Study on Variation Trend of Pre-treatment Blood Human Chorionic Gonadotropin in Predicting Efficacy of Tubal Pregnancy Treated by Drug Therapy / 广州中医药大学学报

Objective To investigate the role of variation trend of pre-treatment blood beta human chorionic gonadotropin(β-HCG)in predicting the efficacy of tubal pregnancy(TP)treated by drug therapy.Methods Clinical data of 380 TP patients treated by drug therapy at the First Affiliated Hospital of Guangzhou University of Chinese Medicine from January 2017 to June 2022 were collected.The patients were divided into 271 cases in the pure Chinese medicine(CM)treatment group(shortened as pure CM group)and 109 cases in the combination of Chinese medicine and western medicine group(shortened as combination group)according to the therapy.The relevant factors that may affect the outcomes of the therapy were analyzed,and logistic regression analysis was used for the control of confounding factors.The influences of pre-treatment β-HCG on the outcomes of TP treated by various therapies were investigated,and the value of variation trend of pre-treatment β-HCG in predicting the efficacy of TP treated by drug therapy was assessed using the receiver operating characteristic curve(ROC curve).Results(1)The results of univariate analysis showed that the initial value of blood β-HCG,the variation trend of β-HCG and the difference value of β-HCG detected for 2 times before treatment were correlated with the treatment outcomes in the pure CM group and the combination group,and the differences were all statistically significant(P＜0.05 or P＜0.01).(2)The results of multivariate regression analysis showed that in the pure CM group,the blood β-HCG values and the variation trend of β-HCG detected for 2 times before treatment were correlated with the treatment outcomes,and the differences were all statistically significant(P＜0.05 or P＜0.01);in the combination group,the menopausal time and blood β-HCG value detected at the second time before treatment were correlated with the treatment outcomes,and the differences were all statistically significant(P＜0.05).(3)After controlling for the confounding factors,the variation trend of pre-treatment β-HCG in the pure CM group was correlated with the treatment outcomes,and the difference was statistically significant(OR=3.35,95%CI being 1.69-6.65,P = 0.001).However,the variation trend of pre-treatment β-HCG in the combination group did not affect the treatment outcomes,and the difference was not statistically significant(P＞0.05).(4)The ROC curve analysis showed that the area under the curve(AUC)in the pure CM group was 0.74,the cutoff value was-0.14,the sensitivity was 71.3%and the specificity was 67.8%.The AUC in the combination group was 0.67,the cutoff value was 0.10,the sensitivity was 73.6%and the specificity was 60.7%.Conclusion The variation trend of pre-treatment blood β-HCG can effectively predict the efficacy of Chinese medicine for the treatment of TP,but has no value for predicting the efficacy of the combination of Chinese medicine and western medicine in treating TP.The variation value of pre-treatment blood β-HCG can be used as a valuable reference indicator for the early prediction of the outcomes of TP treated by drug therapy.

Construction and Validation of a Predictive Model for the Risk of Concomitant Hemorrhage in Patients with Ruptured Tubal Pregnancy / 实用妇产科杂志

