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PubMedDate not supplied

Ectopic pregnancy - two years review from BPKIHS, Nepal.

UNLABELLED: Ectopic pregnancy remains an important cause of morbidity and mortality in early pregnancy. The incidence has increased worldwide with an increase in pelvic infections and improvements in the diagnostic techniques. The objective of this study was to analyse the various aspects of ectopic pregnancy with a view to suggest interventions which would decrease the incidence. MATERIAL AND METHODS: The study was carried out in the department of Obstetrics and Gynaecology, B.P Koirala Institute of Health Sciences, Dharan (Nepal). Data were analysed retrospectively using the case sheets and operative notes from the past two years (April 02-April 04). The gynaecological admissions and records of the total births within the period of study were also used in the analysis. RESULT: The incidence of ectopic pregnancy during this study period was 0.93 of total births and 2.92% of the total gynaecological admissions. The peak age of incidence was in the range of 26-30 years. Majority of patients were in the lower socioeconomic group. Pelvic inflammatory disease and induced abortions were the major risk factors. Their contribution was 61.3% and 38.6% respectively. 70.6% of patients did not use any contraception. 16% used depo provera. Abdominal pain (69.3%), vaginal bleeding (45.3%) and syncopal attacks (21.3%) were the most frequent presenting complaints. 58.6% had amenorrhea of 6-10 weeks. Only 1.3% presented with amenorrhea of greater than 10 weeks. Ampulla (62.6%) followed by isthmus (21.3) were the commonest sites of ectopic implantation. Ovarian and abdominal pregnancies contributed to only 1.3% each. There was no significant difference between the side of the tube involved.82.6% had come with ruptured ectopic but only 12% were in shock. Majority of patients underwent salpingectomy (69.3%) followed by salpingo-oophorectomy (17.3%). Only 2.6% received methotrexate. 70.6% required blood transfusion. CONCLUSION: Majority of patients attending BPKIHS for ectopic pregnancy were between 26-30 years and had history of PID & induced abortions. Surgery (salpingectomy/salpingo-oophorectomy) was the main stay of treatment.

Adult↗
PubMedDate not supplied

[Remnant portion of the tube in ectopic pregnancy: review and report of a case].

PURPOSE: After a review of the literature, to establish what the best treatment is to treat interstitial portion in ectopic gestations. TYPE OF STUDY: Review and report of a case. SITE: Specialized Clinics Hospital of Franco da Rocha of the School of Medicine of Jundiaí. PATIENTS: One patient of the School Hospital. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: Review and clinical observation. CONCLUSIONS: The authors present a case of an exceptional ectopic gestation with a remnant portion of the tube seen at the Hospital above, with absent contralateral ovary. They discuss the etiologic factors of the ectopic gestation with contralateral corpus luteum, and suggest the possibility of internal transmigration in the case presented. They comment on the clinical severity, as the area is highly vascularized, and they also comment of the diagnosis difficulties if gestation proceeds. They discuss the treatment for ectopic gestation in general and the possible prophylactic ways of dealing with the remnant portion of the tube in ectopic gestation. They conclude that randomized studies are needed to find out what the best treatment is for the interstitial portion during salpingectomy due to ectopic gestation.

Adult↗
PubMed1991

Ectopic pregnancy.

The incidence of ectopic pregnancy has been increasing for many years and currently is two to three times higher than it was 20 or 25 years ago. The reasons for this are complex and include increased rates of pelvic and tubal infection, the use of the IUD, surgery in the pelvis for infertility, sterilization and other surgical procedures, in vitro fertilization, and improved diagnosis. Normal tubal physiology, the findings in affected tubes, and the mechanisms of how the ectopic pregnancy develops and involves the tube are considered. The cardinal points of the history and physical examination are presented in considerable detail. Further, the evolution of the tools of diagnosis--curettage, culdocentesis, laparotomy, laparoscopy, hormonal tests, and ultrasound-is considered. The different approaches to therapy are presented. Salpingectomy was once the method of accepted therapy, but currently conservative management (salpingostomy) is the most acceptable approach. More recently, selected patients are being treated with observation and a small subgroup are being managed with methotrexate and other chemical agents injected directly into the ectopic pregnancy. Ectopic pregnancy is still a leading cause of maternal death despite improved diagnosis and therapy. It should be remembered, however, that the total number of women who die from this condition is less than ever before and this is despite the rising incidence of ectopic pregnancy. There is still much to be learned about ectopic pregnancy, its etiology, diagnosis, and management.

