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 31,184 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This article examines causal factors of ectopic pregnancy, discusses management with emphasis on tubal conservation, and updates information on diagnosis, fertility maximization, and minimization of risks of recurrent ectopic gestations. The common factor in ectopic gestations appears to be a delay in the transport of the fertilized ovum to the uterus, allowing the embryo to develop invasive trophoblast. Factors that appear to have increased the incidence of ectopic pregnancy over the past include increased sexual exposure, more effective theraphy for pelvic inflammatory disease, IUDs, tubal surgery, and surgical sterilization reversals. 77% of extrauterine gestations occur in the middle and distal thirds of the fallopian tube, with clinical manifestations largely determined by the site of implantation. Abdominal pain, amenorrhea/vaginal bleeding, and a pelvic mass are the classic signs of an ectopic pregnancy. Newer diagnostic procedures including serum human chorionic gonadotropin-beta subunit assay pregnancy testing supported by ultrasonography and laparoscopy have allowed the vast majority of tubal pregnancies to be diagnoses before rupture, permitting surgery to be undertaken more for the purpose of preserving fertility than for saving the mother's life. Factors in selecting candidates for conservative surgery include medical stability of the patient, parity, desire for future pregnancy, age under 35, mid or distal tubal gestation, prior ectopic gestation or tubal surgery. Considerations influencing the surgical approach for appropriate candidates include location of the pregnancy, condition of the involved and contralateral tube and ovary, pelvic anomalies, previous surgery, and need for ancillary procedures. If the ectopic gestation is located in the mid to distal segment of the fallopian tube, a segmental resection or salpingostomy using microsurgery should give a good anatomic and functional result. A review of the literature indicates that, contrary to prevailing opinion, recurrent etopic gestations are not more common in patients undergoing tubal conservation than in those undergoing more radical procedures. Recent data have shown term pregnancy rates of 40-55% and recurrent ectopic pregnancy rates of 5% in patients with conservative procedures, the improved rate being attributed to availability of microsurgical techniques, finer suture and minimal surgical trauma, which lead to less adhesions and scarring. tudies have indicated that use of Dextran minimizes pelvic adhesion formation, decreasing anatomic distortion leading to subsquent infertility or ectopic pregnancy.
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PMID:Tubal conservation with ectopic gestations. A reappraisal. 623 72

In a review of the world's literature on combined intrauterine and extrauterine pregnancies, 589 cases, including five cases currently reported from the Sloane Hospital for Women, were documented. Analysis of the literature revealed abdominal pain to be the most frequent presenting symptom. A combination of signs and symptoms, including abdominal pain, adnexal mass, peritoneal irritation, and an enlarged uterus, was the most significant finding in support of a presumptive diagnosis of combined gestations. At the Sloane Hospital for Women, the occurrence of both pelvic inflammatory disease and combined pregnancy is approximately three times the reported world incidence. This proportionate increase in both disease states may support a potential etiologic association between pelvic inflammatory disease and simultaneous intrauterine and extrauterine gestations.
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PMID:Combined intrauterine and extrauterine gestations: a review. 634 38

This discussion of acute pelvic inflammatory disease (PID) -- usually a spontaneous infection that occurs among sexually active, menstruating, nonpregnant women -- covers: pathophysiology; microbial etiology (gonorrhea, chlamydia, genital mycoplasmas, and aerobic and anerobic bacteria); epidemiology (number of sexual partners, age, IUDs, previous PID, previous gonorrhea, untreated male sexual contacts, and perihepatitis associated with PID); diagnosis (physical examination, laboratory examination, culdocentesis, examination of the male partner, cultures, and ultrasonography); treatment; and sequelae (recurrent PID, infertility, ectopic pregnancy, and pain). The majority of infections are caused by bacteria and a polymicrobial bacterial infection is common. Neisseria gonorrhea, Chlamydia trachomatis, and a wide variety of aerobic and anerobic bacteria are most frequently isolated from women with PID. Primary PID is usually and acute infection in which organisms ascend into the uterus and fallopian tubes from the cervix. Chronic active infections are unusual except in neglected cases and in Actinomyces infection, but sterile chronic inflammatory adhesions are common residuals of acute infection. Except for women who have an IUD in place or the 15% who have had uterine instrumentation, spontaneous PID is almost totally confined to women who are sexually active. There is a much higher PID rate among younger than older women. Women who use an IUD for contraception are at least 2-4 times more likely to develop PID than nonusers. Women who have had PID are twice as likely to develop the infection as those who have never had it. A history of a prior uncomplicated gonococcal infection is more common among women with PID than among women without disease. Untreated males with urethral N. gonorrhea and possibly with C. trachomatis infection are an important source of infection both for the initial and for recurrent episodes of PID. Abdominal pain is the most common symptom although the pain may be mild or even absent in at least 5% of patients with PID verified by laparoscopy. In patients who have overt PID, it is possible to establish the diagnosis with reasonable certainty by a combination of history, physical examination, Gram stain of cervical secretions, culdocentesis, and examination of the male sexual partner. Adequate treatment of salpingitis includes an assessment of the severity of the infection, administration of appropriate antibiotics, employment of other health measures, close patient follow-up, and treatment of the male sexual patner. 25% of women with 1 episode of salpingitis develop a subsequent episode.
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PMID:Acute pelvic inflammatory disease. 636 7

