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

The value of transvaginal colour and pulse wave Doppler in the diagnosis of pathologic early intrauterine and tubal pregnancy was assessed. Forty-one normal pregnancies, 6 blighted ovum, 6 missed abortions, and 22 suspected ectopic pregnancies (13 proven tubal pregnancies) were examined. Single 5 MHz transvaginal colour and pulse wave Doppler probe was used and once clear signals from uterine vessels, umbilical artery or trophoblastic vessels were obtained. Resistance Index (peak systole--end diastole/peak systole, RI) from the corresponding waveforms was calculated. In 41 normal pregnancies (examined before termination of pregnancy) with gestational age ranged from 6 to 10 weeks mean RI in uterine artery was 0.81 (SD 0.06), in the umbilical artery 1 (SD 0), and 0.48 (0.08) in the trophoblastic vessels. Mean RI from uterine arteries in six pregnancies with blighted ovum and six with missed abortion were 0.77 (SD 0.11) and 0.69 (SD 0.13) respectively. In 2 out of 6 cases of blighted ovum and 4 out of 6 cases of missed abortion flow in trophoblastic vessels could not be detected. These findings suggest ineffective early placentation in pathologic pregnancy. Twenty-two patients with suspected ectopic pregnancy (raised serum beta HCG with empty uterus, amenorrhoea with abdominal pain and/or palpable abdominal mass) were examined. In 13 cases tubal pregnancy was confirmed by laparoscopy and/or laparotomy. In the remaining nine cases the diagnosis was excluded by means of laparoscopy or subsequent negative beta HCG. Doppler diagnosis of ectopic pregnancy was made when colour flow in adnexa with RI less than 0.56 was revealed.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Transvaginal colour Doppler ultrasound in normal and abnormal early pregnancy. 220 Aug 63

The first reported case of simultaneous tubal and intrauterine pregnancy in a woman with an IUD is situ is presented. The incidence of combined pregnancies is estimated as 1 to 2/10.000 gestations. The risk of IUD users to have combined tubal and intrauterine pregnancy is calculated is 1/6,000,000 women years of use. A 32-year old patient, gravida 3, para 2 was admitted because of threatened miscarriage in the first trimester. she had been wearing an IUD for 2 1/2 years. Her symptoms were vaginal bleeding and abdominal pain. Pelvic examination showed an enlarged uterus consistent with a pregnancy of 12 weeks' gestation. A vacuum extraction was performed revealing a Copper-T IUD and intrauterine gestation. In the following days she experienced recurrent abdominal cramps and her physical condition did not improve. The red cell sedimentation test remained slightly elevated. 19 days after the evacuation she still had vaginal bleeding and the pregnancy test was still positive. Pelvic examination now disclosed a right, tender adnexal mass the size of a fist. By laparotomy a ruptured right-sided tubal pregnancy was found surrounded by an organized hematoma containing the right ovary. A right salpingo-oophorectomy was performed after microscopic proof of the existence of tubal pregnancy. The patient with combined pregnancy usually presents symptoms that do not facilitate the diagnosis of this specific disease. The diagnosis may be secured by careful pelvic examination, serial ultra-sound scanning, or eventually laparoscopy.
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PMID:Heterotopic pregnancy. The first case with an IUD in situ. 231 94

The presentation, diagnosis, and treatment of ectopic pregnancy are reviewed. The current trend in treatment of tubal ectopic pregnancy is toward preservation of reproductive function whenever possible. The incidence of ectopic pregnancy has not increased as much over the past several years as some reports indicate; the discrepancy is due to bias introduced by excluding numbers of abortions from the denominators. Pelvic inflammatory disease (PID) is the principal etiologic factor in ectopic pregnancy, and Neisseria gonorrhoeae is the causative agent in most primary tubal infection. Patients with previous abdominal surgery, a history of PID, or who use IUDs have more ectopic pregnancies. The clinical presentation of ectopic pregnancy is variable, and women may be asymptomatic. Any sexually active woman with abnormal bleeding, abdominal pain, or an adnexal mass should be examined immediately to rule out ectopic pregnancy. Culdocentesis may be used to determine whether intraperitoneal hemorrhage is present. The beta human chorionic gonadotropin (hCG) radioimmunoassay is unsurpassed as an endocrine test for diagnosis of ectopic pregnancy, but is time consuming. Diagnostic laparoscopy should not be postponed if a ruptured ectopic gestation is suspected. Ultrasound identification of an intrauterine gestational sac and a serum concentration of beta hCG that exceeds 6500 IU/1 rules out ectopic pregnancy. A sonographically normal uterus and a serum concentration of beta hCG that does not exceed 6500 IU/1 is highly indicative of ectopic pregnancy. Diagnostic laparoscopy to confirm the presence of tubal pregnancy has become routine since technical improvements restored interest in the laparoscope in the early 1960s. Early diagnosis is crucial for preservation of fertility. When a tubal pregnancy is diagnosed, the physician must choose a radical or conservative approach based on the patient's immediate medical condition and desire for future fertility as well as the surgeon's experience. Salpingectomy is the procedure of choice if a fallopian tube is irreparably damaged or if there is a hemoperitoneum associated with shock or profuse bleeding. Rigorous cornual resection is not recommended because it does not exclude a subsequent interstitial pregnancy and may also weaken the myometrium. Colpotomy is rarely indicated, and the removal of a normally functioning ipsilateral ovary is unwarranted. If a conservative approach is feasible, salpingostomy and closure by secondary intention is preferred over salpingotomy and primary closure, which may be complicated by bleeding and edema. Fimbrial evacuation is the easiest procedure but has the highest number of undesirable effects. Midsegment anastomosis, tubouterine implantation, and the Gepfert procedure are either controversial or are associated with poor prognoses. Of all conservative procedures, only salpingostomy offers better results in term pregnancy rates than the radical operations. Salpingectomy is the most efficient treatment for tubal gestation if the patient does not desire future fertility.
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PMID:Ectopic pregnancy. 241 Jan 72

