproducible diagnosis of precursors of ovarian carcinoma cannot be underestimated. We hypothesized that an elevated Ki-67 labeling index may aid the diagnosis of STIC. Accordingly, we compared the Ki-67 index of STIC and HGSC to normal fallopian tube epithelium (FTE) in the same patients and to a control group of patients without carcinoma, matched for age. A total of 41 STICs were analyzed, of which 35 were associated with a concurrent HGSC. In FTE, immunoreactivity for Ki-67 was restricted to a few scattered cells (mean 2.0%). No statistically significant difference was found between patients with and without HGSC (P>0.05). However, both STICs and HGSC had significantly higher Ki-67 indices than normal FTE (PSTICs uniformly had an elevated Ki-67 labeling index that ranged from 11.7% to 71.1% (average 35.6%). There was no correlation of the Ki-67 labeling index in the STICs and the associated HGSC, as the labeling index was lower in STIC in 18/35 (51.4%) whereas it was higher in 17/35 (48.6%) (P=0.86). In conclusion, the findings in this study indicate that compared with FTE, STICs have a significantly higher Ki-67 index similar to HGSC. Accordingly, the Ki-67 index can aid the diagnosis of intraepithelial tubal proliferations suspicious for STIC. Therefore, we propose that a Ki-67 index of 10% is a useful

  9. Ambulatory laparoscopic tubal ligation: A comparison of general anaesthesia with local anaesthesia and sedation

    Directory of Open Access Journals (Sweden)

    Lokesh Gupta

    2011-01-01

    Full Text Available Background: To compare the anaesthetic techniques for laparoscopic tubal ligation using either general anaesthesia with LMA or a combination of local anaesthetic and intravenous sedation, this study was conducted on 60 ASA-1/2 patients in the age group of 20-40 years. Patients & Methods:60 ASA grade I & II female patients undergoing laparoscopic tubal ligation on a day care basis were randomly divided in two groups- group I (GA using LMA, n=30, group II (Local anaesthesia, n=30. Both groups received similar premedication. General anaesthesia in group I was induced with propofol 2-3 mg kg -1 and following LMA insertion, the anaesthesia was maintained with 0.5-1.5% halothane. In group II the incision site was infiltrated with 10 ml of 1.5% lidocaine with adrenaline and patients were sedated with intravenous midazolam 0.07mg kg -1 and ketamine 0.5 mg kg -1 . A rescue dose of 0.15 mg kg -1 of ketamine was given in group II if the patient complained of pain or discomfort during the procedure. Diclofenac sodium 1 mg kg -1 was used for postoperative analgesia in both the groups. All patients were observed in the PACU until they met the discharge criteria. Results:The demographic profile was similar in both the groups. The induction to skin incision time was significantly more in group I (5.13 ±0.93 min vs 3.01 ±1.86 min in group II. The decrease in pulse rate and blood pressure (systolic and diastolic was also significant in group I. The incidence of intraoperative bradycardia was 16.7% and 10% in group I & group II respectively. The changes in SpO 2 during the procedure, recovery time and time to meet discharge criteria were comparable in both the groups. The incidence of PONV was 20% & 3.3% in group I and 10% & 6.6% in group II respectively. All patients in both the groups required postoperative analgesics. Conclusions:Both the techniques were found to be comparable for laparoscopic sterilization, however a longer induction to skin incision time

  10. History of pregnancy loss increases the risk of mental health problems in subsequent pregnancies but not in the postpartum.

    Directory of Open Access Journals (Sweden)

    Catherine Chojenta

    Full Text Available While grief, emotional distress and other mental health conditions have been associated with pregnancy loss, less is known about the mental health impact of these events during subsequent pregnancies and births. This paper examined the impact of any type of pregnancy loss on mental health in a subsequent pregnancy and postpartum. Data were obtained from a sub-sample (N = 584 of the 1973-78 cohort of the Australian Longitudinal Study on Women's Health, a prospective cohort study that has been collecting data since 1996. Pregnancy loss was defined as miscarriage, termination due to medical reasons, ectopic pregnancy and stillbirth. Mental health outcomes included depression, anxiety, stress or distress, sadness or low mood, excessive worry, lack of enjoyment, and feelings of guilt. Demographic factors and mental health history were controlled for in the analysis. Women with a previous pregnancy loss were more likely to experience sadness or low mood (AOR = 1.75, 95% CI: 1.11 to 2.76, p = 0.0162, and excessive worry (AOR = 2.01, 95% CI: 1.24 to 3.24, p = 0.0043 during a subsequent pregnancy, but not during the postpartum phase following a subsequent birth. These results indicate that while women who have experienced a pregnancy loss are a more vulnerable population during a subsequent pregnancy, these deficits are not evident in the postpartum.

