The case report discusses a rare occurrence of tubal pregnancy in a patient with uterine didelphys, managed using combined hysteroscopy and laparoscopy. A 29-year-old Gravida 2 Para 0 (0010) with a right tubal ectopic pregnancy alongside incidental uterine didelphys detected via physical examination and three-dimensional transvaginal ultrasound. The patient underwent a combined diagnostic and operative laparoscopy, where a right salpingectomy was performed using a harmonic scalpel. Diagnostic laparoscopy showed two uterine horns with each attached fallopian tube and ovary with an interostial length of 4 cm. Diagnostic hysteroscopy confirmed the presence of two separate uterine cavities and cervices without communication. The procedure demonstrated that the technique for laparoscopic salpingectomy in cases of uterine didelphys parallels that for a normal uterus. The use of combined hysteroscopy and laparoscopy proved effective in evaluating both the external uterine structure and internal cavity, facilitating accurate diagnosis and treatment of Müllerian anomalies with ectopic pregnancy.

OBJECTIVES: To analyze the cases of medical damage after misdiagnosis of tubal pregnancy, to explore the causes of medical damage, the causal relationship between medical malpractice and the damage consequences, as well as the causative potency, in order to provide evaluation ideas for forensic identification of such cases. METHODS: Eighteen cases of forensic identification of tubal pregnancy related medical damage were collected and retrospectively analyzed from the aspects of age, maternity history, fertility requirements, risk factors, diagnosis and treatment, medical malpractice, damage consequences, and causative potency. RESULTS: All 18 cases were tubal pregnancy, of which 17 cases had medical malpractice, resulting in 14 cases of affected tubal resection, 2 cases of hemorrhagic shock death, 1 case of intrauterine fetal death and affected tubal resection. The other case had the consequence of affected tubal resection, but there was no malpractice in the treatment. CONCLUSIONS Correct diagnosis is helpful to make appropriate treatment plan, prevent disease progression and reduce serious adverse consequences and the occurrence of medical disputes. Scientific and reasonable analysis of the causal relationship between medical malpractice and damage consequences and the causative potency is of great significance to the successful settlement of medical disputes.
Pregnancy ; Female ; Humans ; Retrospective Studies ; Pregnancy, Tubal/surgery* ; Salpingectomy/methods* ; Fertility ; Malpractice

OBJECTIVE: To investigate the expression of Talin1 in the fallopian tube and chorionic villi in patients with tubal pregnancy and its role in regulating invasion and migration of trophoblasts. METHODS: Immunohistochemistry and Western blotting were used to detect the localization and expression level of Talin1 in the fallopian tube and chorionic villi in patients with tubal pregnancy and in women with normal pregnancy. In the cell experiment, HTR-8/SVneo cells was transfected with Talin1 siRNA and the changes in cell invasion and migration were assessed using scratch assay and Transwell assay. The expressions of MMP-2, MMP-9, N-cadherin and Snail in the transfected cells were detected by qRT-PCR and Western blotting. RESULTS: Positive expression of Talin1 was detected in both normal fallopian tube tissues and tissues from women tubal pregnancy, and its expression was localized mainly in the cytoplasm of cilia cells. The expression level of Talin1 was significantly higher in both the fallopian tube and chorionic villi in women with tubal pregnancy than in normal fallopian tube and chorionic villi samples (P < 0.01). In HTR-8/SVneo cells, transfection with Talin1 siRNA significantly inhibited cell invasion (P < 0.01) and migration (P < 0.05), down-regulated the expression of N-cadherin, MMP-2 and Snail (P < 0.05), and up-regulated the expression of MMP-9 in the cells (P < 0.05). CONCLUSION The expression of Talin1 in the fallopian tube and chorionic villi is significantly increased in women with tubal pregnancy, suggesting the association of Talin1-regulated trophoblast cell invasion with the occurrence of tubal pregnancy.
Cadherins/metabolism* ; Cell Movement ; Chorionic Villi/metabolism* ; Fallopian Tubes/metabolism* ; Female ; Humans ; Matrix Metalloproteinase 2/metabolism* ; Matrix Metalloproteinase 9/metabolism* ; Pregnancy ; Pregnancy, Tubal/metabolism* ; RNA, Small Interfering/metabolism* ; Talin/metabolism* ; Trophoblasts/metabolism*

