Bilateral Ectopic Pregnancy Research Articles

Spontaneous bilateral ectopic pregnancy. A case report from Regional Hospital of Niamey

Spontaneous bilateral ectopic pregnancy is an extremely rare event, occurring in 1/750 to 1/580 of all ectopic pregnancies, and in 1 case in 200,000 pregnancies. Nonetheless, this occurrence appears to be on the rise owing to Assisted Reproductive Technology. In this report, we present a singular case of spontaneous bilateral ectopic pregnancy in a 28-year-old patient under our care. The diagnosis was established during exploratory laparotomy, revealing an unruptured ectopic pregnancy on the left and a ruptured ampullary ectopic pregnancy on the right tub, resulting in hemoperitoneum. Bilateral salpingectomy was performed. The patient received one pack of red blood cells transfusion in postoperative period. The recovery period was simple. She left the hospital on post-operative day 3. We recommend a systematic exploration of the contralateral fallopian tube in order to eliminate the risk of a bilateral ectopic pregnancy, which could result in a fatal outcome. Keywords: Bilateral ectopic pregnancy, Salpingectomy, Regional Hospital Center, Niger.

A Rare Case Report: Bilateral Spontaneous Twin Tubal Ectopic Pregnancy from Iran

Introduction/Background: One of the main problems of women of reproductive age is ectopic pregnancy. Lack of early diagnosis and treatment can lead to internal bleeding and death of the patient. Approximately 1.2 to 1.4% of the reported pregnancies is ectopic pregnancy and one of the rarest types of ectopic pregnancy is bilateral ectopic pregnancy, which is reported in only 0.0005% of pregnant women. Case Presentation: A 35-year-old woman with polycystic ovary syndrome, weight 65 kg and height 153 cm, referred for pregnancy. Using examination and history taking, ultrasound and β-hCG titer measurement, one of the masses at 5 to 6 weeks and in the area of the isthmus of the right tube and the other mass two weeks later at 7 to 8 weeks, in the area Infundibulum of the left tube was diagnosed. The most common complication that the patient complained about was abdominal pain and frequent bleeding. Both times, the patient underwent laparoscopy and because of the patient's condition, salpingectomy was performed on both left and right tubes of the patient. Conclusion: Due to the rarity of bilateral twin ectopic pregnancy, early diagnosis with the help of history taking and clinical examination, measurement of β-hCG titer and ultrasound is necessary. Early diagnosis can lead to the reduction of women's mortality.

Spontaneous Bilateral Ectopic Tubal Pregnancy in Low-Resource Countries: About a Case in Burkina Faso, West Africa

Spontaneous Bilateral Ectopic Tubal Pregnancy in Low-Resource Countries: About a Case in Burkina Faso, West Africa

Spontaneous bilateral tubal ectopic pregnancy preoperatively diagnosed by the ultrasound: a case report

BackgroundBilateral ectopic pregnancy is extremely rare, with a tremendous maternal mortality and morbidity risk, requiring rapid diagnosis and management. This condition is usually diagnosed during surgery, as radiologists may not pay enough attention to the contralateral side of interest. Therefore, reminding of this rare but emergent situation can be beneficial for both radiologists and gynecologists. Here we report a case of bilateral ectopic pregnancy, which was first diagnosed with ultrasound and was confirmed during laparoscopy.Case presentationA 34 years old woman complaining of light vaginal bleeding at 6 weeks of gestation by her last menstrual period presented to our institute. The serum β-HCG levels were analyzed and followed during patient’s admission. Unfortunately, serum levels weren’t decreasing and blood test titration before surgery were as: 851,894,975 IU/l (checked daily and not every 48 h because of patient’s status and being bilateral). There was no evidence of intrauterine pregnancy at the transvaginal ultrasound, but heterogeneous adnexal masses were seen at both adnexa, suspected of bilateral ectopic pregnancy. She underwent laparoscopic exploration, which confirmed the diagnosis. Bilateral salpingostomy was done to preserve fertility, and the patient’s recovery was uneventful.ConclusionsEven with a unilateral report of ectopic pregnancy preoperatively in ultrasonography, surgeons should always be aware of the probability of bilateral ectopic pregnancies anytime facing susceptible cases, especially in patients with known risk factors. Also, it is an important reminder for radiologists to check both adnexa when facing a unilateral adnexal mass resembling ectopic pregnancy.

