Persistent trophoblast after conservative treatment of tubal pregnancy: prediction and detection

Article Abstract:

An ectopic pregnancy is one in which the fertilized ovum, or egg, implants outside of the uterus, such as in the fallopian tube, a passage connecting the uterus and ovary. In many cases of ectopic pregnancy, the trophoblast, or outer layer of the developing fertilized egg, may spread to various sites within the fallopian tube. The ectopic egg is removed by surgery, although the risk of inadequate evacuation is greater when the fallopian tube is preserved than when it is completely removed. The incidence of complications following surgery for ectopic pregnancy ranges from 0 to 10 percent. The relation between remaining trophoblastic tissue and development of bleeding and formation of blood masses is not clear. The rate at which human chorionic gonadotropin (hCG), a gonad-stimulating hormone present during pregnancy, decreases is lower in patients with persistent trophoblast than among patients without complications. The value of measuring hCG levels to predict and detect complications associated with persistent trophoblast tissue following surgery for ectopic pregnancy was assessed. Surgery to remove the ectopic pregnancy was performed on 98 women with tubal pregnancies, in which the fertilized egg is implanted in the fallopian tube. Seven of eight patients requiring a second operation had evidence of persistent trophoblast tissue. A second operation was necessary for seven of 31 patients with hCG levels before surgery above 3,000 international units per liter (IU/L) and one of 67 patients with pre-surgery hCG levels below 3,000 IU/L. A second operation was needed for 8 of 22 patients with hCG above 1,000 IU/L two days after surgery and 7 of 11 patients with hCG levels above 1,000 IU/L a weeks after surgery. Recovery was uncomplicated in 86 of 87 women with hCG levels below 1,000 IU/L a week after surgery. These findings show that measurement of hCG levels may help to identify patients at risk of developing persistent trophoblast. Patients with hCG levels less than 3,000 IU/L before surgery should undergo more conservative surgery, which should be followed by monitoring of hCG levels for a week. (Consumer Summary produced by Reliance Medical Information, Inc.)

Measurement, Chorionic gonadotropin, Chorionic gonadotropins

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Persistent tubal pregnancy

Article Abstract:

Ectopic pregnancies occur when the fertilized egg is implanted outside the uterus, usually in the fallopian tubes. In the past, ectopic pregnancies were treated by surgical removal of the entire fallopian tube, but modern surgical treatments are more conservative and often remove only the affected portion of the tube. This trend is associated with a new complication, called persistent ectopic pregnancy, in which a portion of the pregnancy remains implanted. This condition is recognized when pelvic pain occurs after surgery or by increasing levels of beta-human chorionic gonadotropin (b-hCG), the hormone detected by pregnancy tests. Results are presented from a review of all cases of ectopic pregnancy at one medical facility between 1985 and 1988. Eight cases of persistent tubal pregnancy, and three cases of failed conservative treatment, are described. In five of the cases of persistent tubal pregnancy, the tube had been removed completely or partially. Embryos could not be identified in any case. Persistence in nine cases was the result of misdirected surgery: the surgeon had removed the most dilated part of the fallopian tube but had missed the implantation site, located closer to the uterus. The remaining tissue continued to secrete b-hCG, leading to the diagnosis of persistent tubal pregnancy. Suggestions are presented concerning the ways persistent tubal pregnancy could be avoided: better understanding of the pathological process could help in decision-making when the only sign of persistence is a high b-hCG level. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Pregnancy

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Histopathology of fallopian tubes with recurrent tubal pregnancy

Article Abstract:

The incidence of tubal pregnancy (implantation of the early embryo in the fallopian tube instead of the uterus) has increased during the last 20 years, possibly as a consequence of surgical intervention after a previous tubal pregnancy. In cases of tubal pregnancy, which is generally treated surgically, the goal is preservation of the tube by means of conservative surgical techniques. To address the possible effects of these approaches, examinations were conducted on 15 fallopian tubes that had been surgically removed from women with a tubal pregnancy and a history of a previous tubal pregnancy on the same side. The tubes were prepared for microscopic examination and evaluated by the author. The histopathological results are described in detail. Twelve tubes had signs of chronic salpingitis (inflammation of the tube). No signs of focal adhesions (overgrowth of fibrous tissue) or stenosis (tubal narrowing) were found at the previous implantation sites or the sites of surgical intervention. A review is provided of the different approaches to surgical repair of the tube after tubal pregnancy and recommendations are made regarding incision type. The main cause of recurrent tubal pregnancy in these women appeared to be chronic disease, rather than previous tubal surgery. (Consumer Summary produced by Reliance Medical Information, Inc.)

Causes of, Fallopian tubes, Pathology, Salpingitis

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