Complete tubal abortion which didn't require salpingectomy

Czech version

Authors: Jan Zapletal ; Kateřina Maxová ; Michael Jiří Halaška ; Lukáš Rob ; Martin Hruda
Authors‘ workplace: Gynekologicko-porodnická klinika 3. LF UK a FNKV Praha
Published in: Ceska Gynekol 2024; 89(3): 210-214
Category: Case Report
doi: https://doi.org/10.48095/cccg2024210

Overview

Tubal abortion is characterized by the extrusion of the foetus into the abdominal (peritoneal) cavity. It can either be a complete extrusion or incomplete with residual tissue remaining in the fallopian tube. It is a type of ectopic pregnancy that is difficult to determine the exact incidence of tubal pregnancies. Identifying cases of tubal abortions is crucial for individualized care since it can lead to a more conservative treatment approach. The diagnosis should be based on ultrasound imaging, b-hCG levels and visual conformation during exploratory surgery, either open or laparoscopic. The article describes the case of a 30-year old patient who presented with lower abdominal pain and was admitted for a suspected ectopic pregnancy. Ultrasound imaging showed a mass resembling a tubal pregnancy next to the uterus with b-hCG levels of 111.8 U/L. During laparoscopic surgery, a tubal abortion was detected in the pouch of Douglas (Rectouterine pouch). This finding led us to preserve both fallopian tubes. Histopathology confirmed our clinical findings. A conservative approach can be sufficient in case of tubal abortions, which can lead to preserved fertility and tubal functions.

Keywords:

ectopic pregnancy – abortion – laparoscopy – tubal abortion – hCG

Sources

1. Sehnal B, Hanáček J, Matěcha J et al. Fertilitu šetřící terapie u ektopické gravidity. Ceska Gynekol 2023; 88 (1): 20–26. doi: 10.48095/cccg 202320.

2. Hajenius PJ, Mol F, Mol BW et al. Interventions for tubal ectopic pregnancy. Cochrane Database Syst Rev 2007; 2007 (1): CD000324. doi: 10.1002/14651858.CD000324.pub2.

3. Hoover KW, Tao G, Kent CK. Trends in the diag- nosis and treatment of ectopic pregnancy in the United States. Obstet Gynecol 2010; 115 (3): 495–502. doi: 10.1097/AOG.0b013e3181d0c 328.

4. Van Den Eeden SK, Shan J, Bruce C et al. Ectopic pregnancy rate and treatment utilization in a large managed care organization. Obstet Gynecol 2005; 105 (5 Pt 1): 1052–1057. doi: 10.1097/01.AOG.0000158860.26939.2d.

5. Kirk E, Bourne T. Ectopic pregnancy. Obstet Gynaecol Reprod Med 2011; 21 (7): 207–211. doi: 10.1016/J.OGRM.2011.04.003.

6. Zhang D, Shi W, Li C et al. Risk factors for recurrent ectopic pregnancy: a case-control study. BJOG  2016; 123 Suppl 3: 82–89. doi: 10.1111/1471-0528.14011.

7. den Heijer CD, Hoebe CJ, Driessen JH et al. Chlamydia trachomatis and the risk of pelvic inflammatory disease, ectopic pregnancy, and female infertility: a retrospective cohort study among primary care patients. Clin Infect Dis 2019; 69 (9): 1517–1525. doi: 10.1093/cid/ciz 429.

8. Racková J, Záhumenský J, Zikán M et al. Chlamydia trachomatis and Neisseria gonorrhoeae PCR detection in women treated for ectopic pregnancy. J Obstet Gynaecol 2022; 42 (5): 1370–1373. doi: 10.1080/01443615.2021.1979947.

9. Cunningham GF, Bradshaw KD, Halvorson LM et al. Sarcina etrauterina. Williams Gynecology, 2nd ed. USA, NY: McGraw Hill 2008: 198–215.

10. Bouyer J, Coste J, Fernandez H et al. Sites of ectopic pregnancy: a 10 year population-based study of 1,800 cases. Hum Reprod 2002; 17 (12): 3224–3230. doi: 10.1093/HUMREP/17.12.3224.

11. Zdeňková A, Fanta M, Calda P. Metotrexát v léčbě ektopické gravidity. Actual Gyn 2015; 7: 27–32.

12. Racková J, Driák D, Neumannová H et al. Použití metotrexátu u ektopické gravidity a tehotenství neznámé lokalizace. Ceska Gynekol 2016; 81 (2): 140–146.

13. Barnhart KT, Guo W, Cary MS et al. Differences in serum human chorionic gonadotropin rise in early pregnancy by race and value at presentation. Obstet Gynecol 2016; 128 (3): 504–511. doi: 10.1097/AOG.0000000000001568.

14. Derbak A. Mimoděložní těhotenství v ultrazvukovém obraze. Kazuistiky. Retrospektivní analýza. Ceska Gynekol 2016; 81 (1): 63–70.

15. Kubešová B, Líbalová P, Simonová V et al. Retrospektivní analýza efektivity, diagnostiky ektopické gravidity transvaginálním ultrazvukovým vyšetřením. Ceska Gynekol 2013; 78 (4): 338–341.

16. Fischerova D, Paškova A, Břeťak M. Těhotenství neznámé lokalizace. In: Calda, P, Břešták M, Fischerova D (eds). Ultrazvuková diagnostika v těhotenství a gynekologii. 2. vyd. Praha: Aprofema 2010; 428–434.

17. Caspi E, Sherman D. Tubal abortion and infundibular ectopic pregnancy. Clin Obstet Gynecol 1987; 30 (1): 155–163. doi: 10.1097/0000 3081-198703000-00022.

18. Chirculescu B, Chirculescu R, Ionescu M et al. Complete tubal abortion: a rare form of ectopic pregnancy. Chirurgia (Bucur) 2017; 112 (1): 68–71. doi: 10.21614/CHIRURGIA.112.1.68.

19. Sabre A, Arul M. Tubal abortion case series: important clinical findings found on diag- nostic laparoscopy may preserve tubal function and future fertility. J Case Rep Images Obstet Gynecol 2022; 8: 100110Z08AS2022. doi: 10.5348/100110z08as2022cr.

20. Alkatout I, Honemeyer U, Strauss A et al. Clinical diagnosis and treatment of ectopic pregnancy. Obstet Gynecol Surv 2013; 68 (8): 571–581. doi: 10.1097/OGX.0B013E31829CDBEB.

21. Driák D, Sehnal B, Jarošová L et al. Perforace dělohy při nitroděložních výkonech a její řešení. Ceska Gynekol 2022; 87 (4): 295–301. doi: 10.48095/cccg2022295.

ORCID autorů

J. Zapletal 0000-0003-2705-2970

K. Maxová 0009-0003-3473-4766

B. Sehnal 0000-0003-2622-2181

M. J. Halaška 0000-0002-3391-1412

L. Rob 0000-0003-3770-651X

M. Hruda 0000-0002-7606-5164

Doručeno/Submitted: 26. 1. 2024

Přijato/Accepted: 29. 2. 2024

MUDr. Jan Zapletal

Gynekologicko-porodnická klinika

3. LF UK a FNKV