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Ectopic pregnancies: rising incidence rates in Northern California.

In a population of about 300,000 Northern California women aged 15--44, the age-adjusted incidence of ectopic pregnancy rose from 55.5 to 84.2/100,000 women, 1972--1978. The ratio of ectopics to 1,000 deliveries-plus-spontaneous abortions rose from 9.4 to 14.8. The change occurred mainly in women under age 30, and was observed in seven of the eight hospitals in the area. There was no alteration in the frequency of hospitalized pelvic inflammatory disease (PID); salpingitis decreased over the years studied; and tubal sterilization events remained constant at around 0.9 per cent per year of women aged 15--44.

Abortion, Spontaneous↗

Diagnostic ultrasound in threatened abortion and suspected ectopic pregnancy.

200 women threatened with abortion during the first 16 weeks of pregnancy were examined with diagnostic ultrasound to determine whether there were signs of intrauterine life. Of the 90 who showed positive signs, 8 aborted spontaneously later, the other 82 continued their pregnancy. The ultrasound investigation revealed no signs of intrauterine life in 110 patients. Of these, spontaneous abortion or later evacuation because of missed abortion 101 (histopathological examination showed degenerated villi in 98), not pregnant 4, mola hydatidosa 3, extrauterine pregnancies 2. An ultrasound examination was performed to ascertain whether 136 women with suspected ectopic pregnancy had intrauterine pregnancies. 61 of them had an intrauterine gestational sac, confirmed at clinical follow-up. One of the 61 was operated on with laparoscopy because of pain; no abnormalities were found. In 36 of the other 75, laparoscopy was performed. Ectopic pregnancy 21, ovarian or parovarian cyst 11, adhesions 2, salpingitis 1, and normal 1. Diagnostic ultrasound is excellent for accurate prognosis in threatened abortion. Unnecessary operations avoided; hospitalization in suspected ectopic pregnancies reduced.

Abortion, Threatened↗

Natural killer cell activity after gynecologic infections with chlamydia.

The level of blood natural killer (NK) cell activity was determined in relation to chlamydial infections. A group of 10 women who had recovered from chlamydial salpingitis was compared with a similar group who had had chlamydial cervicitis. Ten healthy female blood donors with no history of chlamydial infections served as controls. The spontaneous cytotoxicity of non-adherent blood lymphocytes was determined in a 3-hour assay with radiolabelled K562 cells as targets. There were no significant differences in the NK cell activity of the three groups. No correlation between NK cell activity and chlamydial IgG antibody titer in serum could be found. The level of NK cell activity as determined in this system cannot explain why some patients get a more severe form of chlamydial infection than others do.

Adolescent↗

Doxycycline in human oviduct mucosa and plasma 24-30 hours after an oral dose of 100 mg.

Oviductal and peripheral plasma concentrations 24 hours after the last dose of Doxycycline (DC) were studied in 17 patients. The concentration of DC in healthy oviduct mucosa was 1.3 micrograms/g (range 0.6-1.7) and 1.1 micrograms/ml (range 0.6-1.7) in plasma. One patient with severe chronic salpingitis in acute exacerbation showed 3.6 micrograms/g in tissue and 2.4 micrograms/ml in plasma in proliferative phase.

Adult↗

Induced abortion: Chlamydia trachomatis and postabortal complications. A cost benefit analysis.

The overall prevalence of Chlamydia trachomatis among 873 abortion-seeking women was 9.3% during 1985. Significantly higher age-specific prevalences of C. trachomatis occurred among younger women (p less than 0.001). None of 17 women treated for C. trachomatis before the abortion was carried out, was readmitted to the hospital. Of 64 Chlamydia-positive women, who commenced treatment within the first 2 weeks after the abortion was carried out, 14.1% were readmitted to the hospital, compared with 5.7% of Chlamydia-negative women (p less than 0.02). Postabortal salpingitis was verified at readmission among 10.9% of Chlamydia-positive women and 3.2% of Chlamydia-negative women (p less than 0.01). An analysis of screening of all abortion-seeking women is estimated to be worthwhile when the prevalence of C. trachomatis exceeds 4.3%. We recommend screening for Chlamydia trachomatis of all abortion-seeking women, 30 years or younger, at the pre-abortion visit, provided that treatment can be completed before the abortion is carried out.

