oxytocin and Pregnancy--Tubal

The objective of this study was to evaluate the efficacy of the local use of oxytocin as adjuvant treatment in conservative surgery for tubal pregnancy. The patients were 25 women with laparoscopic diagnosis of tubal pregnancy who were candidates for salpingotomy. Before salpingotomy, each patient was randomly allocated to intramesosalpingeal injection of 20 IU oxytocin diluted to 20 ml with saline solution or 20 ml saline solution. The surgeon then proceeded with salpingotomy and removal of the pregnancy according to the usual technique. The main outcome measures were bleeding during salpingotomy, ease of removal of the pregnancy, bleeding at the site of the pregnancy, and need for recourse to salpingectomy. Twelve women were randomized to the oxytocin group and 13 to the control group. Examination of the surgeons' assessments of the difficulties encountered at the different stages of surgery revealed statistically significant differences between the oxytocin group and controls in each variable. In particular, the amount of endosalpingeal bleeding after removal of the pregnancy was less in the oxytocin group. In one control patient, persistent bleeding due to incomplete trophoblast removal forced the surgeon to perform salpingectomy. Our results indicate that intramesosalpingeal injection of oxytocin facilitates the performance of conservative laparoscopic treatment for tubal pregnancy.

Topics: Adult; Fallopian Tubes; Female; Humans; Laparoscopy; Oxytocin; Postoperative Hemorrhage; Pregnancy; Pregnancy, Tubal

We present a case of interstitial pregnancy causing uterine cornual rupture during induction of prostaglandin midtrimester abortion. As the clinical and ultrasonographic diagnosis of advanced ectopic gestation may be difficult, the possibility of ectopic pregnancy should be considered in cases of unsuccessful attempts of induced abortion.. A 30-year old primigravida with a history of drug addiction came to the Rigshospitalet in Copenhagen, Denmark for prenatal care at 15 weeks gestation. Physicians did an amniocentesis because of family history of trisomy 21. Ultrasound examinations in the 17th and 18th weeks of gestation indicated a living fetus with the placenta on the right lateral wall of the uterus, but there was an insufficient amount of amniotic fluid. Maternal alpha fetoprotein serum levels were extremely high (298 kIU/L). Physicians predicted a poor fetal prognosis and advised the woman to undergo an abortion. On the first day, they inserted 4 vaginal pessaries of 1 mg gemeprost and administered 25-30 mg bupivacain through an epidural catheter to control abdominal pain. 8 hours after first insertion, they began intravenous (IV) administration of oxytocin. Her cervix remain closed and uterine tension did not increase. 2 hours after beginning the oxytocin IV, she suffered from an abrupt severe abdominal pain which was transferred to the right shoulder. Heart rate and blood pressure remained normal. 4 hours later, her body temperature rose, so she received 500 m pivampicillin 3 times/day. She experienced no vaginal bleeding and no uterine contractions. Her cervix had still no opened. On the third day, health workers inserted 5 more pessaries. On the fourth day, they administered 75 ml isotonic saline/hour transcervically, but she still did not abort. Her temperature vacillated even though she received antibiotics and the pain continued despite epidural analgesics. On day 5, health workers administered 3.75 mcg prostaglandin F2 alpha/minute transcervically. After 6 hours of no progress, they performed a laparotomy and observed a macerated, malodorous fetus in the peritoneal cavity which continued 1200 ml of blood. The medial part of the left fallopian tube an the left uterine corner had ruptured. They removed the fetus via wedge resection; it had no malformations. Physicians should consider ectopic pregnancy when attempts at induced abortion do not succeed.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Induced; Adult; Alprostadil; Female; Humans; Oxytocin; Pregnancy; Pregnancy, Tubal; Prostaglandins E, Synthetic; Ultrasonography, Prenatal; Uterine Rupture

Topics: Abortion, Missed; Abortion, Septic; Abortion, Spontaneous; Abortion, Threatened; Ambulatory Care; Anti-Bacterial Agents; Curettage; Diagnosis, Differential; Female; Humans; Oxytocin; Pregnancy; Pregnancy, Tubal; Time Factors

Topics: Adult; Female; Fetal Death; Fetoscopy; Humans; Oxytocin; Pregnancy; Pregnancy, Tubal