Adoption of Complete Bilateral Salpingectomy for Permanent Contraception at Time of Cesarean Delivery in Rhode Island.

OBJECTIVE: Complete bilateral salpingectomy (CBS) can decrease the risk of developing ovarian cancer, although adoption of CBS at cesarean delivery (CD) for permanent contraception has been low. The primary objective was to measure the annual rates of CBS at CD before and after an educational initiative. The secondary objective was to assess rates of providers who offer CBS at CD and their comfort level with the procedure. METHODS: We performed an observational study of OBGYN physicians who perform CD at a single institution. We compared the annual rates of CBS among CD with permanent contraception procedures from the year before and the year after an in-person OBGYN Grand Rounds presentation on December 5, 2019 reviewing the latest research on opportunistic CBS at the time of CD. To evaluate the secondary objectives, anonymous surveys were administered to physicians in-person the month before the presentation. The statistical analysis included chi-square, Fisher's exact test, T-test, ANOVA, and the Cochran-Armitage trend test. RESULTS: After our educational intervention, annual rates of CBS at CD increased from 5.1% [12/05/2018-12/04/2019] to 31.8% [12/5/2019-12/4/2020] (p<0.001), and up to 52% in the last study quarter (p<0.001). Surgical outcomes were similar between tubal ligation and CBS, except for a 5-minute increased total operative time for CBS (p=0.005). Fifty physicians completed the survey prior to the presentation (93% response rate). All physicians offered CBS at time of hysterectomy and interval sterilization, while only 36% offered CBS at time of CD. More physicians felt comfortable performing a CBS with bipolar electrocautery (90%) than suture ligation (56%). CONCLUSION: Our presentation-based educational initiative was associated with a significant increase in performance of CBS at the time of CD.

Trophoblastic Tissue Reimplantation below the Spleen Following Laparoscopic Bilateral Salpingectomy for Ectopic Tubal Pregnancy: A Case Report.

BACKGROUND: Trophoblastic tissue reimplantation after laparoscopic salpingectomy is a very rare complication. These cases may present a diagnostic challenge and the majority of patients need a surgical treatment. CASE PRESENTATION: A 31-year-old patient came to a tertiary referral center for nausea and pain in the upper left abdominal quadrant. Ultrasound and abdominal CT scan showed a 68 × 60 × 87 mm size heterogenic mass below the spleen with arterial extravasation from the lower spleen pole. Recent history of surgery for ectopic pregnancy and serum hCG testing allowed to diagnose extratubal secondary trophoblastic tissue reimplantation below the spleen. Embolization of the bleeding vessel and successful treatment with methotrexate was achieved. CONCLUSIONS: In cases of a nondisseminated trophoblastic tissue reimplantation, consider embolization and treatment with methotrexate if the patient is hemodynamically stable; thus, secondary surgical treatment is preventable.

Development and Efficacy of Gasless Reduced-Port Laparoscopic Surgery for Gynecological Diseases.

Objective: To evaluate the efficacy of gasless reduced-port laparoscopic surgery (GRP-LS) using a subcutaneous abdominal wall lifting method for gynecological diseases. Methods: This study included gasless laparoscopic surgeries performed at our hospital between September 1, 1993 and December 31, 2016. The new GRP-LS technique was compared with the conventional gasless three-port laparoscopic surgery (G3P-LS), based on patient background, operative results in patients treated for laparoscopic myomectomy (LM), laparoscopic ovarian cystectomy (LC), and laparoscopic salpingectomy (LT). Surgeons of the two techniques were categorized by the number of surgeries they had performed, and the number of surgeons and surgeries for each technique were compared. Results: GRP-LS was used in 2,338 cases and G3P-LS in 2,473 cases. GRP-LS was used in 980 LM cases, 804 LC cases, 240 LT cases, and 314 cases for other conditions. The operative time required for GRP-LS was significantly less for LM, LC, LT, and the procedure also had less blood loss for LM and LC than G3P-LS. G3P-LS required a transition to open surgery in 0.69% of cases, whereas GRP-LS showed a very low rate of 0.09%. Sixty-seven of the 78 GRP-LS surgeons (85.9%) had performed fewer than 50 GRP-LSs, and these surgeons performed about half of all surgeries. Eighty-three of the 93 GRP-LS surgeons (89.2%) had performed fewer than 50 G3P-LSs, and these surgeons performed 38.9% of all surgeries. Conclusions: GRP-LS is an effective surgery with few complications and less cosmetic damage and can be easily introduced to novice or inexperienced laparoscopic surgeons.

