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Query: UMLS:C0000737 (abdominal pain)
 31,184 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Although an infrequent cause of acute lower abdominal pain, fallopian tube torsion should be considered whenever a woman presents with this complaint. Early diagnosis and surgical intervention may save a tube that has not yet infarcted, yet initial presentation may give little indication of the seriousness of the condition until peritonitis develops. Definitive treatment is removal of the affected adnexa. Diminished fertility and an increased incidence of ectopic pregnancy in the remaining fallopian tube follows unilateral salpingectomy. A case history of fallopian tube torsion is presented.
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PMID:Torsion of the fallopian tube. 4 97

313 patients with ectopic pregnancy were treated at Chicago Lying-In Hospital in 1968-1975, for a frequency of 1 in 72 deliveries. Historical and physical findings, diagnostic procedures, causative factors, and patient management were reviewed for 284 of these patients. 97.5% of the pregnancies were tubal. 25% of the patients were nulliparas and 31.7% were primiparas. 34.9% had had 1 or more previous abortions. The mean age of the patients was 28. Most had been using no contraception, and only 3.9% had an IUD in situ. The most common symptoms were abdominal pain (96.7%) and amenorrhea (73.6%), while the most frequent abdominal findings were tenderness (83.4%), rebound pain (41.2%), and guarding (28.9%). Adnexal tenderness was found in 72.2% and 30% had distinct adnexal masses. An initial misdiagnosis of pelvic inflammatory disease was made in 132 (46.5%) cases. A culdocentesis and slide latex agglutination inhibition pregnancy test performed in 167 and 102 patients, respectively, gave 82.6 and 73.5% positive rates. Diagnostic laparoscopy was used routinely after 1970 on all nonacute patients in whom ectopic pregnancy was suspected, and this led to a significant drop in the rate of ruptured pregnancies (63% pre-1970 and 45% post-1970). 25% of patients were sterilized, but the treatment of choice was salpingectomy unless the opposite tube was absent or damaged. Gross evidence of pelvic inflammatory disease was noted in 36% of patients and 31% had salpingitis. The most common postoperative complication was fever (42.2%). 3 deaths occurred in the series (2 due to acute pulmonary edema resulting from fluid overload), for a maternal death rate from ectopic gestation of 13.83/100,000 live births. No fetuses survived.
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PMID:Ectopic pregnancy. An eight-year review. 43 84

A case report of ovarian pregnancy in a young white nulligravida, with a Copper 7 IUD in situ, was presented. The patient had the IUD inserted 1 year prior to her January 1977 admittance to the hospital for abdominal pain. After the IUD was removed, laparoscopy revealed blood in the abdominal cavity. The uterus, tubes, and left ovary were normal. The right ovary had a hemorrhagic cystic mass. A corpus luteum was visible near the mass. Microscopic examination of a section of the hemorrhagic mass revealed immature chorionic villi and a corpus luteum separated from the villa by ovarian connective tissue. In the literature on ectopic pregnancy, the risk of ovarian pregnancy was defined as 1/40,000 deliveries. Several studies indicated that the risk was considerably higher for IUD users. The manner in which IUDs enhance the risk of ovarian pregnancy is unknown.
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PMID:Ovarian ectopic pregnancy in association with a copper-7 intrauterine device in situ. 45 25

Beta-HCG in serum was analysed in 64 cases of ectopic tubal pregnancy who wree different groups; ruptured ectopic pregnancy, ectopic pregnancy accompanied by amenorrhea or adnexal mass and ectopic pregnancy without palpable adnexal mass and amenorrhea. The mean HCG levels for the three groups were 8 790 IU/l, 2 580 IU/l and 690 IU/l, respectively, which related more to the symptoms than to the estimated length of pregnancy. Eleven per cent of the women had an IUD and five per cent were taking low dose gestagens. Screening of cases with acute lower abdominal pain or irregular vaginal bleeding with beta-HCG in serum will facilitate an early diagnosis of ectopic pregnancy and be of special value in patients with less typical symptoms.
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PMID:Serum beta-human chorionic gonadotrophin levels in the early diagnosis of ectopic pregnancy. 48 13

Two case reports of intraabdominal pregnancy and review of 9 others which have been seen at the Indiana University Hospital are presented. An incidence of one intraabdominal pregnancy in 7931 deliveries at Indiana University is compared to 1 in 3372 deliveries from a large series at another institution. A perinatal mortality of 91% and a maternal mortality of 18% from our series are contrasted to 90% and 6%, respectively, from the world literature. The diagnosis, management, and outcome of this rare form of extrauterine pregnancy are discussed. Recurrent abdominal pain in the gravid patient may signal abdominal pregnancy. The role of ultrasound in diagnosis and the importance of early surgical intervention with minimal disturbance of the placenta are stressed. In cases of intraabdominal pregnancy, the infant rarely survives and congenital malformations are frequent.
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PMID:Abdominal pregnancy. Review of current management. 90 59

