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Abdominal Ectopic Pregnancy
Published in Botros Rizk, A. Mostafa Borahay, Abdel Maguid Ramzy, Clinical Diagnosis and Management of Gynecologic Emergencies, 2020
Abdominal pregnancy is an implantation in the peritoneal cavity exclusive of tubal, ovarian, or intraligamentous implantations. More than 95% of ectopic pregnancies are in the fallopian tube (tubal pregnancy). The remaining 5% are located in the ovary, the abdomen, the cervix, or a cesarean scar [1, 2]. Abdominal pregnancy accounts for approximately 1.3% of all extrauterine pregnancies [3, 4].
Pregnancy-Related Protein Concentrations and Hormone Levels During Pathological Pregnancies
Published in Gábor N. Than, Hans Bohn, Dénes G. Szabó, Advances in Pregnancy-Related Protein Research, 2020
Pedersen et al.58 observed two women with very low serum concentrations of secretory endometrial protein PP14 who had ectopic pregnancy and fetal heart activity found incidentally by ultrasonography. The concentrations were far below the 5th centile of normal pregnancy level for the 50th day of gestation. One possible explanation is that in tubal pregnancies, the blood is in contact with the poorly decidualized mucosa of the Fallopian tube. Successful application of dual hCG and PP14 pregnancy tests for early diagnosis of ectopic pregnancy is also plausible in high-risk patients susceptible to tubal pregnancy who previously underwent tubal surgery or suffered pelvic inflammation, when conservative treatment to preserve the Fallopian tube is still possible.
Gynecologic Microsurgery
Published in Waldemar L. Olszewski, CRC Handbook of Microsurgery, 2019
Term pregnancies following repair of distal tubal obstructions occur in about one of five patients but the tubal pregnancy rate is almost the same. In the normal tubal ampulla, almost 50% of the epithelial cells lining the mucosal folds are ciliated, all of them beating toward the ampullary isthmic junction. Egg transport through this segment is affected principally by ciliary action on the cumulus mass. Irreversible pathologic changes in the endosalpinx partly account for the high incidence of tubal pregnancy and poor results in terms of intrauterine gestations, despite postoperative patency rates of almost 70 to 80%.
Laparoscopy-assisted suprapubic salpingectomy ‘Kaya technic’ - a low-cost treatment of ectopic pregnancy
Published in Journal of Obstetrics and Gynaecology, 2019
Cihan Kaya, Ismail Alay, Ecem Eren, Ozlem Helvacioglu
In the LASS group, the pneumoperitoneum was created with a Veress needle using carbon dioxide and the pressure was kept at 12 mmHg. The operation table was kept in the Trendelenburg position. A 2 cm trans-umbilical incision was performed and a 10 mm reusable umbilical optical trocar was inserted for endoscopic visualisation (Karl Storz, Tuttlingen, Germany) of the abdominal cavity. A uterine sound was then inserted as a uterine manipulator in all cases to provide an adequate exposure of the pelvic organs. A 10 mm trocar was inserted ≈3 cm above the symphysis pubis in the midline. The free blood or coagulum was aspirated with a conventional aspirator used for open surgical procedures after the removal of the suprapubic trocar as necessary. The pelvis was inspected and irrigated to confirm the diagnosis of tubal pregnancy if there was no adequate visualisation. A 10 mm reusable laparoscopic Babcock grasper (Karl Storz, Tuttlingen, Germany) introduced through the suprapubic port to pull the tube with the ectopic foci outside the abdomen simultaneously after the abdominal pressure was decreased, desuflation was obtained, and the patient was laid in the supine position. The tube was fixed using Heaney tissue forceps used for open surgeries outside the abdomen and the damaged or active bleeding tube was excised and sutured with a 2-0 absorbable suture. After bleeding was controlled, the adnexal remnant was moved back into the abdominal cavity. The trocars were then withdrawn, the umbilical and suprapubic fascia were closed with a 2-0 absorbable suture, and the skin was closed with a 2-0 Vicryl Rapide suture (Vicryl, Ethicon, Somerville, NJ, USA). (Figures 1–3)
Networks of E-cadherin, β1 integrin, and focal adhesion kinase in the pathogenesis of tubal pregnancy
Published in Gynecological Endocrinology, 2019
Huan Jiang, Xiao-Yi Yang, Wei-Jie Zhu
Tubal pregnancy, the most common type of ectopic pregnancy, is identified as an embryo implantation occurs within the Fallopian tube. Because of the anatomic structures of the Fallopian tube are of normality in most of the cases, it is generally accepted that the tubal pregnancy is not simply a direct consequence of tissue destruction but of molecular causes [1]. Adhesion molecules, capable of mediating intercellular attachment, are engaged in the process of implantation [2]. Altered adhesion molecules in the Fallopian tube epithelium can lead to an embryo retention and the occurrence of ectopic pregnancy [3].
From β-hCG values to counseling in tubal pregnancy: what do women want?
Published in Gynecological Endocrinology, 2019
Lorenzo Sabbioni, Emanuela Carossino, Filiberto Maria Severi, Stefano Luisi
Ectopic pregnancy (EP) accounts for 1.5% to 2.0% of all pregnancies [1]. Tubal pregnancy represents the vast majority of all ectopic implants, is a potentially life-threatening condition with a high risk of death and pregnancy complications. It remains the number one cause of first trimester maternal death [2]. Recent improvements in transvaginal ultrasonography have let early diagnosis, resulting in a prompter intervention and treatment before rupture, though increasing the Clinical’s options for the management. Recent literature is focusing the attention whether it is possible or not to predict the tubal rupture, aiming to identify cases at higher risk. The goal is to determine, if possible, which patients with ectopic tubal pregnancy are more critical in the acute management and to determine which are the options to improve their future reproductive life [3]. Controversy still exists about the choice of treatment in optimizing subsequent fertility, with a tailored approach being preferable [4]. Since a variety of factors are implied, the target must be to optimize the treatment taking into account the clinical picture, the surgical facilities and the woman’s desire regarding future pregnancies. In order to do so, both practitioner and patient should actively participate, to see if what is recommended in literature is the best option for the single individual. This is mandatory because two of the preferred approaches – expectant management and treatment with methotrexate – both require a strict follow-up, with a huge cooperation between those figures. The target of this review is not to describe the management of EPs other than the tubal implant. Other localizations are possible, and an increasing part of literature is considering those as a relatively new field of research, even because of emerging social factors such as worldwide increasing rates of cesarean section [2,5].