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The laparoscopic demonstration of a patent tube usually excludes the present of a tubal pregnancy. In the reported case tubal pregnancy was suspected. Tubal patency was tested because of equivocal laparoscopic findings, and an unexpected tubal pregnancy was diagnosed in the presence of tubal patency.
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A woman with two intrauterine pregnancies after two ectopic tubal pregnancies is presented. The first operation removed the left Fallopian tube (on 4 November 1970), while during the recurrent ectopic pregnancy, plastic surgery was applied in the remaining right tube (24 October 1972) with the enucleation of the fertilized egg after Prochownik's method. The patient became pregnant 3 months after the operation and had spontaneous abortion, with a fetus two-and-a half months old; the second time she became pregnant 17 months after the operation and gave birth to a female live-born, 26 days before the term, weighing 2,900 g and 49 cm high. The authors conclude that best results are obtained when the plastic surgery made in the fallopian tube is as small as possible and when postoperative instillation of the tubes is applied.
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174 patients with suspected tubal pregnancy were thoroughly examined. The diagnosis was confirmed in 102 women. As the usual noninvasive and invasive examination methods proved to be rather inaccurate, a new procedure, the 'LH/HCG test', was evaluated. Results were positive in all our cases. It was therefore concluded that this assay should receive primary consideration when tubal pregnancy is in question.
Twelve cases of tubal pregnancy after sterilization operations are reported and the pathogenesis is discussed. Diagnosis is sometimes delayed because of the history of previous sterilization. It is paradoxical that the diagnosis of an intrauterine pregnancy after tubal sterilization is rarely in doubt yet the possibility of the fertilized ovum implanting in a tube known to have been damaged is sometimes overlooked. It is suggested that bilateral salpingectomy is the correct operative treatment for this condition.
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51 women with suspected tubal pregnancy were admitted to our hospital during the past two years. Tubal pregnancy was present in 31 women. Diagnosis is rarely accurate with the conventional examination methods. The "LH/HCG" test was positive in all of our patients. Hence it appears resonable, whenever tubal pregnancy is suspected, to combine several noninvasive examination methods, special preference being given to the LH/HCG test.
Fifty cases of excised tubal pregnancy which occurred in the Igbos of Nigeria are reviewed. Twenty percent of the tubes were unruptured at the time of excision, indicating a high level of awareness of the condition among local doctors. There were several pointers to the conclusion that, in this ethnic group, tubal pregnancy tends to be seen at an advanced stage. It also tends to occur in the younger women, to manifest during the first known pregnancy, to recur, and to be associated with salpingitis. Interstitial tubal pregnancy is also probably relatively common.
Twenty-four conservative surgical procedures for unruptured tubal pregnancies were performed on 23 patients with poor past obstetric performance. All cases were diagnosed preoperatively by laparoscopy. Salpingotomy was performed in 20 cases and fimbrial expression of the ectopic pregnancy was performed in 4 cases. In the group of conservatively treated patients there were 15 live births in 11 women and 28 intrauterine pregnancies in 14 women. No ectopic pregnancies occurred in the operated tube. Early diagnosis and conservative surgical treatment of unruptured tubal pregnancy is appropriate for patients with poor reproductive histories.
A case of unilateral gonadoblastoma in association with a ruptured ectopic tubal pregnancy is presented. The patient had normal menstrual history prior to a missed period followed by abdominal pain and the passage of clots. The surgical specimens, in addition to the ruptured tubal pregnancy, showed nodular foci of typical gonadoblastoma in the right ovary, the remainder of the ovarian tissue being normal. The left ovary was subsequently removed and examination revealed normal constituents without evidence of tumor. Cytogenetic evaluation of peripheral leukocytes showed cells with a normal female sex chromatin complement, 46-XX, as well as cells with 45 chromosomes in which one of the X chromosomes was missing.
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Following laparoscopic diagnosis of unruptured tubal pregnancy, six patients underwent partial salpingectomy using a minilaprotomy technique. None of the patients had any complications resulting from the surgery. Four were discharged within 48 hours of surgery and the others on the 3rd postoperative day. When an ectopic pregnancy has been diagnosed before rupture the technique seems preferable, as it entails a less extensive hospital stay than does conventional laparotomy. The smaller incision is more comfortable and is cosmetically acceptable. The technique is relatively easy to use, and it is hoped that the minimal invasion of the peritoneal cavity will have a less deleterious effect on future fertility.
Long-standing tubal inflammatory lesions occurred in 35 (14%) of 250 tubal pregnancy patients, aged from 14 to 45 yrs, encountered from 1948 to 1969 in an eastern Canadian population where clinically manifest pelvic inflammation is not prevalent and 1/180 is the approximate ratio of ectopic pregnancy to live births. Present in 24 of these 35 patients was follicular salpingitis. For most of the eccyeses, functional derangements appear likely to have been responsible more often than structural alterations of the oviducts; but possible roles for 'physiological salpingitis' in leading to tubal pregnancy may be worthy of investigation.
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