Tubal pregnancy

Egarter C, Husslein P. Treatment of tubal pregnancy by prostaglandins. Lancet 1988 l(8594) 1104-5. 

Pregnancy complications, including ectopic (tubal) pregnancy and preterm (early) delivery. 

Nakayama J, Aoki D, Suga T, Akama TO, Ishizone S, Yamaguchi H, Imakawa K, Nadano D, Fazleabas AT, Katsuyama T, Nozawa S, Fukuda MN. Implantation-dependent expression of trophinin by maternal fallopian tube epithe-ha during Tubal pregnancies possible role of human chorionic gonadotrophin on Ectopic pregnancy. Am J Pathol 2003 163 2211-2219. 

The American Fertility Society (1988) The American Fertility Society classifications of adnexal adhesions, distal tubal occlusion, tubal occlusion secondary to tubal ligation, tubal pregnancies, mullerian anomalies and intrauterine adhesions. Fertil Steril 49 944-955... 

Brit. med. J. (1976) Tubal pregnancy and surgery (Editorial). March, 607. 

Although suppression of FSH and LH is the primary mechanism by which combined oral contraceptives prevent ovulation, there are other mechanisms by which these hormones work to prevent pregnancy. Other mechanisms include reduced penetration of the egg by sperm, reduced implantation of fertilized eggs, thickening of cervical mucus to prevent sperm penetration into the upper genital tract, and slowed tubal motility, which may delay transport of sperm.1 Thus, in... 

Human menopausal gonadotropin, uFSH or rFSH should be administered only by a physician experienced in treating infertility. Before treatment of women, a thorough gynecologic evaluation must be performed to rule out uterine, tubal, or ovarian diseases as well as pregnancy. In cases of irregular bleeding, uterine cancer should be ruled out. 

It has been suggested that members of female religious orders, women who have had tubal ligation or lesbians could provide a no-risk pregnancy pool of volunteers. Although possible, this is not generally a widely applicable solution, because geographic, environmental and volunteer numbers now become added variables. 

Infertility is not a disease state of the individual but, rather, often is considered to be a disease state of the couple. Defined as the inability to conceive pregnancy after 12 months of unprotected intercourse, infertility affects 10 to 13% of couples. Identification of the cause of infertility requires thorough medical histories as well as several diagnostic tests (Table 46.1 1) (88,89). The causes of infertility include ovulatory disorders as well as situations in which tubal factors, uterine factors, cervical factors, and/or immunologic and thrombophilic factors play a substantial role (Table 46.12) (90). 

The most important gynaecological differential diagnosis is ectopic pregnancy. In ruptured tubal gestation a haematoma is seen in the adnexal region together with free intraperitoneal fluid. In the uterus a small pseudogestational sac can be depicted. 

Extra-uterine pregnancy appears to be increasingly frequent (145), and the cause of this increase has yet to be determined. It was to be expected that suspicion would fall upon new forms of contraception, especially where the mode of action is such that an interference with tubal transport can occur. Various studies point to the intra-uterine de-... 

---