  11. Spontaneous Ovarian Pregnancy and Over Protective Management: A Case Report

    Directory of Open Access Journals (Sweden)

    Hatice Ender Soydinç

    2016-05-01

    Full Text Available We aimed to present a case of primary ovarian pregnancy in a 31-year-old patient who presented to the emergency room with symptoms and signs of acute abdomen and positive beta HCG test. A gestation sac of 6 weeks was detected in the right ovary by transvaginal sonography. Emergency laparotomy and extirpation of the ectopic tissue was performed.

  12. Orthodontic management of buccally erupted ectopic canine with two case reports

    Directory of Open Access Journals (Sweden)

    Avesh Sachan

    2012-01-01

    Full Text Available Ectopic canine teeth develop displaced from their normal position. Any permanent tooth can be ectopic, and the cause may be both genetic and environmental. Orthodontic treatment is justified because ectopic canine teeth can migrate in the jaw bone and may damage the adjacent teeth roots and bone. Orthodontic treatment is also justifiable for aesthetic reasons. Diagnosis and treatment of ectopically erupting permanent maxillary canines requires timely management by the orthodontist. Internal or external root resorption of teeth adjacent to the ectopic canine is the most common sequel. Malocclusion with severe crowding is difficult to treat without extraction. Non-extraction treatment of ectopic canines can compromise the patient′s profile. This article represents two cases of extraction treatment approach for buccally displaced or ectopic canine in a patient with severe crowding in the mandibular arch.

  13. Papillary Tubal Hyperplasia. The Putative Precursor of Ovarian Atypical Proliferative (Borderline) Serous Tumors, Noninvasive Implants and Endosalpingiosis

    Science.gov (United States)

    Kurman, Robert J.; Vang, Russell; Junge, Jette; Hannibal, Charlotte Gerd; Kjaer, Susanne K.; Shih, Ie-Ming

    2011-01-01

    In contrast to the controversy regarding the terminology and behavior of ovarian noninvasive low-grade serous tumors (atypical proliferative serous tumor [APST] and serous borderline tumor [SBT]), little attention has been directed to their origin. Similarly, until recently, proliferative lesions in the fallopian tube have not been extensively studied. The recent proposal that ovarian high-grade serous carcinomas are derived from intraepithelial carcinoma in the fallopian tube prompted us to evaluate the possible role of the fallopian tube in the genesis of low-grade serous tumors. We have identified a lesion, designated “papillary tubal hyperplasia (PTH)”, characterized by small rounded clusters of tubal epithelial cells and small papillae, with or without associated psammoma bodies, that are present within the tubal lumen and which are frequently associated with APSTs. Twenty-two cases in this study were selected from a population-based study in Denmark of approximately 1000 patients with low-grade ovarian serous tumors in whom implants were identified on the fallopian tube. Seven additional cases were seen recently in consultation at The Johns Hopkins Hospital (JHH). These 7 cases were not associated with an ovarian tumor. Papillary tubal hyperplasia was found in 20 (91%) of the 22 cases in the Danish study. Based on this association of PTH with APSTs with implants and the close morphologic resemblance of PTH, not only to the primary ovarian APSTs but also to the noninvasive epithelial implants and endosalpingiosis, we speculate that the small papillae and clusters of cells from the fallopian tubes implant on ovarian and peritoneal surfaces to produce these lesions. The 7 JHH cases of PTH that were not associated with an ovarian tumor support the view that PTH is the likely precursor lesion. We propose a model for the development of ovarian and extraovarian low-grade serous proliferations (APST, noninvasive epithelial implants and endosalpingiosis) that

  14. Management of an Unusual Ectopic Eruption of Maxillary Canine.

    Science.gov (United States)

    Aileni, Kaladhar Reddy; Rachala, Madhukar Reddy; Prathima, Chintakunta Reddy; Naveen, Pitalla Kumar; Soujanya, Donthula

    2017-05-01

    Transposition of teeth is a rare condition, with a prevalence of 0.3-0.4% in general population. They are more commonly observed in females, and may occur unilaterally/bilaterally with greater frequency of left side occurrence in unilateral transposition cases. A 17-year-old female patient reported with the chief complaint of unaesthetic smile. On clinical examination the patient was diagnosed with Angle's class I malocclusion with an ectopically erupted maxillary left canine labial to the left central incisor with retained deciduous canine. The treatment plan decided was to extract the retained deciduous canine, level and align the ectopic canine using an R-loop. The treatment for the patient was finished in 14 months and was retained using a fixed lingual retainer in the upper and lower arches.

