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

This discussion of ectopic pregnancy covers mortality, definition, etiology, diagnosis and management, and contraception. In the 1979-81 "Report on Confidential Enquiries into Maternal Deaths in England and Wales," ectopic pregnancy accounted for 11.4% of all maternal deaths. Avoidable factors were found in 64% of deaths from ectopic pregnancy, the most common being delay in diagnosis and operative intervention. Ectopic pregnancy is the implantation of the conceptus outside the uterus or in an abnormal location within the uterus. Tubal gestation invariably has a multifactorial etiology and occurs owing to delay in the transport of the fertilized ovum. Table 1 lists causes. Salpingitis is the main cause of tubal pregnancy and now is considered to be due primarily to chlamydia. The consequences of tubal surgery, for whatever reason, and hormonal treatment also are major etiological factors. Every woman of reproductive age, especially if she has 1 or more etiological factors in her past history, who presents with a history of a missed period and irregular vaginal bleeding or abdominal pain, must be considered to have an ectopic pregnancy until proved otherwise. Diagnosis still is essentially a clinical one. In difficult cases use should be made of radioimmunoassay of beta hCG, ultrasonic scanning, and laparoscopy. In 25% of cases, a correct diagnosis was made only at laparotomy. Culdocentesis and endometrial biopsy are of limited use. In cases of ruptured ectopic pregnancy with circulatory collapse, immediate operative intervention is essential. In regard to contraception, the combined oral contraceptive (OC), in suppressing ovulation and thickening the cervical mucus, has a protective effect. Method failure does not increase the incidence of extrauterline pregnancy above normal. The progestagen-only pill is associated with a small increase in the risk of an initial and recurrent ectopic pregnancy. It does not suppress ovulation and may affect tubal motility, but it can be considered if the combined OC is contraindicated, as it is more advisable than an IUD if ectopic pregnancy is feared. Barrier methods will not affect the incidence of ectopic pregnancy and may protect against pelvic infection. It is still being debated whether the absolute incidence of ectopic pregnancy in IUD users is increased. A woman has a 0.3-5% risk of having a 1st ectopic pregnancy and a 15% chance of having a recurrence when given postcoital contraception. As with barrier methods, there is no effect on the incidence of extrauterine pregnancy with periodic abstinence, but in the case of periodic abstinence there is no protective effect against pelvic infection. Female sterilization does not protect against ectopic pregnancy. Of all failed sterilizations, 12% result in an ectopic pregnancy.
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PMID:Ectopic pregnancy. 1226 10

4 cases of extrauterine pregnancy with IUDs were studied both clinically and pathologically at the Faculty of Medicine of Ain Shams University in Cairo, Egypt. In 3 cases the gestation sac was tubal, with 2 in the ampullary portion and 1 in the isthmic portion. The 4th case was a left tubo-ovarian mass, showing an embryo within an ovarian gestation sac. Microscopic examination of the tube revealed chorionic villi intermingled with areas of necrosis, hemorrhage, and inflammatory cell infiltration. The diagnosis of the ovarian pregnancy was based on the demonstration of chorionic villi in relation to the ovarian medullary portion, showing a loose connective tissue structure and prominent congested blood vessels. Case 1, a 27-year old, para 2+0, presented with pain, amenorrhea, bleeding, and fever. The clinical diagnosis was septic abortion with IUD in situ. The loop was removed and curettage was scanty. Antibiotics were administered. The fever subsided but the abdominal pain persisted and mass in the right adnexa could be felt. Laparoscopy was performed, confirming the diagnosis of right tubal pregnancy. Laparotomy and right salpingectomy were performed. The 2nd case, para 1+0, had an IUD for 1 year and was admitted as an emergency. The diagnosis was acute abdomen, mostly disturbed ectopic pregnancy. Laparotomy was performed, and ectopic pregnancy in the region of the isthmus of the right tube was diagnosed. Right salpingectomy was performed. Both cases 3 and 4 had IUDs for a period of between 1-2 years and had amenorrhea, bleeding, and tenesmus. They were treated as colitis. The amenorrhea ranged between 2-3 months. Examination revealed a mass on the left side. Laparotomy was performed. In case 3 it was ampullary pregnancy on the left side. In case 4 there was a tubo-ovarian mass with an amniotic sac protruding from this mass. Left salpingo-oophorectomy was performed. All patients had uneventful recoveries. Figures illustrate these tubal and ovarian pregnancies.
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PMID:Ectopic pregnancy in patients using intrauterine contraception. 1227 56

A study of 441 ectopic tubal pregnancies treated at Harare Central Hospital between 1981-84 was carried out. During that time, there were 162,964 deliveries in the unit. The incidence of tubal pregnancy in this study was only 0.27%. Patients ranged in age from 13-46 years with the majority (67%) between ages 20-29. 88% of the patients were parous, the mean parity being 2.6 96% of the patients complained of abdominal pain, 78% of amenorrhea, and 64% of abnormal uterine bleeding. Abdominal tenderness (96%) and cervical excitation (91%) were the most significant signs. Paracentesis was positive in 78% of the cases. It was a little value in the diagnosis of chronic or unruptured tubal pregnancy. There was 1 maternal death.
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PMID:Ectopic tubal pregnancy in Zimbabwe. 1228 23

