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Kurosawa H, Watanabe T, Sato N, Muraoka Y, Matsuzawa Y, Watanabe Y. A rare case of extraluminal interstitial pregnancy treated with laparoscopic cornuotomy. J Obstet Gynaecol Res 2024; 50:1273-1276. [PMID: 38711243 DOI: 10.1111/jog.15962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 04/22/2024] [Indexed: 05/08/2024]
Abstract
We report an extremely rare case of an extraluminal interstitial pregnancy. A 36-year-old nulliparous woman visited our hospital during the fifth week of gestation. Although no intrauterine gestational sac (GS) was identified, transabdominal ultrasonography revealed a GS-like cyst was detected in the right uterine horn. She underwent laparoscopic surgery for a suspected interstitial ectopic pregnancy. After laparoscopic cornuotomy, dye leakage was observed from the fimbria rather than the incision site. Finally, the patient was diagnosed with a right extraluminal interstitial pregnancy. Hysterosalpingography performed at three postoperative months revealed bilateral tubal passage. She conceived 7 months after surgery, with safe delivery by elective cesarean section at 38 weeks.
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Affiliation(s)
- Hiroki Kurosawa
- Division of Obstetrics and Gynecology, Tohoku Medical and Pharmaceutical University Wakabayashi Hospital, Sendai, Miyagi, Japan
| | - Tadashi Watanabe
- Division of Obstetrics and Gynecology, Tohoku Medical and Pharmaceutical University Wakabayashi Hospital, Sendai, Miyagi, Japan
| | - Naoto Sato
- Division of Obstetrics and Gynecology, Tohoku Medical and Pharmaceutical University Wakabayashi Hospital, Sendai, Miyagi, Japan
- Department of Obstetrics and Gynecology, Sendai Medical Center, Sendai, Miyagi, Japan
| | - Yuma Muraoka
- Division of Obstetrics and Gynecology, Tohoku Medical and Pharmaceutical University Hospital, Sendai, Miyagi, Japan
| | - Yukiko Matsuzawa
- Division of Obstetrics and Gynecology, Tohoku Medical and Pharmaceutical University Hospital, Sendai, Miyagi, Japan
| | - Yoh Watanabe
- Division of Obstetrics and Gynecology, Tohoku Medical and Pharmaceutical University Hospital, Sendai, Miyagi, Japan
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2
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Kakinuma T, Kakinuma K, Matsuda Y, Yanagida K, Ohwada M, Kaijima H. Efficacy of transvaginal ultrasound-guided local injections of absolute ethanol for ectopic pregnancies with intrauterine implantation sites. World J Clin Cases 2023; 11:788-796. [PMID: 36818618 PMCID: PMC9928688 DOI: 10.12998/wjcc.v11.i4.788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 12/27/2022] [Accepted: 01/12/2023] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Cervical pregnancies, interstitial tubal pregnancies, and cesarean scar pregnancies, which are ectopic pregnancies with intrauterine implantation sites exhibit increasing trends with the recent widespread use of assisted reproductive technologies and increased rate of cesarean deliveries. The development of high-sensitivity human chorionic gonadotropin testing reagents and the increased precision of transvaginal ultrasonic tomography have made early diagnosis possible and have enabled treatment. Removal of ectopic pregnancies using methotrexate therapy and/or uterine artery embolization has been reported. However, delayed resumption of infertility treatments after methotrexate therapy is indicated, and negative effects on the next pregnancy after uterine artery embolization have been reported.
AIM To examine the efficacy and safety of ultrasound-guided topical absolute ethanol injection in ectopic pregnancies with an intrauterine implantation site.
METHODS In this study, we retrospectively examined the medical records of 21 patients who were diagnosed with an ectopic pregnancy with an intrauterine implantation site at our hospital, between April 2010 and December 2018, and underwent transvaginal ultrasound-guided local injections of absolute ethanol to determine the treatment outcomes. We evaluated the treatment methods, treatment outcomes, presence of bleeding requiring hemostasis measures and blood transfusion, complications, and treatment periods. Successful treatment was defined as the completion of treatment using transvaginal ultrasound-guided local injections of absolute ethanol alone.