  15. Ectopic lymphocytic thyroiditis: A case report and treatment options

    Directory of Open Access Journals (Sweden)

    Irami Araujo-Filho

    2017-12-01

    Full Text Available The presence of ectopic thyroid tissue is a rare entity. Non-gland migration occurs during the early stages of embryogenesis to the normal cervical location. Thus, ectopic tissue is lodged, in general, in the path of the thyroglossal duct in the middle line of the neck. The most common location is in the lingual zone, being the lingual thyroid. This, in most cases, will be asymptomatic. However, it is able to manifest itself with symptoms of dysphagia, dysphonia, obstruction of the upper airways or hemorrhage at any moment between childhood and adulthood. This article is a review of this disease, targeting mainly conduct, still very controversial in the literature. [Arch Clin Exp Surg 2017; 6(4.000: 221-227

  16. Heterotopic Pregnancy: A Diagnosis Which Should Be Consider More Often

    Directory of Open Access Journals (Sweden)

    Eray Çaliskan

    2012-03-01

    Full Text Available The aim of this case report is to present two cases of heterotopic pregnancy in the light of the literature, to present the incidence of heterotopic pregnancy which has increased due to ovulation induction and assisted reproductive techniques and that might cause serious problems for the pregnant women and intrauterine pregnancy. A 33 year old woman who conceived via ovulation induction with gonadotropins and intrauterine insemination was evaluated due to abdominal pain at 6th weeks of gestation. Despite an unknown diagnosis with multidiciplinary approach, she was sent to our center due to acute abdomen with unstable hemodynamic status. The 9 weeks old intrauterine fetus was diagnosed to be dead. She was performed emergency laparotomy salpingectomy for the ruptured tubal pregnancy and she received whole blood transfusions. The postoperative period was uneventhful and she was recovered without any complications. Our second case is a 31 years old woman who conceived via spontaneous cycle. She was evaluated due to abdominal pain at 8th weeks of gestation. Heterotopic pregnancy could have been diagnosed with ultrasonography. She had laparascopic salpingectomy with stable vital signs and stable hemoglobin values. Blood transfusion was not necessary and intrauterine pregnancy was continued with healthy. In women admitting with pelvic pain after conceiving with assisted reproductive techniques, for early diagnosis of heterotropic pregnancy, a carefull ultrasonographic examination of the adnexal regions should be performed and heterotopic pregnancy should be kept in mind for the differential diagnosis of any cystic mass. This approach might help plan the optimum treatment and also minimize the harm to the pregnant women and the intrauterine fetus.

  17. Three cases of ectopic sphenoid sinus pituitary adenoma.

    Science.gov (United States)

    Bobeff, Ernest Jan; Wiśniewski, Karol; Papierz, Wielisław; Stefańczyk, Ludomir; Jaskólski, Dariusz Jan

    2017-01-01

    Introduction: Ectopic sphenoid sinus pituitary adenoma is a rare tumour originating from embryologic remnants of Rathke's pouch. Although it is considered a clinically benign neoplasm, necrosis is encountered in 25% of cases and it can invade adjacent bone structures. Aims: To establish clinical, radiological and histopathological features of ectopic sphenoid sinus pituitary adenoma. Material and methods: Analysis of three cases: two females and one man, aged 61-70. Results: One patient presented with a unilateral hearing loss, the other two with headache and vertigo. They all suffered from type 2 diabetes mellitus. Neurological examination revealed no abnormality. Radiological imaging showed a sphenoid sinus space-occupying soft-tissue lesion with bone erosion in 2 cases and empty sella in 2 patients whereas one had a normal pituitary gland. All were operated on via the transnasal approach. Total resection was achieved in one patient and subtotal in two; in two cases we observed intact sellar dura and in one intact sellar floor. Histopathology showed immunoreactivity for synaptophysin in all cases and cytokeratin in two. The Ki-67 index was less than 2%. Immunohistochemical staining demonstrated growth hormone cells in all cases whereas prolactin and adrenocorticotropin in two. The patients were discharged home in good condition with no neurological deficits. Conclusions: Ectopic sphenoid sinus pituitary adenoma should always be considered in differential diagnosis of sphenoid sinus lesion in the elderly, especially in coexistence with empty sella or type 2 diabetes mellitus. Since ectopic sphenoid sinus pituitary adenoma is a benign lesion, surgical removal is an effective treatment. .

  18. Mediastinum Ectopic Parathyroid Adenoma Localized by Sestamibi-SPECT and

    International Nuclear Information System (INIS)

    Mazilu, C.; Mititelu, R.; Ghita, S.; Rimbu, A.; Marinescu, G.; Mazilu, A.; Codorean, I.

    2006-01-01

    Full text: Objective: Localizing of ectopic parathyroid adenomas, mainly of those located at large distal from cervical anterior region is very difficult by imaging methods, due to reduced number of specific imaging features. Material and Method: We present the case of a patient with hyper functional parathyroid tissue located in anterior mediastinum, detected by using nuclear medicine techniques (planar imaging and 99-m-Tc-Sestamibi) and CT with contrast agent. Results and discussions: Parathyroid scintigraphic imaging with metabolic radiotracer (99-m-Tc-Sestamibi) have shown normal uptake in thyroid area but shown a focal area with increased uptake in anterior mediastinum, on early and late planar images, transverse, sagittal and coronal SPECT images and on 3D reconstruction, suggesting the presence of ectopic parathyroid adenoma, which correlated with symptoms and laboratory analysis (high-modified values of PTH, Urinary Ca, Normal serum Ca). Thyroid ultrasonography normal aspect. CT native and with contrast agent showed remnant thymic tissue (?), pre-aortic anterior mediastinum nodule; normal thyroid aspect. Correlating this data was established the diagnosis of primary hyperparathyroidism due to mediastinum ectopic parathyroid adenoma. Surgical intervention showed intra thymic nodular process, well-defined, with 1 cm diameter in right thymic lobe. Thymectomy was realized. AP exam confirmed diagnosis of parathyroid adenoma. Post surgical determination of serum, urinary and PTH showed normalization of these values. Conclusions: In assessing parathyroid adenomas, mainly with ectopic location, combination of morphologic and functional techniques allows an accurate location of these processes, ensuring a correct diagnosis, adequate therapeutical management and optimal long-term prognosis for patient. (author)

