Spontaneous Bilateral Tubal Pregnancy Research Articles

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

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.

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

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.

Occurrence of spontaneous bilateral tubal pregnancy in a low-income setting in rural Cameroon: a case report

BackgroundEctopic pregnancy is a life-threatening emergency warranting immediate recognition and prompt intervention. Bilateral tubal pregnancy is the rarest form of ectopic pregnancy with very limited data on its occurrence reported in sub-Saharan Africa.Case presentationWe report the case of a 40-year-old multigravida with chief complains of lower abdominal pain evolving for 5 days in whom an intraoperative diagnosis of spontaneous bilateral tubal pregnancy (plus ruptured right tube) was made.ConclusionsEctopic pregnancy is one of the major causes of maternal mortality in sub-Saharan Africa. Thus, clinicians should maintain a high index of suspicion, even in the absence of hallmark features and thorough clinical examination undertaken especially in resource-limited settings. Examination of both tubes at laparotomy for ectopic pregnancy should be routine and mandatory.

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.

Bilateral tubal ectopic gestation: A case report

Spontaneous bilateral tubal ectopic pregnancy is a rare occurrence. A case of a recently managed spontaneous bilateral tubal ectopic pregnancy is discussed. A 37-year-old grand multiparous farmer, who had been amenorrhoeic for 12 weeks, presented with lower abdominal pain, bleeding per vaginam, and dizziness. Other clinical and ultrasonographic findings were suggestive of ruptured ectopic gestation. Intra-operative findings included ruptured right tubal and unruptured left tubal ectopic pregnancies. Bilateral partial salpingectomy was performed with uneventful recovery. Intra-operative diagnosis of bilateral tubal ectopic pregnancy was confirmed by histology of the specimens.

Spontaneous bilateral ruptured and unruptured tubal ectopic pregnancies: a case report and literature review from Niger Delta Nigeria

Historically ectopic pregnancy and it's complications account for the most leading cause of first trimester maternal deaths in the world. Bilateral tubal pregnancies in the absence of a preceding induction of ovulation (or tubal manipulation for assisted conception) are very rare occurrences and are associated with high potentials for causing maternal mortality. We herein report an uncommon mode of presentation of an ectopic pregnancy in a multi-parous woman, with a spontaneous bilateral tubal pregnancy. The Patient presented in shock, which was caused by a ruptured right ampullary tubal ectopic pregnancy with massive haemoperitoneum. During a life saving emergency exploratory laparotomy which showed a ruptured right ectopic pregnancy, an enlarged unruptured left ampullary mass highly suspicious of ectopic pregnancy was also removed. Both tubal pathologies were confirmed as ectopic gestations histopathologically. This case underscores the variety of such occurrences, a high index of suspicion, judicious intra-operative inspection of the contra lateral tube and histopathological evaluation of the specimens.

Spontaneous Bilateral Tubal Ectopic Pregnancy

Background: Bilateral tubal pregnancy in absence of preceding induction of ovulation is a rare event, with an estimated incidence of 1/200,000 uterine pregnancies and 1/725–1/1580 ectopic pregnancies. These conditions are usually diagnosed at the time of surgery. This article reports a case of a spontaneous bilateral intact tubal multiple pregnancy associated with an ovarian cyst that was diagnosed intraoperatively and addressed with two different surgical techniques. Case: A 35-year-old woman, gravida 7, para 5+1, presented with a history of 8 weeks' amenorrhoea and intermittent vaginal bleeding; she also had mild lower abdominal pain of 1 week's duration. A urine pregnancy test taken on the day of her admission positive. This patient's abdomen was tender on palpation with a positive rebound and guarding. On pelvic examination, there was mild spotting and cervical motion tenderness were noted. A pelvic ultrasound reveled an echogenic mass lesion in the right adnexae with an ovarian cyst in the left side. A laparotomy reveled a bilateral ectopic tubal pregnancy with an ovarian cyst. Salpingectomy was performed in the unruptured right tube, and the unruptured ectopic pregnancy in the left tube was removed through salpingostomy. Results: This patient's postoperative follow-up was unevenful and histologic testing of the specimens that had been excised confirmed the diagnosis. Conclusions: Despite being rare, bilateral spontaneous ectopic pregnancy should be suspected regardless of the presence or absence of risk factors this condition, such as the use of assisted reproduction techniques. Because of its rarity, diagnosis of spontaneous ectopic pregnancy is difficult, but once the condition is diagnosed, it can be treated surgically. (J GYNECOL SURG 29:321)

