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

Data regarding previous pelvic inflammation, abdominal surgery, endometriosis, obstetrical anamnesis, usage of IUD, occurrence of abdominal pain, vaginal discharge and metrorrhagia were obtained from 120 women with tubal infertility and compared to similar data from 126 pregnant women. Previous abdominal surgery, especially pelvic surgery was the most frequent risk factor present in 59% of the infertile women followed by pelvic inflammation (42%) and endometriosis (10%). In 23% of the infertile women there was no history of abdominal surgery, inflammation or endometriosis. Abdominal surgery, inflammation, ectopic pregnancy, salpingectomy and ovarian resection were significantly more frequent among the women with tubal infertility than among the pregnant women. Finally, there was no significant difference in the occurrence of appendectomy, IUD usage, induced or spontaneous abortion.
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PMID:Risk factors for tubal infertility among infertile and fertile women. 319 33

A retrospective review of the 119 patients with suspected ectopic pregnancy presenting to Duke University Medical Center during the two-year period ending June 30, 1983, was conducted. In order to determine significant differences between patients with and without ectopic pregnancy, the presenting complaints and physical signs were reviewed and analyzed. Significant findings in women with ectopic pregnancy were: (1) vaginal bleeding lasted longer, (2) abdominal rebound tenderness was more prevalent, and (3) abdominal pain was more prevalent in patients with ruptured ectopic pregnancy than in those with unruptured. There were no other significant differences among the signs and symptoms. Patients with and without ectopic pregnancy cannot be easily distinguished on the basis of presenting signs and symptoms. A combination of culdocentesis and quantitative human chorionic gonadotropin provides the maximal discriminative capacity when considering diagnostic laparoscopy for suspected ectopic pregnancy.
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PMID:Contemporary evaluation of suspected ectopic pregnancy. 332 1

Prior tubal sterilization should be regarded as a possible etiologic factor in the pathogenesis of ectopic pregnancy. The authors present the case of a 32-year-old woman, para 4, who presented to Kenyatta National Hospital in October 1985 with complaints of lower abdominal pain and vomiting. She had undergone tubal ligation in February 1985. Examination revealed a ruptured ectopic pregnancy in the lateral part of the left tube. There was active bleeding from the rupture. The right distal stump was intact, and the right proximal stump had no obvious defect. There was a corpus luteum in the left ovary. Ectopic gestation after tubal sterilization apparently occurs when there is recanalization and formation of a proximal tuboperitoneal fistula, allowing sperm passage and fertilization of the ovum in the peritoneal cavity, on the ovarian surface or within the ductal tubal lumen. Although the technical details of this patient's sterilization were not available, laparotomy indicated that a modified Pomeroy procedure using absorbable sutures had been performed. The failure rate for the Pomeroy procedure is estimated at 0.25-2%. Since the incidence of ectopic pregnancy following tubal sterilization is about 1 in 13 in some parts of the world, potential sterilization acceptors should be counseled about this complication and a diagnosis of ectopic gestation should be considered whenever a patient with a previous history of tubal ligation presents with signs or symptoms of pregnancy.
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PMID:Ruptured tubal pregnancy following tubal sterilization. 332 62

A 35-year-old Chinese women admitted to the hospital with lower abdominal pain was diagnosed as being pregnant by a urinary pregnancy test. However, she gave a past history of postpartum sterilization by tubal ligation after her last delivery. Laparotomy was performed immediately and a right tubal pregnancy was confirmed. Ultrasound scanning was performed to discover whether or not an ectopic pregnancy existed. However, some ultrasound requires the demonstration of a live fetus within the gestational sac living outside the uterus, and a distended bladder. Transabdominal ultrasound scanning works well when trying to detect intrauterine rather than extrauterine pregnancies. Transvaginal ultrasound has enabled better evaluation of the uterus and the cul-de-sac.
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PMID:Transvaginal ultrasonographic imaging of ectopic pregnancy. 333 Oct 84

