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PubMed1991

Linear salpingostomy for ectopic pregnancy.

Linear salpingostomy is the procedure of choice for management of uncomplicated ectopic gestations if certain constraints are met. The procedure is straightforward and may be performed by laparotomy. However, laparoscopic salpingostomy is becoming the preferred approach. Additionally, laparoscopy decreased operative time, hospital stay, and patient recovery time. Postoperatively, patients should be observed with weekly assessment of beta-hCG titers to ensure complete resorption of any viable trophoblast. Failure of resorption may result in a persistent ectopic pregnancy. Reproductive outcome is preserved in most patients, with intra-uterine pregnancy rates that approach 60%. Recurrent ectopic gestation rates of 15% are acceptable in view of subsequent close surveillance in women who have undergone previous salpingostomies, which also facilitates earlier diagnosis.

Fallopian Tubes↗
PubMed1991

Serial endovaginal sonography of ectopic pregnancies treated with methotrexate.

Methotrexate therapy is a newly established treatment modality for ectopic pregnancy. We performed this study to determine the time frame for resolution of the sonographically identifiable mass during such therapy and to determine the role of sonography in the management of these patients. Eighteen patients treated with methotrexate for laparoscopically proven ectopic pregnancy consented to long-term follow-up with endovaginal sonography. These 18 patients constitute the study group. The time required for sonographic resolution of the mass was variable, although poor patient compliance with sonographic follow-up affected the conclusions regarding resolution time. One hundred eight days was the longest period accurately known for resolution of a mass. In seven patients, the mass persisted after a negative hCG titer. Enlargement of the adnexal mass during therapy did not necessarily predict treatment failure, as only two of ten such patients required surgery for rupture. Serial sonography did not alter the management of most patients and appears not to be warranted on a routine basis. Follow-up sonography was most useful when complications were suspected. All patients considered for methotrexate therapy should first have an endovaginal sonogram, as cardiac activity remains a relative contraindication to this treatment. We have determined that the mass of an ectopic pregnancy may remain after the hCG is negative. Therefore, a persistent mass should not be interpreted as treatment failure.

Female↗
PubMed1990

[A new technique for the treatment of ectopically erupting permanent first molars].

The problem and treatment of the ectopically erupting permanent first molars have been addressed by many authors since they were first mentioned in the literature by Chapman in 1923. Many treatments involve techniques using the primary second molar. It is better for correcting the eruption of the permanent first molar into normal occlusion to maintain the primary second molar in its normal position. However severe mobility and root resorption are often present when an ectopic eruption is found. An 8-year-old male with ectopic eruption of the maxillary right permanent first molar was examined and treated. The right primary second molar demonstrated severe mobility and root resorption, and therefore a new appliance using the primary first molar was designed. After 4 months from the beginning of the treatment the mobility of the primary second molar decreased, and after 6 months the permanent first molar almost erupted in its normal position.

Child↗
PubMed1990

Laparoscopy and minilaparotomy as operative management of ectopic pregnancy.

The widespread use of serum human chorionic gonadotropin (hCG) monitoring has enabled earlier diagnosis of ectopic pregnancy and increasingly conservative methods of management including operative laparoscopy, medical therapy with methotrexate, and expectant management. We investigated the use of a combined laparoscopic and minilaparotomy approach as an operative management of ectopic pregnancy. Fifteen of 16 patients presenting to the Reproductive Endocrinology Service were managed using either operative laparoscopy or minilaparotomy. Serum hCG values at the time of diagnosis ranged from 239 to 8060 mIU/ml. Nine patients were managed by operative laparoscopy and six by minilaparotomy. All patients were ambulatory and tolerating oral intake within 8 hours of surgery. The average hospitalization was 31 hours from the time of surgery. Thirty-five percent of the patients were discharged within 24 hours and an additional 40% within 36 hours. This approach was applicable to all patients regardless of body habitus, degree of hemoperitoneum, or status of the ectopic pregnancy. Such a combined approach permitted minimal tissue manipulation and shortened hospitalization. Data of the present study suggest that such an approach may be applicable to most clinical circumstances, performed without undue morbidity and potentially avoid a standard laparotomy and its attendant risks and hospitalization.