Abortion, Induced↗

Bilateral female pelvic actinomycosis.

A case of bilateral actinomycotic salpingitis is described. The woman used an IUD and the course of the disease was protracted. Later, Actinomyces israelii was coincidentally identified from vaginal cultures. Attention is drawn to the need for distinction between the presence of Actinomyces israelii and actinomycosis.

Actinomycosis↗

Lower genital tract infection with Neisseria gonorrhoeae and Chlamydia trachomatis in women requesting induced abortion and in their sexual partners.

The prevalence and patterns of gonococcal and chlamydial infection were investigated in a prospective microbiological study on 3,395 women requesting abortion and the sexual partners of culture positive women (organism identified). Neisseria gonorrhoeae was found in only 1.8% of 3,395 women during the whole study period of 7 years, but Chlamydia trachomatis in 13.5% of 1,635 women in the last 3 years. Women with positive cultures were significantly younger (p less than 0.001), and more frequently single (p less than 0.001) than those with negative cultures. Single women had more partners (mean 1.5) than those in an established relationship (mean 1.1). Almost all women with gonorrhea were single. Of the males, 62.7% were examined, of whom 47.3% had positive cultures. Twenty per cent of culture positive males had gonorrhea. A high prevalence of positive cultures in the males was only found where chlamydial cultures had been positive in the female. All women and men with positive culture results received antibiotic treatment before or after the abortion procedure. The incidence of laparoscopically verified post-abortion salpingitis was low, at 0.57%, while a clinical diagnosis of endometritis was made in 3.3%. Routine pre-operative microbial screening for Chlamydiae trachomatis should be considered for all women requesting abortion. Tracing and screening for chlamydial and gonorrheal infection of sexual partners of culture-positive women is necessary as a preventive measure.

Abortion Applicants↗

Risk factors in ectopic pregnancy. Results of a population-based case-control study.

In a population-based case-control study, possible risk factors for ectopic pregnancy were compared in 119 patients with ectopic pregnancy and in 119 age-matched controls with intra-uterine pregnancy from each of the following categories: deliveries, spontaneous abortions and induced abortions. The following factors were found significantly more often in cases of ectopic pregnancy: a history of earlier ectopic pregnancy, a history of salpingitis, a history of earlier operation on the Fallopian tubes, a history of infertility, and a pregnancy that had occurred in spite of an intra-uterine contraceptive device. A history of appendectomy was also found significantly more often among the cases. There was no significant correlation between ectopic pregnancy and a history of no earlier pregnancy, earlier deliveries, earlier spontaneous or induced abortions or a history of other gynecological operations and increased risk of ectopic pregnancy. One or more of the risk factors were found in 76.5% of cases and 23% of controls.

Adolescent↗

Trans-vaginal oocyte retrieval and subsequent in vitro production of embryos from a cow involuntarily culled.

A Holstein cow of high genetic merit, in late lactation (205 days) and diagnosed with salpingitis (after 4 infertile services and veterinary consultation), was subjected to 1 trans-vaginal oocyte collection attempt, prior to slaughter. Of an estimated 10 follicles punctured, a total of 4 cumulus-oocyte complexes were retrieved. These were matured in vitro in a maturation medium for 24 hours. After 24 hours maturation, the oocytes were fertilised in vitro with Percoll-processed frozen/thawed imported semen, of the owner's choice. Fertilisation was achieved in a modified Tyrode's medium. At 18 hours post-insemination, the presumptive zygotes were transferred into culture in vitro in Charles Rosenkran's amino-acid medium and supplemented on Day 4 post-insemination with 10% foetal calf serum. All in vitro procedures were conducted in 50 microl medium droplets, under oil, in a humidified incubator at 38.5 degrees C in 5% CO2 in air. Three of the potential zygotes cleaved and, by Day 7 of culture, these had developed to the morula stage. The embryos were frozen in 1.5 M ethylene glycol and later transferred non-surgically to synchronised Holstein recipient heifers. One morula resulted in the only pregnancy and subsequent birth of a healthy heifer calf. An independent commercial company confirmed parentage through standard blood-typing assays. The genetic salvage of oocytes, for in vitro production of embryos, has potential benefits to the producer.