Objective:To construct and validate a predictive model for the risk of excessive blood loss in pa-tients with ruptured tubal pregnancy,and to provide a basis and tool for the assessment of changes in the condi-tion of patients with ruptured tubal pregnancy.Methods:Clinical data of inpatients with ruptured tubal pregnancy from January 2014 to July 2021 were retrospectively analyzed,who underwent surgical treatment in the Depart-ment of Gynecology,Dongguan Maternal and Child Health Hospital.The pelvic blood volume was categorized into excessive blood loss and non-excessive blood loss groups based on whether the amount of pelvic blood was found to be≥750 ml intraoperatively.Factors influencing the occurrence of excessive blood loss were screened and modeled by univariate analysis,Lasso regression,and multi-factor Logistic stepwise regression.The area un-der the subject working characteristic curve(AUC)was used to evaluate the discrimination of the predictive mod-el,the model's consistency was evaluated by calibration curve and goodness-of-fit test,and the clinical utility of the model was evaluated and validated by the decision analysis curve.Finally,column line plots were drawn.Results:①A total of 386 patients with ruptured tubal pregnancy were included,of whom 124(32.12%)had blood loss≥750 ml.②The optimal predictors for predicting concomitant blood loss in patients with ruptured tubal preg-nancy were screened,including:days of abdominal pain,dizziness,pallor,fatigue,the maximum diameter of para-metrial mass,human chorionic gonadotropin(β-hCG),and hemoglobin(Hb)and the model and the column line graphswere constructed accordingly.③The prediction model AUC was 0.827(95%CI 0.781-0.873);the cut-off value was 0.391,at which point the specificity and sensitivity were 68.55%and 84.35%,respectively,and the AUC validated within the model by resampling was 0.804.Clinical decision curves showed that the threshold probability intervals for the maximum net benefit values ranged from 8.5%-97%,respectively.Conclusions:The constructed prediction model was validated to suggest good discriminatory efficacy and degree of consistency.As a tool,it has clinical application value in predicting the risk of hemorrhage in patients with ruptured tubal pregnan-cy.It can help to determine the occurrence of adverse events such as hemorrhagic shock at an early stage and improve the success rate of rescue treatment.

Forensic Analysis of Eighteen Tubal Pregnancy-Related Medical Damage / 法医学杂志

OBJECTIVES@#To analyze the cases of medical damage after misdiagnosis of tubal pregnancy, to explore the causes of medical damage, the causal relationship between medical malpractice and the damage consequences, as well as the causative potency, in order to provide evaluation ideas for forensic identification of such cases.@*METHODS@#Eighteen cases of forensic identification of tubal pregnancy related medical damage were collected and retrospectively analyzed from the aspects of age, maternity history, fertility requirements, risk factors, diagnosis and treatment, medical malpractice, damage consequences, and causative potency.@*RESULTS@#All 18 cases were tubal pregnancy, of which 17 cases had medical malpractice, resulting in 14 cases of affected tubal resection, 2 cases of hemorrhagic shock death, 1 case of intrauterine fetal death and affected tubal resection. The other case had the consequence of affected tubal resection, but there was no malpractice in the treatment.@*CONCLUSIONS@#Correct diagnosis is helpful to make appropriate treatment plan, prevent disease progression and reduce serious adverse consequences and the occurrence of medical disputes. Scientific and reasonable analysis of the causal relationship between medical malpractice and damage consequences and the causative potency is of great significance to the successful settlement of medical disputes.

Talin1 is highly expressed in the fallopian tube and chorionic villi to promote trophoblast invasion in tubal pregnancy / 南方医科大学学报

OBJECTIVE@#To investigate the expression of Talin1 in the fallopian tube and chorionic villi in patients with tubal pregnancy and its role in regulating invasion and migration of trophoblasts.@*METHODS@#Immunohistochemistry and Western blotting were used to detect the localization and expression level of Talin1 in the fallopian tube and chorionic villi in patients with tubal pregnancy and in women with normal pregnancy. In the cell experiment, HTR-8/SVneo cells was transfected with Talin1 siRNA and the changes in cell invasion and migration were assessed using scratch assay and Transwell assay. The expressions of MMP-2, MMP-9, N-cadherin and Snail in the transfected cells were detected by qRT-PCR and Western blotting.@*RESULTS@#Positive expression of Talin1 was detected in both normal fallopian tube tissues and tissues from women tubal pregnancy, and its expression was localized mainly in the cytoplasm of cilia cells. The expression level of Talin1 was significantly higher in both the fallopian tube and chorionic villi in women with tubal pregnancy than in normal fallopian tube and chorionic villi samples (P < 0.01). In HTR-8/SVneo cells, transfection with Talin1 siRNA significantly inhibited cell invasion (P < 0.01) and migration (P < 0.05), down-regulated the expression of N-cadherin, MMP-2 and Snail (P < 0.05), and up-regulated the expression of MMP-9 in the cells (P < 0.05).@*CONCLUSION@#The expression of Talin1 in the fallopian tube and chorionic villi is significantly increased in women with tubal pregnancy, suggesting the association of Talin1-regulated trophoblast cell invasion with the occurrence of tubal pregnancy.

