Different placentation patterns in viable compared with nonviable tubal pregnancy suggest a divergent clinical management.
OBJECTIVE
In contrast to tubal abortions, viable ectopic pregnancies in color Doppler ultrasonography exhibit a signal-intensive ring around the gestational sac. We investigated the underlying differences in implantation and placentation.


METHODS
Histologic sections of fallopian tubes carrying viable tubal pregnancies (13 patients) and tubal pregnancies that aborted (8 patients) were immunostained for cytokeratin, MIB-1, CD-34, and CD-68. The data were studied by computer-aided image analysis followed by statistical evaluation (Student t test, P <.05).


RESULTS
In contrast to tubal abortions, viable tubal pregnancies are characterized by implantation at the mesosalpingial rather than at the antimesosalpingial side of the organ. They exhibit deeper trophoblast invasion into the thickened tubal wall, more intense trophoblast proliferation (P <.001), and increased villous vascularization (P <.001).


CONCLUSIONS
The morphologic findings correlate with preoperative Doppler ultrasonography. They suggest that trophoblast invasion, placental growth, and the fate of tubal pregnancies depend on the implantation site. They encourage a conservative management of anti-mesosalpingially implanted, nonviable ectopic pregnancies in clinically stable patients.
Kemp
B
B
Department of Obstetrics and Gynecology, Aachen University of Technology, Aachen, Germany.
Kertschanska
S
S
Handt
S
S
Funk
A
A
Kaufmann
P
P
Rath
W
W
D015703:Antigens, CD / Q000032:analysis; D018952:Antigens, CD34 / Q000032:analysis; D015214:Antigens, Differentiation, Myelomonocytic / Q000032:analysis; D034961:Antigens, Nuclear; D010064:Embryo Implantation; D005187:Fallopian Tubes / Q000473:pathology; D005260:Female; D005313:Fetal Death; D006801:Humans; D007150:Immunohistochemistry; D007633:Keratins / Q000032:analysis; D019394:Ki-67 Antigen; D009687:Nuclear Proteins / Q000032:analysis; D010929:Placentation; D011247:Pregnancy; D011274:Pregnancy, Tubal / Q000000981:diagnostic imaging / Q000473:pathology* / Q000628:therapy*; D014327:Trophoblasts / Q000473:pathology; D014463:Ultrasonography; D000097382:CD68 Molecule
D015703:Antigens, CD; D018952:Antigens, CD34; D015214:Antigens, Differentiation, Myelomonocytic; D034961:Antigens, Nuclear; D007633:Keratins; D019394:Ki-67 Antigen; D009687:Nuclear Proteins; C067980:CD68 antigen, human; D000097382:CD68 Molecule