UNASSIGNED: Bilateral tubal ligation (BTL) is an effective permanent method of birth control that is surgically performed to block the woman\'s fallopian tube and prevent the egg from meeting the sperm. It is preferred by women or couples who have achieved their reproductive potential and do not desire pregnancy. BTL carries a low risk of method failure with a subsequent pregnancy which is likely to be ectopic. We present a case of two consecutive ruptured tubal ectopic pregnancies following an interval BTL.
UNASSIGNED: A 40-year-old female, with 7 living children, who previously underwent an interval BTL, presented with acute abdominal pain for 2 days and amenorrhea for 6 weeks. She was stable but had generalized abdominal tenderness, guarding and rebound tenderness, and cervical motion tenderness. Her urine HCG was positive, and a trans-abdominal ultrasound scan revealed a tender echo-complex right adnexal mass, free fluid in the Cul-de-sac, and an empty uterine cavity, consistent with a ruptured right ectopic pregnancy. An emergency exploratory laparotomy was done with findings of a ruptured right distal tube containing products of conception, hemoperitoneum, and previous tubal ligation and left salpingectomy. A right total salpingectomy was done, and the excised right tube containing the mass was sent for histological examination, which revealed chorionic villi and hemorrhagic vascular decidual tissue in the fallopian tube, features suggestive of tubal ectopic pregnancy.

OBJECTIVE: To combine all literature describing cases of isolated fallopian tube torsion in adult non pregnant patients in a systematic manner, to optimize knowledge and practice both for diagnosis and management.
METHODS: EMBASE and PubMed databases were searched for the terms \'tubal\' OR \'fallopian tube\' AND \'isolated\' AND \'torsion\' from the inception of these databases to July 5, 2023. All case reports or case series of adult patients (18 years or older) with isolated fallopian tube torsion were included. Exclusion criteria included: all other study types; cases involving children and adolescents (less than 18 years old); pregnant patients of all trimesters; tubo-ovarian torsion; studies not published in English; duplicates and those not available in text. Following the database search, two authors independently screened the studies and search results were subsequently reported in accordance with PRISMA guidelines. Data was extracted independently by two authors and analysed using Excel. All cases were assessed for bias using a modified version of the tool proposed by Murad et al. RESULTS: 92 unique articles enrolling 131 individual cases were included in this systematic review. Isolated fallopian tube torsion most commonly occurs during reproductive ages between 18 and 45 years. It is uncommon in postmenopausal women. The most common presenting symptoms include unilateral lower abdominal or pelvic pain along the affected side with nausea and vomiting. Risk factors can be intrinsic or extrinsic and can include conditions such as hydrosalpinx, sterilization, pelvic inflammatory disease or cysts. Ultrasound is the optimal imaging modality however Computed Tomography and Magnetic Resonance Imaging can also be used. Imaging in general has low sensitivity, however isolated fallopian tube torsion can be identified with appropriate expertise. The gold standard for isolated fallopian tube torsion management is laparoscopy and detorsion however currently, the most common intervention performed is salpingectomy.
CONCLUSIONS: Isolated fallopian tube torsion is a rare but important gynaecological emergency with significant fertility implications. This study summarizes the most common presentations, investigation findings and surgical interventions in patients with isolated fallopian tube torsion. This study also emphasizes the importance of clinicians maintaining a high degree of suspicion and low threshold for early laparoscopic intervention to retain fertility.

Tubal metastasis from endocervical adenocarcinoma is uncommon and is discovered as an incidental finding on routine sampling of fallopian tubes. In this paper, we present the case of an 81-year-old woman who presented with an adnexal mass during investigations of postmenopausal bleeding. Hysterectomy and bilateral salpingo-oophorectomy with excision of the left adnexal mass were performed, which led to the diagnosis of an incidental HPV-associated endocervical adenocarcinoma with secondary, macroscopic tubal involvement. The patient received adjuvant pelvic radiotherapy and remained well after three months of follow-up, with no evidence of recurrence. Only a few cases of endocervical adenocarcinoma with tubal metastasis have been reported in the literature, which are commonly associated with ovarian, uterine corpus, and/or parametrial tissue involvement. To date, there are only two reported cases of isolated tubal metastasis, and in both cases, tubal involvement was discovered microscopically. Data on the impact of secondary tubal involvement on patient outcomes are limited.

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A cesarean ectopic pregnancy is the rarest of all pregnancies and occurs when pregnancy implants on a cesarean scar. Incidence estimated in overall cesarean delivery is 1/1,800-1/2,500. Following a cesarean procedure, this abnormal embryo implantation into the uterine myometrium and fibrous tissues has a high rate of morbidity and mortality. The most common type of ectopic pregnancy is tubal ectopic pregnancy, and both their incidence and their frequency are rising. Early detection and treatment of ectopic pregnancy are crucial since delays in these processes might result in maternal death and morbidity. We are reporting a case of two concurrent pregnancies in a 27-year-old female with two separate implantation sites. The simultaneous occurrence of a tubal and an ectopic scar pregnancy was highly unusual. Early detection and treatment of ectopic pregnancy help prevent complications, death, and morbidity because it is a potentially fatal condition.

The incidence of ectopic pregnancy (EP) is 1.3-2.4%. Suspicion of EP starts after a positive serum pregnancy test and failure to visualize the intrauterine gestational sac (GS) by transvaginal sonography (TVS). About 88% of tubal EPs are diagnosed by absent intrauterine GS and the presence of an adnexal mass during TVS. Medical treatment of EP using methotrexate (MTX) is cost-effective with a similar success rate to surgical treatment. The presence of fetal heart beats, β-human chorionic gonadotropin >5000 mIU/mL, and EP size >4 cm are relative contraindications for using MTX in the treatment of EP.