Prophylactic salpingectomy with delayed oophorectomy as a two-staged alternative for primary prevention of ovarian cancer in BRCA1/2 mutation carriers: women's point of view.

OBJECTIVE: This study aimed to determine BRCA -mutation carrier women's interest and acceptability of participating in a study examining prophylactic salpingectomy with delayed oophorectomy (PSDO) as an alternative to the current recommendation for bilateral salpingo-oophorectomy for risk reduction. METHODS: This is a cross-sectional questionnaire-based study. All women visiting the high-risk clinics for hereditary breast and ovarian cancer in a single tertiary medical center were asked to complete a questionnaire concerning the two-stage approach from October 2018 to December 2019. Before completing the questionnaire, detailed explanation was given by a senior physician regarding the procedure, related background, possible risks, and benefits. RESULTS: The study population included 293 women, of whom 183 (62.4%) were BRCA1 mutation carriers, 97 (33.1%) were BRCA2 mutation carriers, and 13 (4.4%) had unknown familial mutation. Risk-reducing surgery was completed in 160 (55.17%) of the women. First-degree and second-degree family history was reported in 166 (57.24%) and 52 (17.9%) of the women, respectively. Among women surveyed, more than half of the women (n = 66 [51%]) who had yet to undergo risk-reducing surgery reported interest in having PSDO. Similarly, among those who had already received prophylactic surgery, 64 (40%) also considered PSDO to be an acceptable alternative. Multivariate logistic regression analysis found family history of related malignancies to be the only independent factor associated with reduced interest in a study of PSDO (odds ratio, 0.15 [95% confidence interval, 0.29-0.77]; P = 0.02). CONCLUSIONS: Overall, BRCA -mutation carrier women indicated interest in PSDO risk-reducing surgery, taking into consideration the potential additional risk. These findings suggest that a clinical study exploring the equivalence of PSDO as alternative treatment is feasible.

Postpartum Opportunistic Salpingectomy Compared With Bilateral Tubal Ligation After Vaginal Delivery for Ovarian Cancer Risk Reduction: A Cost-Effectiveness Analysis.

OBJECTIVE: To compare the cost effectiveness of opportunistic salpingectomy and bilateral tubal ligation for sterilization immediately after vaginal delivery. METHODS: A cost-effectiveness analytic decision model was used to compare opportunistic salpingectomy with bilateral tubal ligation during vaginal delivery admission. Probability and cost inputs were derived from local data and available literature. Salpingectomy was assumed to be performed with a handheld bipolar energy device. The primary outcome was the incremental cost-effectiveness ratio (ICER) in 2019 U.S. dollars per quality-adjusted life-year (QALY) at a cost-effectiveness threshold of $100,000/QALY. Sensitivity analyses were performed to determine the proportion of simulations in which salpingectomy would be cost effective. RESULTS: Opportunistic salpingectomy was more cost effective than bilateral tubal ligation with an ICER of $26,150/QALY. In 10,000 patients desiring sterilization after vaginal delivery, opportunistic salpingectomy would result in 25 fewer ovarian cancer cases, 19 fewer ovarian cancer deaths, and 116 fewer unintended pregnancies than bilateral tubal ligation. In sensitivity analysis, salpingectomy was cost effective in 89.8% of simulations and cost saving in 13% of simulations. CONCLUSION: In patients undergoing sterilization immediately after vaginal deliveries, opportunistic salpingectomy is more cost effective and may be more cost saving than bilateral tubal ligation for reducing ovarian cancer risk.

Management of interstitial pregnancy using laparoscopic salpingectomy with complete removal of the interstitial portion.

