Pregnancy In Fallopian Tube Research Articles

Advanced tubal pregnancy at 34 weeks with eclampsia and HELLP syndrome: a case report and literature re

BackgroundTubal ectopic pregnancies in the late stages of pregnancy are uncommon, and reports on their complications are scarce. We present the case of a woman who had a tubal ectopic pregnancy at around 34 weeks and developed severe pre-eclampsia complications.CaseA 27-year-old woman presented to our hospital several times with vomiting and convulsions. A physical exam revealed hypertension, scattered ecchymosis, and a large abdominal mass. A computed tomography (CT) scan performed in an emergency revealed an empty uterus, a stillbirth baby in the abdominal cavity, and a crescent-shaped placenta. Blood tests revealed that the patient had a low platelet count and clotting dysfunction. Laparotomy confirmed advanced right fallopian tube pregnancy without rupture, and salpingectomy was performed. Pathological examination revealed a significantly thickened tubal wall, adhesion of the placenta, and poor placental perfusion.ConclusionThe unusually thickened muscular layer of the tube may be one of the reasons for tubal pregnancy progressing to an advanced stage. Placenta adhesion and the special site to which it is attached reduce the risk of rupture. The detection of a crescent-shaped placenta on imaging may aid in the accurate diagnosis, distinguishing between abdominal and tubal pregnancy. Women with advanced ectopic pregnancy are more likely to develop pre-eclampsia and have poorer maternal-fetal outcomes. These negative outcomes may be influenced by abnormal artery remodeling, villous dysplasia, and placental infarction.

A case of ectopic pregnancy

Background: Ectopic pregnancy is a condition where pregnancy occurs outside the uterine cavity. It is a life-threatening condition and needs to be acted on urgently when suspected. Ectopic pregnancy should be suspected in any woman in childbearing age presenting with irregular vaginal bleeding like this case. Case: 36 years old female presented with history of irregular vaginal bleeding and lower abdominal pain and was found to be pregnant on assessment. She was referred to the emergency department with possible miscarriage however on assessment and imaging she was found to have disturbed ectopic pregnancy in fallopian tube. Conclusion: This case highlights the importance of careful history taking and assessment in women presenting with vaginal bleeding and taking the appropriate steps in arranging urgent management for this life-threatening condition. It is also a reminder that not all cases have a typical presentation and ectopic pregnancy should be suspected in women of childbearing age presenting with vaginal bleeding or abdominal pain. In fact ectopic pregnancy should be suspected until proven otherwise. Key words: ectopic pregnancy, vaginal bleeding.

Differential expression of matrix metalloproteinases in the fallopian tube of women with Chlamydia trachomatis-associated tubal ectopic pregnancy

Chlamydia trachomatis is an established risk factor for ectopic pregnancy (EP) in fallopian tube (FT). Matrix metalloproteinases (MMPs) have potential role in disease pathogenesis, however, dysregulation of extracellular matrix by MMPs/TIMPs (tissue inhibitors of MMPs) in infection-associated EP remains unknown. The aim was to study the expression of MMP-2, -9, -14/TIMP-1, -2, -3 in C. trachomatis-positive tubal EP patients. The study comprised of 100 tubal EP (Group I) and 100 tubal ligation patients (Group II; controls) enrolled from Department of Obstetrics and Gynaecology, VMMC and Safdarjung hospital, New Delhi (India) for collection of FT. Detection of C. trachomatis MOMP was done by PCR while quantitative expression of MMPs/TIMPs was studied by real-time PCR. Data was statistically evaluated by Graphpad prism. Overall, C. trachomatis was found in 18/100 tubal EP patients. After ruling out Neisseria gonnorhoeae and Mycoplasma genitalium, Group I was divided into Group Ia (C. trachomatis DNA-positive) and Group Ib (C. trachomatis DNA-negative; internal controls). Significant upregulation of MMP-2, -9, -14 and downregulated TIMP-1, -2, -3 were found in Group Ia versus controls (Groups Ib/II) (p < 0.05). Fold-change in MMP was significantly higher in Group Ia versus controls (‘p’ < 0.05). Maximum 5.5-fold upregulation was found in MMP-2. It is apparent by molecular analysis that differential expression of MMPs/TIMPs, particularly enhanced MMP-2 leads to tubal EP in C. trachomatis DNA-positive women.