Application and evaluation of ultrasound critical value in ruptured tubal pregnancy / 中华超声影像学杂志

Objective:To evaluate the diagnosis and critical value reporting of ruptured tubal pregnancy by ultrasound.Methods:The clinical and ultrasound data of 70 patients with ruptured tubal pregnancy diagnosed by surgery in Peking Union Medical College Hospital from August 2017 to May 2021 were retrospectively analyzed to evaluate the diagnosis and critical value reporting of ruptured tubal pregnancy by ultrasound.Results:Among the 70 patients, 68 patients underwent gynecological ultrasonography and two patients did not. Sixty-three cases (92.6%, 63/68) were accurately diagnosed as adnexal ectopic pregnancy mass, abdominal and pelvic effusion/blood clot, and 5 adnexal ectopic pregnancy masses (7.4%, 5/68) were missed.Among the 5 missed cases, 4 cases (80%, 4/5) were heterotopic pregnancy (2 cases of IVF-ET 2 embryos, 1 case of patient taking ovulation induction drugs, 1 case of gravida with twin family history) and 1 case (20%, 1/5) of single tubal pregnancy. Critical values were reported in the all 63 cases of ruptured tubal pregnancy diagnosed by preoperative ultrasound.Conclusions:Ultrasound could accurately diagnose tubal pregnancy and assess its rupture, and timely report the critical value, effectively guarantee the medical safety. The particularity and complexity of ultrasound diagnosis in early pregnancy with assisted reproductive technique deserve more attention.

Gravidez heterotópica espontânea: implicações de um diagnóstico tardio / Spontaneous heterotopic pregnancy: implications of a late diagnosis

A gestação heterotópica é uma entidade rara, principalmente se resultante de concepção natural. O diagnóstico é ultrassonográfico, porém a gestação intrauterina concomitante contribui para a dificuldade propedêutica. Neste relato de caso, a detecção foi tardia, a ultrassonografia não identificou a gestação heterotópica e apenas durante a avaliação intraoperatória, por meio de uma cirurgia de emergência devido a choque hemorrágico, houve o reconhecimento. A suspeita de uma gestação heterotópica deve ser sempre aventada quando sinais clínicos típicos (sangramento, dor abdominal) estão presentes, mesmo na ausência de fatores de risco ou imagens anômalas na ecografia. Assim, uma intervenção precoce menos invasiva pode ser realizada, reduzindo a morbimortalidade materna e do feto intrauterino. Este relato de caso destaca uma situação incomum dentro dessa patologia rara: diagnóstico tardio, apenas no segundo trimestre de gestação, sem evidência prévia ultrassonográfica, certificada apenas durante o intraoperatório. O manejo cirúrgico preciso permitiu a manutenção da gravidez intrauterina.(AU)

Heterotopic pregnancy is a rare entity, especially if it is resulted from natural conception. The diagnosis is ultrasonographic, but the concomitant intrauterine pregnancy contributes to the propaedeutic difficulty. In this case report, the detection was late, the ultrasonography did not identify heterotopic pregnancy and, only during intraoperative evaluation through emergency surgery, exploratory laparotomy, there was recognition. The suspicion of a heterotopic pregnancy should always be raised when typical clinical signs (bleeding, abdominal pain) are present, even in absentia of risk factors or anomalous images on ultrasound. Thus, a less invasive early intervention can be performed, reducing maternal and intrauterine fetus morbimortality. This case report highlights an unusual situation within this rare pathology: late diagnosis, only in the second trimester of pregnancy, without previous ultrasound evidence, certified only during the intraoperative period. Precise surgical management allowed the maintenance of intrauterine pregnancy.(AU)