  19. Three cases of ectopic sphenoid sinus pituitary adenoma

    Directory of Open Access Journals (Sweden)

    Ernest Jan Bobeff

    2017-03-01

    Full Text Available Introduction : Ectopic sphenoid sinus pituitary adenoma is a rare tumour originating from embryologic remnants of Rathke’s pouch. Although it is considered a clinically benign neoplasm, necrosis is encountered in 25% of cases and it can invade adjacent bone structures. Aims : To establish clinical, radiological and histopathological features of ectopic sphenoid sinus pituitary adenoma. Material and methods: Analysis of three cases: two females and one man, aged 61-70. Results : One patient presented with a unilateral hearing loss, the other two with headache and vertigo. They all suffered from type 2 diabetes mellitus. Neurological examination revealed no abnormality. Radiological imaging showed a sphenoid sinus space-occupying soft-tissue lesion with bone erosion in 2 cases and empty sella in 2 patients whereas one had a normal pituitary gland. All were operated on via the transnasal approach. Total resection was achieved in one patient and subtotal in two; in two cases we observed intact sellar dura and in one intact sellar floor. Histopathology showed immunoreactivity for synaptophysin in all cases and cytokeratin in two. The Ki-67 index was less than 2%. Immunohistochemical staining demonstrated growth hormone cells in all cases whereas prolactin and adrenocorticotropin in two. The patients were discharged home in good condition with no neurological deficits. Conclusions : Ectopic sphenoid sinus pituitary adenoma should always be considered in differential diagnosis of sphenoid sinus lesion in the elderly, especially in coexistence with empty sella or type 2 diabetes mellitus. Since ectopic sphenoid sinus pituitary adenoma is a benign lesion, surgical removal is an effective treatment.

  20. Transcatheter Embolotherapy with N-Butyl Cyanoacrylate for Ectopic Varices

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Jin Woo; Kim, Hyo-Cheol, E-mail: angiointervention@gmail.com; Jae, Hwan Jun, E-mail: jaemdphd@gmail.com; Jung, Hyun-Seok; Hur, Saebeom; Lee, Myungsu; Chung, Jin Wook [Seoul National University Hospital, Department of Radiology, Seoul National University College of Medicine (Korea, Republic of)

    2015-04-15

    PurposeTo address technical feasibility and clinical outcome of transcatheter embolotherapy with N-butyl cyanoacrylate (NBCA) for bleeding ectopic varices.MethodsThe institutional review board approved this retrospective study and waived informed consent. From January 2004 to June 2013, a total of 12 consecutive patients received transcatheter embolotherapy using NBCA for bleeding ectopic varices in our institute. Clinical and radiologic features of the endovascular procedures were comprehensively reviewed.ResultsPreprocedural computed tomography images revealed ectopic varices in the jejunum (n = 7), stoma (n = 2), rectum (n = 2), and duodenum (n = 1). The 12 procedures consisted of solitary embolotherapy (n = 8) and embolotherapy with portal decompression (main portal vein stenting in 3, transjugular intrahepatic portosystemic shunt in 1). With regard to vascular access, percutaneous transhepatic access (n = 7), transsplenic access (n = 4), and transjugular intrahepatic portosystemic shunt tract (n = 1) were used. There was no failure in either the embolotherapy or the vascular accesses (technical success rate, 100 %). Two patients died within 1 month from the procedure from preexisting fatal medical conditions. Only one patient, with a large varix that had been partially embolized by using coils and NBCA, underwent rebleeding 5.5 months after the procedure. The patient was retreated with NBCA and did not undergo any bleeding afterward for a follow-up period of 2.5 months. The remaining nine patients did not experience rebleeding during the follow-up periods (range 1.5–33.2 months).ConclusionTranscatheter embolotherapy using NBCA can be a useful option for bleeding ectopic varices.

  1. Fibroadenoma in axilla: another manifestation of ectopic breast.

    Science.gov (United States)

    Tiwary, Satyendra K; Kumar, Puneet; Khanna, Ajay Kumar

    2015-04-26

    Fibroadenoma of an accessory breast is a rare disease. The clinical significance lies in the fact that a number of cystic, inflammatory, neoplastic diseases similar to those of a normal breast have been reported in accessory breasts as well. Vigilant self-assessment and complete clinical examination are always encouraged to detect earliest malignancy in the axilla. We report two cases of ectopic breast fibroadenoma with the relevant literature. 2015 BMJ Publishing Group Ltd.