A woman with disseminated tuberculosis experienced preterm delivery, fallopian tube pregnancy, and delivered successfully following in vitro fertilization: a case report

BackgroundDisseminated tuberculosis (TB) is a fatal disease resulting from hematogenous dissemination of Mycobacterium tuberculosis. Spontaneous pregnancy rate of women with TB is low; furthermore, live birth, spontaneous abortion or ectopic pregnancy may be the outcomes even if pregnancy occurs.Case presentationWe report a case of a woman with disseminated TB who had a series of complications including preterm delivery with congenital TB and infant death of pulmonary TB, fallopian tube pregnancy. She was treated by in vitro fertilization-embryo transfer (IVF-ET), and gave birth to a healthy baby.ConclusionDisseminated TB has a significant impact on female fertility. We should take more active efforts to diagnose and treat this disease in a timely fashion. Moreover, IVF treatment is a feasible approach for an infertile woman after TB.

A novel predict factor that increases the success rate of methotrexate treatment in fallopian tube pregnancy.

BackgroundFor stable fallopian tube pregnancy (FTP), methotrexate (MTX) therapy is reported to be as effective as laparoscopy. However, some cases would need further treatment, e.g., another dose of MTX or laparoscopy. This study is to investigate the potential factors during the treatment of FTP that may facilitate the prediction of a successful outcome of MTX therapy.MethodsAll FTP cases admitted to the International Peace Maternal and Child Health Hospital (IPMCH), Shanghai, China from January 2016 to December 2017 were reviewed. All patients received a single dose of 50 mg/m2 MTX prior to other treatment. Statistical analysis was performed to determine the correlation between clinical parameters and the success rate of MTX treatment.ResultsThe success rate of single-dose MTX was 77.53%. The serum beta-human chorionic gonadotropin (β-hCG) level cut-off value was 452.64 IU/L, with a specificity of 76.7% and sensitivity of 43% [area under the receiver operating characteristic curve (AUC) 0.803; P<0.0001]. In addition, serum β-hCG levels and patient age correlated with the success rate of MTX treatment.ConclusionsLower β-hCG levels led to successful MTX treatment for FTP, with a cutoff value of 452.64 IU/L. Younger patients were more sensitive to MTX treatment. These results may help clinicians when deciding the potential therapy for patients with tubal ectopic pregnancies.

Laparoscopic Management of a Heterotopic Pregnancy in the Tubal Stump

To demonstrate how a heterotopic tubal stump pregnancy can be safely managed with laparoscopy, preserving the intrauterine pregnancy. Stepwise demonstration of the technique by means of a video tutorial. The management of pregnancies in the tubal stump after salpingectomy involves either a surgical intervention or systemic therapy. In case of a simultaneous intrauterine pregnancy, although the prognosis for the fetus remains good with live births in approximately 70% of the cases, the surgical management of the tubal stump pregnancy is challenging owing to the risk of bleeding from the uterine horn [1-5]. We present an effective and reproducible laparoscopic technique on the basis of a 31-year-old patient with 2 prior right fallopian tube pregnancies, which were later treated with salpingectomy. The patient is now presenting in the sixth week of gestation after transfer from 2 oocytes with a pregnancy in the tubal stump and a concomitant vital intrauterine pregnancy. The key steps of laparoscopic surgery include (1) continuous absorbable monofilament suture on the uterine horn around the tubal stump to achieve hemostasis and exposure of the proximal part of the tube, (2) removal of ectopic pregnancy, and (3) closure of the excision site with continuous absorbable polyfilament suture. The instillation of vasoconstrictive substances and the use of electrical coagulation should be avoided. The demonstrated laparoscopic technique is a feasible method of removal of a tubal stump pregnancy without interfering with the vital intrauterine pregnancy. The blood loss can be minimized, and laparotomy can be avoided.

Managing Ectopic Pregnancies by Targeting Chorionic Villi with a Transvaginal Injection of Ethanol into the Lacunar Space.