Perihepatitis, or Fitz-Hugh--Curtis syndrome (FHC), is a complication of pelvic inflammatory disease (PID). Although though in the past Neisseria gonorrhoeae was thought to be the only etiological agent, recent data indicate that chlamydia trachomatis can produce the syndrome. Because cervical cultures frequently fail to demonstrate the presence of C. trachomatis, the serologic microimmunofluorescence antibody test is essential to diagnosis; the antibody titer in FHC syndrome is markedly higher than in PID without FHC syndrome. The classic presenting symptom of perihepatitis is severe right upper quadrant abdominal pain. If unnecessary diagnostic and surgical procedures are to be avoided, the FHC syndrome in the sexually active young woman must be included in the differential diagnosis of abdominal pain irrespective of its location. To illustrate the diagnosis and management of the FHC syndrome caused by C. trachomatis, a case of a 16-year-old adolescent female is presented.
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PMID:Perihepatitis (Fitz-Hugh--Curtis syndrome). A review and case presentation. 643 14

75 patients with ectopic pregnancy were treated at Jordan University Hospital between January 1976-December 1982. The ratio of ectopic pregnancies to deliveries was 1:162. The most common symptoms were: abdominal pain--96%; amenorrhea--69.3%; and vaginal bleeding--60%. No patients with pelvic inflammatory disease were found. An IUD was present in 14.6% of the patients and 10.6% of the cases had previous pelvic surgery. Culdocentesis gave false negative results in 16.7% of the patients. Treatment of choice was salpingectomy. There were no maternal deaths in this series.
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PMID:Ectopic pregnancy: a seven-year survey. 667 5

We studied 23 patients with pelvic inflammatory disease associated with symptoms of pleuritic up'per abdominal pain, characteristic of Fitz-Hugh-Curtis syndrome (FHC). A fourfold or greater change in antibody titer to Chlamydia trachomatis was demonstrated by microimmunofluorescence in 14; an IgG antibody titer greater than or equal to 1:1,024 was seen in 13; and IgM antibody was demonstrated in 11. Twenty (87%) of the 23 FHC patients, including all of the 12 with paired sera obtained at least 6 weeks apart, had serologic evidence of acute C. trachomatis infection. Neisseria gonorrhoeae was isolated from seven (30%) of the 23 FHC cases, and C. trachomatis was isolated from three of 10. Two groups of matched controls were studied; one group with PID but without FHC, and the other without PID. A larger proportion of patients with FHC had serologic evidence of acute C. trachomatis infection than either of the two control groups (p less than 0.05 for each comparison). Among those with antibody to C. trachomatis, the geometric mean antibody titer for the FHC group (1:724) was significantly higher than that for the PID group (1:138) or for the non-PID group (1:103). Thus, FHC is not solely attributable to infection with N. gonorrhoeae; most cases are associated with acute C. trachomatis infection.
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PMID:Chlamydia trachomatis infection in Fitz-Hugh-Curtis syndrome. 678 46

