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Ectopic pregnancies occur when the implantation of a fertilized ovum occurs outside of the endometrial cavity. The majority of ectopic pregnancies encountered in clinical practice are located within the fallopian tube. Abdominal pregnancies represent 1% of all ectopic pregnancies. Primary omental pregnancy, in which the extrauterine site of implantation is the greater omentum, is the least common form of abdominal pregnancy. The rarity of an ectopic pregnancy in the omentum and the absence of clinical symptoms often delays diagnosis and proper identification before rupture. The authors describe the case of a 23-year-old woman who had hemoperitoneum from a ruptured omental ectopic pregnancy that mimicked adnexal implantation. Her omental pregnancy was diagnosed through intraoperative exploration and osteopathic structural examination findings.

BACKGROUND: Ectopic pregnancies occur when the implantation of a fertilized ovum occurs outside the endometrial cavity. Such pregnancies occur in approximately 1.5% to 2.0% of all pregnancies and cause 6% of maternal deaths. OBJECTIVES: To evaluate osteopathic structural examination (OSE) findings in patients with ectopic pregnancies of uncommon locations and to establish the utility of these findings in the diagnosis of these ectopic pregnancies. METHODS: In this prospective case series, a focused OSE was performed on each patient with an ectopic pregnancy at her initial presentation after the patient history but before other diagnostic or laboratory tests were performed and surgical treatment was initiated. Chapman reflex points (CRPs) were evaluated pre- and postoperatively. For comparison, patients who had otherwise normal first pregnancies, underwent elective postpartum bilateral tubal ligation, or had simple ovarian cysts were also included and received OSEs. RESULTS: Seven cases with ectopic pregnancies outside the fallopian tube were included. Two primary ovarian pregnancies and 1 heterotopic pregnancy (uterine and ovarian) had somatic dysfunction at the T10-T11 spinal levels and CRPs posterior for the ovary, 1 primary omental pregnancy with somatic dysfunction at the T9-T12 spinal levels and CRPs anterior and posterior for the ileum and jejunum, and 1 tubal pregnancy with somatic dysfunction at the T10-L1 spinal levels and CRPs anterior and posterior for the fallopian tube. Two cornual ectopic pregnancies were not associated with unique findings. These somatic dysfunctions and CRP findings appear to be distinct from those of comparison cases, including first pregnancies at any trimester, simple ovarian cysts, and elective bilateral tubal ligation. CONCLUSION: The OSE findings demonstrated in these cases aided in the final diagnosis and thus can potentially prove helpful in cases of ovarian, tubal, and omental pregnancies to provide clues to abnormal ectopic pregnancy locations where diagnostic imaging results are insufficient or equivocal. Osteopathic structural examinations may allow osteopathic physicians to better prepare for treatment approaches, including surgery.

OBJECTIVE: To assess the efficacy and occurrence of severe side effects associated with the use of a single dose of azithromycin in the treatment of Chlamydia trachomatis in pregnant women. STUDY DESIGN: Patients and their sexual partners were randomized into three treatment groups: both the patient and her sexual partner received a single dose of azithromycin (group 1); the patient was given a standard course of erythromycin, while her partner was given a standard course of tetracycline (group 2); and the patient was given a single dose of azithromycin with the sexual partner given a standard course of tetracycline (group 3). Group 3 was included in order to assess the relative efficacy of tetracycline with respect to the use of azithromycin among patients and to indirectly assess possible patient reinfection by sexual partners. RESULTS: With respect to the cure rate, 4.5% of study participants given azithromycin has positive cultures vs. 21.1% of patients given erythromycin or tetracycline (P = .018). With respect to side effects severe enough to warrant a change in medication, 7.4% of patients receiving azithromycin reported suffering such side effects vs. 38.8% of patients given erythromycin (P = .02). Among sexual partners, 28.6% given tetracycline reported severe side effects vs. none of those given azithromycin (P = .03). CONCLUSION: Azithromycin in the treatment of C trachomatis in pregnant women substantially improved the cure rates while substantially reducing the occurrence of severe side effects associated with the use of a standard course of erythromycin. Since both tetracycline and erythromycin are known to be effective against C trachomatis infection, the improved efficacy of azithromycin is probably due to noncompliance with the multidose, multiday regimen associated with the use of these two antibiotics.