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Laparoscopic salpingectomy in tubal pregnancy: prospective randomized trial using endoloop versus electrocautery

Lim YH, Ng SP, Ng PH, Tan AE, Jamil MA

J Obstet Gynaecol Res, 2007 Dec;33(6):855-62.
PMID: 18001454

Ectopic pregnancy is conventionally managed by laparoscopic salpingectomy. Electrocautery has been used widely to secure hemostasis during salpingectomy. However, this method is associated with a risk of thermal injury to the visceral organs. Endoloop, a pre-tied suture used in laparoscopic surgery may be an alternative treatment tool and its potential use in the management of ectopic pregnancy is explored here. Our study aims to compare the effectiveness of the endoloop technique to electrocautery during laparoscopic salpingectomy for tubal pregnancy.

Matched MeSH terms: Pregnancy, Tubal/surgery*
Fulltext Unilateral live twin tubal ectopic pregnancy presenting at 12 weeks of gestation: A case report

Seak CJ, Goh ZNL, Wong AC, Seak JC, Seak CK

Medicine (Baltimore), 2019 Sep;98(38):e17229.
PMID: 31567985 DOI: 10.1097/MD.0000000000017229

RATIONALE: Abdominal pain in pregnancy represents a demanding diagnostic challenge in the emergency department (ED) due to the extensive list of differential diagnoses to be considered, coupled with the possibility of each disease having nonclassical, atypical signs and symptoms, resultant from the patient's pregnant state. Additionally, emergency physicians (EPs) face limitations on investigative imaging modalities because of the need to minimize fetal radiation exposure. EPs have to tackle this diagnostic challenge while performing a balancing act to maximize both maternal and fetal outcomes in a time-sensitive manner, becauser any delays in decision-making at the ED may threaten the safety of mother and child. Two common causes of abdominal pain in pregnancy presenting to the ED are acute appendicitis and ectopic pregnancy. The latter is almost always diagnosed by 10 weeks of gestation. Here, we report an extremely rare case of unilateral live spontaneous twin tubal ectopic pregnancy presenting past 12 weeks of gestation, diagnosed after magnetic resonance imaging (MRI) of the abdomen.
PATIENT CONCERNS: A 37-year-old gravida 2 para 1 at 12 weeks and 6 days of gestation presented to our ED with a 2-day history of right iliac fossa pain, not associated with vaginal bleeding, fever, diarrhea, and vomiting. On examination, she was tachycardic (pulse rate 124 beats/min) and hypertensive (blood pressure 142/88 mm Hg). There was marked tenderness and guarding at the lower abdomen.
DIAGNOSES: Blood investigations were unremarkable, while abdominal ultrasonography found a live twin gestation with foetal heartbeats of 185 and 180 beats/min. MRI of the abdomen revealed an empty uterine cavity; 2 amniotic sacs and fetuses of diameter 10 cm, and a single placenta were noted in the right uterine adnexa. The patient was diagnosed with right live monochorionic diamniotic twin tubal pregnancy.
INTERVENTION: Our patient underwent emergency laparoscopic right salpingectomy.
OUTCOMES: The operation was successful and her postoperative care remained uneventful up to discharge.
LESSONS: Ectopic pregnancy cannot be ruled out based on prior normal antenatal examinations and gestational age of >10 weeks. EPs should not hesitate to order MRI scans for further evaluation if ultrasonography and laboratory findings are equivocal.

Matched MeSH terms: Pregnancy, Tubal/surgery
Fulltext Delayed haemorrhage in conservative surgery for ectopic pregnancy

Rachagan SP, Neoh HS

Med J Malaysia, 1990 Mar;45(1):84-6.
PMID: 2152077

A case of delayed haemorrhage after conservative surgery for ectopic pregnancy is presented. Brief pathophysiology of the condition is presented. The importance of beta-subunit human chorionic gonadotrophin monitoring of the serum in this patient is highlighted. Surgical procedures to prevent this complication are also discussed.

Matched MeSH terms: Pregnancy, Tubal/surgery*
Fulltext A rare case of heterotopic quintuplets pregnancy

Wu D, Hii LY, Shaw SWS

Taiwan J Obstet Gynecol, 2019 Sep;58(5):684-687.
PMID: 31542093 DOI: 10.1016/j.tjog.2019.07.018

OBJECTIVE: We report a rare case of heterotopic pregnancy and high-order pregnancy occurring simultaneously following the use of the assisted reproductive technique (ART).
CASE REPORT: A 29-year-old woman, Gravida 2 Para 1, became pregnant after receiving intrauterine insemination (IUI). She came to our emergency room due to diffuse low abdominal pain at seven weeks of gestational age. Transabdominal sonography (TAS) revealed a quadruplet intrauterine pregnancy with an enlarged left adnexa and intrapelvic fluid accumulation. Simultaneous occurrence of high-order pregnancy and left tubal pregnancy with internal hemorrhage was suspected. The patient received an emergent laparoscopic resection of the affected Fallopian tube and recovered well for the remaining hospitalization course. Afterwards, she received fetal reduction procedure and eventually gave birth to twin babies.
CONCLUSION: Gynecologist should increase the awareness of heterotopic pregnancy in patients receiving ART. On the other hand, reproductive endocrinologist should reduce the risk of high-order pregnancy without compromising pregnancy rate.

Matched MeSH terms: Pregnancy, Tubal/surgery
A case of rudimentary horn pregnancy that reached term

Ngieng LN

Med J Malaya, 1970 Sep;25(1):65-7.
PMID: 4249500
Matched MeSH terms: Pregnancy, Tubal/surgery
Fulltext Salpingitis isthmica nodosa: review of four cases from the General Hospital, Kota Bharu

Sathyamoorthy P

Singapore Med J, 1994 Feb;35(1):65-6.
PMID: 8009284

Four cases of salpingitis isthmica nodosa diagnosed from a total of 82 hysterosalpingograms, over a period of three years at the General Hospital, Kota Bharu, were reviewed. The diagnosis was made based on the radiographic appearance of globules of contrast medium in the periluminal tissues which were in continuity with the lumen of the fallopian tubes. Three of these patients had ectopic pregnancy. Diagnosis of salpingitis isthmica nodosa which is readily demonstrated by hysterosalpingogram, is extremely important because of its impact on ectopic pregnancy rates. Hysterosalpingography is indicated following ectopic pregnancy to show whether there is diverticulosis of the contralateral tube. By such knowledge, optimal treatment can be offered to patients wishing to attempt further conception. As the disease is relatively localised it is amenable to resection with reimplantation of the distal portion of the tube.

Matched MeSH terms: Pregnancy, Tubal/surgery