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  • Title: Ectopic pregnancy following tubal sterilization surgery.
    Author: Brenner PF, Benedetti T, Mishell DR.
    Journal: Obstet Gynecol; 1977 Mar; 49(3):323-4. PubMed ID: 840461.
    Abstract:
    In a consecutive study of 100 women with the surgical diagnosis of ectopic pregnancy confirmed by histologic examination, 7 women were found to have had prior tubal sterilization surgery. In 3 of these cases the sterilization procedure was bilateral tubal fulguration. The diagnosis of ectopic pregnancy must be given careful consideration if patients conceive after a tubal sterilization procedure of any type. From 6 to 10% of all maternal deaths continue to be attributed to ectopic pregnancy, usually the result of hemorrhage. The failure rate of tubal sterilization has been reported to be .25-2% for the Pomeroy procedure and .4-1.7% for bilateral tubal fulguration. The ratio of ectopic to intrauterine pregnancy is higher among pregnancies occurring after sterilizatitn failure than among the general population. The spermatozoa can get past the diminished diameter of a recanalized oviduct but the fertilized ovum cannot pass. During each year about 250 women with ectopic pregnancy are treated at the Los Angeles County-University of Southern California Medical Center. In a review of 100 consecutive cases with a confirmed diagnosis of ectopic pregnancy, 7 were found to have had tubal sterilizaiton surgery 17 months to 8 years previously. In 3 cases, bilateral tubal fulguration had been done and in 4 cases bilateral tubal ligation was performed. Ruptured extrauterine pregnancy had occurred in the distal segment of the tube in 4 and a cornual pregnancy in 1. There was 1 case of aborting tubal gestation and 1 of unruptured tubal pregnancy. In 1 case the tube containing the ectopic pregnancy had not been ligated but the round ligament was by mistake. It is thought the refulguration, as is now done, following transection of the tubes will reduce the incidence of ectopic pregnancies. The diagnosis of ectopic pregnancy should not be excluded because of a patient's history of bilateral tubal ligation or fulguration.
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