  2. Follicular adenoma in ectopic thyroid. A case-report.

    Science.gov (United States)

    Consalvo, Vincenzo; Barbieri, Gerarda; Rossetti, Amalia Rosaria Rita; Romano, Mafalda; Contieri, Rosaria; Tramontano, Salvatore; Rescigno, Carmela; Infranzi, Massimo; Lombardi, Domenico

    2017-01-01

    The term ectopic thyroid refers to the presence of thyroid tissue located far from its usual anatomic placement and with no vascular connection to the main gland. The presence of swelling in atypical locations is diagnostically differentiated from other pathologies like pleomorphic adenoma or carcinoma, inflammatory lesions like sialadenitis, neurogenic tumors, paraganglioma, fibrolipoma and lymphadenopaties of diverse etiologies. Here we present the case of a submandibular ectopic thyroid in a 67year old woman. She came to our attention for a left submandibular swelling. The anamnesis did not show related pathologies, as well as blood tests. Diagnostic image studies and a FNAC were performed. The mass was surgically removed and histopatology showed a follicular adenoma in the contest of the capsulated lesion. It is important to not underestimate these types of lesions and procede with hematochemical, instrumental tests and above all surgery that can eliminate any diagnostic uncertainty and on the whole be therapeutic. It should not be forgotten that ectopic thyroid tissue can be a site for adenoma or papillary carcinoma and thus any watch and wait strategy should be avoided. Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.

  3. Multiple Ectopic Hepatocellular Carcinomas Arising in the Abdominal Cavity

    Directory of Open Access Journals (Sweden)

    Toru Miyake

    2012-09-01

    Full Text Available Ectopic hepatocellular carcinoma (HCC is a very rare clinical entity that is defined as HCC arising from extrahepatic liver tissue. This report presents a case of ectopic multiple HCC arising in the abdominal cavity. A 42-year-old otherwise healthy male presented with liver dysfunction at a general health checkup. Both HCV antibody and hepatitis B surface antigen were negative. Laboratory examination showed elevations in serum alpha-fetoprotein and PIVKA-II. Ultrasonography and computed tomography revealed multiple nodular lesions in the abdominal cavity with ascites without a possible primary tumor. Exploratory laparoscopy was performed, which revealed bloody ascites and multiple brown nodular tumors measuring approximately 10 mm in size that were disseminated on the perineum and mesentery. A postoperative PET-CT scan was performed but it did not reveal any evidence of a tumor in the liver. The tumors resected from the peritoneum were diagnosed as HCC. The present case of HCC was thought to have possibly developed from ectopic liver on the peritoneum or mesentery.

  4. A Challenging Case of an Ectopic Cushing Syndrome

    Directory of Open Access Journals (Sweden)

    Joana Menezes Nunes

    2014-01-01

    Full Text Available Bronchopulmonary carcinoids are rare pulmonary neoplasms although they account for most cases of ectopic ACTH syndromes. When feasible, the mainstay treatment is surgical resection of the tumor. We report the case of a 52-year-old woman with signs and symptoms suggestive of hypercortisolism for 12 months, admitted to our department because of community acquired pneumonia. Blood hormone analysis showed increased levels of ACTH and urinary free cortisol and nonsuppressibility to high- and low-dose dexamethasone tests. Pituitary MRI showed no lesion and no central-to-peripheral ACTH gradient was present in bilateral inferior petrosal sinus sampling. CRH stimulation test suggested an ectopic ACTH source. Thoracic CT scan revealed a nodular region measuring 12 mm located in the inferior lingular lobule of the left superior lung with negative uptake by 18-FDG-PET scan and negative SRS. The patient was successfully treated with an atypical lung resection and histology revealed an atypical bronchial carcinoid tumor with positive ACTH immunoreactivity. This was an interesting case because the patient was admitted due to pneumonia that may have been associated with her untreated and chronic hypercortisolism and a challenging case of ectopic ACTH syndrome due to conflicting results on the diagnostic exams.

  5. A rare malformation of urinary system: Right ectopic thoracic kidney

    Directory of Open Access Journals (Sweden)

    Musab Ilgi

    2017-01-01

    Full Text Available An ectopic kidney is a common developmental anomaly of the urinary system. However, the thoracic kidney (TK is the rarest state form of an aberrant kidney. The aim of this case report is defining the symptoms in TK diagnosis and constructing a treatment model will promote the best outcomes. These patients come to the physician with the various symptoms, and they could be diagnosed incidentally. In our case, we describe 40 years female patient with severe respiratory problems and upper back pain. In the pulmonary clinic, suspected mass was diagnosed with chest X-ray, and computerized tomography detected nontraumatic nonhernia associated, a truly ectopic TK. Moreover, the thoracic surgeon and urologist team decided to exploration and reconstructed the right ectopic kidney. The 1st month of the control of patient symptoms was disappeared. Overall, TK should be kept in mind in the differential diagnosis of thoracic tumors. Surgical exploration and reconstruction should be thought in patients who have severe respiratory symptoms.