Incidental finding of thoracic outlet syndrome in a case of right tubal ruptured ectopic pregnancy

A 30-year-old woman, (multigravida) suffering from lower abdominal pain and slight vaginal bleeding was transferred to our hospital. She came with a pelvic ultrasound report. The provisional diagnosis of right tubal ectopic pregnancy was made. A laparotomy was carried out. Intraoperatively, blood pressure in both the arms were taken which revealed different blood pressure in different arms. A diagnosis of thoracic outlet syndrome was made. No postoperative complications were observed.

A ruptured cornual pregnancy: a case report

A cornual gestation is a rare form of ectopic gestations accounting for 2-4% of all tubal pregnancies with a high rate of mortality among to 2%-2.5%. A 25 years old woman prima gravida was presented to the obstetrical emergency department with 8 weeks amenorrhea, lower abdominal pain and vaginal bleeding. A clinical diagnosis of ectopic pregnancy was made and confirmed using Ultrasonography and serum beta-hCG test. On laparotomy exploration authors found a left cornual ruptured ectopic pregnancy then authors made a left cornual resection with left salpingectomy. There were no postoperative complications.

Embarazo ectópico tubárico seis años después de una histerectomía supracervical. Reporte de caso / Tubal ectopic pregnancy six years after supracervical hysterectomy. A case report

Resumen El embarazo ectópico en pacientes histerectomizadas es un evento poco común y rara vez se considera en el diagnóstico diferencial en mujeres con esa condición. Se comunica el caso de una paciente de 30 años con antecedentes de histerectomía realizada hacía 6 años, que se presentó en el servicio de urgencias con evolución de tres días de dolor abdominal bajo. La ecografía mostró un saco gestacional con embrión y presencia de líquido libre en el fondo de saco Douglas. El examen histológico de la muestra operatoria reveló vellosidades coriónicas y un embrión dentro de la trompa uterina.

Abstract Ectopic pregnancy in hysterectomized patients is an uncommon event and it is rarely considered in the differential diagnosis. We present the case of a 30-year-old patient with hysterectomy performed 6 years before who presented to the emergency service with a 3-day evolution of lower abdominal pain. Ultrasonography showed a gestational sac with embryo and the presence of free fluid in the Douglas sac. Histological examination of the surgical piece revealed chorionic villi and an embryo within the uterine tube.

Analysis of the influencing factors of the outcome of laparoscopic conservative surgery in patients with tubal pregnancy / 中国综合临床

Objective@#To investigate the influencing factors of fertility outcome after laparoscopic conservative surgery for tubal pregnancy.@*Methods@#From October 2010 to October 2016, 253 cases of tubal pregnancy treated by laparoscopic conservative surgery in General Hospital of Jizhong energy Fengfeng Group Hospital were analyzed retrospectively.All patients were followed up from 24 to 36 months after operation to observe the intrauterine pregnancy.Logistic regression was used to analyze the influencing factors of intrauterine pregnancy.@*Results@#After 24-36 months follow-up, the patients were not contraception and pregnant under the guidance of doctors.Among the 253 cases, 182 (71.1%) were intrauterine pregnancy, 37 (14.6%) were ectopic pregnancy, and 34 (13.4%) were not pregnant.The results of logistic regression showed that high level of hCG, severe pelvic adhesions, obstruction of fallopian tube and history of ectopic pregnancy were the risk factors of intrauterine pregnancy (OR (95%CI) 1.982 (1.075-3.149), 2.410 (1.279-5.069), 2.485 (1.071-3.594), 5.071 (1.094-9.081), P<0.05 or P<0.01).@*Conclusion@#The reproductive outcome of laparoscopic conservative surgery for tubal pregnancy is influenced by many factors.The high level of hCG in preoperative blood, severe pelvic adhesions, obstruction of tubal and ectopic pregnancy history are the risk factors of postoperative pregnancy.