The objective of this study was to evaluate the feasibility of posterior colpotomy for the surgical treatment of tubal ectopic pregnancy in hemodynamically stable women. We performed a retrospective analysis of medical records obtained over a period of 18 months. Twelve cases were identified, with the following characteristics: mean gestational age, 7.7 weeks; mean serum β-human chorionic gonadotropin level, 7,786 mIU/mL; and greater diameter of the mass, 15–69 mm. Treatment was successful in all cases. Salpingectomy was performed in 10 patients (83.3%) and salpingostomy, in 1 patient. The remaining patient only received peritoneal lavage, as the evidence of ectopic abortion with only a slightly dilated uterine tube was found during surgery. The mean surgical time was 42.5 minutes. In the analyzed cases, posterior colpotomy was found to be a feasible alternative method for the surgical treatment of tubal ectopic pregnancy in hemodynamically stable women.
Chorionic Gonadotropin ; Colpotomy ; Fallopian Tubes ; Female ; Gestational Age ; Humans ; Medical Records ; Methods ; Operative Time ; Peritoneal Lavage ; Pregnancy ; Pregnancy, Ectopic ; Pregnancy, Tubal ; Retrospective Studies ; Salpingectomy ; Salpingostomy ; Surgical Procedures, Operative

Ectopic pregnancy is an extrauterine pregnancy, and 98% of which occur in the fallopian tube. The incidence of twin tubal pregnancy is rare but is increasing due to assisted reproductive technology. Spontaneous unilateral twin tubal pregnancy is extremely rare, and only a small number of case reports have been made. We herein report a rare case of spontaneous unilateral twin tubal pregnancy with both fetuses presenting with heart activities and a literature review. Right salpingectomy was performed in this case. Pathologic and histologic assessment confirmed the 2 distinct pregnancies in the same tube. The twins were dichorionic and diamniotic.
Fallopian Tubes ; Female ; Fetus* ; Heart* ; Humans ; Incidence ; Pregnancy ; Pregnancy, Ectopic ; Pregnancy, Tubal* ; Reproductive Techniques, Assisted ; Salpingectomy ; Twins*

OBJECTIVE: To analyze the preoperative diagnostic clues to ovarian pregnancy (OP). METHODS: This study conducted a retrospective chart review of 23 patients with OP and 46 patients with tubal pregnancy (TP) from October 1, 2003 to September 31, 2016 in Hanyang University Hospital. RESULTS: There were no significant differences in demographic and clinical characteristics between the two groups. The presence of an ectopic gestational sac and hemoperitoneum was significantly higher in the TP group (13.0% vs. 95.7%, P=0.000; 13.0% vs. 54.3%, P=0.001, respectively) in preoperative ultrasonogram. The OP group had more ruptured ectopic gestational sacs than the TP group (73.9% vs. 45.7%, P=0.039) in surgical findings. CONCLUSION: For the patients in whom a gestational sac is not detected in the uterus or the fallopian tubes, it is important to be aware of the possibility of OP and rupture of an ovarian gestational sac to promote early diagnosis and surgical intervention.
Early Diagnosis ; Fallopian Tubes ; Female ; Gestational Sac ; Hemoperitoneum ; Humans ; Laparoscopy ; Pregnancy ; Pregnancy, Ovarian* ; Pregnancy, Tubal* ; Retrospective Studies* ; Rupture ; Ultrasonography ; Uterus

OBJECTIVE: To examine the therapeutic outcomes of methotrexate (MTX) in the treatment of unruptured interstitial pregnancy. METHODS: We reviewed the medical records of patients who were diagnosed with interstitial pregnancy and received MTX as first-line treatment between January 2003 and July 2014 at CHA Gangnam Medical Center. The treatment success rates and subsequent pregnancy outcomes were examined. RESULTS: Ninety-seven patients were diagnosed with interstitial pregnancy between January 2003 and July 2014. Of them, 38 initially received MTX treatment. The diagnosis was made at a median of 6+3 weeks (5+0 to 11+3 weeks). Thirty patients received a systemic MTX injection, while the other 8 received a local MTX injection. Systemic treatment composed of an 8-day alternating MTX regimen, single-dose regimen, or high-dose regimen (100 mg/m2 + 200 mg/m2 intravenously over 12 hours). The local injection consisted of a direct MTX injection into the gestational sac with or without systemic MTX injection. Twenty-one patients (55.3%) were successfully treated with MTX. However, MTX therapy failed in 17 patients (44.7%), who required surgery. Mode of MTX treatment was the only predictive variable of MTX treatment success (P=0.039). Treatment success was seen in 7 of 8 patients (87.5%) in the local MTX group vs. 14 of 30 patients (46.7%) in the systemic MTX group. After treatment, 13 patients attempted a successive pregnancy; of them, 10 patients had a confirmed clinical pregnancy and healthy live birth. CONCLUSION: Combined MTX treatment including a local injection might be an initial approach to the treatment of interstitial pregnancy.
Diagnosis ; Female ; Gestational Sac ; Humans ; Live Birth ; Medical Records ; Methotrexate* ; Pregnancy ; Pregnancy Complications ; Pregnancy Outcome ; Pregnancy, Interstitial*