  6. Management Strategies for Aggressive Cushing's Syndrome: From Macroadenomas to Ectopics

    Science.gov (United States)

    Pozza, Carlotta; Graziadio, Chiara; Giannetta, Elisa; Lenzi, Andrea; Isidori, Andrea M.

    2012-01-01

    Cushing's syndrome (CS) is a rare but severe clinical condition represented by an excessive endogenous cortisol secretion and hence excess circulating free cortisol, characterized by loss of the normal feedback regulation and circadian rhythm of the hypothalamic-pituitary axis due to inappropriate secretion of ACTH from a pituitary tumor (Cushing's disease, CD) or an ectopic source (ectopic ACTH secretion, EAS). The remaining causes (20%) are ACTH independent. As soon as the diagnosis is established, the therapeutic goal is the removal of the tumor. Whenever surgery is not curative, management of patients with CS requires a major effort to control hypercortisolemia and associated symptoms. A multidisciplinary approach that includes endocrinologists, neurosurgeons, oncologists, and radiotherapists should be adopted. This paper will focus on traditional and novel medical therapy for aggressive ACTH-dependent CS. Several drugs are able to reduce cortisol levels. Their mechanism of action involves blocking adrenal steroidogenesis (ketoconazole, metyrapone, aminoglutethimide, mitotane, etomidate) or inhibiting the peripheral action of cortisol through blocking its receptors (mifepristone “RU-486”). Other drugs include centrally acting agents (dopamine agonists, somatostatin receptor agonists, retinoic acid, peroxisome proliferator-activated receptor γ “PPAR-γ” ligands) and novel chemotherapeutic agents (temozolomide and tyrosine kinase inhibitors) which have a significant activity against aggressive pituitary or ectopic tumors. PMID:22934113

  7. Severe Cushing's syndrome and bilateral pulmonary nodules: beyond ectopic ACTH.

    Science.gov (United States)

    Tavares Bello, Carlos; van der Poest Clement, Emma; Feelders, Richard

    2017-01-01

    Cushing's syndrome is a rare disease that results from prolonged exposure to supraphysiological levels of glucocorticoids. Severe and rapidly progressive cases are often, but not exclusively, attributable to ectopic ACTH secretion. Extreme hypercortisolism usually has florid metabolic consequences and is associated with an increased infectious and thrombotic risk. The authors report on a case of a 51-year-old male that presented with severe Cushing's syndrome secondary to an ACTH-secreting pituitary macroadenoma, whose diagnostic workup was affected by concurrent subclinical multifocal pulmonary infectious nodules. The case is noteworthy for the atypically severe presentation of Cushing's disease, and it should remind the clinician of the possible infectious and thrombotic complications associated with Cushing's syndrome. Severe Cushing's syndrome is not always caused by ectopic ACTH secretion.Hypercortisolism is a state of immunosuppression, being associated with an increased risk for opportunistic infections.Infectious pulmonary infiltrates may lead to imaging diagnostic dilemmas when investigating a suspected ectopic ACTH secretion.Cushing's syndrome carries an increased thromboembolic risk that may even persist after successful surgical management.Antibiotic and venous thromboembolism prophylaxis should be considered in every patient with severe Cushing's syndrome.

  8. Management Strategies for Aggressive Cushing's Syndrome: From Macroadenomas to Ectopics

    Directory of Open Access Journals (Sweden)

    Carlotta Pozza

    2012-01-01

    Full Text Available Cushing’s syndrome (CS is a rare but severe clinical condition represented by an excessive endogenous cortisol secretion and hence excess circulating free cortisol, characterized by loss of the normal feedback regulation and circadian rhythm of the hypothalamic-pituitary axis due to inappropriate secretion of ACTH from a pituitary tumor (Cushing’s disease, CD or an ectopic source (ectopic ACTH secretion, EAS. The remaining causes (20% are ACTH independent. As soon as the diagnosis is established, the therapeutic goal is the removal of the tumor. Whenever surgery is not curative, management of patients with CS requires a major effort to control hypercortisolemia and associated symptoms. A multidisciplinary approach that includes endocrinologists, neurosurgeons, oncologists, and radiotherapists should be adopted. This paper will focus on traditional and novel medical therapy for aggressive ACTH-dependent CS. Several drugs are able to reduce cortisol levels. Their mechanism of action involves blocking adrenal steroidogenesis (ketoconazole, metyrapone, aminoglutethimide, mitotane, etomidate or inhibiting the peripheral action of cortisol through blocking its receptors (mifepristone “RU-486”. Other drugs include centrally acting agents (dopamine agonists, somatostatin receptor agonists, retinoic acid, peroxisome proliferator-activated receptor γ “PPAR-γ” ligands and novel chemotherapeutic agents (temozolomide and tyrosine kinase inhibitors which have a significant activity against aggressive pituitary or ectopic tumors.