OBJECTIVE: To perform laparoscopic salpingectomy, including the entire interstitial portion of the fallopian tube, in the management of interstitial pregnancy. DESIGN: A step-by-step explanation of the surgical procedure using video with narration. SETTING: Obstetrics and Gynecology department of a hospital. PATIENT(S): A 23-year-old woman, gravida 1 para 0, presented asymptomatically to our hospital to undergo a pregnancy test. Her last menstrual period had occurred 6 weeks previously. Transvaginal ultrasound showed an empty uterine cavity and a right interstitial mass of 3.2 × 2.6 × 2.5 cm. It contained a chorionic sac and an embryonic bud of 0.2 cm long with a heartbeat and the presence of an "interstitial line sign." The myometrial layer surrounding the chorionic sac was 1 mm. The patient's beta-human chorionic gonadotropin level was 10,123 mIU/mL. INTERVENTION(S): On the basis of the anatomy of the interstitial portion of the fallopian tube, we treated interstitial pregnancy using laparoscopic salpingectomy, with complete removal of the interstitial portion containing the product of conception. The interstitial fallopian tube originates at the tubal ostium and follows a tortuous intramural course, progressing laterally away from the uterine cavity toward the isthmic portion. It is lined by muscular layers and an inner epithelium layer. The main blood supply of the interstitial portion is from the uterine artery's ascending branches to the fundus, extending a branch that supplies the cornu and the interstitial portion. Our approach has 3 key steps: 1) dissecting and coagulating the branch extending from the ascending branches to the fundus of the uterine artery, 2) incising the cornual serosa at the junction of the purple-blue interstitial pregnancy and the normal color myometrium, and 3) resecting the interstitial portion containing the product of conception along the outer layer of the oviduct without rupture. MAIN OUTCOME MEASURE(S): The interstitial portion containing the product of conception was removed entirely along the outer layer of the fallopian tube as a natural capsule without rupture. RESULTS(S): The surgery lasted for 43 min, and the volume of intraoperative blood loss was 5 mL. The pathology was confirmatory for interstitial pregnancy. The patient's beta-human chorionic gonadotropin levels decreased optimally. She had a normal postoperative course. CONCLUSION(S): This approach reduces intraoperative blood loss, minimizes myometrial loss and thermal injury, and effectively avoids persistent interstitial ectopic pregnancy. It is not limited by the device used, does not increase the surgery cost, and is greatly useful in treating a selected nonruptured distally or centrally implanted interstitial pregnancy.

Anesthetic effects of isoflurane and fentanyl infusion in capuchin monkeys (Sapajus sp) undergoing salpingectomy or deferentectomy, previously chemically restrained with ketamine-midazolam or ketamine-dexmedetomidine.

BACKGROUND: This study evaluated the anesthetic and cardiorespiratory effects of two anesthetic protocols for salpingectomy or deferentectomy in capuchin monkeys (Sapajus sp). MATERIALS AND METHODS: Five capuchin monkeys (5 per group) received ketamine (20 mg/kg) combined with midazolam (0.5 mg/kg; group KM) or dexmedetomidine (5 µg/kg; group KD) intramuscularly. Anesthesia is induced with propofol intravenously and maintained with isoflurane. Before the start of surgery, fentanyl 3 µg/kg was administered IV, and continuous infusion (10 µg/kg/min) IV was started. Times and quality of anesthetic recovery were evaluated postoperatively. RESULTS: KM and KD resulted in adequate chemical restraint. KD resulted in bradycardia. Intraoperative heart rate and systolic blood pressure were higher in KM than in KD. Both groups had smooth recovery. Time to standing was longer in KM than in KD. CONCLUSION: Both protocols allowed the performance of surgeries, with few cardiorespiratory effects. Anesthetic recovery was smooth and shorter in KD group.

Fibrothecoma of broad ligament with minor sex cord elements: Case report and brief literature review.