Chorionic Gonadotropin↗
PubMed1990

Management of ectopic pregnancy.

Risk factors for ectopic pregnancy include previous ectopic pregnancy, current intrauterine device use, prior fallopian tube surgery, previous pelvic inflammatory disease and a prior history of infertility. Abdominal pain is the most common symptom, followed by amenorrhea or vaginal bleeding, nausea, vomiting, syncope and dizziness. Referred shoulder pain following the onset of abdominal pain is characteristic of intraperitoneal bleeding and, in the appropriate clinical setting, strongly suggests a ruptured ectopic pregnancy. A coordinated evaluation includes measurement of serum human chorionic gonadotropin concentration and transabdominal or, preferably, transvaginal ultrasonography. Treatment is primarily by one of a variety of surgical techniques. Medical therapy with methotrexate or other drugs is currently under investigation.

Chorionic Gonadotropin↗
PubMed1990

[Ectopic pregnancy after the treatment of infertility by the method of extracorporeal fertilization].

During October 1987 to June 1989, 609 infertile couples have been treated using in vitro fertilization and embryo transfer (IVF-ET). Of 78 conceptions (15.7% of transferred embryos), 6 (7.7%) pregnancies were ectopic (5 tubal and 1 ovarian). After diagnosis of ectopic pregnancy all the patients were operated; the ovary was resected in 1 patients and tubectomies were done in 5 patients (laparoscopically in 1). All the diagnoses were confirmed histologically. Since prevention of ectopic pregnancy in IVF-ET is not reliable, the patients enrolled for IVF-ET should be considered to be at risk and closely followed up.

Adult↗
PubMed1990

[The sequela of peri-hepatitis due to Chlamydia trachomatis (Fitz-Hugh-Curtis syndrome) seen during an ectopic pregnancy].

Between January 1st and May 31 1989, there were 31 cases of perihepatic adhesions (Fitz-Hugh-Curtis syndrome) about 90 ectopic pregnancies (rate: 34 p. cent). The Chlamydia's serology is positive at 1/64 level in 97 p. cent of cases and at 1/256 level in 72 p. cent. Only three cases are not allied with pelvic disease. Peri-splenitis accompanies severe hepatitis (3 cases) and no perinephritis was observed in this study. The authors emphasize the wish to explore perihepatic space in all pelvic surgery. In the department of Gynecology and Obstetrics at the University Hospital of Libreville, increased the rate of ectopic pregnancy (1 for 44 deliveries), this coincides with the increased prevalence to Chlamydia trachomatis infection (81 p. cent ectopic pregnancies and 63 p. cent deliveries). This situation creates a new and greater problem of health in sub-Saharan Africa.

Abortion, Spontaneous↗
PubMed1986

Immunohistochemical characterisation of trophoblast antigens and secretory products in ectopic tubal pregnancy.

Fetal trophoblast populations in ectopic fallopian tube pregnancy have been characterised using immunohistochemical techniques. The distribution of trophoblast membrane antigens, low molecular weight epithelial cytokeratins, epithelial membrane antigen, human chorionic gonadotrophin, human placental lactogen, and pregnancy-specific beta 1-glycoprotein in ectopic tubal pregnancy appears similar to that reported in normal early intrauterine pregnancy. These findings emphasise the potential importance of ectopic pregnancy in the study of human gestation.

Antigens, Surface↗
PubMed1988

Maternal serum alpha-fetoprotein levels in ectopic pregnancy. A prospective study.