Spontaneous bilateral tubal pregnancy - case report and review of diagnostic and treatment difficulties

Introduction. Spontaneous bilateral ectopic pregnancy is a rare condition easily overlooked or misdiagnosed. We present a case of spontaneous bilateral tubal ectopic pregnancy and discuss the difficulties in diagnosing and treating such patients. Case outline. A 39-years-old patient with a history of irregular and abundant menstrual cycles complained of pelvic pain and light bleeding after 55 days of amenorrhea. Ultrasound revealed enlarged uterus with a myoma and a heterogenic formation with echogenic ring sign beside the left ovary. Free fluid with clots was present in the pelvis. As the patient was hemodynamically unstable and ectopic pregnancy was suspected, emergency laparotomy was performed. During the surgery we found that both tubes were significantly edematous, dilated, and livid in their ampullary regions. On the left tube anterior wall rupture 15 ? 8 mm was noticeable, while right tube was intact with bleeding from its abdominal ostium. Even though the patient was not informed about the possibility of bilateral salpingectomy, after thorough consideration and due to the extent of tubal damage bilateral salpingectomy was eventually performed. Histopathological analysis confirmed the presence of decidua, partially viable and partially necrotic chorionic villi, and trophoblastic tissue in both right and left tubes. Conclusions. Careful preoperative and intraoperative examination of both Fallopian tubes as well as the whole abdominal and pelvic cavity should be mandatory during every assessment of patients with ectopic pregnancy.

Bilateral Tubal Pregnancy Complicated by Rupture of the Left Fallopian Tube

Introduction: Bilateral ectopic pregnancy is a very rare condition which occurs in 1/725 - 1/1580 ectopic pregnancies, most commonly after induced assisted reproductive techniques. Aim: To present the case of spontaneous bilateral tubal pregnancy, and the problem of insufficiency of available diagnostic methods, which causes that an accurate diagnosis can mostly be made intraoperatively. Case Report: A 37-year-old female, nulliparous, comes at the Clinic of Gynecology and Obstetrics of CCUS, complains of intense suprapubic pain, and difficulty urinating. The expected menstruation was absent for more than 2 weeks. The Grav index test was positive. Beta hCG values were 6312 IU/L. On examination, the patient was extremely pale, hypotensive, gave the impression of hemorrhagic shock, and the abdomen was diffusely palpably painful. After emergency TV ultrasound, then ultrasound and CT of the abdomen and small pelvis, which indicate a moderate amount of thicker fluid in the abdomen and small pelvis in terms of hemoperitoneum and with the left contour of the uterus an oval zone most likely to correspond to ectopic pregnancy, an indication for emergency surgery was made. A laparotomy was performed, and partly liquid and partly coagulated blood was found in the abdomen. The left tube in the isthmic part was ruptured with active bleeding. Right Fallopian tube was pathologically changed, livid, with visible suspicious pregnancy in the ampullary part. Bilateral salpingectomy was performed, and samples are sent for PHD analysis that shows the presence of chorionic villi in both tubes. Conclusion: When ectopic pregnancy is suspected, the possibility of bilateral tubal pregnancy should always be kept in mind, especially in cases accompanied by acute pelvic pain with signs of hemorrhagic shock

Bilateral tubal ectopic gestation: Complication in a patient with previous ectopic pregnancy, rare case report.

IntroductionEctopic pregnancy results of implantation of conceptus outside of endometrial cavity. It remains an important cause of maternal mortality. Spontaneous bilateral tubal pregnancies are the rare form of ectopic and are considered spontaneous when no fertility treatments are involved.Case findingsA 31-year-old nulliparous woman presented at the Family Medicine Clinic with complaints of non-specific mild lower abdominal pain for 3 days and amenorrhea for 5 weeks. Transvaginal Ultrasound showed bilateral unruptured adnexa pregnancies. The trial of medical therapy was done without success and later laparotomy salpingostomy was done. One year later patient was able to conceive and delivery well by cesareans section.DiscussionBilateral ectopic pregnancy is a unique from of twin pregnancy frequently occurring with assisted reproductive technology rather than spontaneous pregnancy. Diagnosis of bilateral ectopic pregnancy is often challenging as the clinical symptoms and signs may not be indicative of bilateral involvement. Laboratory test with βhcg levels cannot suggestive if is unilateral or bilateral nature and sonographers may be falsely reassured if they are not careful and satisfied with visualization of ectopic gestation on one side. Laparoscopic salpingostomy or salpingectomy is the gold standard treatment modality for bilateral tubal ectopic pregnancy although laparotomy may be indicated in unstable patient.Conclusion and recommendationTherefore, any women in childbearing age presenting with clinical features of acute lower abdominal pain should be considered to have potential ectopic gestation.