Spontaneous bilateral tubal pregnancy following hysterosalpingography

We present a case of spontaneous bilateral tubal pregnancy in a woman following hysterosalpingography (HSG), which to our knowledge has not been reported previously. A 29-year-old woman, gravid 0, was referred to our clinic for treatment of left tubal pregnancy after 8 weeks of amenorrhea. Seven weeks prior to that, the patient underwent HSG for evaluation of tubal patency and left tubal obstruction was diagnosed. Initially, except for minimal tenderness over the left adnexa, physical examination was unremarkable. The initial result of a quantitative test for b-human chorionic gonadotropin (bhCG) was 1,584 mIU/ml, but 48 h later this value was 1,886 mIU/ml. The patient’s condition remained stable. Transvaginal ultrasound revealed no evidence of an intrauterine pregnancy, no fluid in the cul-de-sac and an approximately 3 cm-sized ovarian echo at both adnexa. The left tube had a complex structure measuring 2.8 9 1.5 9 1.8 cm. The patient was counseled, and she opted for methotrexate (MTX) therapy, 50 mg/m intramuscularly. Serum b-hCG levels were found to be 1,857 mIU/ml on day 2 after treatment, 1,500 mIU/ml on day 5, and 1,638 mIU/ml on day 7. The patient’s hCG level did not drop, and a second cycle of MTX was injected; however, b-hCG was still 1,405 mIU/ml on day 4 after the second cycle of treatment. We decided that surgical intervention was necessary. Laparoscopy revealed an approximately 3 cm-sized unruptured left ampullary pregnancy, and a left salpingostomy was performed to remove it. Inspection of the right tube revealed an approximately 1 cm-sized bulging area in the ampullary region (Fig. 1). Linear salpingostomy was performed. Pathology confirmed that conceptuses had been removed from both the right and left tubes. Followup b-hCG was 247 mIU/ml on postoperative day 1. Bilateral tubal pregnancy is a rare clinical entity. The reported instance is 1 in 2,00,000 pregnancies [1]. Bilateral tubal pregnancies are more common after assisted reproductive technology, such as ovulation induction [2], in vitro fertilization and embryo transfer (IVF-ET) [3–5], or intracytoplasmic sperm injection (ICSI) [6], than they are after spontaneous conception [1]. The risk factors related to spontaneous ectopic pregnancy are well known, such as pelvic inflammatory disease, endometriosis, previous surgery and its sequelae, and infertility. Spontaneous bilateral tubal pregnancy is also related to the factors previously mentioned, along with double spontaneous ovulation. HSG is a commonly performed diagnostic investigation to assess tubal patency in infertility patients. It has potential therapeutic effects on subfertility [7]. There is evidence for the effectiveness of tubal flushing with oil-soluble contrast media in increasing the odds of pregnancy and live birth versus no intervention; however, there is no significant association between this procedure and miscarriage or ectopic pregnancy [7]. The diagnosis of bilateral ectopic pregnancy can be achieved by finding chorionic villi in surgical specimens obtained from both tubes [1]. There can be great difficulty in diagnosing this condition before surgery, however, in which the level of b-hCG is not particularly useful. Indeed, most often, contralateral ectopic pregnancy is asymptomatic or difficult to differentiate from pelvic pain secondary to medical treatment or to controlled ovarian hyperstimulation [6]. H.-J. Seol S.-Y. Tong (&) Department of Obstetrics and Gynecology, School of Medicine, Kyung Hee University, Seoul, South Korea e-mail: sytong@hanmail.net

A case of spontaneous bilateral tubal ectopic pregnancy

Management of ectopic pregnancies are a relatively common occurrence in day to day practice of a general gynaecologist, but spontaneous bilateral tubal ectopic pregnancy is a rare occurrence worldwide. We report successful management of a case of spontaneous bilateral tubal ectopic pregnancy in the District General Hospital, Nuwara Eliya. <strong>Key words: </strong>tubal ectopic pregnancy; transvaginal ultrasound; laparotomy<strong><em></em></strong> DOI: <a href="http://dx.doi.org/10.4038/sljog.v32i4.3990">http://dx.doi.org/10.4038/sljog.v32i4.3990</a> <em>SLJOG </em>2010; 32(4): 89-90

Ultrasound diagnosis of spontaneous bilateral tubal pregnancy

Ultrasound diagnosis of spontaneous bilateral tubal pregnancy

Bilateral Simultaneous Ectopic Pregnancy

Spontaneous bilateral ectopic pregnancy is the rarest form of ectopic pregnancy. A 31-year-old patient with spontaneous bilateral tubal pregnancy was admitted after light vaginal bleeding, 42 days after her last menstruation. Ultrasonography showed a bilateral tubal ectopic pregnancy. A bilateral laparoscopic salpingectomy was performed without complication and the pathology report confirmed the diagnosis. This is an unusual case of early diagnosis.

Unrecognized spontaneous bilateral ampullary pregnancy treated by laparoscopy

We report on a 35-year-old woman with spontaneous bilateral tubal pregnancy. This is a rare and complex condition with uncertain etiology. Despite preoperative work-up that included clinical examination, serial ultrasound investigation, and serial quantitative beta human chorionic gonadotropin testing, the bilateral disease was not accurately diagnosed until laparoscopy. A bilateral laparoscopic linear salpingostomy was performed along with extraction of the conception products from both tubes. There were no intraoperative or postoperative complications, and the patient was discharged on the 1st postoperative day. Subsequent histopathology confirmed bilateral ectopic pregnancy. To avoid misdiagnosing bilateral ectopic pregnancy, we emphasize the need to combine clinical, sonographic, and laparoscopic investigation when the clinical picture is confusing.

Laparoscopic management of an unrecognized spontaneous bilateral tubal pregnancy.

Laparoscopic management of an unrecognized spontaneous bilateral tubal pregnancy.

Laparoscopic management of an unrecognized spontaneous bilateral tubal pregnancy

Laparoscopic management of an unrecognized spontaneous bilateral tubal pregnancy