Nonsurgical management of tubal pregnancy: necessity in view of the changing clinical appearance

Article Abstract:

The incidence of tubal pregnancy, pregnancies in which the embryo implants in the Fallopian tubes rather than the uterus, has increased greatly. This is partially due to improved diagnostic methods and to increases in underlying causes, such as pelvic inflammatory disease, conservative surgery for tubal pregnancies, and in vitro fertilization techniques. Consequently, tubal pregnancies have become less life-threatening, especially when early diagnosis is made. Treatment has thus evolved with the aim of decreasing the need for drastic surgery and decreasing postsurgical complications and recovery time. This article reviews the nonsurgical methods that are available to treat tubal pregnancy. Minimizing or avoiding surgery decreases the risk of adhesions, so that the fertility rate is likely to be higher. Certain medications can stop the growth and development of embryo cells, which then can be absorbed by the body. These drugs can be given systemically and locally. Methotrexate is the prime example of such medications. It has been used to treat leukemias, and acts by preventing the production of compounds essential for cell growth. A review of reports about methotrexate use indicates that criteria for patient selection are important for successful treatment. Actinomycin D and RU 486 (mifepristone) are two other drugs that have also been administered systemically, and the few reports of their uses are discussed. To decrease side effects of these medications, investigators have studied local administration of methotrexate, potassium chloride, and prostaglandins. Ultrasound or laparoscopy (visualization of the abdominal cavity with a small scope or tube) have been used to guide placement of the drugs. Perhaps medical treatments should not be started unless levels of the hormone associated with viable pregnancies increase. Studies that directly compare these nonsurgical methods of treatment are needed. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Care and treatment, Evaluation, Pregnancy, Ectopic, Ectopic pregnancy, Abortifacients, Methotrexate, Mifepristone

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Maternal death caused by HELLP syndrome (with hypoglycemia) complicating mild pregnancy-induced hypertension in a twin gestation

Article Abstract:

A condition of pregnancy characterized by red blood cell destruction (hemolysis), elevated liver enzymes and low platelet (cells involved in blood clotting) count is collectively termed the HELLP syndrome. Only seven cases have been reported following high blood pressure induced by pregnancy. A 29-year-old woman with an uneventful twin pregnancy began labor in the 39th week of pregnancy. Two hours after admission to the delivery room, the mother's blood pressure increased slightly. The heart rate of one of the fetuses slowed, and a cesarean section delivery was performed. The surgery was uneventful except for slight oozing of blood from suture sites. Two normal healthy fetuses were delivered. Three hours later the mother's heart rate increased, blood appeared in the urine and the hematocrit (the ratio of red blood cells to the total blood volume) declined. Blood products and clotting factors were given to control the disturbed clotting mechanism. A second operation was performed to determine the cause of abdominal swelling (distension). A large amount of blood was removed from the abdominal cavity. Yellowing of the skin resulted from the rapid breakdown of red blood cells. One day later the patient's kidneys began to fail and liver functioning decreased. The patient also had a decrease in blood sugar (hypoglycemia). On the fourth hospital day the patient died. Autopsy revealed fatty deposits in the liver. It is difficult to distinguish HELLP syndrome from other diseases during pregnancy such as acute fatty liver, and blood disorders. (Consumer Summary produced by Reliance Medical Information, Inc.)

Patient outcomes, Mortality, Hemolysis and hemolysins, Hemolysis, Hypoglycemia, Hematologic diseases, Blood diseases in pregnancy

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Outcome of continued pregnancies after first- and second-trimester cervical dilatation by laminaria tents

Article Abstract:

There are a number of methods for performing abortions, but the basic procedure involves first dilating the cervix, then evacuating the fetus. Some procedures can be performed in one phase, but others require two phases. Laminaria tents are used to perform a two-phase procedure. The tents are inserted the evening before evacuation to dilate the cervix. In a few cases, women decide not to continue the abortion after the tents have been put in place. This study examined the outcomes of such cases. Of 1,840 women undergoing an abortion, 21 (1.1 percent) decided to stop the procedure after the tents had been inserted. Four of the 21 later had an abortion, but the other 17 decided to continue the pregnancy. Of these 17 women, 1 had a spontaneous abortion (miscarriage), 2 delivered prematurely, and 14 delivered full-term infants. The tips of the removed laminaria were cultured. Four women who tested positive for chlamydia had full-term pregnancies. Three women were positive for Mycoplasma hominis. One patient was positive for Ureaplasma urealyticum alone, and two of the women who tested positive for chlamydia were also positive for U. urealyticum. Neither of the women who delivered prematurely had positive culture results. The findings suggest that pregnancy outcome is minimally affected by placement and removal of laminaria. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects, Communicable diseases, Cervix uteri, Abortion, Incompetent cervix, Communicable diseases in pregnancy

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