A consecutive series of 49 women (50 procedures), whose conditions were haemodynamically stable, presenting with acute lower abdominal pain, pelvic tenderness, and either a urine concentration of greater than 50 U/l beta human chorionic gonadotrophin or a pelvic mass shown by ultrasonography were treated with operative laparoscopy under video monitoring (videopelviscopy) as an alternative to laparotomy. Ectopic pregnancy, ovarian and non-ovarian cysts, pelvic adhesions, endometriosis, and fibroids were found, for which salpingotomy, salpingectomy and salpingo-oophorectomy, cystectomy, adhesiolysis, thermocoagulation, and myomectomy were carried out by laparoscopy. In one patient pelviscopy was repeated because of persistent tubal pregnancy after the fimbria was expressed. Laparotomies were carried out on three patients because treatment was not possible by laparoscopy and on a further patient two days after adhesiolysis had been attempted. These were the only serious complications. For the 46 cases (45 patients) in which operative laparoscopy was successful the mean stay in hospital was 1.9 days after operation, and this group of patients returned to normal activities and to work after an average of 2.3 and 2.6 weeks respectively. Most gynaecological emergencies that are managed by laparotomy can be treated by laparoscopy and benefit both patients and the health service.
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PMID:Managing gynaecological emergencies with laparoscopy. 252 9

A 35-year-old woman presented to the emergency department with abdominal pain 36 hours after a therapeutic abortion. A positive pregnancy test was thought to be related to the recently terminated intrauterine gestation. The patient was admitted for observation. When monitoring revealed intraabdominal hemorrhage, exploratory surgery was performed and a ruptured tubal pregnancy discovered. The patient recovered uneventfully. The incidence, predisposing factors, and diagnosis of simultaneous intrauterine and extrauterine pregnancy are discussed.
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PMID:Heterotopic pregnancy. 270 88

A 35-year old multigravida was admitted to hospital, 3 weeks a fter bilateral tubal cornual resection, with vaginal bleeding and abdominal pain. An erroneous diagnosis of incomplete spontaneous abortion was made. A week later, she was readmitted for continued pain and vaginal bleeding, and was correctly diagnosed as having a tubal pregnancy, conceived prior to sterilization. Left salpingectomy was performed. Women should be advised to use barrier methods of contraception after their last menstrual period before sterilization.
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PMID:Extrauterine pregnancy four weeks after successful tubal sterilization. 321 13

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

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

We report a case of advanced, unruptured tubal pregnancy proceeding beyond term. A 25-year-old woman was admitted at 42 weeks' gestation because of lower abdominal pain and inability to feel fetal movements. An ultrasound examination suggested fetal death. At laparotomy three weeks after admission, a right-sided, unruptured tubal mass containing a macerated fetus was found.
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PMID:An unruptured tubal pregnancy at term. 375 63

Ectopic pregnancy is a serious complication of pregnancy accounting for 6-13% of all maternal deaths in the U.S. Early diagnosis and treatment is absolutely necessary to ensure a successful outcome. In the period from January 1, 1965-December 31, 1979, 556 consecutive cases of ectopic pregnancy were treated at The Brookdale Hospital Medical Center in Brooklyn, accounting for less than 1% of all pregnancies handled in that period. 3 of these cases had an ovarian pregnancy, 8 had an abdominal, and 545 a tubal pregnancy. Relevant personal characteristics and aspects of obstetric history of these cases were studied. 85% of them had used no contraception prior to the ectopic pregnancy. Maternal age was not a factor in the occurrence of the ectopic pregnancy. The following factors in the clinical history were found to put the patient in a high-risk category: 1) primary or secondary infertility; 2) previous abortion or ectopic pregnancy; 3) previous tubal operation, either reconstructive or sterilizing; 4) recent uterine evacuation; and 5) the use of an IUD or its recent removal due to abdominal pain and/or bleeding. Major symptoms were found to be abdominal pain, common symptoms or early pregnancy, abdominal tenderness, adnexal mass, and tenderness on motion of the cervix. Culdocentesis and laparoscopy are effective diagnostic aids. Procrastination by observation should not be followed.
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PMID:A fifteen year experience with ectopic pregnancy. 645 44


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