RESULTS There were 21 total cases comprising 10 cervical pregnancies, 10 interstitial tubal pregnancies, and 1 cesarean scar pregnancy. All patients completed treatment with this method. No massive hemorrhaging or serious adverse reactions were observed during treatment. The mean gestation ages at the time of diagnosis were 5.9 wk (SD, ± 0.9 wk) for cervical and 6.9 wk (SD, ± 2.1 wk) for interstitial tubal pregnancies. The total ethanol doses were 4.8 mL (SD, ± 2.2 mL) for cervical pregnancies and 3.3 mL (SD, ± 2.2 mL) for interstitial pregnancies. The treatment period was 28.5 days (SD, ± 11.7 d) for cervical pregnancies and 30.0 ± 8.1 d for interstitial pregnancies. Positive correlations were observed between the blood β- human chorionic gonadotropin level at the beginning of treatment and the total ethanol dose (r = 0.75; P = 0.00008), as well as between the total ethanol dose and treatment period (r = 0.48; P = 0.026).
CONCLUSION Transvaginal ultrasound-guided local injections of absolute ethanol could become a new option for intrauterine ectopic pregnancies when fertility preservation is desired.
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Affiliation(s)
- Toshiyuki Kakinuma
- Department of Obstetrics and Gynecology, International University of Health and Welfare Hospital, Nasushiobara 329-2763, Japan
| | - Kaoru Kakinuma
- Department of Obstetrics and Gynecology, International University of Health and Welfare Hospital, Nasushiobara 329-2763, Japan
| | - Yoshio Matsuda
- Department of Obstetrics and Gynecology, International University of Health and Welfare Hospital, Nasushiobara 329-2763, Japan
| | - Kaoru Yanagida
- Department of Obstetrics and Gynecology, International University of Health and Welfare Hospital, Nasushiobara 329-2763, Japan
| | - Michitaka Ohwada
- Department of Obstetrics and Gynecology, International University of Health and Welfare Hospital, Nasushiobara 329-2763, Japan
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Worku M, Teloye MT, Ketema W. Obstetric Performance Following Post-Traumatic Recurrent Fundal Uterine Rupture: A Case Report. Int J Womens Health 2022; 14:1459-1463. [PMID: 36277449 PMCID: PMC9580374 DOI: 10.2147/ijwh.s385397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 10/13/2022] [Indexed: 11/17/2022] Open
Abstract
A case of recurrent post-traumatic fundal uterine rupture followed by an uncomplicated alive birth, unusual obstetric performance following extensive myometrial damage, happened in Hawassa University comprehensive specialized hospital. The first incident of fundal rupture was 5 years earlier than the second, after she sustained a road traffic accident at the gestational age of 31 weeks. There was associated polytrauma. The second uterine rupture was at 33 weeks of gestation, following a fall-down accident on a flat surface while performing routine household activities. The third pregnancy was an uncomplicated elective cesarean delivery, and the tubes were not ligated as the woman strongly wishes to preserve her future fertility. A single facility experience with this rare clinical scenario of obstetric performance is reported to stimulate interest in additional research into the subsequent obstetric performance of patients with recurrent fundal uterine rupture and resultant extensive myometrial damage.
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Affiliation(s)
- Misganaw Worku
- Department of Obstetrics and Gynecology, HawassaUniversity, Hawassa, Sidama Region, Ethiopia
| | - Meles Tazeb Teloye
- Department of Obstetrics and Gynecology, HawassaUniversity, Hawassa, Sidama Region, Ethiopia
| | - Worku Ketema
- Department of Pediatrics and Child Health, Hawassa University, Hawassa, Sidama Region, Ethiopia,Correspondence: Worku Ketema, Email
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4
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Konar H, Konar L, Konar C, Halder A, Saha A, Khamaru J. Uncommon Ectopic Pregnancies—Challenges in the Management. J Obstet Gynaecol India 2022; 72:224-234. [PMID: 35928092 PMCID: PMC9343554 DOI: 10.1007/s13224-021-01605-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 11/15/2021] [Indexed: 10/18/2022] Open
Abstract
Background The risk factors for ectopic pregnancy are on the rise. Despite the progress (availability of serum βhCG, USG and MRI), there are diagnostic and therapeutic challenges in the management. Up to 50% of ectopic pregnancies go undetected. Furthermore, cases seen as emergency with hemodynamic instability need urgent intervention with simultaneous arrangement of transport, blood transfusion and at times multidisciplinary team involvement. This is more challenging in a setting where resources are limited. Objective To evaluate the outcome of women presenting with uncommon ectopic pregnancies as life-threatening emergency. Challenges encountered in diagnosis, pre-operative evaluation, decision for surgery and the procedure are presented. Patients and Methods This is a series of twelve cases of uncommon ectopic pregnancies belonging to eight different types. These were managed under the first author during the period 2001 to 2019. Subjects were analyzed retrospectively. Results Diagnostic dilemma was faced in majority of the cases even with the use of ultrasonography. All the conceptions were spontaneous. Emergency surgical interventions were made on the basis of clinical evaluation. Five cases presented with massive hemoperitoneum. Blood transfusion was needed in nine cases. There was no mortality. One woman (case 4), with abdominal pregnancy, went home with a live baby, after the second laparotomy. Conclusion Uncommon ectopic pregnancies are life-threatening conditions. Clinical acumen and an alert mind are of superior value in diagnosis. Investigations are supportive. Early diagnosis and intervention are lifesaving.