  9. The diagnostic and biological implications of laminin expression in serous tubal intraepithelial carcinoma.

    Science.gov (United States)

    Kuhn, Elisabetta; Kurman, Robert J; Soslow, Robert A; Han, Guangming; Sehdev, Ann Smith; Morin, Patrick J; Wang, Tian-Li; Shih, Ie-Ming

    2012-12-01

    There is compelling evidence to suggest that serous tubal intraepithelial carcinoma (STIC) is the likely primary site for the development of many pelvic high-grade serous carcinomas (HGSCs). Identifying molecules that are upregulated in STIC is important not only to provide biomarkers to assist in the diagnosis of STIC but also to elucidate our understanding of the pathogenesis of HGSC. In this study, we performed RNA sequencing to compare transcriptomes between HGSC and normal fallopian tube epithelium (FTE), and we identified LAMC1 encoding laminin γ1 as one of the preferentially upregulated genes associated with HGSC. Reverse transcription polymerase chain reaction further validated LAMC1 upregulation in HGSC as compared with normal FTE. Immunohistochemical analysis was performed on 32 cases of concurrent HGSC and STIC. The latter was diagnosed on the basis of morphology, TP53 mutations, and p53 and Ki-67 immunohistochemical patterns. Laminin γ1 immunostaining intensity was found to be significantly higher in STIC and HGSC compared with adjacent FTE in all cases (PSTIC and HGSC cells, laminin γ1 staining was diffuse and intense throughout the cytoplasm. More importantly, strong laminin γ1 staining was detected in all 13 STICs, which lacked p53 immunoreactivity because of null mutations. These findings suggest that the overexpression of laminin γ1 immunoreactivity and alteration of its staining pattern in STICs can serve as a useful tissue biomarker, especially for those STICs that are negative for p53 and have a low Ki-67 labeling index.

  10. Bipolar hysteroscopic procedures and placement of Essure microinserts for tubal sterilization: a case control study.

    Science.gov (United States)

    Panel, Pierre; Grosdemouge, Isabelle; Houllier, Marie; Renouvel, Frédérique; Friederich, Ludovic; Le Tohic, Arnaud

    2011-06-01

    To assess the effectiveness and complication rate with Essure microinsert placements for tubal sterilization and the concomitant bipolar intrauterine surgical procedure. Case control study. Department of gynecology and obstetrics of a general hospital in France. 382 women, including 41 undergoing one or several concomitant uterine procedures with Essure placement, and 341 undergoing Essure placement only (controls). Essure placement with or without bipolar hysteroscopic procedure for polyp, myoma, or endometrial ablation. Success rate for microinsert placement and complications at 3 months. Forty-one patients had Essure microinserts placed in combination with a bipolar hysteroscopic procedure: endometrial resection (n=32), fibroma resection (n=4), or polyp ablation (n=5). They were compared with 341 patients who underwent Essure placement only. The success rate for Essure placement was 97.6% in the combination group versus 97.6% in the control group. The complication rate was 4.9% (n=2) in the combination group versus 2.6% (n=9) in the control group. The difference in the success and complication rates was not statistically significant. Performing intrauterine bipolar resection during hysteroscopy for sterilization is possible without reducing the Essure placement success rate and without increasing morbidity. Copyright © 2011 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  11. Dextromethorphan Reduces Postoperative Pain of Post Partum Tubal Ligation under General Anesthesia

    Directory of Open Access Journals (Sweden)

    N. Manochehrian

    2009-04-01

    Full Text Available Introduction & Objective: Postoperative pain has harmful effects in many systems. Dextromethorphan reduces postoperative pain in post partum tubal ligation under general anesthesia. Materials & Methods: In this research 40 patients with ASA class I and II in double blind randomized clinical trial were studied in two groups. 90 minutes before surgery the patients received 90 mg dextromethorphan or placebo (oral. The patients induced general anesthesia with thiopental (5mg/kg, fentanyl 1.5 g/kg and succinylcholin(1-1.5 mg/kg and maintenance with halothane and N2O 50%. Patients were observed studied for analgesic requirement, nausea, vomiting, urinary retention and respiratory depression in recovery and 2,4,8 and 24 hours after surgery. Results: There was no significant difference in age, education, . . . Pain in recovery, 2 and 4 hours after surgery in dextromethorphan was less than placebo group. The analgesic requirement (pethidine in dextromethophan was less than placebo group.Conclusion: Administration of 90 mg dextromethorphan 90 minutes before the surgery under GA reduces pain in recovery time , 2 and 4 hours after the surgery.

  12. Unintended pregnancy among HIV positive couples receiving integrated HIV counseling, testing, and family planning services in Zambia.

