Case 89: Abdominal pain in early pregnancy
Eamon Shamil, Praful Ravi, Dipak Mistry in 100 Cases in Emergency Medicine and Critical Care, 2018
This chapter presents a case study of a 26-year-old woman who comes in to the Emergency Department complaining of severe sharp lower abdominal pain, worse on the right-hand side. In a female of reproductive age, this is an ectopic pregnancy until proven otherwise. As there is evidence of haemodynamic compromise, it is likely that this has ruptured and should be managed as a gynaecological emergency in the resuscitation room. A pregnancy test is the first investigation required in all women of reproductive age to determine whether the abdominal pain may be pregnancy or non-pregnancy related. The patient must be taken straight through for immediate resuscitation; laid flat with high flow oxygen through a non-rebreathe facial mask. The patient requires consent for a diagnostic laparoscopy or laparotomy and salpingectomy and a quick transfer to theatre. Anti-D prophylaxis should be offered to all Rhesus-negative women who have a surgical removal of an ectopic or with repeated vaginal bleeding.
Communication skills – ectopic mismanagement
Antony Hollingworth, Janice Rymer in OSCEs for the MRCOG Part 2: A Self-Assessment Guide, 2011
The patient you are about to see has returned to the emergency gynaecology unit for follow-up after an operation for an ectopic pregnancy 14 days ago. She had a salpingostomy and the ultrasound today has shown a live ectopic on the left side.
Comparison of the long-term effects of single-dose methotrexate and salpingectomy on ovarian reserve in terms of anti-müllerian hormone levels
Published in Human Fertility, 2016
Gulcin Sahin Ersoy, Omer Talip Turhan, Onder Sakin, Sadullah Bulut
The aim of this study was to compare the effects of single-dose methotrexate (MTX) and salpingectomy on ovarian reserve in women with ectopic pregnancy in the late post-treatment period. A total of 181 patients were included in the study; 56 of them received a single-dose of MTX, 45 of them had undergone salpingectomy treatment for ectopic pregnancy in the previous 12–18 months, and 80 healthy women constituted an age-matched control group. The anti-müllerian hormone (AMH), follicle stimulating hormone (FSH) and oestrogen (E2) levels, as well as antral follicle counts (AFC) of the patients were evaluated. The average age was similar in both groups (p = 0.094) and there was no statistically significant difference in the smoking status of the patients (p = 0.949). None of the three groups displayed a significant difference in terms of AFC (p = 0.528), AMH (p = 0.147), FSH (p = 0.393) and E2 levels (p = 0.117). In the treatment of ectopic pregnancy neither the single-dose MTX application nor the salpingectomy had any permanent detrimental effect on the ovarian reserve; serum AMH levels and AFC are unaltered in the long term following single-dose MTX or salpingectomy.
Changes in the ovarian stromal blood flow in patients treated with laparoscopic salpingostomy for ectopic pregnancy
Published in Journal of Obstetrics and Gynaecology, 2013
U. Keskin, N. K. Duru, C. M. Ercan, M. Dede, M. C. Yenen, A. Ergün
This study is aimed to evaluate the impact of laparoscopic salpingostomy on ovarian stromal blood flow indices in patients with ectopic pregnancy, and to compare the ovarian stromal blood flow indices with matched paired healthy women. We included 37 patients who underwent laparoscopic salpingostomy and 37 age- and parity-matched women as controls. The main outcome was the differences in ovarian volume, antral follicle count (AFC), and ovarian stromal blood flow indices between the study group participants after the surgery and the healthy controls. Comparison of the ovarian parameters between the study group after the surgery and the control group revealed no significant differences in terms of ovarian volume (p = 0.783), AFC (p = 0.253), ovarian stromal S/D ratios (p = 0.054), pulsatility index (PI; p = 0.938) and resistance index (RI; p = 0.041). In addition, comparison of the ovarian parameters before and after the surgical treatment revealed no significant differences in the ovarian volume (p = 0.141), AFC (p = 0.084), ovarian stromal S/D ratios (p = 0.187), PI (p = 0.102) and RI (p = 0.108). In conclusion, laparoscopic salpingostomy does not affect ovarian function in terms of ovarian stromal blood flow indices, ovarian volume, and AFC.
The Ethics of Ectopic Pregnancy: A Critical Reconsideration of Salpingostomy and Methotrexate
Published in The Linacre Quarterly, 2009
Ethicists have continued to debate about two means of treating ectopic pregnancy, namely, the removal of the embryo from the tube (salpingostomy) and the use of methotrexate. This article examines the major arguments in favor of considering salpingostomy intentional killing. The article goes on to evaluate the major arguments in favor of the conclusion that methotrexate is intentional killing or intentional mutilation. The tentative conclusion reached is that both salpingostomy and the use of methotrexate should be considered morally permissible.
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