MyMedR

Sivalingam N

Med J Malaysia, 1981 Dec;36(4):254-8.

Forty patients with tubal ectopic pregnancies seen over an 18 month period are studied. Epidemiological parameters in the three major groups are compared. The diagnostic problems, signs and symptoms are discussed. Aetiological factors in this area are compared with changing trends in other centres. Pelvic inflammatory disease remains an important cause. The role of conservative approach in surgical treatment of ectopic pregnancy Z5 discussed. The crude incidence rate of ectopic pregnancy in Johore Baru Hospital between January 1978 and June 1979 is 1:358 deliveries.

Matched MeSH terms: Pregnancy, Tubal/diagnosis; Pregnancy, Tubal/epidemiology*; Pregnancy, Tubal/pathology

Simultaneous intra- and extra- uterine pregnancy. A comprehensive case report

Sinnathuray TA, Tiat CH

Med J Malaya, 1966 Sep;21(1):53-5.

PMID: 4224952

Matched MeSH terms: Pregnancy, Tubal*

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/diagnosis*; Pregnancy, Tubal/surgery

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 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/etiology*; 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/diagnosis*; 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/radiography; Pregnancy, Tubal/surgery

Fulltext A life-threatening condition - ruptured ectopic pregnancy with negative urine pregnancy test: A case report

Mohamad F, Yahya AS, Abdul Rashid A, Devaraj NK, Abdul Manap AH

Malays Fam Physician, 2021 Mar 25;16(1):121-123.

PMID: 33948151 DOI: 10.51866/cr1117

Ectopic pregnancy is an extra-uterine pregnancy and is a potentially life-threatening condition that can lead to death from intra-peritoneal hemorrhage. This case reports a rare occurrence of ruptured tubal pregnancy in which the patient presented early with abdominal pain and a negative urine pregnancy test but subsequently presented again with evidence of intra-peritoneal hemorrhage. A negative urine pregnancy test is often used to rule out pregnancy, but it is not 100% sensitive. Complete assessment is critical in this important diagnosis in order to plan for the appropriate emergency management.

Matched MeSH terms: Pregnancy, Tubal

Fulltext Ectopic pregnancy following levonorgesterol-only emergency contraception: the first Malaysian case report

Natasha MN, Khoo HW, Sulaiman AS, Nur Azurah AG, Md Dali AZH, Jamil MA

Medicine & Health, 2012;7(2):107-111.

MyJurnal

Levonorgestrel (LNG) is a well-known safe and efficacious emergency contraception (EC). However, ectopic pregnancy following the failure of LNG-only EC has been reported. The exact incidence of ectopic pregnancy has been hindered by lack of data due to the fact that LNG-only EC is accessible at pharmacies without a prescription. We describe a case of ectopic pregnancy in an 18 year-old single woman who took LNG-only EC within 48 hours of unprotected sexual intercourse. She presented to the emergency department at 8 weeks period of amenorrhoea with an acute abdomen and hypovolaemic shock. Laparotomy confirmed a ruptured right tubal pregnancy and salpingectomy was performed. The patient was discharged well after 2 days. We aim to highlight this potential adverse effect and to discuss the plausible causality of ectopic pregnancy following administration of LNG-only EC.

Matched MeSH terms: Pregnancy, Tubal

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 Tubal Ectopic Pregnancy: Do Our Women Benefit From Laparoscopic Surgery?

Lim, K.J., Omar, M.H., Jamil, M.A., Ng, S.P.

International Medical Journal Malaysia, 2006;5(2):1-8.

MyJurnal

Introduction: Operative laparoscopy is the gold standard approach for treatment of tubal pregnancy. Although benefits of this approach are well established, data on its uptake trend in Malaysia is largely unknown. Objective: This study aims to determine the operative laparoscopy uptake in management of tubal pregnancy at a busy tertiary hospital and whether the benefits associated with laparoscopic surgery was achieved. Materials and Methods: This prospective observational study was conducted on all women admitted for tubal pregnancy at Hospital Sultanah Aminah, Johor Bahru, a public tertiary hospital over a period of 12 months. The on-call team was responsible for the surgical approach. Patient’s clinical presentation, operative laparoscopic uptake, factors affecting the choice of approach and duration of hospitalization were analyzed. Results: The tubal pregnancy rate was 7.6 per 1000 deliveries. Twenty- seven of the 138 cases (20%) had hypovolemic shock, requiring urgent laparotomy and were excluded from study. The operative laparoscopy rate for stable tubal pregnancy was only 42.3% (47 of 111 cases). Women managed laparoscopically were associated with a significantly higher pre-operative hemoglobin level, mostly nullipara and had surgery performed during office hours. They waited longer for their surgery but were discharged earlier compared to the laparotomy group. There was no difference in the duration of hospitalization. Conclusions: Less than half of all hemodynamically stable tubal pregnancies in our hospital had operative laparoscopy. The current laparoscopy uptake rate can be further improved.

Matched MeSH terms: Pregnancy, Tubal

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