Adolescent↗
PubMedDate not supplied

The diagnosis of ectopic pregnancy by real-time ultrasonography.

The value of ultrasonography in the diagnosis of ectopic gestation was jointly investigated at UNTH and Hansa Clinics. One hundred and two doubtful ectopic pregnancies had ultrasonic evaluation after initial clinical work up. 52 (76.5%) patients out of 68 who had ectopic pregnancy were diagnosed at the first scan. There were 16 (23.5%) false negatives. Twenty-eight (82.4%) patients out of 34 patients who never had ectopic pregnancy were cleared at the first scan. There were 6 (17.6%) false positives who had laparotomy performed. Fetal pulsations were seen as early as 6 weeks in 11.8% of the ectopic pregnancies. This sign was considered diagnostic. Ultrasound was found promising in the confirmatory diagnosis of ectopic pregnancy especially when a strong suspicion was established by history clinical examination and pregnancy test.

Adolescent↗
PubMed1990

[Chlamydia trachomatis infection in women with ectopic pregnancy].

Chlamydia trachomatis infection, presumably sexually transmitted, has been implicated in the spread of tubal infertility and ectopic pregnancy. In searching evidence of Chlamydia trachomatis infection as a possible cause of tubal ectopic pregnancy, we enrolled 40 consecutive pathologically proven tubal ectopic women and 37 normal early intrauterine pregnant women from our OPD and ward from Jan. 1989 to July 1989. All cases underwent a structured interview giving particular attention to past reproductive history, contraception history and past history of STD. The levels of serum antibody IgG to Chlamydia trachomatis in all cases were determined. Seven ectopic women with wearing IUD in situ (group A) and 33 ectopic women with no identical factor (group B) were compared with 37 normal early intrauterine pregnant women (control group). The result showed group B more often had IgG antibody to Chlamydia trachomatis than control group (P = 0.001). Group A had higher antibody to Chlamydia trachomatis than control group but the difference was not statistically significant (P greater than 0.05). We concluded that the above findings add to the evidence that Chlamydia trachomatis infection is a major cause of tubal ectopic pregnancy.

Adult↗
PubMed1990

Ectopic pregnancy at Tikur Anbessa Hospital, Addis Ababa, Ethiopia, 1981-1987: a review of 176 cases.

Between September 1981 and August 1987, 242 cases of suspected ectopic pregnancy were admitted to Tikur Anbessa Teaching Hospital, Addis Ababa, Ethiopia, of which 231 were confirmed at laparotomy. Over the same period of time 28,600 deliveries were conducted in the same hospital, giving a ratio of eight ectopic pregnancies to 1,000 deliveries. Review of the 176 cases records which could be retrieved revealed that 57.9% were in the age group of 20-29 years and 27% were nulliparous. The history revealed lower abdominal pain in 98.8%, amenorrhoea in 82.9% and vaginal bleeding in 73%. On clinical examination, 92% had lower abdominal tenderness, 80.6% cervical excitation tenderness, 26.7% a mass in the adnexa and 31.2% a haemoglobin level of 7 gm percent or less. In 51.7% of the cases the ectopic was on the right and in 44.4% on the left. In 37.5% of the cases more than 1,000 millilitres of blood was contained in the peritoneal cavity. Only two were cases of unruptured ectopic pregnancy. There were 5 (2.8%) cornual and 2 (1.1%) ovarian pregnancies. Culdocentesis was the most reliable diagnostic test. In the 176 cases, repeat ectopic occurred in 7.3%. In a situation like ours, where adequate diagnostic facilities are not available, ectopic pregnancy should always be suspected in women with lower abdominal pain and amenorrhoea, or lower abdominal pain and irregular vaginal bleeding.

Culdoscopy↗
PubMed1989

Ectopic pregnancy in the United States, 1970-1986.

