title: Somatic Dysfunction in the Diagnosis of Uncommon Ectopic Pregnancies: Surgical Correlation and Comparison With Related Pathologic Findings.
abstract: 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.
  
  
  OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.forename: Daniel
authors.initials: D
authors.lastname: Martingano
authors.forename: Hannah
authors.initials: H
authors.lastname: Canepa
authors.forename: Setareh
authors.initials: S
authors.lastname: Fararooy
authors.forename: Dmitriy
authors.initials: D
authors.lastname: Rybitskiy
authors.forename: Sam
authors.initials: S
authors.lastname: Shahem
authors.forename: Francis X
authors.initials: FX
authors.lastname: Martingano
authors.forename: George
authors.initials: G
authors.lastname: Aglialoro
mesh_terms: D000293:Adolescent; D000328:Adult; D001707:Biopsy, Needle; D002983:Clinical Competence; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D005865:Gestational Age; D006801:Humans; D007150:Immunohistochemistry; D007813:Laparotomy / Q000379:methods; D010021:Osteopathic Medicine / Q000379:methods*; D010808:Physical Examination / Q000379:methods*; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery*; D011446:Prospective Studies; D016896:Treatment Outcome; D055815:Young Adult