Methotrexate has been the main mode of non-surgical treatment for ectopic pregnancies. However, we have developed an easier, repeatable method that can be applied even to patients with a high beta-human chorionic gonadotropin (β-hCG) level and/or positive fetal heartbeat, by targeting chorionic villi with a transvaginal injection of absolute ethanol (AE) into the lacunar space (intervillous space). The efficacy and safety of this method were examined in 242 cases of ectopic pregnancy, including 103 with positive fetal heartbeat. Serum β-hCG level was measured at frequent intervals, and transvaginal ultrasonography was performed to observe the gestational sac and hyperechoic inner ring. Of the 242 patients, 222 (91.7%) were successfully treated. The average number of AE injection(s) required was 1.6 (range: 1–5), and the average dose was 3.2 mL. After the treatment, many of the patients tried to conceive again, and 63 of the traceable 145 patients (43.4%), who had fallopian tube pregnancy, and 7 of the traceable 12 patients (58.3%), who had cervical or cesarean scar pregnancies, successfully conceived and delivered babies with no observed side effects. Therefore, this method could be an effective treatment for ectopic pregnancy with the potential to replace conventional surgical interventions and medical treatment using methotrexate.

An uncommon spontaneous right distal tubal pregnancy post bilateral laparoscopic sterilization

Rationale:Tubal sterilization as a contraception method has a high success rate; however, it also carries a low risk of incidental pregnancy. A majority of these pregnancies are ectopic. In this study, we report a rare case of spontaneous right distal tubal pregnancy after bilateral laparoscopic tubal sterilization.Patient concerns:A 36-year-old woman who had undergone bilateral laparoscopic tubal sterilization presented with abdominal pain and a positive test for pregnancy.Diagnosis:Ectopic pregnancy was suspected based on absence of gestational sac in the uterine cavity on ultrasound and elevated beta-human chorionic gonadotropin (β-hCG) level.Intervention:Since the patient had unstable vitals, emergency laparoscopic surgery was performed, which revealed a right distal fallopian tube pregnancy. We performed a complete bilateral residual tubal stump excision.Outcomes:The patient recovered well after surgery, with a reduction in β-hCG level, and was discharged after 3 days.Lessons:To ensure complete sterilization, the gap at the excised end needs to be adequately widened and enhanced with electro-destruction to prevent formation of a fistula.

A Pilot Study Comparing 2- and 3-dimensional Ultrasound Imaging for Confirmation of Essure Fallopian Tube Pregnancy Prevention Implants

To show the feasibility of 2-dimensional (2D) ultrasound (US) imaging compared with 3-dimensional (3D) US to identify the location of implants and assess if the classification developed by Simorre et al in 2016 was applicable to the 2 types of US imaging (i.e., 2D and 3D). A prospective study (Canadian Task Force classification II-2). The department of obstetrics and gynecology in a teaching hospital. One hundred fifty patients who had undergone hysteroscopic sterilization with Essure (Bayer Pharma AG Laboratory, Lyon, France) fallopian tube pregnancy prevention implants were invited by letter to participate in the study; 50 replied positively between January and August 2017. An initial 2D US was performed followed by 3D US reconstruction. The primary end point was to compare the identification of device placement with 2D and 3D US imaging procedures according to this new classification. Secondary considerations were to evaluate the difficulty of attaining images, the quality of implant curvature, the duration of each imaging procedure, and the number of images performed for each technique. Ninety-six percent of tubal implants were observed via 3D US compared with 100% via 2D US. The mean time of 2D US was 14.64 seconds for the right fallopian tube and 15.25 seconds for the left fallopian tube compared with 25.11 seconds for the right and 31.57 seconds for the left fallopian tube in 3D US (p <.01). The mean number of image acquisitions per patient was 1.02 (±0.14 standard deviation) for 2D US compared with 1.37 (±0.64 standard deviation) for 3D US (p <.01). The sonographer had no difficulty performing 2D US in 88% of cases compared with 58% of 3D US cases. Two-dimensional ultrasound appears to be an acceptable alternative to 3D US. We propose a 2D classification for cross section device localization to facilitate image interpretation.