Serum alpha-fetoprotein estimations were performed in 38 cases of ruptured or leaking ectopic pregnancy and 7 cases of ruptured, haemorrhagic corpus luteum cyst. A wide range of values was obtained, but in ectopic pregnancies, 65% of values were above the median range for each respective week of pregnancy. In 11 patients (29%), serum alpha-fetoprotein values were 2.5 times the median. In 13 patients values were within or below the normal range. The study demonstrated that in most cases of ruptured or leaking ectopic pregnancies serum alpha-fetoprotein values were significantly raised. A smaller subgroup of patients may show very low alpha-fetoprotein values in maternal serum.

Female↗
PubMed1989

A sensitive bedside urine test for human chorionic gonadotrophin in suspected ectopic pregnancy.

An ultrasensitive modification of the Tandem Icon urine test for human chorionic gonadotrophin was used by clinicians, without special training, in the evaluation of 51 women with suspected ectopic pregnancy. There were 2 false-positive results. No negative results occurred in the presence of ectopic or ongoing pregnancy. A negative result (the majority of cases) is useful for excluding the diagnosis of ectopic pregnancy. The need for observation in hospital and diagnostic surgery can be greatly reduced by the use of this test in the ward or outpatient department.

Chorionic Gonadotropin↗
PubMedDate not supplied

The contribution of previous induced abortion to tubal ectopic pregnancy.

Data from a one year prospective study of thirty-one tubal ectopic pregnancies and ninety-three matched controls is presented. Compared with the controls, a history of induced abortion, was not only statistically significantly more frequent amongst the subjects (P less than 001) but was the Penultimate cyesis in 41.9% of ectopic cases as against 3.2% of the controls (P less than 001). Non-physicians provided 51.6% and 3.3% of induced abortions in the study and control groups respectively. Complications occurred in 51.6% of study population and 6.5% of controls. It is concluded that induced abortions created the predispotion to tubal implantation in the study population and therefore a reduction in the incidence of illegally induced abortion in the community can reduce the incidence of ectopic tubal gestation and tubal infertility.

Abortion, Illegal↗
PubMedDate not supplied

[Cushing syndrome due to ectopic ACTH secretion].

The authors studied 8 patients (4 males and 4 females) with Cushing's syndrome due to ectopic ACTH secretion. Chronological age ranged from 15 to 45 years and duration of the disease ranged from 3 to 48 months. All patients presented typical signs of Cushing's syndrome, blood hypertension, and four of them had hyperpigmentation of the skin. Five patients had fasting hyperglycemia and all patients but one had serum hypokalemia (serum K = 2.2 to 3.9mEq/l). The circadian rhythm of cortisol was absent in all patients and basal cortisol levels were elevated in all patients but one. Basal ACTH levels evaluated in 7 patients were elevated in 6 (29 to 1050 pg/ml-MRC). One patient presented normal depression of urinary 17-OH after two days of dexamethasone and normal increase of urinary 17-OH and serum 11-dexycortisol after methyrapone. Four patients had carcinoid tumor (3 thymic and 1 bronchial), two had pancreatic islets cell tumors, one had bilateral pheochromocytoma and medular carcinoma of the thyroid, and one had oat cell carcinoma of the lung and medular carcinoma of the thyroid. Thoracic X-rays identified the ectopic ACTH secretion tumor in four cases, all confirmed by CT scan. Abdominal CT showed a difuse enlargement of the adrenals in seven cases and bilateral nodules in one case (pheochromocytomas). Six patients died within 3 years of the diagnosis. The authors concluded that clinical and hormonal findings could mislead the findings of ACTH ectopic secretion and Cushing's disease, and suggest that thoracic X-rays and CT scans of the skull, thorax, and abdome should be done in all cases of Cushing's syndrome.

ACTH Syndrome, Ectopic↗
PubMed1989

[Diagnosis of ectopic pregnancy].

