Spontaneous bilateral tubal ectopic pregnancy: a gynecological challenge.

IF 1.8 Q3 OBSTETRICS & GYNECOLOGY Jornal Brasileiro de Reproducao Assistida Pub Date : 2024-06-01 DOI:10.5935/1518-0557.20230058
Sana Ghades, Abderahmen Daadoucha, Hamed Jemel, Nour Rouis, Mohamed Ridha Fatnassi
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Abstract

Bilateral ectopic pregnancy is very rare. Although the frequency of ectopic bilateral pregnancy has increased with the advent of medically assisted procreation, spontaneous bilateral tubal pregnancies remain rare. Early detection of this type of ectopic pregnancy is important to prevent maternal mortality and morbidity. Conservative surgery must also be considered, as preservation of both tubes is presumed to offer better fertility prospects. We report the case of a 35-year-old patient at five weeks of amenorrhea with bilateral ectopic pregnancy diagnosed based on ultrasound scans and confirmed during laparotomy. A 35-year-old woman with a history of three vaginal deliveries, non-smoker, on contraceptives (microprogestins), presented with pelvic pain and amenorrhea of five weeks. A beta HCG test came back positive. Pelvic ultrasound revealed a moderate hemoperitoneum and an empty uterus with hematometra. It also showed heterogeneous left and right adnexal masses measuring 3 cm and 4 cm, respectively. An emergency laparotomy was performed. Per-operatively, two bilateral tubal pregnancies of 3 cm and 4 cm were founded. The patient received conservative treatment with bilateral salpingotomy. Postoperative management was uneventful. The diagnosis of spontaneous bilateral tubal ectopic pregnancy is rare and often established at the time of surgery, hence the importance of a rigorous and vigilant examination of the two tubes during ultrasound examination and surgery, so as not to miss it and to better prevent maternal mortality. Conservative surgery must be carefully chosen.

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自发性双侧输卵管异位妊娠:妇科难题。
双侧异位妊娠非常罕见。虽然随着医学辅助生育的出现,双侧异位妊娠的发生率有所上升,但自发性双侧输卵管妊娠仍然很少见。早期发现这种类型的异位妊娠对于预防孕产妇死亡和发病非常重要。同时还必须考虑保守性手术,因为保留双侧输卵管被认为能提供更好的生育前景。我们报告了一例 35 岁患者的病例,她停经 5 周,根据超声扫描诊断为双侧异位妊娠,并在开腹手术中得到证实。一名 35 岁的妇女曾有三次阴道分娩史,不吸烟,服用避孕药(微孕酮),因盆腔疼痛和闭经五周而就诊。beta HCG 检测结果呈阳性。盆腔超声波检查显示有中度血性腹膜和空子宫,并伴有血子宫。超声波还显示左侧和右侧附件有不同程度的肿块,大小分别为 3 厘米和 4 厘米。医生紧急进行了开腹手术。术中发现了两个分别为 3 厘米和 4 厘米的双侧输卵管妊娠。患者接受了双侧输卵管切开术的保守治疗。术后治疗顺利。自发性双侧输卵管异位妊娠的诊断非常罕见,而且往往在手术时就已确诊,因此在超声检查和手术时必须对双侧输卵管进行严格、警惕的检查,以免漏诊,更好地预防孕产妇死亡。必须慎重选择保守性手术。
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来源期刊
CiteScore
3.30
自引率
6.70%
发文量
56
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