Ectopic Pregnancy in a Referral Hospital in the Volta Region of Ghana West Africa

Background: Ectopic pregnancy is still a global problem for women of reproductive age with increasing burden of the disease and increasing mortality especially for women living developing world like Africa. In Ghana studies evaluating the burden of ectopic pregnancy have been conducted in major centres like Korle-Bu and KATH but few in other centres. This study tends to evaluate the prevalence, clinical presentation and finding of ectopic pregnancy in a referral hospital in the Volta region of Ghana. Methodology: This was a 3 years (2013-2016) retrospective review of all gynaecological admission in the Volta regional hospital. All ectopic pregnancy cases/ record were identified, retrieved and information on the socio-demographics, clinical presentations, intraoperative findings and outcome of surgery were all extracted for analysis. Result: A prevalence of 2.05% (53/2582) was recorded over the study period. 58.5% (31/53) of the women were married and between the age group of 21 - 30. 47.2% (25/53) had primary school education. Lower abdominal pain was common in 98.1% (52//53), 69.2% (37/53) had vaginal bleeding while 96.4% (51/53). Fallopian tube pregnancy was seen in 96.2% (51/53) while 3.8% (2/53) were abdominal pregnancy. Tubal rupture and heamoperitoneum were seen in 73.6% (39/53) of the women. 78.4% (40/51) of the fallopian tube pregnancy occurred at the ampulla. All the women in this study were successfully managed with radical surgery. Conclusion: There is still the need to evaluate the prevalence of ectopic pregnancy in the region. Proper education of women of reproductive age and provision of equipment and skills to enable early diagnosis of ectopic pregnancy is very necessary in ensuring less radical and traumatic management with less implication on fertility of women post-surgery.

Spontaneous Ruptured Heterotopic Fallopian Tube Pregnancy: A Challenging Case

Spontaneous Ruptured Heterotopic Fallopian Tube Pregnancy: A Challenging Case

Study on the clinical effecacy of hysteroscopy combined with laparoscopy in treating fallopian tubal obstruction

Objective To observe and study the clinical efficacy of laparoscopy combined with hysteroscopy in treatment of obstruction of fallopian tube. Methods 72 cases of patients who were treated for fallopian tubal obstruction were selected as the research object,and they were randomly by simple randomization divided into two groups,the observation group and the control group,with 36 cases in each group.The hysteroscopic treatment was used in the control group,hysteroscopy combined with laparoscopy were treated in the observation group.Then operation effect and 1 years after surgery in pregnancy of the two groups were compared. Results In the control group,70 fallopian tube had 56 successful recanalization with the recanalization rate of 80%.At 3 months after operation it blocked 8,restenosis rate was 14.2%.In the observation group,68 fallopian tube had 62 successful recanalization with the recanalization rate of 91.1%,and at 3 months after operation it blocked 10,restenosis rate 16.2%.The recanalization rate in the observation group was significantly higher than that of the hysteroscopy wire group(χ2= 6.231,P 0.05).The control group of 14 cases with intrauterine pregnancy,the pregnancy rate was 38.9%,1 cases of tubal pregnancy,the pregnancy rate was 2.7%.24 cases of pregnancy with intrauterine in the observation group,the pregnancy rate was 66.7%,2 cases of tubal pregnancy,the pregnancy rate was 5.4%.The intrauterine pregnancy rate in the observation group was significantly higher than that of the hysteroscopy group,there was significant difference(χ2= 5.568,P 0.05). Conclusion Hysteroscopy combined with laparoscopy in treatment of fallopian tubal obstruction can make up for the deficiency of hysteroscopic treatment alone,it can greatly improve the fallopian tube recanalization rate and pregnancy rate after operation, it is worthy for clinical application. Key words: Hysteroscopy; Laparoscopy; Fallopian tube disesse

DNA sequencing identifies mutation of the von Hippel–Lindau gene in tubal pregnancy

Genetic mutations in the von Hippel–Lindau (VHL) gene are common in certain diseases. The effects on the VHL gene in the tubal pregnancy tissues are unknown but with further study, it was found that the VHL gene may be related to prognosis or therapy selection. This study was conducted to analyse the VHL gene in tissues of human fallopian tube and tubal pregnancy. A total of 35 patients undergoing salpingectomy for tubal pregnancy were recruited into the experimental group. Samples of ampullary fallopian tube during mid-secretory phase were collected from 10 patients with benign uterine disease as the control group. Fluorescent dye dideoxy termination method was performed to detect three exons sequences of the VHL gene in tissues of both the human fallopian tube and tubal pregnancy. The DNA sequences of three exons of VHL gene coding region in tubal pregnancy were not found in mutations. The present study suggested that the VHL gene mutations were not related with tubal pregnancy.

