John C Siegle | PubMed Health

PubMed2006

Heterotopic pregnancy after 2 prior ectopic pregnancies: a case report.

BACKGROUND: Heterotopic pregnancy is a rare occurrence, with spontaneous pregnancy often unsuspected and associated with delayed diagnosis. When previous ectopic pregnancy has been treated, future pregnancy is associated with an increased risk for ectopic pregnancy and potentially heterotopic pregnancy. Conservative treatment for ectopic pregnancy with either surgery or methotrexate leaves the patient with hope for potential future fertility, especially when assisted reproductive technology is not available. CASE: A woman who had been treated for ectopic pregnancy in both fallopian tubes presented with a spontaneous heterotopic pregnancy. CONCLUSION: Heterotopic pregnany may occur after treatment of previous ectopic pregnancy and may lead to a successful outcome when diagnosed and treated appropriately.

Adult↗

PubMedDate not supplied

Randomized comparison between two microlaparoscopic techniques for partial salpingectomy.

OBJECTIVE: We compared 2 techniques for performing a partial salpingectomy by using microlaparoscopy and either bipolar coagulation or loop ligation. METHODS: A 3-mm transumbilical laparoscope with secondary midline port sites midway and suprapubically was used to perform a partial salpingectomy in 109 women desiring permanent sterilization. Each patient was randomly assigned to undergo a tubal resection either after Pomeroy ligation (n= 54) or after bipolar coagulation with Kleppinger forceps (n=55). Postoperative pain, as assessed using a 10-point visual analog scale, was the primary comparison endpoint. RESULTS: No technical difficulties with either technique required conversion to a minilaparotomy. The mean time to remove both tubal segments was not different between techniques (7 minutes, 21 seconds; range, 4 minutes, 25 seconds to 15 minutes, 43 seconds). Each segment (mean, 1.6 cm; range, 0.8 to 3.5 cm) was confirmed in the operating room, then histologically. Postoperative pain at 6 hours was scored similarly (median, ligation 4.6, coagulation 4.0 of 10). Outpatient recovery was the same, unless pelvic pain required overnight observation (ligation, 4 patients; coagulation, 2 patients). CONCLUSION: Partial salpingectomy, using microlaparoscopy with either bipolar coagulation or loop ligation, was performed with comparable ease, confirmation of the removed tube, and similar postoperative discomfort.

Adult↗