Uterine serosal pregnancy is an extremely rare form of ectopic pregnancy. This is a report of a 35-year-old primigravida woman who was diagnosed with uterine serosal pregnancy via laparoscopic intervention. A 35-year-old woman (gravida 1, para 0) was referred from a local clinic for a ruptured left tubal pregnancy at amenorrhea 5+0 weeks with elevated serum beta human chorionic gonadotropin (16,618 mIU/mL). A pregnancy on the left posterior wall of the uterine serosa was diagnosed during the operation and successfully treated with laparoscopic surgery as a conservative management strategy to enable fertility preservation. With the advantages of ultrasonography and laparoscopy, an early diagnosis of a primary abdominal pregnancy located on the left posterior wall of the uterine serosa was made, prior to the occurrence of severe intra-abdominal massive hemorrhage, which was then treated laparoscopically as a conservative management strategy enabling the preservation of fertility.
Adult ; Amenorrhea ; Chorionic Gonadotropin ; Early Diagnosis ; Female ; Fertility ; Fertility Preservation ; Hemorrhage ; Humans ; Laparoscopy ; Pregnancy* ; Pregnancy, Abdominal ; Pregnancy, Ectopic ; Pregnancy, Tubal ; Serous Membrane ; Ultrasonography

Ectopic pregnancy is an implantation of the fertilized ovum on a place except the endometrium. Most of the ectopic pregnancies are located at the fallopian tube. Few cases of retroperitoneal hematoma associated with ectopic pregnancy have been reported on previously; in each the retroperitoneal space had been the site of implantation. In contrast, we treated a patient with an ectopic pregnancy that implanted in the tube and then perforated through into the retroperitoneal space. To our knowledge this is very rare case of retroperitoneal hematoma caused by a ruptured tubal pregnancy.
Endometrium ; Fallopian Tubes ; Female ; Hematoma ; Hemorrhage* ; Humans ; Laparoscopy ; Pregnancy ; Pregnancy, Ectopic ; Pregnancy, Tubal* ; Retroperitoneal Space ; Zygote

OBJECTIVE: To investigate individual pretreatment serum human chorionic gonadotropin (hCG) cutoff value for medical treatment success with single-dose and multi-dose regimen of methotrexate in tubal ectopic pregnancy. METHODS: Eighty-five women who received methotrexate for the treatment of tubal ectopic pregnancy during 2003 to 2015 were selected. Fifty-three women received a single-dose regimen and 32 women received a multi-dose regimen. Medical treatment failure was defined as necessity of surgical treatment. The medical treatment success rate was estimated in both regimens and the pretreatment serum hCG titer to predict the success was assessed by receiver operating characteristics curve analysis. RESULTS: Pretreatment clinical and laboratory parameters were similar between group of single-dose regimen and multi-dose regimen. Treatment success rate was 64.2% in the single-dose regimen group and 71.9% in the multi-dose regimen group (P>0.05). Pretreatment serum hCG titer was an independent prognostic factor for treatment success in each regimen. Serum hCG cutoff value to predict the treatment success was 3,026 IU/L in single-dose regimen group and 3,711 IU/L in multi-dose regimen group. CONCLUSION: We recommend use of single-dose regimen when pretreatment serum hCG <3,026 IU/L but multi-dose regimen may be favored when initial serum hCG level between 3,026 and 3,711 IU/L.
Chorionic Gonadotropin* ; Female ; Humans* ; Methotrexate* ; Pregnancy ; Pregnancy, Ectopic* ; Pregnancy, Tubal ; ROC Curve ; Treatment Failure