Diagnosis and management of ectopic pregnancy american. Based on radiological and laboratory investigations, the differential diagnosis included ruptured ectopic. Ectopic pregnancy can present as an acute lifethreatening emergency when it ruptures and accounts for about 10% of all maternal mortalities. Home march 1987 volume 30 issue 1 the histopathology of tubal pregnancy. In this openlabel, multicentre, international, randomised controlled trial, women aged 18 years and older with a laparoscopically confirmed tubal pregnancy and a healthy contralateral tube were randomly assigned via a central internetbased randomisation program to receive salpingotomy or salpingectomy. If an ectopic pregnancy is diagnosed early but active monitoring isnt suitable, treatment with a medicine called methotrexate may be recommended. Received june 8th, 1987 revised and accepted december 10th, 1987 abstract the histopathological.
Diagnosis and management of ectopic pregnancy the bmj. It presents late clinically and it is difficult to be imaged radiographically. You wont need to stay in hospital after treatment, but regular blood tests will be carried out. The most common site for ectopic pregnancy is fallopian tube more details s 9095%.
A ruptured left interstitial tubal ectopic was found tablefig1. Ectopic pregnancy, condition in which the fertilized ovum egg has become imbedded outside the uterine cavity. Histomorphology of fallopian tubes in ectopic pregnancy. Theyre also called tubal pregnancies because most of them happen in the fallopian tubes. Its given as a single injection into your buttocks. Although ectopic molar pregnancy is a rare entity but all ectopic. With an increasing incidence of ectopic pregnancy worldwide, a histopathological study of the resected fallopian tubes. A 34yearold woman without any medical history presented to our hospital emergency unit with a history of 4 days of progressively increasing pain in the left iliac fossa, fever and vaginal bleeding for the past 3 weeks.
Ectopic pregnancy continues to be a significant cause of morbidity and mortality in women of reproductive age group throughout the world. Ectopic pregnancy symptoms, diagnosis and treatment bmj. In fact, 50% of ectopic pregnancies are associated with some degree of tubal disease. Department of obstetrics and gynecology, university of tuebingen f. Traditional risk factors for ovarian ectopic pregnancy are similar to those for tubal pregnancy, but use of an iud seems to be disproportionately associated. Histopathology fallopian tube ectopic pregnancy with embryo. A 40yearold female presented to the emergency department ed with a 2day history of vaginal. The most common extrauterine location is the fallopian tube, which accounts for 96 percent of all ectopic gestations picture 1ab 1. Several genetic and environmental factors might modulate occurrence of ep. Ectopic molar pregnancy is an uncommon event in clinical practice. Ectopic pregnancy is a pregnancy in which the developing blastocyst becomes implanted at a site other than the endometrium of the uterine cavity. Jun 10, 2011 the estimated prevalence of ectopic pregnancy is 12% worldwide.
Evaluation of serum creatine kinase in ectopic pregnancy with. If the betahcg is 1500 miuml there is a good chance an ultrasound is diagnostic. Salpingotomy versus salpingectomy in women with tubal. She was followed up with serial beta hcg which became normal within 1 month. Nov 01, 2012 tubal reconstructive surgery 45 timesassisted reproductive technique ovulation induction, ivfet and gift 47% risk of heterotopic pregnancy 1%previous ectopic pregnancy 715% chances of repeat ectopic pregnancy 11. Histopathology fallopian tubeectopic pregnancy with. Spontaneous unilateral tubal twin ectopic pregnancy. Histological results of salpingectomy for ectopic pregnancy.
The fallopian tube is the most common site for ectopic pregnancy 9095%. Ct scan showed a left pelvic mass compatible with a tuboovarian abscess. Force project, 1990 the incidence of ectopic pregnancy was 3. We are presenting a case of an interstitial pregnancy which was a surprise intra operative finding. An interstitial ectopic pregnancy is a rare and a dangerous form of an ectopic pregnancy. Evaluation of serum creatine kinase in ectopic pregnancy with reference to tubal status and histopathology osman h. In this paper, we report a case of ectopic complete molar pregnancy in a 39yearold lady who presented to the emergency department with lower abdominal pain, abdominal distention, and lowgrade fever. Ruptured tubal ectopic pregnancy is also implicated in maternal death during the first trimester of pregnancy 611. Ectopic pregnancy remains common in the western world.
A transvaginal scan was suggestive of a leftsided, ruptured ectopic. A classical triad of ectopic pregnancy pain, amenorrhea and bleeding per vaginum seen in 53. Ectopic pregnancy ep is reported in about 1%2% of pregnant females and is associated with mortality and morbidity. Dec 20, 2016 the incidence of ectopic pregnancy has been increasing worldwide. The prevalence of ectopic pregnancy is 12% and it is an important cause of maternal morbidity and mortality consider ectopic pregnancy in all pregnant women presenting with abdominal pain or vaginal bleeding women with a history of ectopic pregnancy, tubal. Risk increases with prior ectopic pregnancy, tubal surgery, history of sexually transmitted infections, smoking, in vitro fertilization, or if pregnant despite iud usage.
Transvaginal sonography is the imaging method of choice for diagnosing and excluding ectopic pregnancy. Among tubal ectopic pregnancy the most common site was ampulla 53. Epidemiology it is the most common type of ectopic by far, accounting for 9397% of cases. Spontaneous unilateral tubal twin ectopic pregnancy ochsner. The site of implantation most commonly is a fallopian tube.
Tubal ectopic commonly seen in 2832 years age group. Bilateral tubal pregnancy is the rarest form of ectopic pregnancy. Tubal ectopic pregnancy radiology reference article. There has been significant rise in incidence of ectopic pregnancy from 34 per to almost 16 per pregnancies 12. Products of conception, abbreviated poc, is stuff formed from the union of egg and sperm.