In 1986, both the rate of hospitalizations due to ectopic pregnancy and the number of hospitalizations decreased from those reported in the previous year, although the decreases were not statistically significant. If this leveling off of previous yearly increases becomes a continuing trend, possible explanatory hypotheses include a leveling off of disease occurrence, and an increasing use of outpatient management. The case-fatality rate rose slightly in 1986, to 4.9 deaths per 10,000 ectopic pregnancies, although this rate still represents an 86% decline from the 35.5 deaths per 10,000 ectopic pregnancies reported in 1970. In 1986, ectopic pregnancy accounted for only 1.4% of all pregnancies but was associated with over 13% of maternal deaths. Compared with white women, women of black and other minority races had a 1.6 times greater risk of ectopic pregnancy. Ectopic pregnancy remains one of the leading causes of maternal death in the United States and continues to be an important public health problem.

Adolescent↗
PubMed1989

Comparison of abdominal and vaginal sonography in suspected ectopic pregnancy.

We compared the accuracy of vaginal sonography in 100 women suspected of having an ectopic pregnancy, in whom a living fetus was not seen by abdominal sonography. Vaginal sonography provided more useful diagnostic information in 44% of the cases, 31% of the ectopics and 52% of the intrauterine pregnancies. Among the 39 ectopic gestations, vaginal scanning was more accurate than abdominal scanning in detecting the ectopic pregnancy (90 versus 80%) and cul-de-sac fluid (77 versus 46%), in identifying an ectopic gestational sac (69 versus 44%), and in diagnosing a tubal pregnancy as unruptured (76 versus 50%). Only one false-positive diagnosis was made by each method of scanning. Among the 61 intrauterine pregnancies, vaginal scanning allowed a more accurate detection of the content of the sac (fetus/yolk sac) in 49% of the cases. In two women, normal intrauterine sacs of 2 and 2.5 mm were detected only by vaginal scanning, at hCG levels of 740 and 840 IU/L (First International Reference Preparation), respectively. Vaginal scanning appears important for early diagnosis of intrauterine pregnancy and more accurate diagnosis of ectopic pregnancy.

Abdomen↗
PubMed1987

Contemporary evaluation of suspected ectopic pregnancy.

A retrospective review of the 119 patients with suspected ectopic pregnancy presenting to Duke University Medical Center during the two-year period ending June 30, 1983, was conducted. In order to determine significant differences between patients with and without ectopic pregnancy, the presenting complaints and physical signs were reviewed and analyzed. Significant findings in women with ectopic pregnancy were: (1) vaginal bleeding lasted longer, (2) abdominal rebound tenderness was more prevalent, and (3) abdominal pain was more prevalent in patients with ruptured ectopic pregnancy than in those with unruptured. There were no other significant differences among the signs and symptoms. Patients with and without ectopic pregnancy cannot be easily distinguished on the basis of presenting signs and symptoms. A combination of culdocentesis and quantitative human chorionic gonadotropin provides the maximal discriminative capacity when considering diagnostic laparoscopy for suspected ectopic pregnancy.

Chorionic Gonadotropin↗
PubMed1988

Intermediate trophoblast in uterine curettings in the diagnosis of ectopic pregnancy.

Confirming the presence of an intrauterine implantation site in endometrial curettings without recognizable chorionic villi is important in the diagnosis and management of ectopic pregnancy. In order to evaluate histologic features that might be useful in establishing the diagnosis of an intrauterine gestation, we conducted a retrospective review of 150 endometrial curettings obtained from women with incomplete abortions or ectopic pregnancies. The specimens were divided into three groups: 1) intrauterine gestations with villi, 2) intrauterine gestations without villi, and 3) known ectopic pregnancies. Differences in the histologic appearance of the endometrium between intrauterine and extrauterine pregnancies were evaluated, with emphasis on 34 curettings from intrauterine gestations in which no chorionic villi were identified and 12 curettings from ectopic gestations. Histologic features assessed in these 46 cases included the presence of intermediate trophoblastic cells; caliber, thickness, and hyalinization of spiral arteries; the presence of a fibrinoid matrix; the Arias-Stella phenomenon; decidua; inflammation; and thrombosis. Intermediate trophoblast in vessels and/or decidua was recognized by conventional light microscopy in 14 (41.2%) of 34 intrauterine cases with no villi, but was identified by immunoperoxidase reactions for hPL in 24 (70.6%) and keratin in 20 (58.8%) of these cases. Endometria from intrauterine gestations also demonstrated a significant increase in arterial wall thickness, hyalinization and lumen diameter, and thrombosis when compared with the endometria associated with ectopic pregnancies. Intermediate trophoblast, enlarged hyalinized spiral arteries, and fibrinoid matrix were not seen in any of the ectopic pregnancies. Based on these findings, intrauterine implantation can be diagnosed, in the absence of villi, by the presence of intermediate trophoblast associated with enlarged vessels replaced by hyaline, or with fragments of fibrinoid matrix.

