Bilateral Tubal Ectopic Pregnancy Research Articles

Spontaneous bilateral tubal ectopic pregnancy: A case report

Unilateral tubal ectopic pregnancies (UTEP) are commonly encountered by physicians. Bilateral tubal ectopic pregnancies (BTEPs), however, are rare and due to the identical clinical presentations of BTEP and UTEP, there is a significant degree of diagnostic difficulty for the former, requiring a high index of suspicion. It should be considered a possibility in any newly pregnant woman of child-bearing age. The purpose of this article is to provide the reader with an example of a clinical presentation of BTEP, and a discourse on management of these patients. We present a case of a 27-year-old patient, who was seen at the emergency department of the Queen Elizabeth Hospital, Barbados, with signs and symptoms of a ruptured ectopic pregnancy. Intraoperative findings included a ruptured left ectopic pregnancy and an intact right fallopian tubal ectopic pregnancy. Left salpingectomy and right salpingostomy were performed, conserving the intact tube; her recovery was solely complicated by a superficial surgical site infection.

Bilateral tubal ectopic with intrauterine pregnancy (Heterotopic) in spontaneous conception: A case report of rare presentation

Heterotopic pregnancy (HP) means simultaneous presence of intrauterine and extra uterine gestations. It’s a very rare condition of having bilateral tubal Ectopic and intrauterine pregnancy. We had a case of young female of 27 yrs. of age with spontaneous conception with severe andominal pain. Ultrasound suggestive of intrauterine and unilateral Tubal ectopic pregnancy with ovarian cyst. We had performed laparoscopy and found bilateral tubal ectopic with intrauterine pregnancy and performed bilateral salpingectomy with cystectomy. Early Diagnosis and timely treatment can prevent fatal complications.

Bilateral Tubal Ectopic Pregnancy: A Case Report

Introduction: Bilateral tubal ectopic pregnancy without prior fertility treatment is rare and, although true incidence is unknown, about 250 cases have been reported in medical literature so far. Its diagnosis is commonly made during surgery as pre-operative diagnosis is difficult. To the best of our knowledge, this is the first reported case of spontaneous bilateral tubal ectopic pregnancy in Ghana. Case Presentation: We report on a 25-year-old G2P1A who had an exploratory laparotomy done on account of a ruptured right ectopic pregnancy. Examination of the contralateral tube at surgery, however, revealed an unruptured ampullary ectopic pregnancy and diagnosis was thus revised to a bilateral tubal ectopic pregnancy. A right salpingectomy and left salpingostomy were carried out as she had future fertility wish. Conclusion: Bilateral tubal ectopic pregnancies present a number of diagnostic challenges pre-operatively and examination of the contralateral tube, especially for those cases requiring surgical intervention, cannot be over – emphasized in the management of tubal ectopic pregnancies in general.

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.

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.

129 A rare presentation of bilateral tubal ectopic pregnancy after spontaneous conception

Bilateral tubal ectopic pregnancyis the rarest form of extra-uterinepregnancy, occurring in 1:200,000 pregnancies,and is usually associated with infertility treatment. This case highlights the diagnosis and prompt management of this rare gynaecological presentation. A 32 year old female presented to the emergency department with acute onset, severe lower abdominal pain. She had one previous child delivered vaginally but no other pregnancies. She had been actively trying to conceive and her last menstrual period was seven weeks previously.

A case of bilateral tubal ectopic pregnancy following intrauterine insemination

The incidence of unilateral ectopic pregnancy (EP) is 1-2% with the tubal EP being the commonest. Bilateral tubal pregnancy occurs 1 in every 750 to 1,850 EP following assisted reproductive technologies. We present a case of bilateral tubal EP in a 28 year old woman who underwent intrauterine insemination with donor sperm.

