Case study: twin pregnancy and ectopic pregnancy.
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Adult↗
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Results for “Pregnancy, Ectopic”
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Ruptured ectopic pregnancy in an ectopic tube. First case report.
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Adult↗
Intrauterine pseudogestational sac in ectopic pregnancy.
Ultrasonic diagnosis of ectopic pregnancy has been thought to depend on exclusion of intrauterine pregnancy on the basis of absence of an intrauterine gestational sac. Two cases illustrating intrauterine echoes suggesting a gestational sac associated with ectopic pregnancy and a plausible explanation for this phenomenon are presented. Because of this and the rare possibility of coexisting intrauterine and extrauterine pregnancies, the ultrasonographer must be wary of dismissing the possibility of an ectopic pregnancy because of an intrauterine gestational sac, whether real or apparent.
Adult↗
Incidental ectopic pregnancy.
Three cases of incidental ectopic pregnancy are described in which the patients were found to have unsuspected ectopic pregnancy when operated for an elective gynecologic procedure.
Adult↗
Analysis of ultrasonographic criteria in the evaluation for ectopic pregnancy.
To assess the usefulness of ultrasound in diagnosing ectopic pregnancy, the ultrasonographic findings, pregnancy test results, and proven diagnoses in 148 patients referred for evaluation for ectopic pregnancy were reviewed. Of these patients, 33 were subsequently proven to have ectopic gestations. The ultrasonograms were coded for uterine size, intrauterine gestation sac, adnexal mass, adnexal ring, cul-de-sac fluid, or normal findings. With a positive pregnancy test, the presence of an intrauterine gestation sac excludes the diagnosis of ectopic pregnancy. Of those patients with positive pregnancy tests and no intrauterine gestation sac, 73% had ectopic pregnancy. All patients with normal ultrasonograms had other diagnoses. With a negative pregnancy test, the intrauterine findings are not helpful, and evaluation of the adnexa is more important. An adnexal ring is a significant, though not absolute, indicator of ectopic pregnancy. A normal scan excludes this diagnosis. Other criteria were not significant. A clinical approach to the evaluation for ectopic pregnancy, based on the data accumulated in this study, is suggested.
Female↗
The conservative surgical management of unruptured ectopic pregnancy.
With the earlier and more accurate diagnosis of ectopic pregnancy based on rapid beta-subunit pregnancy tests and the use of ultrasound and laparoscopy, the percentage of diagnosed unruptured ectopic pregnancies is rapidly increasing. This, coupled with the earlier treatment of pelvic inflammatory disease, the use of IUDs, and increasing numbers of tubal plastic surgery, caused the authors to evaluate the problem of conservative management of ectopic pregnancy. In this study 98 patients at the Yale-New Haven Hospital who had ectopic pregnancies between 1972 and 1977 are evaluated. Fifty of these patients underwent a salpingectomy or salpingo-oophorectomy. Forty-eight patients underwent salpingostomy. This represents an increase in the conservative surgery rate from 8 to 35.5%. The overall term viable pregnancy rate was 40%, along with a 10% repeat ectopic rate. There was no advantage as far as term viable pregnancy when comparing salpingostomy and salpingectomy. Conservative surgery did not increase the repeat ectopic rate. Salpingostomy is therefore recommended in unruptured ampullar ectopic pregnancies in order to preserve reproductive function. If current trends continue, this will be an increasingly important problem. The statistics are based on a 73% follow-up, with all patients actively trying to conceive.
Castration↗
Ectopic pregnancy. An eight-year review.
Ruptured ectopic pregnancy constitutes a major gynecologic emergency that may result in death. From January 1968 through December 1975, 313 patients with ectopic pregnancy were treated at Chicago Lying-In Hospital. The historical and physical findings, diagnostic procedures, causative factors and patient management are reviewed and discussed. The most common symptoms were abdominal pain and amenorrhea. More than half the patients were misdiagnosed prior to admission. Only 30% had distinct adnexal masses. The treatment of choice was salpingectomy unless the opposite tube was absent or damaged. Three deaths occurred in this series. Only 31% of the patients gave histopathologic evidence of pelvic inflammatory disease.