    Science.gov (United States)

    Wall, Kristin M; Haddad, Lisa; Vwalika, Bellington; Htee Khu, Naw; Brill, Ilene; Kilembe, William; Stephenson, Rob; Chomba, Elwyn; Vwalika, Cheswa; Tichacek, Amanda; Allen, Susan

    2013-01-01

    We describe rates of unintended pregnancy among HIV positive couples in Lusaka, Zambia. We also identify factors associated with unintended pregnancy among oral contraceptive pill (OCP) using couples in this cohort. Data were analyzed from couples randomized in a factorial design to two family planning intervention videos. Rates of unintended pregnancy were stratified by contraceptive method used at time of pregnancy. Predictors of time to unintended pregnancy among OCP users were determined via multivariate Cox modeling. The highest rates of unintended pregnancy were observed among couples requesting condoms only (26.4/100CY) or OCPs (20.7/100CY); these rates were not significantly different. OCP users accounted for 37% of the couple-years (CY) observed and 87% of unintended pregnancies. Rates of unintended pregnancy for injectable (0.7/100CY) and intrauterine device (1.6/100CY) users were significantly lower relative to condom only users. No pregnancies occurred among contraceptive implant users or after tubal ligation. Factors associated (psex without a condom. Long-acting reversible contraceptive methods were effective in the context of integrated couples HIV prevention and contraceptive services. Injectable methods were also effective in this context. Given the high user failure rate of OCPs, family planning efforts should promote longer-acting methods among OCP users wishing to avoid pregnancy. Where other methods are not available or acceptable, OCP adherence counseling is needed, especially among younger and new OCP users. ClinicalTrials.gov NCT00067522.

  13. Browse Title Index

    African Journals Online (AJOL)

    Items 101 - 150 of 159 ... Vol 4, No 1 (2015), Regional Differences in the Tunica Media of the Uterine Artery of ... Vol 3, No 2 (2014), The Changing Face of Human Anatomy Practice: ... spontaneous tubal twin ectopic pregnancy: A rare occurrence ...

  14. Interleukin-1 is the initiator of Fallopian tube destruction during Chlamydia trachomatis infection

    DEFF Research Database (Denmark)

    Hvid, Malene; Baczynska, Agata; Deleuran, Bent

    2007-01-01

    Chlamydia trachomatis infection is associated with severe Fallopian tube tissue damage leading to tubal infertility and ectopic pregnancy. To explore the molecular mechanisms behind infection an ex vivo model was established from human Fallopian tubes and examined by scanning electron microscopy...

  15. Pregnancy Complications

    Science.gov (United States)

    ... data. Highlights of some of our research follow Obesity In the United States, obesity during pregnancy is ... trial among adults with glucose intolerance and impaired fasting glucose. Results identified intervention strategies that reduced the ...

  16. Pregnancy care

    Science.gov (United States)

    ... have few or mild symptoms during pregnancy. Many women work their full term and travel while they are pregnant. Others may have to cut back on their hours or stop working. Some women require bed rest ...

  17. Teenage Pregnancy

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    ... the baby, making plans for relatives or an adoptive family to raise the baby, or terminating the pregnancy. ... The decision to place a baby with an adoptive family is legal and binding. However, most states do ...

  18. História reprodutiva de mulheres laqueadas Historia de la reproducción de mujeres con ligadura de trompas Reproductive history of women with tubal ligation

    Directory of Open Access Journals (Sweden)

    Ana Izabel Oliveira Nicolau

    2010-10-01

    -demographic variables and sex. METHODS: This is a quantitative and retrospective documentary study, developed in a Natural Birth Center in July 2008 in the city of Fortaleza-CE. The sample was composed by 277 medical records of patients who had tubal ligation. RESULTS: There were a high number of pregnancies associated with: low education, early onset of sexual life, lack of prior use of reversible contraceptive methods, and high frequency of cesarean delivery and abortions. CONCLUSIONS: The profile found reaffirms the need of: strengthen the guidance and exchange of information on family planning among health professionals and their patients; encouraging male participation; and, guarantee access to the various contraceptive methods.

  19. Medical abortion and the risk of subsequent adverse pregnancy outcomes

    DEFF Research Database (Denmark)

    Virk, Jasveer; Zhang, Jun; Olsen, Jørn

    2007-01-01

    BACKGROUND: The long-term safety of surgical abortion in the first trimester is well established. Despite the increasing use of medical abortion (abortion by means of medication), limited information is available regarding the effects of this procedure on subsequent pregnancies. METHODS: We...... identified all women living in Denmark who had undergone an abortion for nonmedical reasons between 1999 and 2004 and obtained information regarding subsequent pregnancies from national registries. Risks of ectopic pregnancy, spontaneous abortion, preterm birth (at ... weight (abortion were compared with risks in women who had had a first-trimester surgical abortion. RESULTS: Among 11,814 pregnancies in women who had had a previous first-trimester medical abortion (2710 women...

  20. Loratadine and Pregnancy

    Science.gov (United States)

    ... loratadine more frequently during pregnancy. Can taking loratadine cause other pregnancy problems? Loratadine is not expected to cause other pregnancy problems. A study of 161 women taking loratadine ...