Spontaneous and Simultaneous Bilateral Ruptured Tubal Ectopic Pregnancy: A Case Report

Simultaneous bilateral tubal ectopic pregnancy is a rare entity. The reported incidence ranges between 1 in 725 to 1 in 1580 of all ectopic pregnancies, and it is higher in women undergoing assisted reproductive techniques or ovulation induction. Its spontaneous appearance is almost exceptional. There are no unique features in clinical presentation helping to distinguish it from unilateral ectopic pregnancy. This makes the pre-operative diagnosis difficult, so it’s commonly made during surgery. Whether the ectopic pregnancy is spontaneous or induced, fast management is essential and includes early diagnosis, detailed ultrasound scan, careful contralateral tube control, and also specimen’s histological verification. Thus the treatment will depend on the hemodynamic stability of the patient, the extent of tube damage, as well as the desire for future pregnancies. We report a case of 40 year old patient, gravida 1 without any ectopic pregnancy risk factors, who suffered from abdominal pain and vaginal bleeding at 8 gestation weeks. Endovaginal ultrasound detected adnexal ruptured mass in the right fallopian tube. Urgent laparotomy was performed for suspicious ruptured ectopic pregnancy. A right and left ruptured ectopic pregnancy were found during operation. Bilateral salpingectomy is done and patient is discharged from hospital 3 days later without complications.

Bilateral Alive Tubal Ectopic Pregnancy and its Management

Ectopic pregnancy is an important cause of maternal mortality. Bilateral tubal pregnancies are rare; The reported incidence is only 1 in 200 000 pregnancies. Detecting bilateral tubal ectopic pregnancy is urgent because of the associated morbidity and mortality1 The management of bilateral tubal ectopic pregnancies may be medical or surgical, and depends to a large extent on the state of the fallopian tubes at presentation. The main challenge being to identify and treat as early as possible .Risk factors for ectopic pregnancy comprises of previous ectopic pregnancy, tubal damage secondary to tubal surgery, Adhesions secondary to previous laparotomies, chronic infection and Endometriosis. Other nonspecific factors that might contribute to an increased risk are cigarette smoking, age more than 35 years, and use of Assisted reproductive technology( ovulation induction). Presentation to the health care services may varies widely from mild vaginal bleeding and lower back and abdominal pain to clinically unstable condition and shock due to ruptured ectopic and life threatening internal bleeding.

SPONTANEOUS BILATERAL TUBAL PREGNANCY: A CASE REPORT

ABSTRACTBACKGROUND: Ectopic pregnancy is implantation outside the uterine cavity and its one of obstetrics emergency and it is among the common causes of maternal death in the first trimester of pregnancy. It complicates up to 2% of all pregnancies, but bilateral tubal pregnancies are among the rarest medical occurrence and its incidence 1 in 1580 to 1 in 200,000 pregnancies. CASE: This is a case report of a 38-year-old woman who presented with lower abdominal pain and vaginal bleeding of 3 days. She had left sided unruptured tubal ectopic and right sided ruptured tubal ectopic pregnancy . Trans abd ominal Ultrasonography revealed a 5 X 3cm left ad nexal mass suggestive of ectopic pregnancy, uterine cavity was empty and free fluid was seen in the pelvis and paracolic gutter. The diagnosis of bilateral tubal ectopic was made intraoperatively. Bilateral salpingectomy was performed. Histopathology examination confirmed bilateral tubal ectopic pregnancy. CONCLUSION: It is very important to carefully review both adnexa during sonographic evaluation and when exploratory laparotomy or laparoscopy is undertaken for ectopic pregnancy. KEYWORDS: Pregnancy, tubal, ectopic, bilateral, salpingectomy

Misdiagnosis of spontaneous bilateral tubal pregnancy: a case report and review of literature

Purpose of Investigation: Spontaneous bilateral tubal ectopic pregnancy (BTP) is the rarest form of ectopic pregnancy. Materials and Methods: A case of BTP diagnosed during surgery is reported and an algorithm has been proposed for the management of such patients. It is a case of a 32-year-old female at gestational age of nine weeks with spontaneous pregnancy reported vaginal bleeding. Results: The case describes the importance of identifying and examining both tubes at laparoscopy, despite the rarity of bilateral extra-uterine pregnancy. Emergency exploratory laparotomy revealed ruptured ectopic pregnancy along with active bleeding of the right tube (fimbrial region). The left tube was distended with a 3×4-cm mass at the fimbrial region. Conclusion: Bilateral conservative surgery is possible with unruptured ectopic tubal pregnancy.

