ABSTRACT
@#Ectopic pregnancy is one of the leading causes of maternal morbidity and mortality worldwide, as seen in 9 to 13% and up to 30% of maternal deaths in developed and developing countries, respectively. Bilateral tubal pregnancy is an exceedingly rare condition with an even greater risk of rupture and hemorrhage than that of the unilateral type. This is a case of a 32 yearold G4P3 (4004) who presented with amenorrhea of 5 weeks, vaginal bleeding, and abdominal pain. The triad of symptoms, elevated serum β-HCG levels, along with a transvaginal ultrasound finding of a right adnexal mass led to the impression of a ruptured ectopic pregnancy, probably tubal. Patient underwent laparoscopy and intraoperative findings revealed bilateral tubal pregnancy for which bilateral salpingectomy was done. Oftentimes, as in this case, bilateral tubal pregnancy is diagnosed intraoperatively. However, it is possible, as seen in a review of cases, that a combination of history, symptoms, and clinical findings may point to a probable diagnosis which is imperative in treatment planning. Bilateral tubal pregnancy is rare, but due to a rise in pelvic inflammatory disease, its consequences, and the advent of assisted reproductive techniques, the risk for this condition increases with important clinical implications.
Subject(s)
Pregnancy, EctopicABSTRACT
A case of simultaneous bilateral tubal pregnancy following in-vitro fertilization and embryo transfer is presented. On the 22 days after ET, the patient complained of low abdominal pain and vaginal spotting for one day and was suspected of left tubal pregnancy by transvaginal ultrasonography. However, laparoscopy revealed the bilateral tubal pregnancy and laparoscopic bilateral salpingectomy was performed. This unusual type of ectopic pregnancy must be kept in mind when evaluating a patient suspected of a possible early abnormal gestation after assisted reproductive technologies. It is critical to perform a close inspection of the abdomen, pelvis, and contralateral tube during surgery.
Subject(s)
Female , Humans , Pregnancy , Abdomen , Abdominal Pain , Embryo Transfer , Embryonic Structures , Fertilization , Laparoscopy , Metrorrhagia , Pelvis , Pregnancy, Ectopic , Pregnancy, Tubal , Reproductive Techniques, Assisted , Salpingectomy , UltrasonographyABSTRACT
Se presenta el caso clínico de una paciente de 29 años de edad, la cual fue sometida a una laparotomía exploradora, con el diagnósticos de embarazo tubario derecho complicado. En el acto operatorio se comprueba dicho diagnóstico, agregándose como hallazgo, la presencia de un embarazo tubario izquierdo.
We present a clinical case of a 29 year-old patient, which was subjected to an exploratory laparotomy with the diagnosis of a complicated right tubal pregnancy. At operation is proven this diagnosis, and the presence of a left tubal pregnancy was found.
Subject(s)
Humans , Female , Pregnancy , Adult , Pregnancy, Ectopic/surgery , Pregnancy, Ectopic/diagnosis , Pregnancy, Multiple , Pregnancy, Tubal/surgery , Pregnancy, Tubal/diagnosis , LaparotomyABSTRACT
Bilateral tubal pregnancy is the least common type of all extrauterine pregnancies, 1:725-1:1580 of pregnancies are bilateral. Simultaneous tubal pregnancies have been reported in natural cycles, recently, after ovulation induction, assisted reproductive techniques. The high incidence of ectopic pregnancy assisted with ovulation induction continues to be a problem. Bilateral tubal pregnancy associated with the ovulation induction has been reported few cases of 3.0% to 6.0% in frequency. This paper describes a case of simultaneous bilateral tubal pregnancy after ovulation induction and intrauterine insemination in a 27 year old patient. The diagnosis was confirmed by laparoscopy performed 30 days after intrauterine insemination, which revealed bilateral tubal pregnancy and mild hyperstimulated ovaries. Bilateral salpingectomy was performed. With a review of the literature on this topic, diagnostic aspect and incidence and treatment options are discussed.
Subject(s)
Adult , Female , Humans , Pregnancy , Diagnosis , Incidence , Insemination , Laparoscopy , Ovary , Ovulation Induction , Ovulation , Pregnancy, Ectopic , Pregnancy, Tubal , Reproductive Techniques, Assisted , SalpingectomyABSTRACT
Over the last 20 years, the frequency of multiple pregnancy has increased mainly because of the introduction of exogenous pituitary gonadotropins in the treatment of infertility. Since the advent of assisted reproductive technology, the concern about ectopic implantation of embryos has increased dramatically and it continues to be a major complication of in vitro fertilization and embryo transfer (IVF-ET). Bilateral tubal pregnancy is the least common type of ectopic implantation of two embryos. Of all extrauterine pregnancies, 1:725~1:1580 are bilateral1,2. Simultaneous tubal pregnancies have been reported in natural cycles, recently, after ovulation induction, in-vitro fertilization2,3. The high incidence of ectopic pregnancy associated with IVF-ET continues to be a problem and frequencies of between 2.4 and 12.4% have been only a few reports of simultaneous bilateral tubal pregnancies following IVF-ET4. This paper describes a case of a simultaneous bilateral tubal pregnancy after IVF-ET in a 33 year old patient. The diagnosis was confirmed by diagnostic laparoscopy performed 25 days after embryo transfer(sixth week of gestation), which revealed bilateral tubal pregnancy. Bilateral salpingectomy was performed. With a review of the literature on this topic, diagnostic aspects and treatment options are discussed.