A Rare Case of Bilateral Tubal Ectopic Pregnancy Following Intracytoplasmic Sperm Injection-Embryo Transfer (ICSI-ET)

Abstract Bilateral tubal ectopic pregnancy is a very rare form of ectopic pregnancy. The incidence is higher in women undergoing assisted reproductive techniques or ovulation induction. We report the case of bilateral tubal ectopic pregnancy. The patient was 30 years old and had a 3-year history of infertility; she was referred to the in-vitro fertilization (IVF) program because of tubal factor infertility. A pregnancy resulted from the transfer of two embryos during an artificial cycle. Despite the increase in β-hCG values during the follow-up, 22 days after the embryo transfer, the β-hCG levels were 2,408 U/L and the serum progesterone (P4) level was 10.53 ng/ml. After application with methotrexate, β-hCG levels did not decrease effectively. Moreover, the sonographic screening revealed a suspicious bilateral tubal focus for ectopic pregnancy. A mini-laparotomy was performed and a bilateral tubal pregnancy was found. In the case of unilateral tubal pregnancy after the transfer of two embryos, the situation of the other tube should be systematically checked and β-hCG levels should be monitored.

A Rare Case of Spontaneous Bilateral Tubal Ectopic Pregnancy.

The rarest form of ectopic pregnancy is bilateral tubal ectopic pregnancy in which twining occurs with pregnancy in both the tubes. The fates of two pregnancies are independent of each other. We report a 28 years woman with out any high risk factor of ectopic pregnancy had spontaneous right sided un-ruptured tubal ectopic and left sided ruptured tubal ectopic pregnancy. The diagnosis of ectopic pregnancy was made on clinical suspicion and ultrasonography. The diagnosis of bilateral tubal ectopic was made during surgery and confirmed on histopathological examination. To avoid missing ectopic pregnancy a high index of suspicion is required and close examination of both tubes at the time of surgery even in presence of significant adhesion.

Embarazo ectópico molar tubárico: a propósito de un caso clínico / Tubal ectopic pregnancy molar: a case report

Introducción: La incidencia de gestación ectópica es 20/1000 embarazos. La mola hidatiforme ocurre en 1/1000 embarazos. Los casos de mola hidatiforme en embarazos ectópicos albergados en las trompas de Falopio constatados en la literatura mundial son excepcionales. Objetivo: Presentamos un caso clínico de embarazo ectópico molar tubárico y revisión de la literatura. Conclusión: La enfermedad trofoblástica gestacional asociada a embarazo ectópico es un entidad extremadamente rara que debe tenerse en cuenta por su trascendencia.

Introduction: The incidence of ectopic pregnancy is 20/1000 pregnancies. The hidatidyform mole occurs in about 1/1000 pregnancies. The cases of hidatidyform mole in ectopic pregnancies located in the Fallopian tube collected in world literature are exceptional. Objective: We present a clinical case of an ectopic molar pregnancy in the tubes and a literature review. Conclusion: The trophoblastic pregnancy disease associated to an ectopic pregnancy is an extremely rare entity that should be considered because of its transcendence.

Molar pregnancy presents as tubal ectopic pregnancy

Hydatidiform moles are abnormal gestations characterized by the presence of hydropic changes affecting some or all of the placental villi. Hydatidiform moles arise as a result of the fertilization of an abnormal ovum. In this report, the patient was a 29 year old Asian woman who had induction of ovulation with letrozol. Since the majority of molar gestations arise within the uterine cavity thus the occurrence of a hydatidiform mole within ectopic gestational tissue is rare. It is important to differentiate a hydatidiform mole from a conventional ectopic pregnancy, particularly in infertile women who have a history of ovulation induction

[Comparison of serum CA-125 level in ruptured and unruptured tubal pregnancies in Yazd/Iran during 2001-2006]

This study aimed to determine if serial measurement of serum CA-125 level could be used as a useful test in the differential diagnosis of intact and ruptured tubal pregnancies. In a single-blind prospective controlled clinical study, 59 women with tubal pregnancy of 6-12 weeks [26 women with ruptured tubal pregnancy, 33 women with intact tubal pregnancy and 59 women with normal intrauterine pregnancy of the same gestational age as control group] were studied prospectively. Serum CA-125 levels were measured in all women and compared among three groups. Demographic features [age, gestational age, parity and educational level] were not significantly different in three groups. CA-125 level in ruptured tubal pregnancy group was significantly higher than that in control group [P = 0.04]. Both these two groups had higher levels of CA-125 comparing to the intact tubal pregnancy group [P = 0.001, P = 0.006, respectively]. In intact tubal pregnancies managed with medical treatment, serial measurements of CA-125 could be a supplementary test for an early diagnosis of tubal rupture

