CHALLENGE FOR THE GYNECOLOGIST - CASE OF TUBAL ABORTION
Tubal abortion represents a rare entity in the gynecology practice, defining an ectopic pregnancy with the gestational sac situated in the peritoneal cavity, consequence of the extrusion from the fallopian tube through the terminal ostium. It often complicates with severe internal bleeding causing acute surgical abdomen. The diagnosis is frequently difficult and relies on a combination of ultrasound scanning, serial serum beta-human chorionic gonadotrophin (β-hCG) measurements, whilst observing the clinical status of the patient. We present the case of a 27 years-old woman admitted for lower abdominal pain, having a positive pregnancy test. The level of β-hCG was 1185 mU/mL and transvaginal ultrasound revealed a fluid collection in the pouch of Douglas, an empty uterus and an adnexal mass image of 22/14mm. At first, medical management was preferred, a single dose regimen of Metotrexat was administered. 48 hours later, as the symptoms became more evident and the collection in the Douglas pouch increased, diagnostic laparoscopy was performed.
The diagnosis of complete tubal abortion was evident based on sonographic findings, the β-hCG dynamics and the laparoscopic features. Preserving the implicated fallopian tube through a minimally invasive procedure allowed the patient’s rapid recovery and a short hospital stay.
2. A. Petca, A. Veduta, C. Mehedintu, N. Maru, R. Petca and M. Bot. “Ectopic pregnancy în rudimentary horn: early diagnosis and management,” Ginecologia.ro, vol. 20, pp. 20-22, 2018.
3. C. J. Elson, R. Salim, N. Potdar, M. Chetty, J. A. Ross, E. J. Kirk on behalf of the Royal College of Obstetricians and Gynaecologists. “Diagnosis and management of ectopic pregnancy,” BJOG, vol. 12, pp. e15–e55, 2016.
4. E. Caspi and D. Sherman. “Tubal abortion and infundibular ectopic pregnancy,” Clin. Obstet. Gynecol., vol. 30, pp. 155-163,Mar. 1987.
5. V. N. Sivalingam, W. C. Duncan, E. Kirk, L. A. Shephard and A. W. Horne. “Diagnosis and management of ectopic pregnancy,” J. Fam. Plann. Reprod. Health Care, vol. 37,Oct. 2011.
6. R. Wakankar adn K. Kedar. “Ectopic Pregnancy - A rising Trend,” Int. J. Sci. Study, vol. 3, pp. 18-22,Aug. 2015.
7. S. Rawal. “Successful use of single dose of methotrexate for the treatment of unruptured ectopic pregnancy at Tribhuvan University Teaching Hospital, Kathmandu, Nepal,” NJAG, vol. 7, pp. 45-49, Jan. 2012.
8. S. Mohan and M. Thomas. “Ectopic pregnancy: reappraisal of risk factors and management strategies,” Int. J. Reprod. Contracept. Obstet. Gynecol. vol. 4, pp. 709-715,Jun. 2015.
9. M. Agdi and T. Tulandi. “Surgical treatment of ectopic pregnancy,” Best Pract. Res. Clin. Obstet. Gynaecol., vol. 23, pp. 519–527,Aug. 2009.
10. M. Vermesh, P. D. Silva, M. V. Sauer, J. M. Vargyas and R.A. Lobo. “Persistent tubal ectopic gestation: patterns of circulating beta-human chorionic gonadotropin and progesterone, and management options,” Fertil. Steril., vol. 50, pp. 584-588,Oct. 1988.
11. J. Nathorst-Böös and R. R. Hamad. “Risk factors for persistent trophoblastic activity after surgery for ectopic pregnancy,” Acta Obstet. Gynecol. Scand., vol. 83, pp. 471-475,May 2004.
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