Primary splenic pregnancy is the rarest form of extrauterine pregnancy. Only six cases have previously been documented, none of which occurred in North America. A case of this rare entity is presented in which a pregnancy was found to arise from the spleen, requiring splenectomy. In addition to the classic signs of a fulminant ruptured ectopic pregnancy, a history of upper abdominal pain was the only distinguishing feature.
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PMID:Splenic pregnancy--case report. 334 37

An analysis of the clinical data of 552 patients treated for ectopic pregnancy during 1973-82 in our hospital showed that the prevalence of this complication rose twofold (P less than 0.01) from an annual rate of 10.9 per thousand in 1973 to 20.9 per thousand in 1982. As regards parity distribution, the proportion of the 2-paras increased significantly (P less than 0.05) and this increase was significantly greater (P less than 0.001) than in the total population of parturients during this period. The increasing incidence of ectopic pregnancies had a significant positive correlation (P less than 0.05) with the use of an intrauterine device (IUD), but not with previous or present pelvic inflammatory disease or gynaecological or abdominal surgery. Because the 158 patients with an IUD in situ (34%) had a significantly less frequent past history of salpingitis, pelvic operation, infertility, ectopic pregnancy or spontaneous abortion and had less actual pelvic inflammatory changes than the 259 patients without contraception (57%), the IUD seemed to be directly involved with the increased risk of ectopic pregnancy. In the present study lower abdominal pain occurred in 97% of the patients and menstrual disorders in 93%; pelvic examination revealed adnexal mass in 63% and adnexal tenderness in 90% of the patients. Laparoscopy, a sensitive urinary pregnancy test (detection limit 75 IU/1) and culdocentesis were the most important factors in the diagnosis of ectopic pregnancy as evidenced by positive results in 97, 90 and 83% of the cases, respectively. Due to improved diagnostic procedures the annual rate of an unruptured tube at operation increased from 49% to 73% during the study period.
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PMID:Ectopic pregnancy--an analysis of the etiology, diagnosis and treatment in 552 cases. 348 6

Abdominal ultrasound is an extremely useful diagnostic tool in the evaluation of the patient with abdominal symptoms. Its advantages include its being noninvasive, portable, and not requiring the use of radiographic contrast material. Sonography has great utility in the diagnosis of abdominal aortic aneurysm. For purposes of diagnosing ectopic pregnancy, ultrasound is best used in conjunction with beta-HCG radioimmunoassay. With respect to the patient with right upper quadrant abdominal pain, ultrasonic scanning has become the method of choice for visualizing the gallbladder and identifying cholelithiasis. The choice of ultrasound for demonstrating urinary obstruction due to ureterolithiasis is somewhat more controversial. Its use should particularly be considered in patients to whom the administration of radiographic contrast material is inadvisable.
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PMID:Abdominal ultrasound. 351 92

To illustrate the way in which cases of ectopic pregnancy present in a family practice setting in contrast to the hospital setting, 7 case reports of ectopic pregnancy are reviewed. A 6-month study of ectopic pregnancies conducted at the Duke-Watts Family Medical Center showed that the classic symptoms of ectopic pregnancy occur uncommonly and to wait for some or all of the triad of symptoms delays diagnosis and treatment. The cases reported highlight the way women present with a tubal pregnancy that has not yet ruptured the fallopian tubes. None of these women presented with the classic triad of symptoms -- aberrant menses, abdominal pain, and an adnexal mass. 4 of 7 patients had risk factors for ectopic pregnancy, and 5 women had an aberrant menstrual pattern. The only woman who did not have vaginal bleeding was the woman whose tube had ruptured. None of these women has an adnexal mass when seen initially. The woman who experienced classic pain also had the ruptured fallopian tube. In 4 cases there was reluctance to consider the diagnosis. In 2 cases in which the diagnosis was considered, a less sensitive pregnancy test -- the urine test -- was ordered. Surgically, 1 tube was preserved intact. 2 other women had conservative operative procedures performed in the hope of optimizing their future fertility. A more comprehensive evaluation of pelvic complaints should be performed when risk factors such as prior ectopic pregnancies or pelvic inflammatory disease are reported. If pregnancy is diagnosed, its location needs to be ascertained by ultrasound examination. Contraceptive use does not rule out the possibility of an ectopic pregnancy, and a pregnancy, under these conditions, is more likely to be ectopic. A physician needs to insist on pathologic examination of all abortions. Exclusion of an ectopic pregnancy is indicated if no products of conception are found. There needs to be prompt referral to allow for conservative tubal surgery in cases of ectopic pregnancies diagnosed prior to rupture.
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PMID:Ectopic pregnancy: 'classic' vs common presentation. 357 17