Serum markers in the diagnosis of tubal pregnancy: [review]

The introduction of highly sensitive methods, such as transvaginal sonography and measurement of serum b-human chorionic gonadotropin, has dramatically improved ectopic pregnancy diagnosis in recent years. Early diagnosis is the key to successful and conservative management of women with ectopic pregnancy; however, approximately 50 percent of such women are initially misdiagnosed, resulting in significant morbidity and mortality. In order to improve diagnosis, several serum markers are being investigated including progesterone, CA 125, pregnancy-associated plasma protein-A, vascular endothelial growth factor, and maternal creatine kinase. Measurement of serum vascular endothelial growth factor, alone or together with other markers, could be a promising method for earlier and more accurate differential diagnosis. However, the clinical applicability of these findings remains to be evaluated in larger prospective studies.

Heterotopic pregnancy

A rare case of simultaneous tubal pregnancy and intrauterine pregnancy is discussed. Patient had an atypical presentation of abdominal pain and a abnormal uterine bleeding but no period of amenorrhea. On clinical examination there was suspicion of ectopic gestation but ultrasonography revealed early intrauterine pregnancy along with luteal cyst. Because of increase severity of pain she was reviewed again. Repeat sonography findings were consistent with heterotopic which was confirmed by laparotomy and histopathology

Unruptured left cornual pregnancy: case report.

Cornual pregnancy is a rare condition. The morbidity and mortality are directly related to the length of time for diagnosis. The present paper reports a case of unruptured left cornual pregnancy which was diagnosed by the patient's symptom, physical examination and positive urine pregnancy test. Ultrasonography confirmed the diagnosis. Left cornual resection was carried out in the present case without immediate or long-term complication.

Embarazo ectópico tubario bilateral: reporte de un caso / Bilateral tubal ectopic pregnancy: a case report

Se reporta un caso de embarazo ectópico tubario bilateral. Se analiza el cuadro clínico y su dificultad diagnóstica.

Embarazo tubario: revisión actualizada de factores de riesgo y diagnóstico / Ectopic pregnancy: the current review risk factors and diagnosis

Debido a diversas variaciones epidemiológicas, la incidencia del embarazo ectópico ha aumentado significativamente llegando a convertirse en prácticamente el 2 por ciento de todas las gestaciones. Si a esto le agregamos su elevada mortalidad entendemos por qué esta patología debe ser manejada tanto por el médico general, como por el especialista. El curso de la enfermedad no complicada es indolente por lo que debemos tener presente un alto índice de sospecha en las pacientes que presentan factores de riesgo, como son: el antecedente de cirugía tubaria, de EE previo y la presencia de un embarazo producto de TRA. Cuando la enfermedad debuta por su complicación el diagnóstico debe establecerse a la brevedad y debe considerarse a una paciente en edad fértil con un abdomen agudo, portadora de EE hasta demostrar lo contrario. Además de la sospecha clínica, los 2 elementos más importante en el diagnóstico de la enfermedad son la determinación de beta-HCG y la USTV. La mayor disponibilidad de estas dos herramientas en los servicios de urgencia, ha permitido establecer un diagnóstico precoz del EE agilizando su tratamiento, el que clásicamente ha sido quirúrgico. Actualmente la laparoscopía es la pieza clave del manejo quirúrgico de la enfermedad, sea este radical o conservador. Sin embargo dada la precocidad de los diagnósticos, hemos visto como el tratamiento farmacológico es actualmente una alternativa segura y eficaz en grupos seleccionados. De esta manera el EE inicial no complicado, en algunos centros, es considerado una patología de tratamiento médico.

Due to many epidemiologic variations, the incidence of the ectopic pregnancy has increased its significance tobecome practically 2 percent of all the gestations. Its high mortality allows us to understand why this pathologymust be handled by general doctor, and by the specialist. The course of the noncomplicated disease is indolent so we must strongly suspect in the patients who present risk factors: the antecedent of surgery, previous ectopic pregnancy and fertility treatment due pregnancy. When the disease starts with its complication, the diagnosis must be quickly done and must be considered to all female in fertile age presenting an acute abdomen, until discarding. Inaddition to the clinical suspicion, the 2 elements more important in the diagnosis of the disease are thedetermination of beta-HCG and ultrasound. The greater availability of these two tools in the urgency services,has allowed to establish a precocious diagnosis of EE facilitating its treatment, the one that classically has been surgical. At the moment, laparoscopy is the key piece of the surgical handling of the disease, radical or conservative. Nevertheless, given the precocity of thediagnoses, pharmacologic treatment may be a safe and effective alternative in selected groups. Initial, noncomplicated EE , in some centers, is considered a medical treatment pathology.