RATIONALE: Sex cord-stromal tumors are always found in ovary, but the occurrence of this kind of tumor at extraovarian locations is extremely rare. Up to now, the case concerning fibrothecoma of broad ligament with minor sex cord elements has not been reported, and it is extremely challenging to diagnose before surgery. In this case report, we summarized pathogenesis, clinical features, laboratory finding, imaging studies, pathology, and therapeutic schedule of this tumor, with the aim of raising awareness and attention to this type of disease. PATIENT CONCERNS: A 45-year-old Chinese woman was referred to our department with intermittent lower abdominal pain for about 6 years. On examination, both ultrasonography and computed tomography revealed she had a right adnexal mass. DIAGNOSIS: Based on the results of histology and immunohistochemistry, the final diagnosis was confirmed as fibrothecoma of broad ligament with minor sex cord elements. INTERVENTIONS: This patient underwent laparoscopic unilateral salpingo-oophorectomy with excision of the neoplasm. OUTCOMES: Eleven days post-treatment, the patient complained that the symptoms of abdominal pain was disappeared. There is no evidence of disease recurrence 5 years after laparoscopic surgery according to the consequences of radiologic examination. CONCLUSION: The natural history of this kind of tumor is uncertain. Although main treatment of this neoplasm might be surgical resection and good prognosis can be achieved, we believe that long-time follow-up is extremely important in all patients diagnosed as fibrothecoma of broad ligament with minor sex cord. Laparoscopic unilateral salpingo-oophorectomy with excision of the tumor should be recommended to these patients.

Diagnosis and management of ovarian vein thrombosis after laparoscopic -assisted vaginal hysterectomy with bilateral salpingectomy: A case report and literature review.

OBJECTIVE: We present a case who developed ovarian vein thrombosis (OVT) after laparoscopic-assisted vaginal hysterectomy with bilateral salpingectomy to share our experience. CASE REPORT: A 46-year-old woman came to our hospital due to severe dysmenorrhea induced by adenomyosis. Medical treatments were given but with unsatisfactory effect. As the patient had completed family planning, a hysterectomy was scheduled. However, on the sixth postoperative day, the patient complained of low abdominal pain with fever on and off. After a series of examinations, right OVT was diagnosed. The patient was treated with antibiotics only. Under close surveillance, the OVT resolved spontaneously, and the patient was discharged. CONCLUSION: Diagnosis of OVT requires highly suspicion owing to its rarity and non-specific presentation. OVT is a potentially serious venous thromboembolism that sometimes can be life threatening. Anticoagulant treatment is still controversial. Conventional Tomography with contrast medium could detect early OVT with high sensitivity and specificity.

HOPPSA update: changes in the study protocol of Hysterectomy and OPPortunistic SAlpingectomy, a registry-based randomized controlled trial.

BACKGROUND: The HOPPSA trial is a multi-center national registry-based randomized controlled trial to test the safety and effectiveness of performing opportunistic salpingectomy at hysterectomy to reduce the risk of epithelial ovarian cancer (EOC). The study protocol was first published in January 2019 and is available at https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-018-3083-8 . Here, we report amendments made to the study protocol since commencement of the trial. CHANGES IN METHODS AND ANALYSIS: The primary outcomes analyses have been changed. (1) Complications will be analyzed using binomial generalized estimating equation (GEE) with log link function, while the unadjusted analyses according to Miettinen and Nurminen will be performed as a sensitivity analysis. (2) Absolute change in Menopause Rating Scale (MRS) will primarily be analyzed using a mixed effects model, adjusted for baseline MRS and center as a random effect. (3) Time to EOC will be analyzed using the mixed effects Cox regression model with center as random effect, while the unadjusted log-rank test will be performed as a sensitivity analysis. The primary outcome Complications will be based solely on the specific assessment in the GynOp quality registry. The Clavien-Dindo classification will be evaluated as a secondary outcome. Furthermore, MRS is also measured three years postoperatively to better pinpoint the onset of menopausal symptoms. DISCUSSION: The changes to the protocol mainly concern the analyses of data. No changes to recruitment, randomization, intervention, or follow-up of primary outcomes have been made. An interim analysis during 2021 concluded that the study should continue until the target sample size is reached. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03045965 . Registered 8 February 2017.

Xanthogranulomatous Salpingitis Presenting as Pyosalpinx in a Non-Sexually Active Adolescent Girl.