Review on oral methotrexate in medical management of ectopic pregnancy: a 2 years experience in hospital Shah Alam

Background: The objective of this study is to determine the success rate of oral methotrexate in Hospital Shah Alam for the past 2 years.Methods: This is a cross-sectional study using secondary data obtained from medical record office in Hospital Shah Alam on patients with ectopic pregnancy. A total of 35 patients who fulfilled the criteria for medical management were selected. They were prescribed with oral methotrexate with the dose of 60 mg given in 3 divided doses every 2 hours using the standard tablet of 2.5mg. Follow up was done at day 4, day 7 and till HCG level achieve less than 20 iu/litre.Results: 29 patients were successfully treated with oral methotrexate 60 mg (82.8%). Another 6 patients had to undergo laparoscopic surgery with confirmed leaking, ruptured tubal pregnancy. 4 patients needed second dose of Methotrexate due to rising HCG level and all of them were successfully treated after the second dose. The side effects of oral methotrexate were tolerated well by all patients. There are numbers of predictors for success which are the level of HCG <4000 iu/litre, size of mass <4cm, no abdominal pain during early presentation and decrease of HCG level in between day 4 to day 7 after oral methotrexate.Conclusions: The success rate of oral methotrexate for stable ectopic pregnancy is good making it a suitable option for clinical settings which has no specialised equipment to handle cytotoxic drugs.

Spontaneous heterotopic triplet pregnancy with a two viable intrauterine embryos and an ectopic one with right tubal rupture / Gravidez heterópica tripla espontânea com dois embriões intrauterinos viáveis e um ectópico com ruptura da tuba uterina direita

Abstract Heterotopic pregnancy (HP) is defined as the simultaneous development of an intra- and an extra uterine gestation. The occurrence of a spontaneous triplet HP is an exceptionally rare medical condition. We report the case of a young woman with spontaneous heterotopic triplets at 8weeks of gestation, with amisdiagnosis of topic twins and acute appendicitis. The ectopic tubal pregnancy was ruptured and a salpingectomy was performed by laparotomy. The intrauterine pregnancy progressed uneventfully. The two healthy babies were delivery by cesarean section at 36 ± 2 weeks of gestation. Heterotopic triplets with ruptured tubal ectopic pregnancy represent a special diagnostic and therapeutic challenge for the obstetrician. A high rate of clinical suspicion and timely treatment by laparotomy or laparoscopy can preserve the intrauterine gestation with a successful outcome of the pregnancy.

Resumo A gravidez heterotópica é definida como o desenvolvimento simultâneo de uma gestação intra- e extra-uterina. A ocorrência de gravidez tripla heterotópica espontânea é uma condição médica excepcionalmente rara. Relatamos o caso de uma jovem com gravidez tripla espontânea, às 8 semanas de gestação, com um diagnóstico errôneo de gêmeos tópicos e apendicite aguda. A gravidez tubária ectópica estava rota e uma salpingectomia foi realizada por laparotomia. A gravidez intrauterina progrediu sem intercorrências. Os bebês nasceramsaudáveis por cesariana realizada às 36 semanas de gestação.Agravidez de heterotópicos comectopia e rotura tubária é umdesafio diagnóstico e terapêutico.Umalto índice de suspeita e tratamento oportuno por laparotomia ou laparoscopia podem preservar a gestação intrauterina com um resultado bem sucedido da gravidez tópica.