Chorionic Villi↗
PubMed1980

Sonographic patterns of ectopic pregnancy - how do they help in making the diagnosis?

The diagnosis of ectopic pregnancy is clinically difficult. To determine how the different sonographic patterns help in making the diagnosis of ectopic pregnancy, the ultrasound examinations of twenty-three patients were retrospectively reviewed. Four sonographic types of ectopic pregnancy were found: Type 1--Cystic adnexal mass with a fetal pole. Type 2--Cystic adnexal mass with no fetal pole. Type 3--Complex or solid adnexal mass. Type 4--Pelvis fluid with no mass. In Type 1, a specific ultrasound diagnosis of ectopic pregnancy could be made. In Types 2, 3 and 4 the sonographic findings although suggestive of an ectopic pregnancy were not specific. In these cases the diagnostic accuracy was increased if culdocentesis was performed when ultrasound demonstrated fluid in the pelvis. Unlike previous reports, uterine size, endometrial echoes and myometrial echoes were found to be of no value in making the diagnosis. The positive pregnancy test increased the diagnostic specificity of the ultrasound examination. Even if the pelvic sonogram was normal, an ectopic pregnancy could not be excluded if the pregnancy test was positive.

Adolescent↗
PubMed1995

The fine structure of normal and ectopic (tubal) human placental villi as revealed by scanning and transmission electron microscopy.

The aim of this study was to examine the development of chorionic villous trees during early periods of normal intrauterinal and ectopic (tubal) pregnancies, and to study the structural specializations on the free surface of mature placental villi by scanning and transmission electron microscope (SEM and TEM). In order to study the structures of placental villi between 28 and 34 days old (pc), early, 6-8 week normal and ectopic, and full term human placenta samples were obtained from legal curettage and hysterectomized cases, and spontaneous deliveries, and tissues samples were prepared for SEM and TEM. Three-dimensional configurations of the developing chorionic villous trees were observed as large main villus groups, covered with abundant microvilli of different size and diameters. It appeared that the chorionic villous trees which emerged from the chorionic plate divided gradually into branches of which ramifications originated as buds. These buds gradually grew and were transformed into shoots. The number of developing new villi appeared to increase gradually from 28 days to 9 weeks (pm) of gestation. From the 4th week onwards the massive trophoblastic sprouts were observed on the surface of main chorionic villi which transformed into primary, secondary and tertiary villous trees. When the placental villi formation in ectopic pregnancy was compared with the intra-uterinal pregnancy, an arrested development was remarkable. The configurations of ectopic placental villi seemed to be disparate, such as curved lines or compressed and wrinkled positions so that the three dimensional aspect had been wizened. The ramification and new villi formation seen as in the normal placenta were not only decreased but also infrequent. Some placental villi samples displayed a gradually thinning terminal region. Trophoblastic degenerations were frequently found on the surface of ectopic villi ultrastructurally. According to these results, we comment that in ectopic pregnancy the placental villi formation and development could have been delayed. At term, some specialized structural modifications were observed on the free surface of the mature placental villi. The presence of some dome-like balloonings and many crateriform hollows were the most striking features of the mature intermediate and terminal villi. According to the increasing physiological needs of the growing fetus, these special structures that are related to lung-like and kidney-like functions and named "nephropneumonic-like units", formed in the mature placental barrier. We have observed that these special units were showing a smooth surface similar to an inflated balloon.(ABSTRACT TRUNCATED AT 400 WORDS)

Chorionic Villi↗
PubMed1993

Laparoscopic management of ectopic pregnancy.