We investigated the apparently high incidence of tubal ectopic hydatidiform moles in women referred for treatment to a supraregional trophoblastic tumour. Women of reproductive age presenting acutely with gastrointestinal symptoms, particularly diarrhoea, as well as those presenting with abdominal pain andor vaginal bleeding should have a urinary hcg test. The estimated incidence is 1 in 725 to 1 in 1580 of all ectopic pregnancies. Tubal ectopic hydatidiform moles are rare lesions, and only 40 cases have been reported in the world literature. Examination of histopathologic sections taken of tubal ectopic pregnancies and gross dissections of these specimens suggest that, in the majority of cases, the growth of the developing trophoblast takes place in a largely extratubal site and that the common clinical impression that the mass associated with the tubal ectopic pregnancy is a dilated fallopian. In the united kingdom nearly 12 000 ectopic pregnancies are diagnosed each year, which gives a prevalence of 1.
A negative histopathology result could occur even in the case of correctly diagnosed and surgically treated tubal ectopic pregnancy. The histopathological examination of several sections of tubal ectopic pregnancies shows that the growth of the trophoblast usually. The incidence is higher in women undergoing assisted reproductive techniques or ovulation induction. Develioglua, cenk askallia, gurkan uncua, billur samlib, omer daragenlia objective to study the value of creatine kinase in ectopic pregnancy with reference to tubal histopathology. Although the ovary can accommodate more readily than the fallopian tube to the expanding pregnancy, rupture at an early stage is the usual consequence 7. Ectopic pregnancy symptoms, diagnosis and treatment. Totally, more than 200 cases of bilateral tubal ectopic pregnancy have been reported in the. Case description of negative histopathology result after salpingectomy due to tubal ectopic pregnancy. The clinical presentation is unpredictable and there are no unique features to distinguish it from unilateral ectopic pregnancy. Ruptured tubal ectopic pregnancy is also implicated in maternal death during the first trimester of pregnancy 611 there has been significant rise in incidence of ectopic pregnancy from 34 per to almost 16 per. A 40yearold female presented to the emergency department ed with a 2day history of vaginal bleeding associated with lower abdominal pain. The histopathology of the developing tubal ectopic pregnancy. Tubal ectopic pregnancy or adnexal ectopic pregnancy is the most common location of an ectopic pregnancy.
Mar 01, 2016 bilateral simultaneous tubal ectopic pregnancy btp is the rarest form of ectopic pregnancy. The histopathological examination of several sections of tubal ectopic pregnancies shows that the growth of the trophoblast usually takes place in an extraluminal subperitoneal site and that dilation of the tube is caused by coagulated blood and not by the trophoblast. Risk increases with prior ectopic pregnancy, tubal surgery, history of sexually transmitted infections, smoking, in vitro fertilisation, or if pregnant despite iud usage. Adnexal sonographic findings in ectopic pregnancy and. Proximal pathology is less often isolated than distal pathology 4. Histopathology fallopian tubeectopic pregnancy with embryo. Kindlerb department of obstetrics and gynecology, university of tuebingen and university of kiel e r. She was experiencing dizziness, pain in her abdomen, and vaginal bleeding. The condition of tubal ectopic pregnancy is presented from diverse points of.
The condition is the leading cause of pregnancy related death in the first trimester. The prevalence of ectopic pregnancy is 12% and it is an important cause of maternal morbidity and mortality consider ectopic pregnancy in all pregnant women presenting with abdominal pain or vaginal bleeding women with a history of ectopic pregnancy, tubal surgery, or tubal pathology are at. Nov 01, 2005 ectopic pregnancy is a highrisk condition that occurs in 1. The majority of ectopic pregnancies occur in the fallopian tube 96 percent, but other possible sites include. A gravida 4, parity 2, female, with 1 previous abortion, presented at 8 weeks of pregnancy. Because of the paucity of data, little guidance for the appropriate management of a twin tubal ectopic pregnancy is available. Interstitial pregnancy is a rare variant of tubal ectopic pregnancy that carries a risk of lifethreatening hemorrhage. The incidence of ectopic pregnancy in developed countries is about 19. Infections pid or salpingitis may not be documented abdominal pelvic surgery or tubal ligation congenital abnormality des history of previous ectopic pregnancy smoking identified in of ectopic pregnancies. The abdomen was filled with 1500 ml of fresh blood clots. View the article pdf and any associated supplements and figures for a period of 48 hours. The estimated prevalence of ectopic pregnancy is 12% worldwide. Based on radiological and laboratory investigations, the differential diagnosis included ruptured ectopic pregnancy versus. The histopathology of tubal pregnancy parmley tim h.
There are separate articles for chorionic villi and gestational trophoblastic disease. The rate of bifocal tubal pathologies was significantly greater in cases of proximal ep 45. Diagnostic errors occur because of its rarity, its presentation mimicking a routine tubal pregnancy, only a small mass available for histology and frequent lack of discriminating immunohistochemistry. Diagnostic accuracy of ultrasound features for tubal ectopic pregnancy ectopic pregnancy and miscarriage. Unilateral tubal twin pregnancies occur in approximately 1 of every 125,000 spontaneous pregnancies. Fiftyfive women with ectopic pregnancy and 24 undergoing tubal ligation with a segmental resection of the fallopian tube were evaluated for histopathology of the fallopian tube, chlamydia trachomatis serum antibodies, antibodies to a chlamydial sarkosylsoluble 57kda protein, and for isolation of c. Clinical practice guideline the diagnosis and management of ectopic pregnancy 3 key recommendations 1. Fallopian tube damage commonly results from prior pelvic infection, such as gonorrhea, chlamydia, or other sexually transmitted infections stis. Typically presents 68 weeks after last normal menstrual period, but can present earlier or later.
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