Animals↗

A retrospective study on the effectiveness of a screening effort to reduce the complications of gonorrhea.

In an effort to evaluate the effectiveness of a mass screening program for gonorrhea, a retrospective study was carried out on patients admitted to the hospital with the diagnosis of acute and chronic salpingitis. This study was done at the Confederate Memorial Medical Center in Shreveport, Louisiana. Admissions were reviewed for the year prior to the screening program, and compared to the numbers that were admitted after 2 years of screening. A 70% increase was found to have occurred despite extensive efforts to identify and treat asymptomatic women with gonorrhea, and their male contacts. This finding contrasts dramatically with the experience of others who have reported success in reducing the spread of gonorrhea by such a screening program.

Female↗

Group A Streptococcus causing PID from an initial pharyngeal infection. A case report.

BACKGROUND: Pelvic inflammatory disease (PID) is a difficult diagnosis. Five billion dollars is spent on over 1 million women diagnosed each year. Atypical organisms and prior history of tubal ligation may complicate the diagnosis. CASE: A woman who had undergone tubal ligation and abstained from intercourse for over two years developed group A streptococcal salpingitis. It occurred following an upper respiratory infection with the same organism. CONCLUSION: PID is rare in a woman with prior tubal ligation who is not engaging in intercourse. In this case it followed an upper respiratory infection with group A Streptococcus. Low diagnostic suspicion must be maintained for uncommon pathogens in PID in women with prior tubal ligation who are not engaging in intercourse.

Diagnosis, Differential↗

Drug use and syphilis. Co-factors for HIV transmission among commercial sex workers in Guyana.

A cross-sectional survey was conducted among 124 street- and brothel-based female commercial sex workers (CSWs) in Georgetown in January and February 1997 to determine the seroprevalence of human immunodeficiency virus (HIV) infection and describe the sexual practices and drug use patterns. Their median age was 30 years (range 17 to 52 years). 119 (88%) reported regular alcohol consumption while looking for clients, 27 (22%) said they smoked cocaine and 51 (42%) reported use of marijuana. Street-based CSWs were significantly more likely to report marijuana use (p = 0.033). 72% reported that they never used condoms with regular sex partners and 35% reported that they never used condoms with clients. Brothel-based women were significantly more likely to report consistent condom use with their clients (p = 0.05). 46% (54/118) tested HIV positive and 28% (33/118) had a positive serological test for syphilis. Factors that were significantly associated with HIV infection included a positive serological test for syphilis (OR = 7.56; 95% CI = 2.7-21.97; p < 0.01) and a history of having received treatment for syphilis (OR = 2.93; 95% CI = 1.12-7.8). Weak associations were also found between HIV infection and a history of cocaine use (OR = 2.57; 95% CI = 0.95-7.11; p = 0.039); having more than four clients per night (OR = 5.14; 95% CI = 1.65-16.74; p = 0.04); and a history of receiving treatment for salpingitis (OR = 2.31; 95% CI = .93-5.75; p = 0.0035). No statistically significant association was found between HIV infection and marijuana use nor any sociodemographic variables (age, place of work, and duration of sex work). There is an urgent need for a community based behavioural intervention programme targetting this high risk population.

Adolescent↗

Tuboovarian abscess mimicking malignancy: report of two cases.

Tuboovarian abscess is a well-known sequela of acute or chronic salpingitis. In a small percentage of patients, these inflammatory masses compress or even rupture into the adjacent viscera, thus simulating the condition of pelvic malignancy, particularly when the clinical presentations are indolent. We describe two cases of tuboovarian abscess mimicking malignancy. Case 1: A 39-year-old woman with an intrauterine device had a clinical presentation mimicking an exophytic submucosal colorectal tumor with suspicious mucosal invasion. She complained of tenesmus but did not experience fever or adnexal tenderness. A right tuboovarian abscess with fistula formation into the rectosigmoid colon was noted during laparotomy. Case 2: A 46-year-old woman with an intrauterine device had a preoperative diagnosis of uterine myoma with degeneration. At laparotomy, an omentum cake with dense pelvic adhesions was noted. Malignancy appeared to be present, and debulking surgery was performed. The final pathologic examination revealed bilateral chronic tuboovarian abscesses and focal omental abscess.