In response to the dramatic increase in the incidence of ectopic pregnancy in the United States and worldwide, diagnostic and surgical procedures have evolved to provide safe, efficacious and cost-effective resolutions of this condition. Laparoscopic management of ectopic pregnancy, developed in this regard, continues to be the subject of equivocal reviews. In an effort to further elucidate the issues surrounding the laparoscopic management of ectopic pregnancy, a retrospective investigation was undertaken of 82 women admitted to a community hospital in the Northwest for operative resolution of ectopic pregnancy. Of these patients, 81 (99%) were treated successfully by the laparoscopic approach, the majority (90%) by salpingostomy, with no occurrence of postoperative complications. In contrast to the 3-14% incidence of persistent ectopic pregnancy found in other studies of this approach, a 1% rate was noted here. A sampling of patients treated by laparoscopic and non-laparoscopic approaches demonstrated a 13% reduction in hospital charges for those treated by laparoscopy. In addition, laparoscopy involved a shorter hospital stay and fewer of the unpleasant effects associated with abdominal surgery. The results of this study further support laparoscopic management as an efficacious, safe and cost-effective approach for the resolution of ectopic pregnancy.

Adult↗
PubMed1997

Rapid hospital discharge following laparoscopy for ectopic pregnancy. A promise unfulfilled?

This study was done to determine whether laparoscopy for ectopic pregnancy in the United States is associated with rapid postoperative discharge, defined as 2 days or less, and to estimate how often ambulatory treatment of ectopic pregnancy occurs without subsequent hospital admission. We used the National Hospital Discharge Survey to estimate the frequency of ectopic pregnancy admissions, operations, and length of hospital stays in 1990. We used the National Ambulatory Medical Care Survey to estimate the number, type, and disposition of office visits for ectopic pregnancy in 1990. According to National Hospital Discharge Survey data, tubal pregnancy led to an estimated 57,000 hospital admissions in 1990. Most (70%) of the 26,000 patients treated with laparoscopy were in the hospital 3 days or more, and most (73%) underwent salpingectomy. The number of ambulatory visits for ectopic pregnancy was too low to estimate reliably according to the standards of the National Center for Health Statistics. We found that laparoscopy was used frequently for the treatment of ectopic pregnancy but was not associated with rapid postoperative discharge. Further research is needed to determine whether these findings persist and whether reimbursement incentives, patient preference, or problems with the diffusion of technology are responsible.

Adolescent↗
PubMed1998

[Risk factors for ectopic pregnancy. Case-control study].

BACKGROUND: To analyze risk factors for ectopic pregnancy in an Italian population. METHODS: A retrospective case-control study has been carried out on 213 cases of ectopic pregnancy and 213 controls. The control subjects were women who delivered spontaneously at the same time and in the same hospital of the cases considered. RESULTS: Smoking more than 10 cigarettes/die doubles the risk of ectopic pregnancy. IUD causes an increased risk in women using this contraceptive method for less than two years. A history of abdominal surgery was associated with about a double risk of ectopic pregnancy. The risk was higher in cases of cesarean section and pelvic surgery. CONCLUSIONS: Abdominal surgery (particularly pelvic surgery and cesarean sections), use of IUD for less than two years and cigarette smoking are the risk factors found to be a cause for ectopic pregnancy in the population studied. It was not possible to evaluate the history of pelvic inflammatory disease because there were not enough data. For this reason it is suggested it will be possible in the future to compile a register data, collecting all the cases of ectopic pregnancy as a part of a prevention campaign.

Abdomen↗
PubMed2005

Is ectopic expression caused by deregulatory mutations or due to gene-regulation leaks with evolutionary potential?

It has long been thought that gene expression is tightly regulated in multicellular eukaryotes, so that expression profiles match functional profiles. This conception emerged from the assumption that gene activity is synonymous with gene function. This paradigm was first challenged by comparative protein electrophoresis studies showing extensive differences in expression patterns among related species. The paradigm is now being challenged by evolutionary transcriptomics using microarray technologies. Most gene expression profiles display features that lack any obvious functional significance. The so-called "ectopic" expression refers to the expression of genes at times and locations where the target gene is not known to have a function. However, ectopic expression might be associated with genuine function even if this function is not essential or has yet to be ascertained. Alternatively, ectopic expression might come about as a superfluous by-product of regulatory systems, which would call for a revision of prevailing ideas about the specificity of gene regulation. We herein review available evidence for ectopic expression and the hypotheses proposed for its origin and evolution. We propose that ectopic expression must be regarded as part of an integrated phenotypic whole. It seems likely that ectopic expression represents a leak in the evolution of regulatory systems, but one that is endowed with considerable evolutionary possibilities.