Contralateral Tubal Ectopic Pregnancy after Ovulation of Another Side Ovary in Spontaneous Cycles: A Case Report and Review of the Literature

Pregnancies in the same side tube after the same side ovary ovulation are more common. We report an unusual case of contralateral tubal ectopic pregnancy after ovulation of another side ovary in spontaneous cycles. A 32-year-old woman underwent laparoscopic left fallopian tube conservative surgery because of left tubal pregnancy two years ago. She returned to our hospital with a positive pregnancy test and lower abdominal pain 28 d after the dominant follicle discharged in the right side ovary detected by transvaginal ultrasound in spontaneous cycles. Transvaginal ultrasonography revealed no intrauterine gestational sac but a left adnexal mass measuring 2.6 cm × 2.5 cm. Videolaparoscopy was performed, and the diagnosis of an ectopic pregnancy in the let fallopian tube was confirmed by pathologic report. Tubal damage is the most important risk factor for tubal ectopic pregnancy. Embryos can be reversely migrated toward fallopian tubes, due to retrograde action of endometrial waves and uterine contractions, that is another necessary reason which contributes to such tubal pregnancy. Total salpingectomy or tubal sterilization is necessary for avoiding repeated tubal ectopic pregnancy.

Clinical Research for the Treatment of Tubal Obstructive Infertility by Fallopian Tube Recanalization Combined with Traditional Chinese Medicine

Objective: To observe the clinical curative effect of Fallopian Tube Recanalization combined with Traditional Chinese Medicine and to explore the mechanism of Traditional Chinese Medicine in the treatment of Tubal Obstructive Infertility. Method: We selected 180 patients with Tubal Obstructive Infertility and randomly divided them into 3 groups, each group contained 60 subjects. The subjects of the first group received treatment of Fallopian Tube Recanalization combined with Traditional Chinese Medicine, the second group received Fallopian Tube Recanalization alone and the third group received Traditional Chinese Medicine alone. Then we observed the success rate of each group according to their Fallopian tube patency rate, pregnancy rate and Fallopian tube re-adhesion formation rate. Result: (1) The success rate of the first group was 81.7%, while that of the second group was 78.3%, and 56.7% for the third group. There was a significant difference between the first group and the third group, as well as the second group and the third group (P<0.05). (2) One year’s follow-up after treatment showed the pregnancy rate (defined as numbers of pregnancy over numbers of successful recanalization procedures) of the first, second and third group were 65.3%, 53.2% and 64.7% respectively. Although there was no significant difference between these 3 groups, the pregnancy rate of the two groups which applied Traditional Chinese Medicine was higher than the group which applied recanalization procedure alone. (3) One year after treatment, there were 5 Fallopian tube re-adhesion cases in the first group, 12 cases in the second group and 5 cases in the third group, the re-adhesion rate was 10.2%, 25.5% and 14.7% respectively. There was a significant difference between the first group and the second group (P<0.05). Conclusion: Interventional Fallopian Tube Recanalization can increase the rate of patency of occluded Fallopian tube, while Traditional Chinese Medicine can decrease post-operational tubal re-adhesion formation rate and facilitate pregnancy. The two treatments can be combined to treat Tubal Obstructive Infertility.

Clinical course of ectopic pregnancy: A single-center experience

OBJECTIVES:The objective was to highlight the frequency, clinical profile, and predisposing factors of ectopic pregnancy (EP) in a general hospital.MATERIALS AND METHODS:This descriptive study was conducted at the Obstetrics and Gynaecology department of Hera General hospital, Makkah, Saudi Arabia, from July 1, 2009 to December 29, 2010. Data were collected on chief medical complaints, sociodemographic characteristics, past obstetrics and gynecological history, management done, and outcome of management. Data were analyzed using Microsoft Office Excel (version 2007).RESULTS:Out of total 7564 pregnancies, 44 (0.58%) patients were diagnosed as EP. Out of 44, 22 (50%) patients presented within 24 h of onset of symptoms. Mean age was 28 ± 7 years. Multigravida were predominant in 25 (57%), and 21 (48%) had gestational age of 6-8 weeks at the time of presentation; the common presenting features were amenorrhea (41, 93.2%), abdominal pain (39, 88.6%), and tenderness (38, 86%). Previous pelvic surgery (13, 29.5%), infertility treatment (11, 25%), and pelvic inflammatory disease (10, 22.7%) were the common predisposing factors. Twenty-five (57%) presented with ruptured EP and were operated within 24 h, and the remaining were kept under observation till further diagnosis. After confirming the diagnosis, 12/19 underwent laparoscopy, whereas 7/19 received medical treatment. Surgery confirmed fallopian tube pregnancies in 35 (94.5%). No mortality was observed.CONCLUSION:Previous pelvic surgeries were the major etiological factor for EP. Other factors were infertility treatment and pelvic inflammatory disease. The most common site of EP was fallopian tubes.