Case report of spontaneous bilateral tubal ectopic pregnancy in the National Hospital of Pikine, Dakar

Ectopic pregnancy still remains an important cause of maternal morbidity and mortality notably because of using assisted reproductive techniques. The diagnosis is usually made intra operatively and levels of serum BHCG and ultrasound has not been useful in the diagnosis of bilateral tubal ectopic pregnancy. This leads to emphasize on the importance of meticulous ultrasound examination when an ectopic pregnancy is suspected but also a complete tubal and abdominal examination at the time of surgery even if there may be issues with significant adhesive disease. Conservative treatments like “tubal caesarean,” despite the risk of recurrence, are still very useful in our context because of the inaccessibility of assisted reproductive treatment. Risk factors for ectopic pregnancy have not been found in our case but a research track could be opened on a traditional pharmacopoeia called “ALDANKE” widely used in Senegal.

Bilateral Simultaneous Tubal Ectopic Pregnancy with a Third Intrauterine Pregnancy: A Rare Case of Heterotopic Pregnancy

Abstract Background: Bilateral tubal ectopic pregnancies are rare; if associated with intrauterine pregnancy, these ectopic pregnancies are extremely rare. Urgent management of this extremely rare ...

The risk factors of miscarriage and obstetrical outcomes of intrauterine normal pregnancy following heterotopic pregnancy management.

To investigate the clinical characteristics and risk factors for miscarriage of intrauterine normal pregnancy of patients with a heterotopic pregnancy (HP) after treatment.This was a retrospective study of medical records from CHA Bundang Medical Center. Sixty-four patients who were diagnosed with a HP between February 2006 and July 2017 were included in this study. All analyses were performed using SAS software, version 9.4 (SAS Institute, Inc., Cary, NC). P values < .05 were considered statistically significant.Forty-eight patients had tubal ectopic pregnancies (EP), 10 patients had cornual EPs, 1 patient had a cesarean section scar EP, 4 patients had an ovarian EP, and 1 patient had bilateral tubal EP. Among the 64 patients, 14.1% (9/64) miscarried before 10 weeks of gestation after management. Mean gestational age (GA) at treatment was 5.97 ± 0.50 weeks and 6.80 ± 1.04 weeks for miscarriage and nonmiscarriage group, respectively (P = .008). Significant differences were observed between 2 groups in terms of ultrasonographic features at the time HP was diagnosed (P = .040) Logistic regression models indicated that gestational age at treatment showed significant differences between 2 groups (OR: 0.003, 95% CI: 0.001–0.604).Immediate management after diagnosis could expect favorable prognosis of HP. GA at treatment was the only independent risk factor for miscarriage in patients with HP regardless of treatment methods.

Delayed Detection of Spontaneous Bilateral Tubal Ectopic Pregnancies After Methotrexate Treatment

BackgroundBilateral tubal ectopic pregnancies are a rare subset of ectopic pregnancy that can pose a diagnostic dilemma for clinicians. There is no distinct clinical presentation for bilateral tubal ectopic pregnancies, although they are typically associated with assistive reproductive techniques. In addition, there is no single diagnostic feature to help clinicians delineate bilateral tubal ectopic pregnancies from other types of ectopic pregnancy prior to passing the discriminatory zone (such as heterotopic pregnancy or twin ectopic [two gestational sacs in one tube]). Diagnosis is typically made via direct visualization intraoperatively and therefore treatment is usually surgical. Case ReportWe present a case of spontaneous bilateral tubal ectopic pregnancies diagnosed 7 days apart via transvaginal ultrasound. The patient presented to the emergency department with pelvic pain on the contralateral side of her previously diagnosed ectopic pregnancy and vaginal spotting. Bilateral adnexal masses were visualized on ultrasound and her serum beta–human chorionic gonadotropin level had a 5.9% decline from day 4 to day 7 after methotrexate administration 7 days prior; gynecology was consulted. The patient was successfully treated with an additional dose of intramuscular methotrexate without any complications. Why Should an Emergency Physician Be Aware of This?The implications of this case suggest that diagnosis of bilateral tubal ectopic pregnancies requires clinicians to have a high level of suspicion in any pregnant female with a suspected or known ectopic pregnancy who presents with pelvic pain regardless of prior diagnosis or treatment.

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.