Animals↗
PubMed1985

6-OHDA-induced ectopia of external granule cells in the subarachnoid space covering the cerebellum. III. Morphology and synaptic organization of ectopic cerebellar neurons: a scanning and transmission electron microscopic study.

The present report describes the ultrastructure, surface morphology, and synaptic connectivity of ectopically placed cerebellar neurons after treatment of newborn rats with 100 micrograms 6-hydroxydopamine (6-OHDA), administered intracisternally. In addition to granule cells which form the majority of ectopic neurons, neurons exhibiting the ultrastructure of basket/stellate cells are found in the subarachnoid space over the cerebellum. The ectopic neurons present an almost complete spectrum of homologous efferent and afferent connections. Parallel fiber synapses are found on thorns of spiny branchlets of Purkinje cell dendrites which also have grown out into the subarachnoid space, and on the somata and dendrites of basket/stellate cells. Many ectopic parallel fibers are seen to pass into the molecular layer of the underlying cerebellar cortex through defects in the pial surface, presumably connecting with intracortical postsynaptic partners. Synapses between ectopic Purkinje cell dendrites and basket/stellate cell axons are also observed; however, the source of these axons remains uncertain. Granule cell dendrites are engaged in glomeruli with mossy fibers. Moreover, ectopic granule cell colonies are densely innervated by noradrenergic fibers. Our results show that the technique of generating ectopia of external granule cells provides an additional model for investigating influences of epigenetic factors on the development of nerve cells.

Animals↗
PubMed1993

Ectopic Purkinje cells in the adult rat: olivary innervation and different capabilities of migration and development after grafting.

The abnormal location of large numbers of neurones is characteristic of genetic mutations which impair the migratory processes of developing nerve cells. Nevertheless, the presence of small amounts of ectopic neurones is a fairly common finding even in normal adult animals. The first aim of this study was to investigate a series of features of ectopic Purkinje cells in normal adult rats and particularly to assess whether these cells are still capable of interacting with their normal afferents. Several displaced Purkinje cells, identified by anti-D28k calbindin immunolabelling as well as by typical morphological features, were present in the brainstem and cerebellum of all the examined animals. Two distinct morphological types of such cells could be recognized: 1) noncortical Purkinje cells, located in several areas of the dorsal brainstem and cerebellum, characterised by poorly developed and randomly oriented dendrites; and 2) cortical Purkinje cells, exclusively located in the dorsal cochlear nucleus, characterised by large dendritic trees oriented along parasagittal planes. Tracing experiments, in which Phaseolus vulgaris leucoagglutinin (PHA-L) was injected into the inferior olive, revealed that several ectopic Purkinje cells, belonging to both types, were contacted by the terminal arbours of olivary axons, structurally similar to cerebellar climbing fibres. On the basis of the observation that ectopic Purkinje cells were more frequent in the dorsal cochlear nucleus than in any other of the examined regions, we tested the hypothesis that this nucleus might represent a particularly favourable environment for the survival and development of Purkinje cells. By grafting embryonic cerebellar tissue in the fourth ventricle, only minimal migration of Purkinje cells into the recipient parenchyma was observed when the transplant was placed on the brainstem surface caudal to the cochlear nucleus. By contrast, when the graft was apposed to the latter nucleus, large numbers of Purkinje cells migrated and developed in its superficial layers. These Purkinje cells passed through all the different phases which characterise the normal ontogenesis of this neuronal population and finally developed mature structural features similar to those displayed by cortical ectopic Purkinje cells. This study demonstrates that at least some of the ectopic Purkinje cells receive their physiological olivary input. This fact indicates that Purkinje cells are able to attract olivary axons and establish specific connections, even if they are displaced in an abnormal environment. In addition, we show that the dorsal cochlear nucleus represents a particularly favourable environment for the survival and the development of Purkinje cells.

Animals↗