Broad ligament pregnancy is a rare event and always delays in diagnosis. A pregnant woman in early twenties presented for our center. Routine ultra-sonography revealed a first trimester abdominal pregnancy. Broad liga...Broad ligament pregnancy is a rare event and always delays in diagnosis. A pregnant woman in early twenties presented for our center. Routine ultra-sonography revealed a first trimester abdominal pregnancy. Broad ligament pregnancy was diagnosed intraoperation and treated with laparoscopic resection successfully. The patient has a history of right tubal pregnancy 2 years ago and terminated with Laparoscopic Salpingostomy. According to the long term followed-up for the patient, we found that she had recurrent right tubal pregnancy 5 months after the broad ligment ectopic pregnancy. She received the salpingectomy laparoscopically. We presented the case to discuss the clinical management of broad ligament ectopic pregnancy and options of surgical treatments of tubal pregnancy to reduce the risk of recurrent.展开更多
Serous tubal intraepithelial carcinoma is a putative precursor of high-grade serous carcinoma, which is the most common histological type of ovarian or pelvic peritoneal cancer. Serous tubal intraepithelial carcinoma ...Serous tubal intraepithelial carcinoma is a putative precursor of high-grade serous carcinoma, which is the most common histological type of ovarian or pelvic peritoneal cancer. Serous tubal intraepithelial carcinoma is commonly found in patients with breast cancer susceptibility gene mutations who undergo risk-reducing salpingo-oophorectomy. Incidental serous tubal intraepithelial carcinoma found by a non-prophylactic surgery is rare. A 33-year-old woman referred to our hospital for a diagnosis of ectopic pregnancy. She underwent a laparoscopic right salpingectomy. Pathologically, ectopic pregnancy in the ampulla of the right fallopian tube was confirmed and serous tubal intraepithelial carcinoma was observed in the fallopian tube. Subsequently, she underwent a laparoscopic hysterectomy, bilateral oophorectomy, and left salpingectomy as additional treatment. She has experienced no recurrence thus far for 37 months since the surgery.展开更多
Objective To investigate the safety, feasibility, and effectiveness of uterine artery embolization in association with methotrexate(MTX) infusion for the treatment of tubal ectopic pregnancy. Methods Fifty-one patient...Objective To investigate the safety, feasibility, and effectiveness of uterine artery embolization in association with methotrexate(MTX) infusion for the treatment of tubal ectopic pregnancy. Methods Fifty-one patients with tubal ectopic pregnancy were referred for interventional management. All patients received super-selective arteriography of the uterine artery, were infused with 50–100 mg methotrexate(MTX) through a catheter, and underwent embolization of the uterine artery with a gel-foam pledge. Clinical presentation, findings of physical examination, β-HCG values, and the size of the ectopic mass were documented for comparison. The concentration of MTX in blood was evaluated at 0.5, 6, 12, 24, 36, and 48 hours after the procedure. Results Forty-seven out of the 51 patients had clinical resolution of their tubal pregnancy(92.2%). The average time for the β-HCG value to decrease and come back to normal was 9.16 ± 2.54 days(mean +/-SD). MTX levels in peripheral blood could not be detected for patients who received 50 or 75 mg MTX at 36 hours after the procedure, while the MTX level was 0.01 μmol/L at 48 hours after the procedure for patients who received 100 mg. Out of the 4 cases whose ectopic mass size was ≥5 cm, 3 failed to respond to the treatment; however, those whose ectopic mass size was ≤5 cm responded positively to the treatment, regardless of the β-HCG concentration and abdominal bleeding, except for 1 patient who had to undergo laparoscopy for severe abdominal pain and who showed a reduction in her β-HCG level. Conclusion Uterine artery embolization in association with methotrexate infusion is safe and effective in the treatment of tubal ectopic pregnancy, especially for those women with mild to moderate bleeding, or for those at risk of a major hemorrhage. The selection criterion of mass size >5 cm should, therefore, be carefully considered.展开更多
This research paper presents the infrequent case of a heterotopic pregnancy based on a tubal ectopic pregnancy with molar degeneration in concurrent eutopic pregnancy. Treatment with evacuation/suction curettage and p...This research paper presents the infrequent case of a heterotopic pregnancy based on a tubal ectopic pregnancy with molar degeneration in concurrent eutopic pregnancy. Treatment with evacuation/suction curettage and perlaparoscopic salpingectomy was required. This case report confirms what is biologically valid in the statistically unlikely.展开更多