INTRODUCTION: Although pelvic inflammatory disease is seen in sexually active women, it can also be seen in virgin girls. One of the conditions that can develop if not treated appropriately is pyosalpinx. A case of pyosalpinx causing xanthogranulomatous inflammation, a rare type of inflammation, is presented. CASE: A 15-year-old virgin adolescent patient underwent salpingectomy for left pyosalpinx, and the pathology result revealed xanthogranulomatous salpingitis. CONCLUSION: Pelvic inflammatory disease is extremely rare in virgin adolescents and there is usually an underlying anatomic anomaly. No anatomical anomaly was detected in our case, but the detection of E.coli in the abscess fluid culture and the chronic constipation of our patient made us think that the cause of the disease was an ascending infection originating from the gastrointestinal tract.

First step in implementation of opportunistic salpingectomy for prevention of ovarian cancer: Current care and its determinants.

INTRODUCTION: Opportunistic salpingectomy (OS) refers to additional removal of the fallopian tubes during abdominal surgery performed for another medical indication, as prevention for ovarian cancer. As OS has been inconsistently implemented, its clinical practice varies worldwide. To reduce this variation, insight is required into current clinical practice and its determinants. Therefore, the study aim was to determine the implementation of counseling and performance of OS between 2015 and 2018, and its patient, surgical, physician, and hospital characteristics. MATERIAL AND METHODS: Retrospective study using electronic medical records from six different Dutch hospitals: two academic, two large teaching, and two non-teaching hospitals. Patients were considered eligible for OS if they underwent elective non-obstetric abdominal surgery for a gynecological indication from January 2015 through December 2018. Primary outcomes were uptake of counseling and performance of OS. Multilevel multivariable logistic regression analyses were conducted to identify characteristics associated with OS. RESULTS: A total of 3214 patients underwent elective non-obstetric abdominal surgery for a gynecological indication and were eligible for OS. Counseling on OS increased significantly from 2.9% in 2015 to 29.4% in 2018. In this period, 440 patients were counseled on OS, of which 95.9% chose OS. Performance of OS increased significantly from 6.9% in 2015 to 44.5% in 2018. Counseling for and performance of OS were more likely in patients who had surgery by laparoscopic approach, were counseled by a gynecological resident, or had more than three contact moments before surgery. Additionally, OS was less likely in patients who had vaginal surgery. CONCLUSIONS: Although the uptake of OS increased from 2015 to 2018, the majority of patients who were eligible for OS were not counseled and did not undergo OS. Its clinical practice varies on patient, surgery, and physician characteristics. Therefore, an implementation strategy tailored to associated determinants is recommended.

A case report of a successful multidisciplinary management of an abdominal pregnancy.

Abdominal pregnancy is defined as one that occurs outside of the uterus and fallopian tubes in the abdominal cavity. We present the case of a 30-year-old Peruvian female patient from Lima with a surgical history of exploratory laparotomy due to tubal ectopic pregnancy and appendectomy without further relevant personal or family histories. She attended the emergency room of a social security hospital in Peru with a referral from a district hospital and a diagnosis of abdominal pregnancy at 14 weeks of gestational age without previous prenatal controls. Symptomatology at hospital admission was colic-type abdominal pain in the hypogastrium without vaginal bleeding, fluid loss or fever. During hospitalization, she underwent an exploratory laparotomy with embolization of the uterine artery, left salpingectomy, and removal of the abdominal ectopic pregnancy. The evolution was favorable after the surgery, and she was discharged. Without further complications, she continues her controls at the obstetrics and gynecology outpatient service without complications.

El embarazo abdominal es aquel embarazo que ocurre fuera del útero y las trompas de Falopio en la cavidad abdominal. Presentamos el caso de una paciente peruana de 30 años proveniente de la ciudad de Lima, con antecedentes quirúrgicos de laparotomía exploradora por embarazo ectópico tubárico y apendicectomía, sin otras patologías ni antecedentes familiares de importancia. La paciente acude al servicio de urgencias de un hospital del seguro social en Perú derivada de un hospital distrital con diagnóstico de embarazo abdominal a las 14 semanas de edad gestacional, sin controles prenatales previos. La sintomatología al ingreso hospitalario fue dolor abdominal de tipo cólico a nivel del hipogastrio, sin sangrado vaginal, pérdida de líquidos o fiebre. Durante su hospitalización se le realizó una laparotomía exploratoria con embolización de la arteria uterina, salpingectomía izquierda y extracción del embarazo abdominal. La evolución fue favorable tras la intervención quirúrgica, siendo dada de alta. Actualmente continúa sus controles en el servicio de consulta externa del servicio de ginecología y obstetricia sin complicaciones.