The incidence of ectopic pregnancy (EP) is about 1.3-2.4%. Approximately 6% of maternal deaths in the first trimester occur following ruptured EP. A 35-year-old lady, G4, P3, pregnant 7 weeks + 2 days, presented with left iliac pain, after positive pregnancy test, and β-human chorionic gonadotropin (β-hCG) 3614 mIU/ml. The transvaginal sonography showed an empty uterus, with a well-defined left adnexal echogenic structure measuring 38×32 mm (left adnexal gestational sac - GS) with foetal pole (bagel sign). The colour Doppler examination showed foetal cardiac activity with circumferential Doppler flow around the GS (ring of fire). She was diagnosed as left undisturbed tubal pregnancy with foetal cardiac activity. She refused the option of laparoscopic surgery. Therefore, she was counselled for medical treatment using methotrexate (MTX). She was also informed that the MTX treatment may fail due to the presence of foetal cardiac activity, and she may need more than one MTX dose. She received the first MTX dose at an initial β-hCG 3614 mIU/ml. The fourth day β-hCG after the first MTX dose was 5421 mIU/ml, while the seventh day β-hCG was 5055 mIU/ml [< 15% decrease of β-hCG (6.75%)]; therefore, she was given a second MTX dose. The fourth day β-hCG after the second MTX dose was 3851 mIU/ml, while the seventh day β-hCG was 2218 mIU/ml [> 15% decrease of β-hCG (42.4%)]; therefore, she was discharged home for follow-up in the outpatient department. This report represents the treatment of left undisturbed tubal pregnancy with foetal cardiac activity using a two-dose MTX regimen.

BACKGROUND: Ectopic pregnancy results of implantation of conceptus outside of endometrial cavity. It remains an important cause of maternal mortality. Spontaneous bilateral tubal pregnancies are the rare form of ectopic and are considered spontaneous when no fertility treatments are involved.
UNASSIGNED: A 31-year-old nulliparous woman presented at the Family Medicine Clinic with complaints of non-specific mild lower abdominal pain for 3 days and amenorrhea for 5 weeks. Transvaginal Ultrasound showed bilateral unruptured adnexa pregnancies. The trial of medical therapy was done without success and later laparotomy salpingostomy was done. One year later patient was able to conceive and delivery well by cesareans section.
CONCLUSIONS: Bilateral ectopic pregnancy is a unique from of twin pregnancy frequently occurring with assisted reproductive technology rather than spontaneous pregnancy. Diagnosis of bilateral ectopic pregnancy is often challenging as the clinical symptoms and signs may not be indicative of bilateral involvement. Laboratory test with βhcg levels cannot suggestive if is unilateral or bilateral nature and sonographers may be falsely reassured if they are not careful and satisfied with visualization of ectopic gestation on one side. Laparoscopic salpingostomy or salpingectomy is the gold standard treatment modality for bilateral tubal ectopic pregnancy although laparotomy may be indicated in unstable patient.
CONCLUSIONS: Therefore, any women in childbearing age presenting with clinical features of acute lower abdominal pain should be considered to have potential ectopic gestation.

In the Muslim world, the use and acceptance of long-term and permanent contraceptives were limited. Our aim was to investigate those limiting factors so we can help making these methods widely available and acceptable to the society.
There were 1365 women from Facebook groups in the period 08/10/2020-8/11/2020. Participants were married women, living in Jordan. This was a cross-sectional study. Statistical Package for Social Sciences (SPSS), version 16, software was used for statistical analysis (Chicago, Illinois, USA).
Among participants, 22.3% had never used any contraceptives. Non-hormonal IUCD was the most commonly used method. There was a statistically significant association between the use of hormonal IUCD and women\'s age, marriage duration, education and number of children (p < 0.0001). Tubal ligation was adopted by only 44 (3.22%) participants. 19.68% of participants declined tubal ligation merely due to religious issues. Women who completed only high school level of education underwent tubal ligation significantly more than those with university (Bachelor) and post-university (Master or PhD) degrees (p < 0.0001 and 0.026, respectively). Only 1.83% of women\'s partners underwent vasectomy, the majority of these vasectomies (72.0%) were done because of the need for lifelong contraception. Around 17% of women\'s partners had poor knowledge about vasectomy. Further, women\'s employment status (housewives or full-time employees) was found to be the only variable that affected acceptance of vasectomy (p = 0.0047).
Women endured a heavy burden of contraception. Cultural and religious taboos influenced tubal ligation. Vasectomy was still very rarely adopted by men due to the lack of knowledge about the procedure. Our results raised the need for further dissemination of contraception knowledge and counselling through the primary care and maternity centers, mosques and media in official, comprehensive and integrated programs. Future research is needed in the field of permanent contraceptive methods.

The latest recommendations of 2006 on tubal sterilization reported an infectious risk of 1.5 to 2.5% for the vaginal approach. There is, however, limited literature on this approach. The primary objective of our study was to investigate the feasibility of tubal sterilization via posterior colpotomy. The secondary objectives were to study the reproducibility of this approach, the postoperative infection rate after tubal sterilization via posterior colpotomy, to evaluate its peroperative and postoperative morbidity.
This retrospective study, conducted at the Antibes\'s Hospital, included patients over 18 years of age who underwent tubal ligation with clips or bilateral vaginal salpingectomy from 2005 to 2021.
We included a total of 158 patients: 88% by clips and 12% by bilateral salpingectomy. The average operative duration was of 27 minutes. There were no infectious or postoperative complications directly related to the sterilization. There were two failures of the technique, requiring conversion to laparoscopy (1.3%) and four subsequent pregnancies (2.5%).
We were able to show low morbidity and failure rates with this surgical technique. It, therefore, does not appear to be inferior to the laparoscopic approach. Moreover, it is reproducible technique.