Embarazo tubárico bilateral / Bilateral ectopic pregnancy

En este artículo se presenta el inusual caso de un embarazo tubárico bilateral, en una paciente de 27 años de edad, con dos embarazos previos, uno de ellos gemelar. Cinco años atrás se había realizado un Pomeroy

Gestação tubária após transferência embrionária intra-uterina homolateral à ectópica prévia pós-concepção natural tratada com dose única de metotrexate / Tubal pregnancy following intrauterine embryo transfer homolateral to a previous ectopic pregnancy after natural conception treated with a single-dose methotrexate

Este trabalho objetiva o relato de uma gravidez ectópica em paciente submetida à ciclo de indução da ovulação para fertilização in vitro (FIV) com transferência embrionária transcervical, e com história de cirurgia laparoscópica diagnosticando aderências pélvicas como questionável sequela de prévia apendicectomia, que evoluiu com gestação tubária direita homolateral à gestação ectópica pós-concepção natural. Discute, ainda, fatores de risco associados à gestação tubária relacionada à FIV. Mais importante é conscientização da necessidade do diagnóstico precoce dessa complicação para que consiga, de forma menos invasiva e mais efetiva, sucesso no tratamento e, ainda, orientar sobre a possiblidade dessa ocorrência, mesmo após a transferência embrionária intra-uterina

Bilateral tubal pregnancies after tubal sterilization in a human immunodeficiency virus seropositive woman.

Bilateral tubal ectopic pregnancies are rare occurrences. Bilateral tubal ectopic pregnancy in a patient who had undergone tubal sterilization is also very rare. The authors report a case of a 32-year-old, gravida 2, parity 1, human immunodeficiency virus seropositive who had previously undergone tubal sterilization. She presented with abdominal distention and vaginal bleeding after 12 weeks of amenorrhea. Pre-operative diagnosis was ruptured ectopic pregnancy. Emergency exploratory laparotomy and bilateral salpingectomy were performed. The pathology report confirmed bilateral tubal pregnancies. She was well at the fifth day of discharge and four-week follow-up. Ectopic pregnancy should always be suspected in reproductive-age patients presenting with amenorrhea even if they have undergone tubal sterilization. To the authors' knowledge, there has been no report of bilateral tubal pregnancy in a patient with human immunodeficiency virus seropositive after tubal sterilization.

Embarazo ectópico bilateral simultáneo / Simultaneous bilateral ectopic pregnancy

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.

La grossesse tubaire : epidemiologie; diagnostic et traitement. A porpos de 93 cas colliges dans le service de gynecologie et d'obstetrique du CHU de Cocody

"L'etude retrospective descriptive realisee dans le service de gynecologie et d'obstetrique du CHU de Cocody du 1er Janvier 1999 au 30 Juin 1999 concerne 93 cas de grossesse tubaire correspondant une frequence de 49sur1000 accouchements. Les facteurs de risque sont domines par les antecedents d'infections genitales (45;5 pour cent) et d'avortements a risque (38;7 pour cent). L'echographie a ete necessaire au diagnostic dans 45;5 pour cent des cas. Le traitement a consiste en une salpingectomie dans 91;3 pour cent des cas. L'analyse de cette situation rend necessaire l'amelioration du diagnostic de la grossesse tubaire. Ceci ""est possible qu'en rendant systematique la realisation d'echographie precoce chez les femmes a risque lorsque les signes cliniques de grossesse tubaire sont presents. A ce prix; nous pouvons esperer eviter les traitements radicaux et proposer des techniques modernes comme la chirurgie coelioscopique et le traitement medical considerees a priori comme les traitements de reference"

Embarazo triple heterotópico / Triplet heterotopic pregnancy

Se describe un caso de embarazo triple heterotópico, consistente en un embarazo gemelar monocigótico y uno ectópico tubárico, diagnosticado a las 10 semanas de gestación. El embarazo gemelar resultó ser un aborto retenido y el ectópico accidentado

Embarazo heterotópico: informe de un caso y revisión bibliográfica / Heterotopic pregnancy. One case presentation and bibliographic review

Se presenta el caso de un embarazo heterotópico tubario espontáneo, en paciente primigesta con sobrevivencia del producto intrauterino; tratada en el H.G.Z.M.F.No. 8 IMSS de Ciudad Sahagún Hgo., se señala la frecuencia en la literatura, sus posibles orígenes, su cuadro clínico, los métodos auxiliares de diagnóstico y tratamiento. Se concluye que el embarazo heterotópico es un desorden raro, pero puede ocurrir y es potencialmente peligroso para la madre y el feto intrauterino. Su detección oportuna favorece el pronóstico