Mental practice for laparoscopic salpingectomy.

Mental practice (MP) is a method of enhancing surgical training by rehearsal of a task without physical action. The primary objective of the study was to develop and validate a MP tool for laparoscopic salpingectomy (LS). An imagery script for LS was developed and used to facilitate a structured MP session for trainees in Obstetrics and Gynaecology and expert gynaecologists across three teaching hospitals in the UK. A virtual platform was used for one trainee group to assess its feasibility compared to a face-to-face approach. Pre- and post-session assessments were conducted to evaluate the impact of the script on motivation, confidence, preparedness and quality of imagery and demonstrated a significant improvement in global imagery scores for both novice groups. The expert group scored significantly higher than the face-to-face novice group on all items both before and after MP, indicating construct validity. There were no significant differences demonstrated between the two novice groups, thus demonstrating the virtual platform to be a non-inferior approach - an important consideration in the current COVID era.

Possible Association of Hysterectomy Accompanied with Opportunistic Salpingectomy with Early Menopause: A Retrospective Cohort Study.

Opportunistic salpingectomies (OSs) are concurrently performed with hysterectomies to prevent epithelial ovarian cancer. This study aimed to investigate the correlation between OS and early menopause in females who have undergone hysterectomies. This was a retrospective cohort study involving 79 females who had undergone a hysterectomy, with or without an OS, between January 2007 and December 2015. Their ages at surgery, at menopause, and the lengths of time from surgery to menopause were compared. An OS had been performed in 54 and not performed in 25 of the enrolled patients, comprising the OS and non-OS groups. Body mass index was significantly higher in the OS group (OS: 25.27 ± 4.17 vs. non-OS: 22.97 ± 3.27, p = 0.01). Additionally, menopausal sleep problems were more prevalent in the OS group than in the non-OS group (41% vs. 12%, p = 0.01). Notably, the time from surgery to menopause was significantly shorter in the OS group than in the non-OS group (OS: 1.84 ± 1.85 vs. non-OS: 2.93 ± 2.43, p = 0.031). After adjusting the covariates, the OS group was associated with a significantly shorter period between surgery and menopause (p = 0.029). In conclusion, these results showed that a hysterectomy plus an OS might cause earlier menopause than a hysterectomy only. An OS should be preoperatively discussed with patients regarding the possibility of early menopause. The findings of this study require further large-scale investigations to reinforce the results.

Outcome and Management of Serous Tubal Intraepithelial Carcinoma Following Opportunistic Salpingectomy: Systematic Review and Meta-Analysis.

OBJECTIVE: Serous ovarian cancer is the most common subtype of epithelial ovarian carcinoma-the most prevalent type of ovarian cancer. High-grade serous ovarian carcinoma (HGSOC) is thought to arise from the distal fallopian tube, with a precursor lesion known as serous tubal intraepithelial carcinoma (STIC). STICs are found in the final pathology of a salpingectomy specimen in 10%-20% of women with a BRCA gene mutation and 1%-7% of women without a mutation. However, there is currently no official guideline and a paucity of data on the management of STICs. DATA SOURCES: We performed a systematic review following PRISMA guidelines. Five databases were searched for relevant studies on STICs. STUDY SELECTION: Two independent reviewers performed the abstract and full-text screening and data extraction, with conflicts resolved through discussion with the third reviewer. The risk of bias of each study was assessed using the Newcastle-Ottawa scale. DATA EXTRACTION AND SYNTHESIS: Fourteen articles were included. Ninety-nine patients who were diagnosed with STIC and subsequently followed for a mean period of 55.5 months were included in this analysis. Eighty-three patients (83.9%) were BRCA mutation carriers. After the diagnosis of isolated STIC, 7 patients (7.3%) received chemotherapy and 25 (26%) underwent surgical staging. Three of the 25 patients were diagnosed with HGSOC based on the staging surgery. Nine patients were later diagnosed with HGSOC during follow-up, with an average duration of follow-up of 58.5 months between the diagnosis of STIC and the diagnosis of HGSOC. CONCLUSION: Based on our review of the literature, there is a 10.7% risk of having concurrent HGSOC at the time of STIC diagnosis, and the risk of developing a subsequent HGSOC is 14.5%. BRCA mutation status should be determined in cases of isolated STIC, as 83.9% of patients included in this study were found to carry BRCA mutations. We believe it is necessary to further investigate the role of surgical staging following the diagnosis of STIC.