Increased expression of the von Hippel–Lindau gene in the implantation site of human tubal pregnancy

The objective of this study was to investigate the expression of the von Hippel-Lindau (VHL) gene in tissues of human fallopian tube and tubal pregnancy. Twenty patients undergoing salpingectomy for tubal pregnancy were recruited into the study group. Tissues of tubal pregnancy were separated into both the implantation and non-implantation sites as the implantation group and the non-implantation group, respectively. Samples of ampullary fallopian tube during mid-secretory phase were collected from twenty patients with benign uterine disease as the control group. Immunohistochemistry, real-time reverse transcription polymerase chain reaction, and Western blotting analysis were performed to detect expressions of VHL mRNA and protein. The results showed that VHL immunostaining appeared in the cytoplasm of tubal epithelial cells. Expression of VHL mRNA in the implantation group was higher than that in the non-implantation group or the control group (P < 0.01). Intensity of VHL protein in the implantation group was increased compared with that in the non-implantation group (P < 0.05) or in the control group (P < 0.01). There was no difference on expressions of VHL mRNA and protein between the non-implantation group and the control group (P > 0.05). In conclusion, VHL mRNA and protein are present in human tubal tissues. The VHL gene expression is increased in the implantation site of tubal pregnancy, and locally elevated expression of the VHL gene might be associated with human tubal pregnancy.

Repeat Ectopic Pregnancy in Ipsilateral Fallopian tube after Laparoscopic Corneal Resection for an Interstitial Pregnancy: Case report and Literature Review

Repeat Ectopic Pregnancy in Ipsilateral Fallopian tube after Laparoscopic Corneal Resection for an Interstitial Pregnancy: Case report and Literature Review

The frequency of CD25+CD4+ and FOXP3+ regulatory T cells in ectopic endometrium and ectopic decidua

BackgroundThe presence of regulatory T (Treg) cells in human endometrium is crucial for maintaining immunological homeostasis within the uterus. For this study we decided to evaluate the subpopulations of Treg cells in conditions where a disturbance in the immunological equilibrium in ectopic endometrium and decidua has been observed, such as in cases of ovarian endometriosis (involving local immune cell suppression) and ectopic pregnancy (involving an increase in local immune system activity). We then compared these findings to what we observed in the normal eutopic endometrium of women during the secretory phase of the menstrual cycle (with immune cells under individual control).MethodsThe endometrium tissue samples evaluated in our study were obtained from 47 women during one of two kinds of laparoscopic procedures. 16 of the women underwent laparoscopies due to Fallopian tube pregnancies (EP), and 16 due to ovarian endometrioma, while 15 women made up a control group. The presence of regulatory T cells in these tissue samples was evaluated by FACS.ResultsIn our study, the percentages of FOXP3+ cells within the subpopulation of CD4+ T lymphocytes found in the decidua of the patients treated for Fallopian tube pregnancies were statistically significantly lower than both those observed in the ovarian endometriosis tissue samples and those found in the secretory eutopic endometrium samples of the control group.ConclusionThe disturbance in the immunological equilibrium observed in ectopic endometrium and decidua would seem to be related to the alteration in the Treg cell population that occurs in these ectopic tissues.

Serous Cystadenoma and Ectopic Pregnancy in the Fallopian Tube

The coexistence of a cystadenoma with an ectopic pregnancy in the same fallopian tube is extremely rare. A 30-year-old gravid woman exhibited increasing human chorionic gonadotropin concentrations. Intramuscular methotrexate therapy was administered and ectopic precautions were taken. The patient eventually underwent diagnostic laparoscopy. After pathologic review, an ectopic pregnancy and serous cystadenoma were identified in the left fallopian tube.