Ultrastructural Changes Of Pregnant Fallopian Tube In Women With Fubal Pregnancy

Fallopian tube can"pick up" eggs and is the place for fertilization as well as the channel for transportation of gametes and fertilized egg. It plays an important role in pregnancy, providing favorable environment and nutrition for the fertilized egg in its initial development. However, once the fertilized egg implants in tubal lumen, tubal pregnancy will be caused. In recent years the incidence of tubal pregnancy increased to2%. In consequence, the fertility reduced,20%of the patients suffering infertility and10-27%repeating ectopic pregnancy. The main reason for tubal pregnancy is the damage of the oviduct caused by salpingitis, which is related to fallopian tube obstruction and deciliation. In addition to the naked shape and tubal patency, mucuous membrane structure also affects the function of fallopian tube. But reports are rare on mucosal ultrastructure alterations of pregnant tube. Should pregnant tube be retained? Does it do good to the function of tube? All of these will be discussed in this study.Objectives:To discover the ultrastructural changes of pregnant fallopian tube of patients with tubal pregnancy, and investigate the relationship between tubal pregnancy and the damaged tubal function.Methods:Fifteen specimens of human fallopian tubes were obtained from patients of tubal pregnancy under strict criteria including:clinical diagnosis of tubal pregnancy, HCG higher than5,000IU/L, no internal bleeding, ipsilateral salpingectomy with patients’permission, and ampullary tubal pregnancy with laparoscopic diagnosis and postoperative pathological diagnosis. The control group included patients at reproductive age. those with attachment resection due to benign ovarian cysts, no fertility requirements, no history of pelvic inflammation but the history of vaginal delivery, and importantly, with normal structure of fallopian tube pathologically confirmed. Materials were obtained and fixed immediately after tubal excision. Samples were observed and pictured under scanning electron microscopy (SEM) after rinsing several times in physiological saline, washing away blood and so on, fixing in2.5%glutaraldehyde for24hours, rinsing specimens in PBS, gradient alcohol dehydration, tert-buty1alcohol mixed with100%alcohol in a ratio of1:1, putting the specimen in the pure tert-butyl alcohol once, absorbing the tertiary butyl alcohol, frozen drying, gluing and metal spraying. Transmission electron microscopy (TEM) was used in materials obtaining, before and after fixation, gradient alcohol dehydration, acetone replacement, resin soak, sectioning and staining, and observing and picturing on screen. To observe the ultrastructural changes of the ipsilateral tube of infertile patients after conservative surgery, these patients need to meet the following requirements:conservative operation history due to tubal ampullar pregnancy, infertility, regular menstruation, normal sex life, no contraception over a year; histerosalpingograms showing a block in ipsilateral tube in need of laparoscopy. For those laparoscopic surgery can not restore the patency of obstructed tube, the ipsilateral oviduct was removed, and its fimbriated and ampullar organizations were observed and studied with scanning electron microscopy (SEM).Results:(1) For patients with pregnant tube, SEM and TEM showed the same ultrastructure changes in mucosal of at the implanting place.(2) The epithelium of graviditas ampullaries consisted of ciliated cells and secretory cells. The number of ciliated cell and that of cilia on each ciliated cell decreased. Besides, the cilia were sparsely distributed, and irregularly and desultorily arranged; The total of secretory-cells increased and these cells revealed more obvious convexity to the lumen compared with the normal group. Meanwhile, the secretory cells varied in size and the number of microvillis on the top of the cells reduced, showing the shape of granule and irregular arrangement.(3)In the same magnification of SEM, the number of secretory cells and ciliated cells were of statistically significant (P<0.05) compared with control group in tubal pregnancy. No statistical difference was found between cilia length and diameter.(4) The cilia in pregnant tube showed9+2complex microtube structure and the decrease of mitochondria. The secretory cells grew more convex on the top in the shape of columns, and synthesis of secretory organelles reduced. Lamina propria and nonspecific inflammatory cells infiltration were clearly observed. Stromal cells were in irregular shape, with rough endoplasmic reticulum and free ribosome in the cytoplasm.(5) There were ultrastructure changes of pregnant fallopian tube in non-implanting place; the amount of ciliated cells dropped while that of secretory cells rose in both umbrella and isthmus; cilia and microvilli revealed the same changes with the ultrastructure changes in ampulla.(6) Tubal mucosa in ipsilateral tube of infertile patients after conservative surgery showed significant reduction of ciliated cells at previous pregnant site and their sparse distribution in the secretory cells. The secretory cells increased significantly in number but the retained cilias remained in shape. Secretory cells varied in size and convexity to the lumen; Differences in size and morphology were also noted in microvilli. The epithelium in fimbriated extremity showed similar changes.Conclusions:We conclude that there were significant ultrastructure changes and irreversible function damages in pregnant tube. It is recommended that the fallopian tube be resected when there are surgical indications of fallopian pregnancy.