Effect of laparoscopic salpingotomy on ovarian reserve function in patients with tubal pregnancy / 中国综合临床

Objective To investigate the effect of laparoscopic salpingotomy and salpingectomy on ovarian reserve function in patients with tubal pregnancy??Methods From October 2014 to March 2017,201 cases of tubal pregnancy in Jizhong energy Fengfeng Group Hospital were selected and divided into observation group (112 cases) and control group (89 cases) according to different treatment methods??The observation group was treated with laparoscopic salpingectomy, while the control group was treated with laparoscopic salpingectomy??The number of sinus follicles and ovarian volume were measured by color Doppler ultrasound at third days of menstruation on first,third,sixth months after the operation respectively and the ovulation was detected in 6 months after the operation??The intrauterine pregnancy of the two groups was observed one year after operation??Results There was no significant difference in the number and volume of healthy ovarian antral follicles between the two groups in 1,3 and 6 months after operation respectively (all P＞0??05)??The number of sinus follicles in the 1,3 and 6 months after the operation were (7??71 ± 3??12), (7??86 ± 2??03) and (7??65 ± 1??89) in observation group respectively,while that in the control group were (4??06 ± 1??05),(3??91 ± 1??14) and (4??89±2??03)respectively??There was no significant difference in the number of sinus follicles in different time groups ( Fintra?group＝0??573,P＞0??05)??The difference between the groups was statistically significant (F inter?grouP＝634??306,P＜0??01,Finteraction＝463??257,P＜0??01)??The ovarian volume of the patients in the 1,3 and 6 months after the operation were (8??49 ± 1??67),(9??01 ± 3??07) and ( 8??51 ± 2??67) cm3 in observation group respectively, and were ( 5??70 ± 2??58), ( 4??81 ± 2??10) and ( 6??03 ± 1??96) cm3 in control group respectively??There was no significant difference in the ovarian volume of the affected side at different time points after operation( Fintra?group＝0??671,P＞0??05)??The difference between the groups was statistically significant ( Finter?group＝ 449??106, P＜ 0??01 ), F interaction＝ 261??017, P＜ 0??01 )??The ovulation rate at 6 months ( 82??1%, 92／112 ) and intrauterine pregnancy rate at 1 year ( 71??8%,79／110) in the observation group were higher than those in the control group (56??2%,50／89) and (31??0%,27／87)??There were significant differences between the two groups(χ2＝12??601,28??753,all P＜0??05)??Conclusion Laparoscopic salpingotomy is better than salpingectomy in the treatment of tubal pregnancy??The ovulation rate and intrauterine pregnancy rate are also superior to salpingectomy??It shows that laparoscopic fenestration can protect the ovarian reserve reserve function and reproductive function of patients??

Effect of different grades of corpus luteum blood flow on conservative treatment in patients with unruptured tubal pregnancy / 中国综合临床

Objective To study the effect of different grades of corpus luteum blood flow on conservative treatment of unruptured tubal pregnancy??Methods One hundred and fifty?six patients who were diagnosed with unruptured tubal pregnancy in the General Hospital of Northern War Zone and accepted conservative treatment from February 2013 to February 2018 were retrospectively analyzed??The patients were divided into corpus luteum blood level 0 group(0 grade group,36 cases),corpus luteum blood level 1 group (1 grade group,41 cases),corpus luteum blood level 2 group(2 grade group,45 cases),corpus luteum blood level 3 group ( 3 grade group, 34 cases ) according to the corpus luteum blood flow classification in pregnancy??The levels of blood β?HCG,the packet reducing and the curative effect were compared among the four groups??Results The time ofβ?HCG decreased to normal after treatment in 0～3 grade group was (14??4 ±2??7) d, (16??2± 3??9) d, ( 23??3± 4??8) d, (27??0± 4??6) d respectively,there was significant difference among the four groups (F＝5??338,P＝0??039)??The time of mass disappeared completely after treatment in 0－3 grade group was (13??2±2??2) d,( 15??9± 3??0) d,( 21??8± 2??9) d,(24??1± 3??4) d respectively,there was significant difference among the four groups ( F＝4??229,P＝0??043)??The curative rate in 0－3 grade group was 91??7%(33／36),87??8%(36／41),82??2%( 37／45),73??5%( 25／34) respectively,there was significant difference among the four groups(χ2＝4??586,P＝0??041)??There was no significant difference in incidence of adverse reactions among the four groups ( P＞0??05)??Conclusion The different classification of corpus luteum blood flow in pregnancy of unruptured tubal pregnancy have significant influence on the conservative treatment effect??The higher the blood flow classification,the longer treatment time and the worse the curative effect??