Simultaneous bilateral fallopian tubal pregnancy of a laparoscopic definite spontaneous unilateral ovulation: a case report

BackgroundBilateral simultaneous fallopian tubal pregnancy is one of the rarest forms of ectopic pregnancy. Due to the lack of unique features and clinical presentation to distinguish bilateral from unilateral ectopic pregnancy, challenges the diagnosis.Case reportA 27-year-old Asian woman presented with pelvic pain and vaginal bleeding. Pelvic transvaginal ultrasound showed fluid in Douglas Pouch and posterior fornix puncture revealed unclotted blood. Laparoscopic examination unveiled bilateral ectopic pregnancy with two corpus luteum visible in the right ovary, suggesting a double spontaneous unilateral ovulation. Bilateral fallopian tube fenestration and embryo extraction were performed to preserve fertility.ConclusionDiagnosis of bilateral tubal pregnancy is difficult during preoperative ultrasound examination and careful examination during laparoscopic inspection of the whole pelvic cavity to avoid missed diagnosis.

Spontaneous Bilateral Ectopic Pregnancy in a Patient With Endometriosis

Background Bilateral ectopic pregnancies (EPs) occur in 1 of 200,000 pregnancies. Evidence suggests that endometriosis is an independent risk factor for unilateral EPs. However, the link between endometriosis and bilateral EPs has not been established. Case Report We report a case of a bilateral EP in a patient with endometriosis. The patient was initially misdiagnosed with the unilateral EP. Why Should an Emergency Physician Be Aware of This? Although rare, bilateral EP should be on a differential diagnosis in a pregnant patient presenting with abdominal pain or vaginal bleeding. This includes patients presenting with worsening symptoms after the recent surgery for the unilateral EP. Endometriosis as a risk factor for bilateral EP cannot be established based on a single report, but such a report should raise awareness of the issue.

Bilateral Ectopic Pregnancy; Due to Damage of the Tubes by Chronic Gonorrhoea-Case Report

Bilateral Ectopic Pregnancy; Due to Damage of the Tubes by Chronic Gonorrhoea-Case Report

Role of Ayurveda in the Management of Female Infertility Due to Poly Cystic Ovarian Syndrome with a History of Bilateral Ectopic Pregnancy, Right Sided Salpingectomy, and Left Sided Hydrosalpinx

Poly cystic ovarian syndrome (PCOS), fallopian tubal blockage, and repeated spontaneous abortions are some of the causes of female infertility. Hormonal treatment or drilling of ovaries, microsurgery of fallopian tubes, andin vitrofertilization are the accepted standard treatment procedures. In Ayurveda, the condition is correlated with named as Vandhyatva. Acharyas have described the causes as Garbhasrava, Beeja Dushti, and Mithya Ahara Vihara. Here, we report a case of infertility secondary to PCOS with a surgical history of emergency laparoscopic right-sided salpingectomy for ectopic pregnancy. Methotrixate administration for left side ectopic pregnancy, consequently for second time and left-sided hydrosalpinx. The case was treated as per the classical reference which includes virechana karma, kala basthi, marsha nasya karma, and Uttara basthi karma. Music therapy, rasayana chikitsa, and yoga were incorporated as adjuvant therapy to achieve shuddha garbha sambhava samagri (pure factors of fertilization and conception). Adopted treatment plan has given good result with successful intrauterine pregnancy and birth of healthy female baby through cesarean section.

Bilateral Tubal Molar and Embryonic Pregnancy

Aim: To report a case of bilateral tubal molar and embryonic pregnancy diagnosed and treated at the Yalgado Ouedraogo Teaching Hospital in Ouagadougou, Burkina Faso. Observation: It was an 18-year-old patient, G2P0 with no known pathological history. She was received in obstetric emergencies for suspicion of ectopic pregnancy in a two-month amenorrhea context. At the admission, the physical examination had found a sensitivity of the hypogastric region with a cry of the umbilicus and the bleeding. At pelvic ultrasound, the uterus was empty with a medium-abundance pelvic effusion and a left extra uterine mass. The initial rate of beta HCG was 5700 ml IU per ml. A framed laparotomy was carried out. The operative exploration has revealed a right tubal pregnancy cracked and a left unbroken tubal pregnancy. The diagnosis of a bilateral ectopic pregnancy was retained. A right salpingectomy and a left tubal caesarean section were carried out. Histological analysis confirmed the diagnosis of a left embryonic ectopic pregnancy associated with a right molar ectopic pregnancy. Conclusion: The systematic use of histological analysis for any extra uterine pregnancy treatment is required to not ignore an associated molar pregnancy.

Spontaneous Synchronous Bilateral Ectopic Pregnancy

Background: The occurrence of simultaneous ectopic pregnancies in two extrauterine locations is rare, particularly in spontaneous pregnancies. Case: This article describes the case of a 32-year-old woman who presented with persistently elevated β-hCG levels after a salpingectomy for a left ectopic tubal pregnancy. Results: Follow-up elevated β-hCG levels led to the discovery of a simultaneous right tubal ectopic pregnancy. Conclusions: Bilateral ectopic pregnancy is rare but must be suspected when β-hCG is elevated after treatment of an ectopic pregnancy. β-hCG follow-up can be helpful, even if chorionic villi are present in the initial surgical specimen. (J GYNECOL SURG 33:202)

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.