Objective: To compare the effects of treatment of tubal pregnancy (TP)and its following second pregnancy by intratubal methotrexate injection(IMI) alone and combination of IMI with Chinese herbal medicine. Methods: Th...Objective: To compare the effects of treatment of tubal pregnancy (TP)and its following second pregnancy by intratubal methotrexate injection(IMI) alone and combination of IMI with Chinese herbal medicine. Methods: Thirty-five patients suffering from unruptured TP were divided into two groups at random, to the 19 patients in the treated group, the treatment of combined IMI with Ectopic Pregnancy decoction No. 2 (EP2, a traditional Chinese medical decoction) was applied, and to the other 16 patients in the control group, IMI alone was applied for control. Serum concentrations of human chorionic gonadotro-pinβ(β-HCG), size of the gestational sac, existent time of fetal cardiac beat and peritoneal fluid were measured before and after treatment. And hysterosalpingography were performed 6 months after ending the treatment to verify the presence of tubal obstruction and the condition of relapse.Results: The treatment of all the 35 women was successful. The recovery duration of serumβ-HCG, disappearance duration of TP sac and existent time of peritoneal fluid in the treated group were 20.0±7. 8 days, 1.2±0. 7 months and 10. 7±2. 9 days respectively, which were significantly different from those in the control group (24. 4 ±8.1 days, 3.6±1.7 months and 19.1±3. 2 days respectively(P<0. 05, P<0.01 and P<0. 05 respectively), but the existent time of fetal cardiac beat in the two groups (8.8±1. 9 days vs 9.0±1. 3 days) was not significantly different (P>0.05). The post-treatment oviduct obstructive rate in the two groups was 10.5% and 43.8% respectively, that in the treatment group was less significant (P<0.05). The relapse rate of EP in the treatment group was insignificantly different from that in the control group (5.3% vs 18.8%, P>0.05). Conclusion: The two therapies (IMI alone and IMI combined with EP2) could obtain e-qual efficacy in curing TP. Compared with IMI alone, the combined therapy appears to have the effects of accelerating the resorption of gestational sac and peritoneal fluid, improving the patency of fallopian tube and ameliorating the circumstance of pregnancy, which is favorable to improvement of the re-pregnancy rate and reduction of the re-occurrence of ectopic pregnancy as well as to the enhancement of the effect of IMI in killing trophocytes. But there is not enough proof to show the potency of EP2 in killing embryo.展开更多
Laparoscopic surgery is the standard surgical approach for ectopic pregnancy. However, some surgeons prefer laparotomy for patients with acute bleeding. We evaluated four cases of tubal pregnancy with massive hemoperi...Laparoscopic surgery is the standard surgical approach for ectopic pregnancy. However, some surgeons prefer laparotomy for patients with acute bleeding. We evaluated four cases of tubal pregnancy with massive hemoperitoneum (>800 ml) and performed laparoscopic surgery. The patient age ranged from 20 to 37 years, and the gestational age ranged from 5 to 8 weeks. All cases were hemodynamically unstable. Two cases had hemoperitoneum of >2000 mL, which was caused by the rupture of the left isthmus tube. In three cases, surgery could be started within approximately 30 min, and in one case, the start time extended owing to difficulty in anesthesia introduction. Moreover, in three cases, the target lesion was reached within 7 min, and the lesion was excised in approximately 20 min from the start of insufflation, and in one case with a lesion exceeding 7 cm, the time extended. All patients were safely treated via laparoscopic surgery. To initiate surgery without deterioration of the hemodynamic condition, blood transfusion can be started simultaneously with preparation for laparoscopic surgery. Lifting the lesion with a pair of forceps can help immediately stop bleeding, even if it is difficult to secure the visual field owing to massive bleeding. When there is difficulty in anesthesia or a large pregnancy lesion, care should be taken to avoid an increase in the amount of bleeding associated with extension of the perioperative period.展开更多
A 34-year-old woman came into the Emergency Department of PUMCH with the complaint of sudden lower abdominal pain lasting 4 hours on May 1st, 2004. She had normal menstruation cycle with a period of 30 days. But her l...A 34-year-old woman came into the Emergency Department of PUMCH with the complaint of sudden lower abdominal pain lasting 4 hours on May 1st, 2004. She had normal menstruation cycle with a period of 30 days. But her last menstruation was started 37 days ago. She experienced laparosalpingectomy for right tubal pregnancy on Jan. 23rd, 2003. During that operation, it was found that she had pelvic adhesions in the Douglas pouch.展开更多