The diagnosis of ectopic pregnancy rests on the results of plasma beta-HCG hormone assays and on those of ultrasonography. If the plasma level of beta-HCG is lower than 10 m IU/ml, the woman is not pregnant; if it is higher than 10 IU/ml, ectopic pregnancy is excluded when ultrasounds show a gestation sac within the uterine cavity from the 5th week of amenorrhoea onward. The diagnosis of ectopic pregnancy is certain when ultrasounds show a gestation sac outside the uterine cavity; it is highly probable when they show an inhomogeneous masson the side of the uterus or a collection of blood in Douglas' pouch.

Chorionic Gonadotropin↗
PubMed1989

Ectopic pregnancy. What to do during the 20-day window.

An analysis of serial serum human chorionic gonadotropin (hCG) levels in 357 pregnant women revealed that the rise in hCG in normal intrauterine pregnancies differed from that in both ectopic gestations and abnormal intrauterine pregnancies. However, measurement of serial hCG levels cannot differentiate an ectopic from an abnormal intrauterine pregnancy. A protocol was developed for the management of patients with suspected ectopic pregnancy before ultrasound can reliably confirm an intrauterine gestation.

Biopsy, Needle↗
PubMed1989

Modern management of ectopic pregnancy.

The modern management of ectopic pregnancy has been influenced greatly by recent advances in human chorionic gonadotropin determination and ultrasound. Serum progesterone determination holds promise as a means of identifying abnormal gestations. Early diagnosis of tubal pregnancies has prompted conservative surgical treatment and the use of medical therapy in selected cases. Because of the improvement in diagnostic aids and conservative treatment, we are documenting a change in epidemiologic profiles. The incidence of ectopic pregnancy has increased, with a concomitant decrease in mortality. Fertility after conservative surgical procedures appears improved over that with radical treatment. However, women with ectopic pregnancies continue to have reduced fertility potential.

Chorionic Gonadotropin↗
PubMed1989

Ectopic pregnancy: the surgical epidemic.

Ectopic pregnancy has become a major health problem in terms of its morbidity and its impact on health care resources. In a case-control study involving 40 black patients, the odds ratio of developing ectopic pregnancy in current and former intrauterine device users is 11.7, which is statistically significant. The odds ratio for patients with a history of pelvic inflammatory disease is 4.4, which is statistically insignificant. A review of the current literature indicates Chlamydia salpingitis as the major cause of the ectopic epidemic. Prompt and effective treatment of this venereal disease may curtail health care expenses and prevent suffering of thousands of women each year.

Adolescent↗
PubMed1989

Unilateral twin ectopic gestation. A case report.

The occurrence of unilateral twin ectopic pregnancy has remained remarkably rare in spite of the rapidly rising incidence of singleton ectopic gestations. A ruptured ectopic pregnancy occurred with an intact twin gestation.

Adult↗
PubMed1989

[Ectopic pregnancy--still a challenge in gynecology. A contribution to diagnosis and therapy].

The diagnostic and therapeutic management in 80 cases with ectopic pregnancy is analysed. Only in 36 cases (45%) there was an accordance of installation diagnosis with the intraoperative status. 44 patients (55%) were suspicious to suffer from acute pelvic inflammatory disease, abortion or irregular uterine bleedings. Only in 28 cases (35%) the clinical symptomatology was so characteristic for ectopic pregnancy that operation had been performed without any other diagnostic procedures. In 34 cases (43%) a laparoscopy was necessary to get the correct diagnosis. In all the other 18 patients (22%) the indication for operation was made by punction of the cul-de-sac, curettage, and/or ultrasound. Because of an increased blood loss more than 500 ml an intra- or postoperative blood transfusion was necessary in about 1/3 of all treated patients. In 32% it was possible to preserve the fallopian tube. The corresponding operative procedure consisted of salpingotomy and manual expression of tubal pregnancy. Local vasoconstrictive acting substances are recommended. If there are hints at an ectopic pregnancy by histologic examination of tissue got by curettage quick and well-organized management is necessary to use the possibility of conservative operation-procedures. Histologic examination of all abortion tissue is requested.

Adolescent↗