2 data sets from the National Center for Health Statistics were examined to study national trends in the occurrence of ectopic pregnancy (EP). 2 estimates of EP occurrence were calculated from the National Hospital Discharge Survey: 1) the number of EPs per 10,000 women aged 15-44 and 2) the number of EPs per 1000 reported pregnancies, which include EPs, legal abortions, and live births. From 1970-78, approximately 262,000 women aged 15-44 were discharged from US hospitals with a diagnosis of EP. The estimated number of EPs increased steadily from 17,800 in 1970 to 42,400 in 1978, while the EP rate/1000 reported pregnancies increased from 4.5 to 9.4. The EP rate/1000 reported pregnancies increased steadily with age, from 4.5 for women 15-25, 9.7 for women 25-34, to 15.2 for women 35-44. From 1970-78, the overall EP rate was 1.6 times higher for nonwhite than for white women. The EP rate for white women rose from 4.0/1000 reported pregnancies in 1970 to 8.4 in 1978, while for nonwhite women it rose from 7.1 to 12.5. The EP rate increased with age for both races. More than 1% of reported pregnancies in nonwhite women were ectopic; for nonwhite women aged 35-44 the rate was 2.6%. According to national vital statistics on mortality by cause, 437 women aged 15-44 died from EP between 1970 and 1978. The death-to-case rate declined more than 70% from 35 deaths/1000 EPs in 1970 to .9 in 1978. The death-to-case rate declined for both white and nonwhite women but remained consistenly higher for nonwhites. Overall the death-to-case rate for nonwhite women was 3.4 times that for white women. A likely cause of the marked increase in EP incidence between 1970-78 is pelvic inflammatory disease. Clinicians should consider the possibility of EP especially when treating nonwhite women over 35 who complain of menstrual irregularity and abdominal pain.
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PMID:Ectopic pregnancy in the United States 1970 through 1978. 682 60

The accurate diagnosis of acute lower abdominal pain continues to be a problem. In Israel, a diagnostic sign often sought as indicating pelvic peritonitis is a rectal temperature of greater than 1.0 C higher than the simultaneous oral temperature. We established that in each of the 20 emergency rooms surveyed both oral and rectal temperatures are measured as part of the admission procedure for patients with acute lower abdominal pain. The charts of three groups of 100 patients with acute lower abdominal pain were studied retrospectively. A rectal temperature of greater than 1.0 C higher than the oral was found in about 10% of each group. Both oral and rectal temperatures were raised in 56, 69 and 37% of each group, respectively. The rectal temperature alone was elevated in 8.5% of patients with appendicitis or pelvic inflammatory disease (PID), as well as in 6% of patients with undiagnosed abdominal pain. Oral temperatures alone were elevated in 4.5% of patients with acute appendicitis or PID and also in 13% of patients with undiagnosed abdominal pain. These differences were not significant. We conclude that the common Israeli practice of measuring both rectal and oral temperatures in patients with acute lower abdominal pain gives no more information than the measurement of either one.
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PMID:Rectal temperature in the diagnosis of acute lower abdominal pain. 686 54

To identify the long-term sequelae and morbidity associated with acute pelvic inflammatory disease (PID) patients with acute PID and matched controls were interviewed at five-monthly intervals for about 21 months after entry into the study. In some instances morbidity among the patients was increased, particularly at five months after admission to hospital. Significantly more patients than controls had visited hospital as outpatients, been admitted to hospital and undergone abdominal operations, and had to alter their normal daily routine and take time off work. The cumulative rates for all of these, except for time off work, were significantly higher in the patients than in the controls. Differences between the two groups both at early and later interviews and cumulatively were evident in the incidence of abdominal pain (other than menstrual pain), change in menstruation (longer and more painful), and pain during sexual intercourse, which persisted in one-fifth of patients after the initial acute episode.
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PMID:Morbidity associated with pelvic inflammatory disease. 708 78

A multicentered, multinational prospective study of the short-term complications associated with mini-incision for postpartum sterilization performed within 3 days of delivery was undertaken to determine the safety of this approach. Subjects were fully informed, multiparous volunteers with at least 1 living child who had uncomplicated deliveries and were medically fit for operation. Each of the participating centers, Bangkok, Chandigarh, Havana, Manila, Sydney, Santiago, and Singapore, provided premedication and anesthesia according to routine practice. Procedures were carried out via sub- or peri-umbilical incisions of less than 5 cm. Length of incision and duration of operation from incision to skin closure were longer in subjects receiving general anesthesia. Follow-up observations on the 1026 women were made at 8 hours, 1 week, and 6 weeks postoperation. Major complications occurred in 3 subjects; 40 of the 43 subjects with minor complications had wound complications, mostly minor infections. Other minor complications were signs of pelvic inflammatory disease in 2 patients. The majority of subjects with minor complaints, mostly abdominal pain or headache, were in Havana and Bangkok. It is concluded that sterilization in the immediate postpartum period through a mini-incision adjacent to the umbilicus is a safe procedure which can be simply and rapidly performed under regional or local anesthesia. The complication rate for the procedure was low, 4.5% overall, and no cases of thromboembolism were reported.
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PMID:Mini-incision for post-partum sterilization of women: a multicentred, multinational prospective study. 716 Jan 81


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