Rare uterine serosal pregnancy after in vitro fertilization in a woman with bilateral salpingectomy

Objective:To improve the understanding of ectopic pregnancy after bilateral salpingectomy through case analysis and literature review.Method:A case of uterine serosal pregnancy after in vitro fertilization and embryo transfer(IVF-ET)in a woman with bilateral salpingectomy was reported in detail and summarized,and relevant literatures searched in Pubmed were analyzed.Results:The patient had a sudden abdominal pain 18 days after transplantation.Ultrasound showed no pregnancy sac in the intrauterine cavity and bilateral adnexal areas,but there was a large amount of fluid in the Pouch of Douglas,which was an indication for surgical exploration.During the operation,the pregnancy tissue was found on the uterine serosal and cleared in time.And the patient recovered well after surgery.Review of the literatures showed that most of ectopic pregnancies after bilateral salpingectomy were treated surgically and had a good prognosis.Conclusion:Ectopic pregnancy after bilateral salpingectomy is extremely rare and should be early judged by the patients’signs.Surgical treatment timely can achieve good outcome.

Post-salpingectomy interstitial heterotopic pregnancy after in vitro fertilization and embryo transfer:A case report

BACKGROUND Heterotopic pregnancy(HP)refers to the coexistence of ectopic pregnancy and intrauterine pregnancy.Salpingectomy is proposed as a pretreatment before in vitro fertilization and embryo transfer(IVF-ET)to reduce the risk of HP.HP after IVF-ET occurs in women who had already underwent bilateral salpingectomy,even though it is extremely rare.CASE SUMMARY A case of a 29-year-old woman with recurrent interstitial HP after IVF-ET following salpingectomy is presented.The main symptom was a sudden and worsening pelvic pain.Physical examinations revealed signs of peritoneal bleeding and irritation with stable vital signs.Transvaginal ultrasound showed a live intrauterine pregnancy and another live embryo with cardiac activity in the left cornu extending beyond the lateral edge of the uterus.Her hemoglobin concentration was 8.0 g/dL,and serum human chorionic gonadotropin value was 171116.9 mIU/mL.With the diagnosis of ruptured HP with internal bleeding,an emergency laparoscopic resection of left cornu was performed.The interstitial pregnancy was removed with caution to protect the intrauterine pregnancy.After the surgical treatment,the intrauterine pregnancy continued with no complications.A healthy baby was delivered by caesarean section at 39 wk.Outcomes of another three cases are further summarized.CONCLUSION Post-salpingectomy HP is a rare but challenging condition.Surgical treatment is preferred in the case with a viable intrauterine pregnancy.

Current Updates on Salpingectomy for the Prevention of Ovarian Cancer and Its Practice Patterns Worldwide

A paradigm shift of the origin of ovarian cancer to fallopian tube has brought more focus on bilateral salpingectomy as a preventive method for ovarian cancer. Bilateral salpingectomy has shown a dramatic reduction in the risk of ovarian cancer. Bilateral salpingo-oophorectomy has been a long-used practice to prevent ovarian cancer, but it brings surgical menopause and an increased mortality rate to women undergoing such a surgery at the age of <47.5. With the prophylactic bilateral salpingectomy, however, the ovarian function remains unaltered. Recent studies have shown that prophylactic salpingectomy was helpful not only in preventing high-grade serous type ovarian cancer, but also in decreasing adnexal pathologies. With the publication of committee opinion, more practitioners have accepted this proposal, but some are more concerned about its disadvantages. This review illustrates the latest updates on salpingectomy as a preventive method for ovarian cancer, including its advantages and disadvantages, clinicians' opinions, public opinions, so as to find out Obstetricians' and Gynecologists' practice pattern related to opportunistic salpingectomy worldwide.

Effect of modified laparoscopic salpingectomy on ovarian reserve:Changes in the serum antimüllerian hormone levels

Objective:To retrospectively estimate the impact of modified laparoscopic salpingectomy on the ovarian reserve in infertile women.Methods:There were 74 infertile women undergone modified laparoscopic salpingectomy from June 2016 to January 2017,and their levels of serum antimüllerian hormone,basal follicle-stimulating hormone and estradiol were reviewed retrospectively.Results:No significant change was detected in serum antimüllerian hormone at 3 months after surgery compared to preoperative level(p=0.857).Similar changes were observed for the basal follicle-stimulating hormone(p=0.102)and estradiol(p=0.233)level.Conclusions:Our results revealed that modified laparoscopic salpingectomy might be a valuable treatment for hydrosalpinx before in vitro fertilization.

