Tubal conservation in ectopic pregnancy: a study of 200 cases.

There have been 1152 cases of ectopic pregnancy at Kaiser Permanente Hospital from 1953 to 1980. In 200 cases the involved tube was preserved with no surgical complications. There have been 122 subsequent pregnancies, 24 of which were repeat ectopic pregnancies. Twelve were in the involved tube and 12 were in the opposite tube, demonstrating conclusively that both tubes are at equal risk of ectopic pregnancy. Conserving the involved tube does not increase the incidence of ectopic pregnancy but does increase the chances for intrauterine pregnancy in this subfertile population.

Fallopian tube adenocarcinoma: common extraperitoneal recurrence.

Fallopian tube adenocarcinoma is a rare gynecologic tumor that spreads like epithelial ovarian carcinoma. From 1954 to 1982, thirty patients with tubal adenocarcinomas were treated at UCLA and by the Southern California Permanente Medical Group. The mean age was 52 years. Pain, irregular or postmenopausal bleeding, and vaginal discharge were the most common presenting symptoms. Twenty-two had undergone previous pelvic or abdominal surgery. A pelvic mass was the most common physical finding, while Pap smears, IVP, and BE were rarely helpful in making the diagnosis or planning treatment. All of the patients in this report underwent primary therapeutic surgery. Nineteen patients received radiation and fourteen, systemic chemotherapy. Surgical stage was prognostic for survival. Fourteen patients with Stage I and II disease are NED (4 at 2 years; 10 at 5 years). No patients with Stage III or IV disease survived 5 years. Recurrences were noted as late as 6 years after primary therapy and 10 of 14 recurrent sites were extraperitoneal.

Abdominal pregnancy: a study of twenty-one consecutive cases.

Early abdominal pregnancy is self-limited by hemorrhage from trophoblastic invasion, with complete abortion of the gestational sac that leaves a discrete crater which is sometimes difficult to identify. Advanced abdominal pregnancy survives the hemorrhage of trophoblastic invasion and partial tubal abortion and implants secondarily in the first trimester on any adjacent structure. It may progress to term if not diagnosed or interrupted by abruptio placentae and have spurious labor and fetal death. A case of cornual abortion with secondary implantation on the uterus is discussed.

Ruptured corpus luteum with hemoperitoneum: a study of 173 surgical cases.

Ovarian hemorrhage from the corpus luteum of menstruation or pregnancy can be a life-threatening surgical condition which occurs at all stages of a woman's reproductive life. A corpus luteum cyst predisposes to rupture. There may be a delay of menses. Pregnancy increases the risk of rupture, and there is an increased risk of abortion and ectopic pregnancy. Most ruptures occur in the right ovary and can be misdiagnosed as appendicitis. Culdocentesis is positive for hemoperitoneum, and if the hematocrit is over 12%, surgical intervention is indicated for hemostasis. A tissue diagnosis should be made by cystectomy, luteectomy, or wedge excision.

Ectopic pregnancy associated with the intrauterine device: a study of seventy cases.

Seventy cases of ectopic pregnancy associated with an IUD comprised 10% of all ectopics in a 9 year period. This increased to 15% in the last 19 months as more IUD's were in use. In two thirds of the ectopics the IUD had been in situ more than 1 year. Unusual bleeding and cramping attributed to the IUD obscured the diagnosis and resulted in removal or replacement of the IUD in over one half the cases 1 to 8 weeks before surgery. The episodic nature of the abdominal hemorrhage in two thirds of all ectopics resulted in surgery on day 44 average gestational age. The IUD is probably not causal in ectopic pregnancy but does not protect the predisposed patient from ectopic pregnancy which should be suspected in any patient with an IUD who has irregular bleeding and abdominal pain.

Repeat ectopic pregnancy: a study of 123 consecutive cases.

In a study of 1,330 ectopic pregnancies, 123 (9 per cent) patients experienced repeat tubal pregnancies. Of these 123 patients with repeat ectopics, 96 (78 per cent) were surgically sterilized with their second operative procedure. The remaining 27 potentially fertile patients have had nine pregnancies, but only three living children. Cornual wedge resection of the uterine tube predisposed in interstitial pregnancy and to rupture of the uterus in four cases. Four patients had three ectopic pregnancies each. Repair of the involved tube is usually technically possible following linear salpingotomy and should be done if future fertility is desired. If the patient does not desire future pregnancy, she should be sterilized to avoid the risk of repeat ectopic pregnancy.