Ectopic pregnancy is defined as the fertilized ovum implants in a location outside the endometrial cavity, remains to be an important cause of maternal morbidity and mortality worldwide and is a health problem with in...Ectopic pregnancy is defined as the fertilized ovum implants in a location outside the endometrial cavity, remains to be an important cause of maternal morbidity and mortality worldwide and is a health problem with incidence ranges between 0.25% and 2% of all pregnancies. In our study, in Izmir Katip Celebi University Ataturk Training and Research Hospital, Department of Obstetrics and Gynecology from 2011 to 2013, 96 cases with diagnosis of ectopic pregnancy managed by the adapted RCOG’s Guide were analyzed retrospectively. The data were analyzed as follows: age, the history of operation, smoking, the presence of intrauterine device, blood groups, hemoglobin, platelets, values of B-hCG, the diagnostic interval, intra-abdominal free fluid and/or acute abdomen, the method of treatment and the success of treatment.展开更多
文摘Broad ligament pregnancy is a rare event and always delays in diagnosis. A pregnant woman in early twenties presented for our center. Routine ultra-sonography revealed a first trimester abdominal pregnancy. Broad ligament pregnancy was diagnosed intraoperation and treated with laparoscopic resection successfully. The patient has a history of right tubal pregnancy 2 years ago and terminated with Laparoscopic Salpingostomy. According to the long term followed-up for the patient, we found that she had recurrent right tubal pregnancy 5 months after the broad ligment ectopic pregnancy. She received the salpingectomy laparoscopically. We presented the case to discuss the clinical management of broad ligament ectopic pregnancy and options of surgical treatments of tubal pregnancy to reduce the risk of recurrent.
文摘Serous tubal intraepithelial carcinoma is a putative precursor of high-grade serous carcinoma, which is the most common histological type of ovarian or pelvic peritoneal cancer. Serous tubal intraepithelial carcinoma is commonly found in patients with breast cancer susceptibility gene mutations who undergo risk-reducing salpingo-oophorectomy. Incidental serous tubal intraepithelial carcinoma found by a non-prophylactic surgery is rare. A 33-year-old woman referred to our hospital for a diagnosis of ectopic pregnancy. She underwent a laparoscopic right salpingectomy. Pathologically, ectopic pregnancy in the ampulla of the right fallopian tube was confirmed and serous tubal intraepithelial carcinoma was observed in the fallopian tube. Subsequently, she underwent a laparoscopic hysterectomy, bilateral oophorectomy, and left salpingectomy as additional treatment. She has experienced no recurrence thus far for 37 months since the surgery.
基金supported by a grant from Jiangsu Provincial Medical Youth Talent(QNRC2016711)
文摘Objective To investigate the safety, feasibility, and effectiveness of uterine artery embolization in association with methotrexate(MTX) infusion for the treatment of tubal ectopic pregnancy. Methods Fifty-one patients with tubal ectopic pregnancy were referred for interventional management. All patients received super-selective arteriography of the uterine artery, were infused with 50–100 mg methotrexate(MTX) through a catheter, and underwent embolization of the uterine artery with a gel-foam pledge. Clinical presentation, findings of physical examination, β-HCG values, and the size of the ectopic mass were documented for comparison. The concentration of MTX in blood was evaluated at 0.5, 6, 12, 24, 36, and 48 hours after the procedure. Results Forty-seven out of the 51 patients had clinical resolution of their tubal pregnancy(92.2%). The average time for the β-HCG value to decrease and come back to normal was 9.16 ± 2.54 days(mean +/-SD). MTX levels in peripheral blood could not be detected for patients who received 50 or 75 mg MTX at 36 hours after the procedure, while the MTX level was 0.01 μmol/L at 48 hours after the procedure for patients who received 100 mg. Out of the 4 cases whose ectopic mass size was ≥5 cm, 3 failed to respond to the treatment; however, those whose ectopic mass size was ≤5 cm responded positively to the treatment, regardless of the β-HCG concentration and abdominal bleeding, except for 1 patient who had to undergo laparoscopy for severe abdominal pain and who showed a reduction in her β-HCG level. Conclusion Uterine artery embolization in association with methotrexate infusion is safe and effective in the treatment of tubal ectopic pregnancy, especially for those women with mild to moderate bleeding, or for those at risk of a major hemorrhage. The selection criterion of mass size >5 cm should, therefore, be carefully considered.
文摘This research paper presents the infrequent case of a heterotopic pregnancy based on a tubal ectopic pregnancy with molar degeneration in concurrent eutopic pregnancy. Treatment with evacuation/suction curettage and perlaparoscopic salpingectomy was required. This case report confirms what is biologically valid in the statistically unlikely.