Directed to the health care professional, this review covers the current concepts of pelvic inflammatory disease (PID) affecting adolescent and young adult women. It defines PID and discusses the magnitude of the problem, risk factors (sexual activity, age, method of contraception, history of previous PID, history of gonococcal of chlamydial lower genital tract infection, and uterine instrumentation), etiologic agents (N. gonorrhea, aerobic and anaerobic bacteria, chlamydia trachomatis, genital mycoplasmas, and other pathogens), pathogenesis, clinical and laboratory features, diagnostic evaluation, differential diagnosis, treatment, and sequelae. The Centers for Disease Control define acute PID as "the acute clinical syndrome (unrelated to pregnancy or surgery) attributed to the ascent of microorganisms from the vagina and endocervix to the endometrium, fallopian tubes, and/or contiguous structures." The true incidence and prevalence of PID in women is uncertain. Recent data show an increase to 267,200 in the average annual number of hospitalizations for PID during the 1975-81 period for women 15-44 years of age. PID occurs rarely in sexually inactive women. The large number of PID cases among adolescents reflects in part the high proportion of sexually active females in that group. The risk of developing PID in sexually active females is inversely related to age; 1/3 of all patients in Westrom's series were 19 years of age or younger at the time of their 1st PID episode, and 69% of all women with PID were younger than 25 years. Women who have had 1 episode of PID have a 20-25% chance of developing subsequent episodes. A large series of PID cases verified by laparoscopy has shown that only a small proportion of patients (3%) present with a severe clinical illness. Low abdominal pain is the most common symptom and may be present for variable periods of time prior to diagnosis. Other common symptoms include vaginal discharge (55%), irregular vaginal bleeding (36%), urinary symptoms (19%), nausea and vomiting (10%), and proctitis symptoms (7%). The major goals of therapy in PID are to prevent infertility and other long-term sequelae. About 15% of patients fail to respond to initial antibiotic therapy, 20% experience recurrences, 20% develop involuntary infertility, and 8% of post-PID patients who conceive have an ectopic pregnancy. Early diagnosis and treatment reduces the risk of residual tubal damage.
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PMID:Acute pelvic inflammatory disease. 360 34

In this study, we examined whether the doubling time of human chorionic gonadotropin is different at different stages of early pregnancy and whether the use of multiple nomograms for doubling time of human chorionic gonadotropin rather than a single critical value can improve the diagnosis of ectopic pregnancy. Forty-four women with intrauterine pregnancies who had abdominal pain and/or vaginal bleeding but who did not abort their pregnancies and 44 women with surgically proved ectopic pregnancies were studied. No difference was found in the doubling time of human chorionic gonadotropin when women were classified according to recently published criteria (Pittaway DE, Reish RL, Wentz AC. Doubling times of human chorionic gonadotropin increase in early viable intrauterine pregnancies. Am J Obstet gynecol 1985;152:299-302), and estimates of the doubling time of human chorionic gonadotropin were not influenced by the initial human chorionic gonadotropin values or the sampling interval used. In the human chorionic gonadotropin range of practical interest, multiple nomograms identified 26 of 33 (79%) women with ectopic pregnancy who had rising levels of human chorionic gonadotropin, whereas our previously reported criteria identified 28 of 37 (76%) cases. The false positive rate for each method was 9.7%. Seventeen (19%) of 88 patients could not be allotted to the human chorionic gonadotropin categories for which nomograms of the doubling time of human chorionic gonadotropin have been derived. We conclude that our previous recommendations for determining the rate of increase of human chorionic gonadotropin in serum from paired samples do not require revision at this time.
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PMID:Observations on the log human chorionic gonadotropin-time relationship in early pregnancy and its practical implications. 360 70


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