Spontaneous Bilateral Tubal Ectopic Pregnancy: Incidental Finding During Laparoscopy – Brief Report and Review of Literature

Objective: Bilateral tubal ectopic pregnancies are rare; the reported incidence is only 1 in 200 000 pregnancies. Detecting bilateral tubal ectopic pregnancy is urgent because of the associated morbidity and mortality. The appropriate fertility-preserving surgery must also be considered, as preservation of both tubes is presumed to offer better fertility prospects. Case Report: A 39-year-old gravida 2, para 1 presented with vaginal bleeding at 8 + 4 weeks of gestation. An approximately 18 mm adnexal mass in the right fallopian tube was detected on ultrasound. Laparoscopy was performed because ectopic pregnancy was suspected. This suspicion was confirmed during laparoscopy; the right fallopian tube was found to contain a mass measuring 20 mm in the isthmic part. Ultrasound of the left fallopian tube also showed a mass in the ampullary region (diameter: 10 mm), also suspicious for ectopic pregnancy. Bilateral salpingotomy was performed laparoscopically. Pathological examination confirmed the diagnosis. Conclusions for Practice: Although ectopic tubal pregnancy is seen more often after assisted reproductive techniques, bilateral spontaneous ectopic pregnancies must also be considered in other cases. Laparoscopic surgery is effective to confirm the diagnosis and treat heterotopic pregnancies. Further studies will be needed to confirm whether unilateral or bilateral conservative fertility-preserving surgery is more appropriate.

Heterotopic triplet pregnancy with bilateral tubal ectopic post-IVF–ICSI of two 12-cell embryos

A heterotopic pregnancy is the coexistence of intrauterine and extrauterine pregnancy. It can be as rare as 1:30,000 in spontaneous pregnancies but can be as high as 1:100 following artificial reproductive techniques (ART) [1]. Bilateral tubal ectopic pregnancy is another extremely rare clinical condition, with an estimated prevalence of 1:200,000 in spontaneous pregnancies [2]. It accounts for one in 750 to one in 1580 ectopic pregnancies [3]. Heterotopic triplets are even more uncommon, and cases with bilateral tubal ectopics and coexisting intrauterine pregnancy are limited, if not unheard of. To add to the rarity of these clinical conditions is when there is a heterotopic triplet pregnancy with bilateral tubal ectopics resulting from the transfer of only two embryos as is explained in the case of our patient. Our patient was a 37-year-old woman with unexplained secondary subfertility of 6 years (gravida 2, para 0 þ 1 miscarriage) with a confirmed intrauterine pregnancy after her first attempt of in vitro fertilization (IVF). She had controlled minimal ovarian stimulation for a total of 10 days. Four mature eggs were retrieved on Day 11, and intracytoplasmic sperm injection was performed on all the eggs. Only two embryos at the 12-cell stage were found suitable for transfer. The patient was prescribed with oral dydrogesterone 8 hourly for luteal support. The Day-10 posttransfer serum b hCG level confirmed a successful implantation, and she was scheduled for follow up. Unfortunately, she presented herself

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

Simultaneous Bilateral Tubal Ectopic Pregnancy after Intracytoplasmic Sperm Injection and Embryo Transfer, in a Patient with Stage 3 Endometriosis

Objective: To describe a simultaneous bilateral tubal ectopic pregnancy after intracytoplasmic sperm injection and embryo transfer: A case report. Setting: Department of Reproductive Medicine, Femme- Mère-Enfant University Hospital, Bron, France. Introduction: The incidence of extra-uterine pregnancy increases to 2% to 12% following IVF-ET; several pathogenic theories have been suggested, including abnormal hormonal secretion or exogenous hormones administered in assisted reproductive technology (ART). Patient and method: A 32year-old nulliparous woman, with primary infertility and endometriosis stage 3, was treated by ART with intracytoplasmic sperm injection and embryo transfer. Result: The patient showed simultaneous bilateral extrauterine pregnancy, managed by laparoscopic salpingectomy. Discussion: The various possible pathophysiological mechanisms are described, with a review of the literature on simultaneous bilateral extra-uterine pregnancy following ART. Conclusion: In pregnancies following ART, ectopic pregnancy should always be screened for by serum hCG monitoring and transvaginal ultrasound until the implantation site can be confirmed, as incidence is higher than in spontaneous pregnancy. Even if serum hCG concentration increases normally, possible bilateral EP should always be investigated if no intrauterine gestational sac can be seen.