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.
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PMID:Ectopic pregnancy associated with the intrauterine device: a study of seventy cases. 93

A survey of all women between the ages of 15-50 who underwent laparotomy at the Women's Hospital, Liverpool, from January 1970 to December 1974, was performed to identify etiological factors in ectopic pregnancy. There were 49 ectopic pregnancies during this peirod. The majority of patients were 30-35 years of age (20), 16 were in the 25-29 group. 63.3% had a previous viable pregnancy, 16.3% had a previous abortion, and 3 patients had a previous ectopic pregnancy. The major sysmptoms were vaginal bleeding followed by abdominal pain. Only 16.3% gave a history of previous pelvic infection. However, 53.5% were found to have evidence of previous pelvic infection. 4 patients. Results indicate that pelvic inflammatory disease is still the greatest cause of ectopic pregancy.
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PMID:Ectopic pregnancy: a five year review. 95

A 30-year old primigravida with a history of drug addiction came to the Rigshospitalet in Copenhagen, Denmark for prenatal care at 15 weeks gestation. Physicians did an amniocentesis because of family history of trisomy 21. Ultrasound examinations in the 17th and 18th weeks of gestation indicated a living fetus with the placenta on the right lateral wall of the uterus, but there was an insufficient amount of amniotic fluid. Maternal alpha fetoprotein serum levels were extremely high (298 kIU/L). Physicians predicted a poor fetal prognosis and advised the woman to undergo an abortion. On the first day, they inserted 4 vaginal pessaries of 1 mg gemeprost and administered 25-30 mg bupivacain through an epidural catheter to control abdominal pain. 8 hours after first insertion, they began intravenous (IV) administration of oxytocin. Her cervix remain closed and uterine tension did not increase. 2 hours after beginning the oxytocin IV, she suffered from an abrupt severe abdominal pain which was transferred to the right shoulder. Heart rate and blood pressure remained normal. 4 hours later, her body temperature rose, so she received 500 m pivampicillin 3 times/day. She experienced no vaginal bleeding and no uterine contractions. Her cervix had still no opened. On the third day, health workers inserted 5 more pessaries. On the fourth day, they administered 75 ml isotonic saline/hour transcervically, but she still did not abort. Her temperature vacillated even though she received antibiotics and the pain continued despite epidural analgesics. On day 5, health workers administered 3.75 mcg prostaglandin F2 alpha/minute transcervically. After 6 hours of no progress, they performed a laparotomy and observed a macerated, malodorous fetus in the peritoneal cavity which continued 1200 ml of blood. The medial part of the left fallopian tube an the left uterine corner had ruptured. They removed the fetus via wedge resection; it had no malformations. Physicians should consider ectopic pregnancy when attempts at induced abortion do not succeed.
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PMID:Misdiagnosis of interstitial pregnancy followed by uterine cornual rupture during induced midtrimester abortion. 132 30

A 33-year-old highly parous woman developed severe abdominal pain and signs of circulatory collapse 10 months after tubal sterilisation in the absence of symptoms of pregnancy. A ruptured ectopic pregnancy sited interstitially in the right tube and extending into the myometrium and parametrium was found at laparotomy. Histopathologic examination revealed an ectopic pregnancy consisting of choriocarcinoma--a rare but life-threatening combination in a sterilised woman.
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PMID:Choriocarcinoma associated with ectopic pregnancy after tubal sterilisation. 133 25

Clinical experience with and adverse effects of methotrexate for the treatment of unruptured ectopic pregnancy are described. Ectopic pregnancy is suspected in the presence of the following: positive results on pregnancy test (e.g., test for beta-human chorionic gonadotropin [beta-hCG]), lower abdominal pain, a normal or slightly enlarged uterus, and a mass on either side of the midline. When laparoscopy is required for diagnosis, surgical correction is done at the same time. However, use of serial beta-hCG titers, vaginal ultrasound examinations, serum progesterone concentrations, and dilation and curettage (when the pregnancy is confirmed to be nonviable) allows earlier detection of ectopic pregnancy without laparoscopy. If rupture has not occurred, i.v. or i.m. methotrexate is administered; usually, i.m. leucovorin is given, on alternate days, to prevent hematologic toxicity. Adverse effects of methotrexate include stomatitis, gastritis, and hepatic enzyme elevation. Use of a single-dose regimen of i.m. methotrexate without leucovorin has been associated with a lower frequency of toxicity. Selection criteria for patients are as follows: (1) an unruptured ectopic pregnancy less than or equal to 3.5 cm in greatest dimension on transvaginal ultrasound, (2) no active renal or hepatic disease, and (3) no evidence of leukopenia or thrombocytopenia. Intramuscular methotrexate therapy is a safe and effective alternative to surgery for the treatment of unruptured ectopic pregnancy.
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PMID:Methotrexate for treatment of unruptured ectopic pregnancy. 153 28


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