Abortion, Spontaneous↗
Ectopic pregnancy: a 15-year review of 160 cases.
Our review of the incidence of ectopic pregnancy in metropolitan Oklahoma City hospitals from 1960 through 1975 revealed an overall statistically significant increase. Review of the incidence of gonorrhea during the same period for the State of Oklahoma also showed a statistically significant increase. There was a significant correlation between the incidence of ectopic pregnancy and the incidence of gonorrhea. The 160 cases of ectopic pregnancy from University Hospital reviewed in detail included all ectopic pregnancies admitted from 1960 to 1975. Findings revealed 56% were white women with an average age of 26.8 years and average parity of 2.49. Pain (97.5%), amenorrhea (83%), and abnormal uterine bleeding (68%) were the most common presenting complaints, while abdominal tenderness (85%) and pelvic mass (54%) were the common physical findings. Culdocentesis was positive in 78% of the patients. Thirty-nine percent had a history of pelvic inflammatory disease and 8% a previous ectopic pregnancy. Admission diagnosis was correct in 67%. Unilateral adnexal procedure was the treatment in 81%. Fifty-seven percent of the ectopic pregnancies were right-sided, and hemoperitoneum averaged 950 ml. Postoperative complication rate was 55%. Follow-up pregnancy rate was 50%, and future ectopic pregnancies occurred in 6% of these.
Adolescent↗
Human chorionic gonadotropin (beta-subunit) in the early diagnosis of ectopic pregnancy.
In 15 women with suspected ectopic pregnancy considerable amounts of beta-subunit of human chorionic gonadotropin (hCG) were detected in the serum by the radioimmunoassay technique. The diagnosis was proved by laparotomy. In another 25 suspected cases beta-hCG values were less than 1 mU/ml, and in those cases the diagnosis was excluded. The detection of the beta-subunit of hCG in the serum was found to be an excellent tool for the early diagnosis of ectopic pregnancy, thus helping to prevent the dangerous sequelae which follow in the late diagnosis of this condition. The advantage of detecting the beta-subunit of hCG rather than hCG is discussed.
Chorionic Gonadotropin↗
Ectopic pregnancy: criteria and accuracy of ultrasonic diagnosis.
Of 26 ectopic pregnancies, a correct positive ultrasonic diagnosis was made in 77%, while a false negative diagnosis was made in 23%. Most commonly, the ectopic pregnancy appeared as a complex adnexal mass immediately adjacent to an enlarged "empty" uterus. Ultrasonic identification of an extrauterine gestational sac, allowing a definitive diagnosis of ectopic pregnancy, was uncommon.
Diagnostic Errors↗
Serum beta-human chorionic gonadotrophin levels in the early diagnosis of ectopic pregnancy.
Beta-HCG in serum was analysed in 64 cases of ectopic tubal pregnancy who wree different groups; ruptured ectopic pregnancy, ectopic pregnancy accompanied by amenorrhea or adnexal mass and ectopic pregnancy without palpable adnexal mass and amenorrhea. The mean HCG levels for the three groups were 8 790 IU/l, 2 580 IU/l and 690 IU/l, respectively, which related more to the symptoms than to the estimated length of pregnancy. Eleven per cent of the women had an IUD and five per cent were taking low dose gestagens. Screening of cases with acute lower abdominal pain or irregular vaginal bleeding with beta-HCG in serum will facilitate an early diagnosis of ectopic pregnancy and be of special value in patients with less typical symptoms.
Amenorrhea↗
Ectopic pregnancy as an etiologic agent in appendicitis.
The association of ectopic pregnancy and acute appendicitis has seldom been discussed in literature. This report presents 2 patients who had simultaneous right tubal pregnancies and acute periappendicitis. The cases reported here suggest the possibility that an ectopic pregnancy can produce an inflammatory reaction of the appendix. Ectopic pregnancy as an etiological stimulus for acute appendicitis is discussed. The advisability of examining the appendix at the time of surgery for pelvic disease, and performing an appendectomy at the same time, if pathology of the appendix is suspected, is emphasized. The use of elective appendectomy in surgery for ectopic pregnancy is reviewed.