Assisted Reproduction of Pretreatment with Laparoscopic “Core-pulling” Salpingectomy for Patients with Hydrosalpinx before in vitro Fertilization Embryo Transfer

Objective To investigate the reproduction-assisting effects of laparoscopic ＂corepulling＂ salpingectomy for patients with hydrosalpinx on ovarian reserve,responsiveness to stimuli and outcomes of in vitro fertilization and embryo transfer（IVF-ET）.Methods Infertile females receiving treatment in Reproductive Medicine Center of Yantai Yuhuangding Hospital due to fallopian tube disorders（n=214） were enrolled from July 2006 to December 2007 and further divided into three groups.＂Core-pulling＂ procedure group（group A） consisted of patients receiving pretreatment with ＂corepulling＂ salpingectomy due to hydrosalpinx in our center（n=31）,wherein 16 patients received IVF-ET.Conventional procedure group（group B） consisted of patients receiving conventional salpingectomy for hydrosalpinx or ectopic pregnancy in our center or other institutes prior to IVF-ET（n=59）.Control group（group C） consisted of patients receiving IVF-ET without the history of previous hydrosalpinx or salpingectomy（n=124）.Results At baseline,the antral follicle count of group B was significantly less than that of groups A and C（8.6±2.5 vs 8.3±2.0 vs 9.8±2.4）.The mature oocytes retrieved numbered less than the other two groups,in a statistically significant manner compared with group C（13.1±5.7 vs 10.6±5.0 vs 12.0±6.2）.Patients of groups A and B received more gonadotropin while the dosage of group B differed significantly from group C（31.0±17.7 vs 37.6±8.3 vs 30.0±4.6）.E2 level on hCG injection day was slightly lower in group B than in the other two groups,statistically significant compared with that of group C,but not compared with that of group A.After receiving IVF-ET,patients of group A showed significantly higher conception rate than groups B and C（62.5% vs 43.6% vs 39.2%）.Conclusion Compared with the conventional procedure,laparoscopic ＂core-pulling＂ salpingectomy should be recommended for patients with hydrosalpinx intending to receive IVF-ET,which did not interfere with the ovarian reserve or responsiveness but improve the conception rate in clinical practice.

Clinical Analysis on Laparoscopic Salpingectomy for Ectopic Pregnancy Following IVF/ICSI-ET

Objective To investigate whether laparoscopic surgery is valuable during early pregnancy and its influence on delivery outcome of the patients.Methods A retrospective analysis was undertaken of 14 heterotopic pregnancies conceived by IVF/ICSI-ET and underwent laparoscopic salpingectomy from December 2001 to September 2009.Results The mean age of 14 patients was 29 ± 5.3 years with range of 21-39 years.The ectopic pregnancy was located in the ampulla（11 patients,78.57%） and isthmus（3 patients,21.43%）.All 14 patients underwent successful laparoscopic salpingectomy without complications.Eleven（78.57%） patients delivered live singleton infants at full term via caesarean section while 3（21.43%） had spontaneous abortion.The birth weight of viable newborns ranged from 2 600 g to 3 720 g and had a high Apgar score.Conclusion During early pregnancy,the heterotopic pregnancy should be diagnosed and treated early and laparoscopic salpingectomy can be a safe and effective choice.The well experienced surgeons and accessibility of the modern equipments are mandatory.

Ectopic Pregnancy: Epidemiological, Clinical, Therapeutical, Anatomopathological Aspects and Prognosis at the Department of Obstetrics and Gynecology of the Teaching Hospital Souro Sanou of Bobo-Dioulasso: About 79 Cases and Literature Review

Objective: To study the epidemiological, clinical, therapeutical, anatomopathological aspects and prognosis of the ectopic pregnancy. Methodology: It was a transversal and descriptive study from January 1st to December 31st 2018 at the department of obstetrics and gynecology of the Teaching Hospital Sourô Sanou of Bobo-Dioulasso. Results: During the study period, we registered 4706 deliveries with 1272 cases of cesareans and 79 cases of ectopic pregnancy with a frequency of 1 ectopic pregnancy for 60 deliveries and 6 ectopic pregnancies for 100 caesareans. The average age of the patients in our study was 28.66 years old (19 - 45 years) and the average parity of 1.96 [0 - 6]. Married women represented 83.54 % of the workforce. The risk factors were dominated by sexual transmitted diseases (25.31%) and abortions (20.25%). Clinical signs were dominated by pelvic pain (100% of cases), metrorrhagea (86.5% of cases) and amenorrhea (64.6% of cases). Culdocentesis brought lysed incoagulable blood in 83.7% cases. The immunological pregnancy test was positive in 100% of cases. Plasma beta dosage was carried out in 2 cases. Salpingectomy was performed in 97.4% cases. The site of the ectopic pregnancy was interstitial in 11.3% cases, isthmic in 8.86% cases, infundibular in 11.3% cases, ampullar in 77.22% cases. On the anatomopathological level, we noted an acute salpingitis in 23.38% cases and a chronic salpingitis in 44.94% cases. Postoperative were simple in 97.7% of cases and we deplored one case maternal death. Conclusion: Ectopic pregnancy is a surgical emergency of the first trimester pregnancy. The delay in diagnosis is common in our context, with as consequence a mutilated treatment. The etiological factors are dominated by the chronic salpingitis and the acute salpingitis. The prevention is based on combatting genital infections, promoting contraceptive methods and a good post abortion care.