A Case of Bilateral Ectopic Pregnancy Following Intra-Uterine Insemination

We describe a case of a 31-year-old lady with primary subfertility who conceived only after her third intra-uterine insemination. She was diagnosed to have a right ectopic pregnancy which failed methotrexate treatment. Diagnostic laparoscopy confirmed bilateral ectopic pregnancies. A review was conducted for any consensus reached on diagnosis and optimal management of bilateral ectopic pregnancies after artificial reproductive techniques (ARTs). A search on Pubmed was carried out for publications in peer-reviewed journals with the following keywords: bilateral tubal ectopic pregnancy, heterotopic. Ten suitable publications were retrieved. Bilateral tubal ectopic pregnancy is rare, often missed on radiology and an unexpected finding at surgery. There should be a high index of suspicion for bilateral ectopic pregnancies after ART. Poor correlation with B-hCG levels further confuses diagnostic accuracy. It is prudent to ensure accurate diagnosis of bilateral ectopic pregnancies and appropriate intervention to reduce morbidity and mortality. Salpingostomy should be considered in patients with subfertility to preserve the possibility of future pregnancies. J Med Cases. 2016;7(7):286-290 doi: http://dx.doi.org/10.14740/jmc2484w

Ultrasound diagnosis of bilateral ectopic pregnancy: Still a myth?

Bilateral ectopic pregnancy is a rare entity. If missed, it can lead to significant increase in morbidity of the patient. Our study highlights the importance of imaging in aiding in the diagnosis of this type of extrauterine pregnancy as well as the necessity of a prompt evaluation of both adnexae during laparoscopy.

Bilateral Tubal Ectopic Pregnancy: Case Report of Ectopic Pregnancy Following Intrauterine Insemination

Bilateral Tubal Ectopic Pregnancy: Case Report of Ectopic Pregnancy Following Intrauterine Insemination Bilateral tubal ectopic pregnancy is a rare clinical condition that may occur after assisted reproductive techniques or spontaneous pregnancy. We report an unusual case of bilateral ectopic pregnancy after intrauterine insemination.

Bilateral Ectopic Pregnancy: A Case Study

The incidence of ectopic pregnancy is climbing due to increasing tubal damage associated with infection, surgery, and assistive reproductive technologies. With this comes a rise in abnormal cases being presented for diagnosis and the risk of them being incorrectly handled. Bilateral ectopic pregnancies are one such abnormality, where their frequency has been so low that the differential tends not to come to mind when managing a patient with ectopic symptoms. The case study presented describes this occurrence, with the second ectopic pregnancy being missed on initial diagnosis only to be discovered when β-hCG levels failed to decline. The prognosis for a missed ectopic gestation is poor, with rupture being the most common and severe complication, making accurate diagnosis and management of bilateral ectopic pregnancy critical to patient care.

Tubal Flushing – A Novel Treatment Modality for Ectopic Pregnancy

A new technique of tubal flushing is being demonstrated in two patients- one with bilateral ectopic pregnancy and the other with unilateral ectopic pregnancy. In both patients, ectopic was located at the ampullary region. 6-7 ml of dilute vasopressin was injected into the tubal lumen just proximal to the site of ectopic gestation. The products of conception are expelled from the fimbrial end of the tube on injection of vasopressin. Both patients were followed up with β HCG estimation on the second postoperative day and then again after two weeks.

Heterochronic bilateral ectopic pregnancy after ovulation induction

Ectopic pregnancy is identified with the widely-applied assisted reproductive technology (ART). Bilateral ectopic pregnancy is a rare form of ectopic pregnancy which is difficult to be diagnosed at the pre-operation stage. In this paper, we presented an unusual case of heterochronic bilateral ectopic pregnancy after stimulated intrauterine insemination (IUI), where there has been a delay of 22 d between the diagnoses of the two ectopic pregnancies. Literature was reviewed on the occurrence of bilateral ectopic pregnancy during the past four years in the MEDLINE database. We found 16 cases of bilateral ectopic pregnancy reported since 2008, and analyzed the characteristics of those cases of bilateral ectopic pregnancy. We emphasize that ovulation induction and other ARTs may increase the risk of bilateral ectopic pregnancy. Because of the difficulty in identification of bilateral ectopic pregnancy by ultrasonography, the clinician should be aware that the treatment of one ectopic pregnancy does not preclude the occurrence of a second ectopic pregnancy in the same patient and should pay attention to the intra-operation inspection of both side fallopian tubes in any ectopic pregnancy case.