Conservative laparoscopic management of tubal ectopic pregnancy

To study the success, safely and post-operative reproductive performane of conservative laparoscopic treatment of ectopic pregnancy [EP]. Study design: 32 cases of EP were retrospectively analyzed. These cases were managed during the period from Jnuary 1992 to Jnuary 1996. Out of these cases, 24 were primarily treated by laparoscopy and 8 with laparotomy due to hypovolemia and shock at the time of hospital admission [3], previous multiple abdominal surgery [2], extensive pelvic adhesions [1], associated uterine myomas [1] and anesthesia contraindication to laparoscopy [1]. The twenty four cases treated by laparoscopy were analyzed as regards the type and site of EP, type of sugery done, operation time and intra- and post-operative complications. Follow up of 28 out of the 32 patients was available as regards subsequent fertility. Out of the 24 patients primarily treated by laproscopy, 23 [95,8%] were successfully managed by laparoscopy alone and only one [4.2%] needed laparotomy due to intra-operative hemorrhage. Seventeen patients [70.8%] were subjected to laparoscopic linear salpingostomy, two patients had complete tubal abortion at the time of laparoscopy [8.4%] and laparoscopic salpiagectomy was done in the remaining 5 patients [20.8%] due to ruptured tube [4] and the absence of need for further pregnancy [1]. In all patients who were successfully treated by laparoscopy, there was no need for blood transfusion and no major intra- or post-operative complications. The mean duration for hospital stay was 25.3 hours for laparoscopically treated patients and 3.6 days for those treated by laparotomy. Twenty-eight patients [out of the original 32 cases of EP] requesting further pregnancy, 18 [64.3%] delivered a living infant within 24 months of follow up. Laparoscopic management of tubal EP is recommended in all cases except those who are shocked; hemodynamically unstable or those with other contra-indications to laparoscopy. Conservative salpingostomy is recommended in cases with unruptured tube that request future pregnancy

Transvaginal sonography and color doppler imaging in the follow-up of patients with gestational trophoblastic disease

Uterine morphology assessed by transvaginal sonography [TVS] and the hemodynamics of intra-tumoral vessels assessed by color Doppler ultrasound [CDU] were prospectively correlated with the clinical outcome of 9 patients with gestational trophoblastic disease [GTD]. Six patients were managed and followed without treatment and 4 of them achieved complete local resolution. Three patients were referred for sonographic evaluation of persistent trophoblastic disease. Our four patients with one referred subject did not need any further treatment [Observation group, n = 5]. Two of our patients plus two of the three referred patients were found to have persistent disease and they received chemotherapy [Treatment group, n = 4]. In the observation group both techniques; TVS and CDU, had 100% accuracy in predicting local resolution or local persistence. Persistence was predicted 1-2 weeks before the increase of B human chorionic gonadotropin [B-hCG] levels, whereas resolution was observed up to 6 weeks before the disappearance of beta-hCG. In one patient normal uterine morphology and vascularization in the presence of elevated hCG levels was associated with extrauterine spread. In the treatment group, normal uterine ultrasound morphology and negative color Doppler results had 75% negative predictive value, A false-positive result was observed in one case. We conclude that ultrasound evidence of abnormal uterine morphology or persistent vascularization on color Doppler examination with persistent hCG levels is indicative of local persistence. Normal uterine morphology with negative color Doppler results may be associated with extrauterine spread