Prevention,diagnosis,and management of interstitial pregnancy:A review of the literature

Objective:The incidence of interstitial pregnancy(IP)has increased by using assisted reproductive technology,especially after ipsilateral salpingectomy.This review aimed to examine the current state of prevention,risk factors,diagnosis,and management of IP,based on the current literature.Data sources:We searched PubMed for English language articles published up to June 2018.The search terms included interstitial pregnancy,ectopic pregnancy or cornual pregnancy,angular pregnancy,and combinations of these terms.Study selection:Articles were obtained and reviewed to analyze risk factors,diagnosis,prevention,and management of IP.Results:Ipsilateral salpingectomy is the main high-risk factor of IP,especially after in vitro fertilization.Cornual suture at the time of salpingectomy helps to reduce the IP rate.Laparoscopic cornuostomy appears to be an effective treatment in intact cases,although it sometimes needs to be combined with methotrexate therapy in ruptured cases complicated by persistent disease.

Negative Pregnancy Test—Can It Confidently Rule out an Ectopic?

We have presented an unusual case of ectopic pregnancy with the negative urinary pregnancy test and a very low level of serum beta-hCG (11 IU/L). Ultrasound scan revealed right adnexal mass. Medical management and laparoscopic salpingectomy allowed for a favourable outcome.

Factors Affecting Success of Laparoscopic Salpingostomy for Tubal Ectopic Pregnancy: One Hundred Case Experience

Objective: The aim of this work is to predict those patients who will have a successful laparoscopic salpingostomy from those who will be obligated to go for salpingectomy. Methods: This study included 100 cases of diagnosed ectopic pregnancy in low parity women and was prepared for laparoscopic salpingostomy versus salpingectomy. Clinical data were collected from the patients (parity, gestational age and clinical presentation), b-hcg, ultrasound data (vascularity of the mass, viability of fetal pole and site of the ectopic in relation of the ipsilateral ovary), laparoscopic data (presence of mass invasion of the tube, free fluid in Douglas pouch, start of tubal abortion and site of ectopic). Then we started to do salpingostomy on the antimesenteric border of fallopian tube using the spatula with monopolar diathermy and try to remove the conceptus from the tube with hydro dissection and check bleeding from the implantation site, only cauterization of the edges of the tubes at the site of salpingostomy was allowed. The process was called to be successful if no more bleeding from the fallopian tube and tubes were conserved, but it was a failed procedure if too much bleeding from the bed of fallopian tube and laparoscopic salpingectomy was done. Results: 28 cases (28%) had laparoscopic salpingostomy (success group) and 72 cases (72%) failed salpingostomy and we went for laparoscopic salpingectomy (failure group). 67 cases with the ectopic in the medial 1/2 of the tube (from which 15 case had salpingostomy and 52 cases had salpingectomy) and 33 cases with ectopic in the lateral 1/2 of the tube (from which 12 cases had salpingostomy and 20 cases had salpingectomy) with no significant difference in both groups (P value 0.075). 42 case showed start of tubal abortion of which 24 cases (57.2%) had salpingostomy and 18 cases (42.8%) had salpingectomy with highly significant difference between both groups (P value 0.000). 52 cases during laparoscopy showed invasion of the mass to the fallopian tube and impending tubal rupture, from this group 21 cases had salpingostomy and 31 cases had salpingectomy. Conclusions: In tubal pregnancy, presence of non-viable fetal pole together with signs of start of tubal abortion and presence of mild free fluid in Douglas pouch and no mass invasion of the fallopian tube can effectively predict the success of laparoscopic salpingostomy and tubal conservation with no need for salpingectomy in low parity females.

Spontaneous Bilateral Tubal Ectopic Pregnancy:A Case Report

Bilateral ectopic pregnancy is the rarest form of ectopic pregnancy. We report a case of spontaneous bilateral tubal ectopic pregnancy diagnosed intra operatively. A 30-year-old patient was admitted to the emergency room of N’Djamena mother and child hospital complaining of vaginal bleeding and abdominal pain. Salpingectomy left tube and salpingotomy right tube were performed without complication and that histopathological report confirmed the diagnosis.

Laparoscopic management of recurrent ectopic pregnancy: A retrospective cohort study describing 10-years of experience in a tertiary care hospital

Objective:Recurrent ectopic pregnancy(REP)is rare,but can have severe consequences for patients.The aim of this study was to report outcomes of laparoscopic management of REP in our center.Methods:Retrospective cohort study including REP treated surgically at a single,tertiary-care academic medical center between 2009 and 2018.All patients undergoing laparoscopic salpingostomy or salpingectomy were included.Patients were then followed up to monitor outcomes of future reproductive events.Results:Of 41 eligible patients,14 suffered from ipsilateral recurrence including 5 cases of tubal stump pregnancy.In the other 27 cases,the REP occurred in the contralateral tube that was previously unaffected.All patients with ipsilateral recurrence underwent salpingectomy.In patients with contralateral recurrence,salpingectomy was carried out in 21 patients(77.8%)and salpingostomy in 6 patients(22.2%).32 patients(78%)subsequently sought to conceive either spontaneously or by in vitro fertilization.The subsequent live birth rates were 51.8%(14/27)in the salpingectomy group and 60.0%(3/5)in the salpingostomy group.Conclusion:Where trained laparoscopists and adequate facilities are available,it is possible to achieve acceptable reproductive outcomes after REP irrespective of the surgical approach.