Temporal Trend in the Frequency of Ectopic Pregnancies in Lombardy, Italy

An electronic search concerning the surgical approach in cases of interstitial pregnancy from January 2000 to May 2013 has been carried out. Fifty three studies have been retrieved and included for statistical analysis. Conservative and radical surgical treatments in 354 cases of interstitial pregnancy are extensively described. Hemostatic techniques have been reported as well as clinical criteria for the medical approach. Surgical outcome in conservative versus radical treatment were similar. When hemostatic techniques were used, lower blood losses and lower operative times were recorded. Conversion to laparotomy involved difficulties in hemostasis and the presence of persistent or multiple adhesions. Laparoscopic injection of vasopressin into the myometrium below the cornual mass was the preferred approach.

Section: Discussionmentioning

confidence: 99%

Interstitial Pregnancy: A ‘Road Map' of Surgical Treatment Based on a Systematic Review of the Literature

Cucinella¹,

Calagna²,

Rotolo³

et al. 2014

“…Risk factors for TOA are similar to those for PID, including multiple sexual partners, prior history of PID, no history of contraceptive use, history of intrauterine device (IUD) insertion, and low socioeconomic status [3]. Long-term complications of PID and TOA are tubal factor infertility, ectopic pregnancy, chronic pelvic pain, and recurrent infection [4,5]. …”

Section: Introductionmentioning

confidence: 99%

Predictive Markers of Tubo-Ovarian Abscess in Pelvic Inflammatory Disease

Lee

Rhim

Kim

et al. 2015

Background/Aims: The purpose of this study was to identify predictive markers for tubo-ovarian abscess (TOA) through a comparison of clinical and laboratory data in patients diagnosed with pelvic inflammatory disease (PID). Methods: We reviewed the medical charts of 499 females who were admitted to hospital with clinical, surgical, imaging-based diagnoses of PID between 2001 and 2011. The patients were divided into the following two groups: (1) PID with TOA and (2) PID without TOA. Results: The TOA and non-TOA groups were comprised of 69 and 430 females, respectively. Mean age, history of intrauterine device (IUD) insertion and inflammatory markers, including erythrocyte sedimentation rate, C-reactive protein (CRP) and CA-125 levels, were higher in the TOA group than the non-TOA group. Independent factors that predicted TOA were older age, IUD insertion, increased CRP and CA-125, and chlamydia infection. CA-125 was found to have the highest predictive value for TOA. TOA size was associated with increased surgical therapy compared to patients with smaller abscesses. Conclusions: Increased age, IUD insertion, chlamydia infection, and increased CRP and CA-125 level were the independent factors predictive of TOA in acute PID. These predictive values will be expected to help decrease gynecological morbidity by early diagnosis and appropriate treatment of TOA.

“…Most ectopic pregnancies are located in the fallopian tube [2]. However, they may also occur in the uterine cervical canal, between the leaves of the broad ligament, within the ovarian cortex, in a scar from a cesarean section or on the peritoneal surface (abdominal pregnancy) [3].…”

Section: Discussionmentioning

confidence: 99%

Diagnosis and Treatment of Retroperitoneal Ectopic Pregnancy: Review of the Literature

Jiang¹,

Lv²,

Sun

et al. 2013

Retroperitoneal ectopic pregnancies (REP) are extremely rare, and early diagnosis and treatment is very difficult. We completed an English literature search in MEDLINE through PubMed for articles on REP. We identified 14 articles (all case reports) but selected only 12 because of unavailable data in the other 2 articles. We also report the case of an REP which was misdiagnosed as ectopic choriocarcinoma. The 33-year-old woman was admitted via the outpatient department with a history of 54 days of amenorrhea and persistent elevated serum β-human chorionic gonadotropin (hCG) levels.The presumed diagnosis ectopic choriocarcinoma was made based on imaging findings. Single-drug chemotherapy with methotrexate (MTX; 20-mg intramuscular injection daily for 5 consecutive days) was administered. An upper abdominal mass was noticed by the patient and laparotomy was performed. A retroperitoneal pregnant lesion was found and removed successfully. The diagnosis, treatment and mechanisms of REP are discussed. We believe REP should be considered in patients with elevated serum β-hCG levels when the uterus and adnexa appear to be normal. Systemic administration of MTX in nonruptured REP before operation may prove to be helpful.