Multivariate analysis of laparoscopic conservative surgery for persistent ectopic pregnancy after tubal pregnancy / 中国综合临床

Objective To investigate the influencing factors of persistent ectopic pregnancy (PEP) after laparoscopic conservative surgery for tubal pregnancy.Methods Three hundred and one cases of tubal pregnancy treated by laparoscopic conservative surgery in Jizhong energy Fengfeng Group Hospital from October 2007 to October 2017 were divided into PEP group ( 21 cases) and non PEP group ( 280 cases) according to whether PEP occurred after operation.The age,menopause time and preoperative serum of the two groups were analyzed.The levels of beta?human chorionic gonadotropin (beta?hCG),surgical methods, corpus luteum exfoliation, methotrexate and mass diameter were analyzed.Logistic regression was used to analyze the multiple factors.Results There was no significant difference in age between the two groups.There were significant differences in the time of menopause, preoperative serum beta?hCG level, operative methods,corpus luteum exfoliation, methotrexate application and mass diameter between the two groups (P＜0.05 or P＜0.01).Multivariate logistic regression analysis showed that short menopause time, high preoperative serum beta?hCG concentration, sac extrusion at the umbrella end of fallopian tube, no corpus luteum exfoliation, no intraoperative methotrexate and small mass diameter were risk factors for persistent ectopic pregnancy (OR(95%CI) were 1.476 ( 1.035～3.961),1.513 (1.391～3.017),5.301 (1.304～19.570),1.104 (1.015～2.769),1.180 (1.020～2.543),1.540 (1.181～5.120),respectively, all P＜0.05).Conclusion PEP is prone to occur in patients with tubal pregnancy treated by laparoscopic conservative surgery,such as short menopause time,small size of mass,high preoperative serum beta?hCG concentration,no corpus luteum exfoliation,no local methotrexate and umbrella sac extrusion.Therefore,the key measures to reduce the occurrence of PEP in clinic are to choose the right operation time,appropriate operation method,corpus luteum exfoliation and local injection of methotrexate.

Effect of laparoscopic salpingotomy with suturing on prognosis of patients / 中国综合临床

Objective To investigate the effect of laparoscopic salpingotomy with suturing on prognosis of patients.Methods One hundred and thirty two cases patients of laparoscopic salpingotomy and embryo extraction in our hospital from October 2015 to Febrary 2017 were were divided into observation group (68 cases) with suturing and control group (64 cases) without suturing according to the operation procedure.The patency of fallopian tube was observed at 3 months after operation and the intrauterine gestation rate and recurrent ectopic pregnancy rate were observed 1 years after operation in two groups.Results The fallopian tube patency in the observation group and the control group was 58 cases (85.3％) and 39 cases (60.9％) respectively at 3 months after operation.7 cases (10.3％) and 12 cases(18.8％) of the fallopian tube were not smooth in the observation group and the control group respectively at 3 months after operation.The fallopian tube obstruction in the observation group and the control group was 3 cases (4.4％) and 13 cases (20.3％) respectively at 3 months after operation.The patency rate of fallopian tube in the observation group was higher than that in the control group (Z =6.215,P ＜ 0.05).The intrauterine gestation rate (69.1％ (47/68)) in the observation group was significantly higher than that in the control group (37.5％(24/64)) 1 years after operation and the difference between the two groups was statistically significant (x2 =5.41,P ＜0.05).The rate of recurrent ectopic pregnancy in the observation group (10.3％(7/68)) was significantly lower than that in the control group (26.6％(17/64)) and the difference between the two groups was statistically significant (x2 =4.826,P ＜ 0.05).Conclusion The laparoscopic salpingotomy with suturing can improve the patency rate of the fallopian tube and the rate of intrauterine gestation and reduce the rate of recurrent ectopic pregnancy in the patients after the operation.