文摘Objective: To compare the effects of treatment of tubal pregnancy (TP)and its following second pregnancy by intratubal methotrexate injection(IMI) alone and combination of IMI with Chinese herbal medicine. Methods: Thirty-five patients suffering from unruptured TP were divided into two groups at random, to the 19 patients in the treated group, the treatment of combined IMI with Ectopic Pregnancy decoction No. 2 (EP2, a traditional Chinese medical decoction) was applied, and to the other 16 patients in the control group, IMI alone was applied for control. Serum concentrations of human chorionic gonadotro-pinβ(β-HCG), size of the gestational sac, existent time of fetal cardiac beat and peritoneal fluid were measured before and after treatment. And hysterosalpingography were performed 6 months after ending the treatment to verify the presence of tubal obstruction and the condition of relapse.Results: The treatment of all the 35 women was successful. The recovery duration of serumβ-HCG, disappearance duration of TP sac and existent time of peritoneal fluid in the treated group were 20.0±7. 8 days, 1.2±0. 7 months and 10. 7±2. 9 days respectively, which were significantly different from those in the control group (24. 4 ±8.1 days, 3.6±1.7 months and 19.1±3. 2 days respectively(P<0. 05, P<0.01 and P<0. 05 respectively), but the existent time of fetal cardiac beat in the two groups (8.8±1. 9 days vs 9.0±1. 3 days) was not significantly different (P>0.05). The post-treatment oviduct obstructive rate in the two groups was 10.5% and 43.8% respectively, that in the treatment group was less significant (P<0.05). The relapse rate of EP in the treatment group was insignificantly different from that in the control group (5.3% vs 18.8%, P>0.05). Conclusion: The two therapies (IMI alone and IMI combined with EP2) could obtain e-qual efficacy in curing TP. Compared with IMI alone, the combined therapy appears to have the effects of accelerating the resorption of gestational sac and peritoneal fluid, improving the patency of fallopian tube and ameliorating the circumstance of pregnancy, which is favorable to improvement of the re-pregnancy rate and reduction of the re-occurrence of ectopic pregnancy as well as to the enhancement of the effect of IMI in killing trophocytes. But there is not enough proof to show the potency of EP2 in killing embryo.
文摘Laparoscopic surgery is the standard surgical approach for ectopic pregnancy. However, some surgeons prefer laparotomy for patients with acute bleeding. We evaluated four cases of tubal pregnancy with massive hemoperitoneum (>800 ml) and performed laparoscopic surgery. The patient age ranged from 20 to 37 years, and the gestational age ranged from 5 to 8 weeks. All cases were hemodynamically unstable. Two cases had hemoperitoneum of >2000 mL, which was caused by the rupture of the left isthmus tube. In three cases, surgery could be started within approximately 30 min, and in one case, the start time extended owing to difficulty in anesthesia introduction. Moreover, in three cases, the target lesion was reached within 7 min, and the lesion was excised in approximately 20 min from the start of insufflation, and in one case with a lesion exceeding 7 cm, the time extended. All patients were safely treated via laparoscopic surgery. To initiate surgery without deterioration of the hemodynamic condition, blood transfusion can be started simultaneously with preparation for laparoscopic surgery. Lifting the lesion with a pair of forceps can help immediately stop bleeding, even if it is difficult to secure the visual field owing to massive bleeding. When there is difficulty in anesthesia or a large pregnancy lesion, care should be taken to avoid an increase in the amount of bleeding associated with extension of the perioperative period.
文摘A 34-year-old woman came into the Emergency Department of PUMCH with the complaint of sudden lower abdominal pain lasting 4 hours on May 1st, 2004. She had normal menstruation cycle with a period of 30 days. But her last menstruation was started 37 days ago. She experienced laparosalpingectomy for right tubal pregnancy on Jan. 23rd, 2003. During that operation, it was found that she had pelvic adhesions in the Douglas pouch.
文摘Ectopic pregnancy is defined as the fertilized ovum implants in a location outside the endometrial cavity, remains to be an important cause of maternal morbidity and mortality worldwide and is a health problem with incidence ranges between 0.25% and 2% of all pregnancies. In our study, in Izmir Katip Celebi University Ataturk Training and Research Hospital, Department of Obstetrics and Gynecology from 2011 to 2013, 96 cases with diagnosis of ectopic pregnancy managed by the adapted RCOG’s Guide were analyzed retrospectively. The data were analyzed as follows: age, the history of operation, smoking, the presence of intrauterine device, blood groups, hemoglobin, platelets, values of B-hCG, the diagnostic interval, intra-abdominal free fluid and/or acute abdomen, the method of treatment and the success of treatment.