The authors described two cases of the ruptured unrecognized interstitial pregnancy. 32-year-old woman, was admitted for abdominal colics in 17th week of uncontrolled pregnancy. Obstetric finding on admission was normal, while ultrasonography pointed to 17th week of gestation. During the first night of hospitalization, severe abdominal pain, with collapse, tachycardia and hypotension developed. Laparotomy was performed in general endotracheal anesthesia with resuscitation measures, and revealed hematoperitoneum and ruptured right-sided interstitial pregnancy with a dead fetus among the bowels. Abdominal hysterectomy without adnexa was performed. S. J., a 35-year-old tertigravida, six years before, left-sided adnexectomy was performed for perforated tubal pregnancy. 5 weeks before artificial abortion now, ultrasonography revealed a vital fetus biometrically corresponding to the 11th week of gestation. The condition was recognized as an unsuccessful artificial abortion and intact pregnancy. During preoperative preparation the patient lost consciousness and required immediate resuscitation. The abdominal cavity was opened by Pfannenstiel's relaparotomy, and revealed hematoperitoneum with numerous adhesions between the small intestine, sigma, uterus and urinary bladder, and ruptured left-sided interstitial pregnancy. Adhesiolysis was completed, a lesion in the sigma was sutured, and hysterectomy was performed. Exploration of the abdominal cavity revealed a dead fetus among small intestine loops, and an indurated, sharply delineated neoplasia of the head of the pancreas.
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PMID:Ruptured interstitial pregnancy Two case reports. 1255 31

A 28-year-old woman with severe right lower abdominal pain and vaginal bleeding at 7 weeks' (+/- 2 days') gestation was seen in the emergency room of our institution. The pregnancy was the result of natural conception after ovarian stimulation with gonadotropins. Transvaginal sonography revealed five intrauterine gestational sacs containing five live embryos. A positive fetal heartbeat was detected in the fallopian tube on the right. Laparoscopic findings disclosed the enlarged uterus with the unruptured right ectopic pregnancy in the ampullary region and an extrauterine pregnancy in the left tube as well. A linear salpingotomy was performed on the right tubal pregnancy. We decided to perform salpingectomy on the left tube because it was impossible to preserve the tube, and exploration of it showed the existence of another gestational sac. It is necessary to decry inappropriate and injudicious use of assisted reproductive technologies, especially by individuals with little or no training in monitoring the agents and treatments prescribed. In 2003, still waiting for official legislation from the Italian Parliament on assisted reproductive technology, we have to face dramatic situations, such as this very unique case of heterotopic pregnancy.
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PMID:Simultaneous bilateral tubal pregnancies and intrauterine pregnancy with five fetuses. 1520 Jul 74

A case of heterotopic pregnancy is reported that presented with 7 weeks of amenorrhea, lower abdominal pain and spotting per vaginum. Ultrasound showed an intra-uterine gestational sac as well as right-sided ruptured tubal pregnancy. Emergency laparotomy and right salpingectomy was performed. Subsequent ongoing alive intra-uterine pregnancy was delivered by vaginal route at term.
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PMID:Heterotopic pregnancy-outcome and management. 1532 Oct 43

Omental pregnancy is a very rare form of ectopic pregnancy. Here we presented a case of primary omental pregnancy diagnosed at surgical exploration. A 28 year old woman submitted with severe abdominal pain, without any delay of menstruation. History of the patient revealed no use of contraceptive method. There was no gestational sac in the endometrial cavity and no tubal ring in the adnexa, but free peritoneal fluid in the pouch of Douglas was detected at ultrasonography. Laparotomy was done according to pre-operative diagnosis of ruptured tubal pregnancy. Bilateral tubes and ovaries were intact; omental pregnancy was detected and partial omentectomy was performed. Although 16 cases of omental pregnancy (mostly secondary) were reported in the literature, herein we describe a primary omental pregnancy without adnexial involvement.
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PMID:Primary omental pregnancy: case report. 1564 Feb 59

We report a case of combined intrauterine and tubal pregnancy in a 32 year old para. The patient presented at the Gynaecological emergency unit, with lower abdominal pain, and vaginal bleeding. A pelvic scan confirmed an intrauterine pregnancy. While being managed as a case of threatened abortion, her condition deteriorated and the likelihood of an ectopic pregnancy was entertained. A repeat scan revealed significant peritoneal collection. suggestive of haemoperitoneum, and laparotomy confirmed heterotopic pregnancy. She had a right salpingectomy without complications. The patient had a supervised antenatal care and safe delivery of the intrauterine pregnancy.
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PMID:Heterotopic pregnancy in a natural conception cycle. A case report. 1647 69

We report a case of ruptured tubal pregnancy with massive life-threatening hemoperitoneum. The 38 year-old woman presented with gynaecologic haemorrhage, pelvic pain and hypovolemic shock. Without any ambiguity, the diagnosis was directly made during contrast enhanced Multidetector Computed Tomography (MDCT). Massive hemoperitoneum with fresh blood clots in the hypogastric area, active free peritoneal extravasation of intravascular contrast material and dramatic peripheral enhancement, - "ring of fire" sign - of an adnexal cystic structure were the key signs. These signs must be known by the emergency radiologist because of the more and more use of CT as the first imaging modality in emergency departments particularly for patients with abdominal pain and presenting life-threatening symptoms.
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PMID:MDCT diagnosis of ruptured tubal pregnancy with massive hemoperitoneum. 1785 2

A 32-year-old Thai woman presented with acute severe lower abdominal pain and 8 weeks of amenorrhea. The patient was hypotension, had anemia and signs of lower abdominal peritonitis. Initial diagnosis was tubal pregnancy with rupture. Intraoperatively, there were hemoperitoneum and two fetuses were found in the pelvis. Final diagnosis of ruptured unilateral twin tubal pregnancy was achieved. A right salpingectomy was done. There was no immediate complication.
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PMID:Rupture of unilateral twin tubal pregnancy. 1838 92


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