Surgical treatment of tubal ectopic pregnancy through posterior colpotomy: experience from a Brazilian university hospital

The objective of this study was to evaluate the feasibility of posterior colpotomy for the surgical treatment of tubal ectopic pregnancy in hemodynamically stable women. We performed a retrospective analysis of medical records obtained over a period of 18 months. Twelve cases were identified, with the following characteristics: mean gestational age, 7.7 weeks; mean serum β-human chorionic gonadotropin level, 7,786 mIU/mL; and greater diameter of the mass, 15–69 mm. Treatment was successful in all cases. Salpingectomy was performed in 10 patients (83.3%) and salpingostomy, in 1 patient. The remaining patient only received peritoneal lavage, as the evidence of ectopic abortion with only a slightly dilated uterine tube was found during surgery. The mean surgical time was 42.5 minutes. In the analyzed cases, posterior colpotomy was found to be a feasible alternative method for the surgical treatment of tubal ectopic pregnancy in hemodynamically stable women.

Problems that should be emphasized in the diagnosis and treatment of tubal pregnancy / 中国实用妇科与产科杂志

Tubal pregnancy is common and is in lackof detailed clinical research.It seems to be simple todiagnose and easy to handle,but once it is ignored,itcan lead to serious consequences and even death.Withthe changes in today′s social environment and people′sconcept,and with the widespread use of IVF and othertechnologies,new cases have emerged in tubal preg-nancy.We should re-emphasize the diagnosis andtreatment of tubal pregnancy.

Embarazo ectópico tubárico con feto vivo en una adulta joven / Ectopic tubal pregnancy with alive fetus in a young adult woman

Se describe el caso clínico de una paciente de 21 años de edad quien acudió al Cuerpo de Guardia del Hospital Ginecobstétrico Docente Tamara Bunke Bider de Santiago de Cuba por presentar dolor leve en bajo vientre y sangrado en forma de manchas luego de que le fuera realizado un legrado uterino por aspiración 8 días atrás. Se efectuó una ecografía ginecológica que mostró un embarazo ectópico tubárico de 11 semanas en el lado derecho, con el feto vivo, por lo cual se indicó laparotomía exploratoria de urgencia y salpingectomía parcial en la trompa derecha. La paciente evolucionó de manera satisfactoria

The case report of a 21 years patient who went to the emergency room of Tamara Bunke Bider Teaching Gynecological-Obstetrics Hospital in Santiago de Cuba is described. She presented a slight pain in low stomach and bledding in form of stains after a suction curettage 8 days earlier. A gynecological echography that showed an ectopic tubaric pregnancy of 11 weeks in the right side, with alive fetus was carried out, reason why an exploratory emergency laparotomy and partial salpingectomy in the right tube were indicated. The patient had a satisfactory clinical course

A rare case of spontaneous live unilateral twin tubal pregnancy with both fetuses presenting with heart activities and a literature review

Ectopic pregnancy is an extrauterine pregnancy, and 98% of which occur in the fallopian tube. The incidence of twin tubal pregnancy is rare but is increasing due to assisted reproductive technology. Spontaneous unilateral twin tubal pregnancy is extremely rare, and only a small number of case reports have been made. We herein report a rare case of spontaneous unilateral twin tubal pregnancy with both fetuses presenting with heart activities and a literature review. Right salpingectomy was performed in this case. Pathologic and histologic assessment confirmed the 2 distinct pregnancies in the same tube. The twins were dichorionic and diamniotic.