Ovarian pregnancy after bilateral salpingectomy in a patient with in vitro fertilization: a case report.

Ovarian pregnancy is rare but may occur with in vitro fertilization-embryo transfer in women who have undergone bilateral salpingectomy. We report a case of an approximately 30-year-old woman who had in vitro fertilization and a history of bilateral salpingectomy, and was diagnosed with an ovarian pregnancy. Laparoscopic enucleation of the gestational product in the ovary and ovarian remnant reconstruction were performed. The patient recovered well after surgery and was discharged home 5 days postoperatively. ß-human chorionic gonadotropin was undetectable 3 weeks after the surgery. Awareness of the possibility of ovarian pregnancy after in vitro fertilization-embryo transfer is the most important step in an early diagnosis and treatment. Salpingectomy should be carefully performed to eliminate the risk of heterotopic pregnancy, especially in cases where a subsequent gestation is desired.

Ectopic Pregnancy.

Ectopic pregnancy occurs in 2% of all pregnancies and is a potentially life-threatening emergency. A high level of clinical suspicion is required for any pregnant patient who presents with vaginal bleeding and/or pelvic pain. Workup should begin with immediate triage based on vital signs, a pregnancy test, and transvaginal ultrasound. Ectopic pregnancy can be treated either medically with methotrexate or surgically with either salpingectomy or salpingostomy. Carefully counseled, asymptomatic patients may be candidates for expectant management.

Tubal ectopic pregnancy: a retrospective cohort study on clinical characteristics, treatment options and reproductive outcomes within 5 years.

PURPOSE: To investigate the association between different treatments of tubal ectopic pregnancy (EP) -expectant management, methotrexate (MTX), selected or recommended laparoscopic surgery-and the subsequent reproductive outcomes. METHODS: We conducted a retrospective cohort study including 228 EPs. The patients were divided into four treatment groups: 28 (12.3%) with expectant management successfully, 60 (26.3%) with MTX successfully, 140 patients with laparoscopic salpingectomy, of which 47 (20.6%) were assigned to selected surgery group because they opted for surgical treatment versus MTX, 93 (40.8%) were assigned to recommended surgery group as recommended by the attending physician. RESULTS: The recommended surgery group had the lowest rate of intrauterine pregnancy (IUP) (77.42%) and live birth (LB) (72.04%), while the incidence of recurrent EP (REP) (20.43%) was the highest, but the statistical differences were not significant. We did not observe significant differences of the EP-IUP time interval, rates of LB and miscarriage (MIS) between the four groups. Compared to the MTX group, recommended surgery was negatively associated with IUP (adjusted OR, 95%CI: 0.34, 0.11-1.03) and LB (0.35, 0.14-0.92), while it had higher risk for REP (3.48, 1.03-11.74) in the subsequent pregnancy. Further, compared to selective surgery group, recommended surgery was negatively associated with IUP (0.15, 0.03-0.68) and LB (0.23, 0.07-0.74), while it had higher risk for REP (6.83, 1.43-32.67) in the subsequent pregnancy. Expectant treatment was negatively associated with assisted reproductive technology (ART) (0.08, 0.02-0.40) compared with MTX. Of the185 patients who had LBs, all adverse outcomes were not statistically different between the four groups. CONCLUSION: Patients with recommended laparoscopic salpingectomy had worse reproductive outcomes than the other treatment groups. The disease status of EP may play an important role in the association rather than the surgery alone.