Abscess↗

[Primary carcinoma of the fallopian tube: a clinicopathological study of 11 cases].

OBJECTIVES: Clinicopathological study of eleven cases of carcinoma of the fallopian tube to understanding possible risk factors for therapeutic failure. DESIGN: The study group consisted of 11 cases of primary carcinoma of the fallopian tube treated in our Department over 25-year period. Clinical and pathologic data were obtained from the hospital records review. RESULTS: The mean age of the patients was 57.22 years. Pelvic pain was the predominant symptom (81.8%). Three of 11 patients had the classic syndrome of "hydrops tubae profluens". On the physical examination the pelvic mass was the most frequent finding (72.7%). Five of the 11 patients had never been pregnant and five had had a single pregnancy. In all patients the diagnosis was established at the time of laparotomy. The tumor was unilateral in 72.7% of the cases with equal frequency in the left or the right tube. The tube was significantly dilated in nine patients, in two other the tumor was smaller then 10 mm. Histologically the vast majority of the tumors was papillary serous adenocarcinoma, and only in one case clarocellulare adenocarcinoma was found. The histologic grade was in 63.6% poorly- and in 36.4% moderate differentiated. In 6 patients we found evidence of salpingitis. All of the patients received postoperative adjuvant therapy: irradiation and or chemotherapy. The mean interval from diagnosis to death was 44.5 months. CONCLUSIONS: Multicenter studies are needed to improve the understanding of possible risk factors for diagnostic additionally therapeutic failure and the optimal treatment for each stage of the disease should be defined.

Adenocarcinoma, Clear Cell↗

Gynaecology and general surgery.

The gynaecological disorders most likely to be met by the general surgeon are those that present with acute abdominal symptoms and those unexpectedly encountered at laparotomy. The former group includes ectopic pregnancy, acute salpingitis, and complications of ovarian cysts and abortion and the latter endometriosis, ovarian tumours, and myomatosis. The characteristics and treatment of these various conditions are described and principles outlined for the guidance of the general surgeon in dealing with gynaecological problem.

Abdomen, Acute↗

Bilharzia of the Fallopian tube.

The incidence of bilharziasis of the Fallopian tube was studied in a control group of patients and in patients with ectopic pregnancies and severe salpingitis, but no significant difference was found. Two groups of 55 patients, each of which comprised 17 with ectopic pregnancies and 38 with severe pelvic sepsis, were studied for parity, symptoms and signs. Patients in one group suffered from tubal bilharziasis and those in the other did not. The findings in these two groups were similar and a typical clinical picture for bilharziasis was not found.

Acute Disease↗

[Alterations in Fallopian tube biopsies caused by pregnancy (author's transl)].

The clinical significance of decidual changes and inflammation in Fallopian tubes of women undergoing sterilization shortly after the delivery was assessed microscopically in 133 resected specimens. Thirteen excision specimens obtained from non pregnant patients served as controls. Foci of ectopic decidua in the mucosa were found in 14.3% of cases in the first group, whereas none was noted in the control group. An inflammatory reaction consisting of edema, hyperemia, and lymphocytic, histiocytic and occasional granulocytic infiltration was noted in 67.6% of patients ligated after delivery. No significant inflammatory reaction was demonstrated in specimens of the control group. In the post partum group the clinical findings and the gross examination of the tubes at the time of operation did not suggest any inflammatory changes. The microscopic changes observed therefore do not warrant the diagnosis of a salpingitis and are to be considered as a physiological response during pregnancy.

Adult↗

Tubal pregnancy in Nigerian Igbos.

Fifty cases of excised tubal pregnancy which occurred in the Igbos of Nigeria are reviewed. Twenty percent of the tubes were unruptured at the time of excision, indicating a high level of awareness of the condition among local doctors. There were several pointers to the conclusion that, in this ethnic group, tubal pregnancy tends to be seen at an advanced stage. It also tends to occur in the younger women, to manifest during the first known pregnancy, to recur, and to be associated with salpingitis. Interstitial tubal pregnancy is also probably relatively common.

Adolescent↗