Acute Disease↗
Grey scale ultrasonography in the diagnosis of ectopic pregnancy.
Grey scale pelvic ultrasonography was performed in 36 patients with suspected ectopic pregnancy and in 3 with pelvic mass and bleeding. Thirteen cases were diagnosed as extrauterine pregnancy which was confirmed at operation. There were one false-positive and 2 false-negative studies. The overall diagnostic accuracy was 92.3%. The major diagnostic criteria in unruptured ectopic pregnancy were an extrauterine gestational sac or fetus and an abnormal uterine echo pattern. In addition, a complex mass due to hematoma was seen in ruptured ectopic pregnancy. Chronic ruptured ectopic pregnancy simulated pelvic inflammatory disease and was difficult to diagnose.
Adolescent↗
Copper T IUD use and ectopic pregnancy rates in the United States.
Over a four-year exposure period, the rate of ectopic pregnancy for women using a Copper T IUD was less than 1 per 1000 years of use. The cumulative 4-year probability of having an ectopic pregnancy while using the Copper T was 4 per 1000 women. These results are based on a study of 35,496 women with 38,064 years of use. Data on ectopic pregnancies in the United States provide a basis with which IUD experience may be compared. The National Hospital Discharge Survey shows a doubling in the number of ectopic pregnancies and in the incidence rates between 1965 and 1976. The relative risk of ectopic pregnancy among IUD users as compared with sexually active women not using the pill or sterilization may have been above 1 in 1965. In 1976, the relative risk is estimated to have been below 1. Compared with all woman-years of exposure, including women using contraceptive sterilization and the pill, the relative risk of extopic pregnancy to IUD users in 1976 was about 1. The IUD could not have been a major factor contributing to the recent doubling in the rate of ectopic pregnancy in the U.S.
Adult↗
Effect of the venereal diseases epidemic on the incidence of ectopic pregnancy -- implications for the evaluation of contraceptives.
This paper identifies a basis for quantifying the risk of ectopic pregnancy in pregnancy seekers and in users of the major means of contraception, with and without prior tubal infection. The doubling, in U.S. in recent years, of both numbers of ectopic pregnancies and the prevalence of nonsurgical sterility is correlated with the epidemic of gonorrhea and other sexually transmitted, salpingitis-producing diseases. The risk of ectopic pregnancy in women who have once had salpingitis is shown, on the basis of Weström's landmark prospective study and many retrospective studies, to be approximately 10-fold that of normal women. Fertilization-preventing contraceptives reduce uterine and ectopic pregnancies in the same proportion and in both categories of users--that is, in normal-risk and high-risk (post-salpingitis) women. Intrauterine contraceptives, however, markedly reduce uterine pregnancies, but have little effect on the incidence of ectopic pregnancy. Among IUD users, therefore, the incidence of ectopic pregnancy will be disproportionately great in relation to the fraction of high-risk women in the population of users. This disproportionate influence of prior salpingitis may confuse the comparative evaluation of contraceptive safety because the proportions of normal-risk and high-risk women probably vary widely, since public health data show extremely wide geographic differences in the incidence of gonorrhea -- the best known but not the only sexually transmitted, salpingitis-producing disease.
Contraception↗
Editorial: Ectopic pregnancy and the I.U.D.
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Female↗
Reproductive performance among patients with tubal ectopic pregnancy.
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Abortion, Spontaneous↗
[Combined intra-uterine and ectopic pregnancy following the treatment with clomiphen (author's transl)].
Report on a case of combined pregnancy in a 25 year old patient who was treated with Clomiphen for anovulatory cycles. The left tubal pregnancy was removed at 12 weeks gestation. The intra-uterine pregnancy resulted in a term delivery of a 3 kg. 670 g. normal infant. Combined pregnancies rarely occur without treatment with ovulation inducing agents by superfecundation and superfetation. Ovulation inducing agents increase the theoretical possibility of combined pregnancy. Obstetricians should be alert to the possibility of combined pregnancy following induction of ovulation.
Adult↗