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5
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Hoyos LR. Reply to Drs. Max Brincat and Tom Holland letter to the editor re: Hoyos LR, et al. Outcomes in subsequent pregnancies after wedge resection for interstitial ectopic pregnancy: a retrospective cohort study. J Matern Fetal Neonatal Med 2019; 34:839-840. [PMID: 31062636 DOI: 10.1080/14767058.2019.1616691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Luis R Hoyos
- Department of Obstetrics & Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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6
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Hoyos LR, Vilchez G, Allsworth JE, Malik M, Rodriguez-Kovacs J, Adekola H, Awonuga AO. Outcomes in subsequent pregnancies after wedge resection for interstitial ectopic pregnancy: a retrospective cohort study. J Matern Fetal Neonatal Med 2018; 32:2354-2360. [DOI: 10.1080/14767058.2018.1437411] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Luis R. Hoyos
- Department of Obstetrics & Gynecology, Wayne State University/Hutzel Women’s Hospital, Detroit, MI, USA
| | - Gustavo Vilchez
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, University of Missouri – Kansas City School of Medicine, Kansas City, MO, USA
| | | | - Mokerrum Malik
- Department of Obstetrics & Gynecology, Wayne State University/Hutzel Women’s Hospital, Detroit, MI, USA
| | - Javier Rodriguez-Kovacs
- Department of Obstetrics & Gynecology, Wayne State University/Hutzel Women’s Hospital, Detroit, MI, USA
| | - Henry Adekola
- Division of Maternal–Fetal Medicine, Department of Obstetrics & Gynecology, Hurley Medical Center, Michigan State University, Flint Campus, Detroit, MI, USA
| | - Awoniyi O. Awonuga
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics & Gynecology, Wayne State University/Hutzel Women’s Hospital, Detroit, MI, USA
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7
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Therapeutic outcomes of methotrexate injection in unruptured interstitial pregnancy. Obstet Gynecol Sci 2017; 60:571-578. [PMID: 29184866 PMCID: PMC5694732 DOI: 10.5468/ogs.2017.60.6.571] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 06/06/2017] [Accepted: 06/22/2017] [Indexed: 11/08/2022] Open
Abstract
Objective To examine the therapeutic outcomes of methotrexate (MTX) in the treatment of unruptured interstitial pregnancy. Methods We reviewed the medical records of patients who were diagnosed with interstitial pregnancy and received MTX as first-line treatment between January 2003 and July 2014 at CHA Gangnam Medical Center. The treatment success rates and subsequent pregnancy outcomes were examined. Results Ninety-seven patients were diagnosed with interstitial pregnancy between January 2003 and July 2014. Of them, 38 initially received MTX treatment. The diagnosis was made at a median of 6+3 weeks (5+0 to 11+3 weeks). Thirty patients received a systemic MTX injection, while the other 8 received a local MTX injection. Systemic treatment composed of an 8-day alternating MTX regimen, single-dose regimen, or high-dose regimen (100 mg/m2 + 200 mg/m2 intravenously over 12 hours). The local injection consisted of a direct MTX injection into the gestational sac with or without systemic MTX injection. Twenty-one patients (55.3%) were successfully treated with MTX. However, MTX therapy failed in 17 patients (44.7%), who required surgery. Mode of MTX treatment was the only predictive variable of MTX treatment success (P=0.039). Treatment success was seen in 7 of 8 patients (87.5%) in the local MTX group vs. 14 of 30 patients (46.7%) in the systemic MTX group. After treatment, 13 patients attempted a successive pregnancy; of them, 10 patients had a confirmed clinical pregnancy and healthy live birth. Conclusion Combined MTX treatment including a local injection might be an initial approach to the treatment of interstitial pregnancy.
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8
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Egger E. Recurrent Interstitial Pregnancy: a Review of the Literature. Geburtshilfe Frauenheilkd 2017; 77:335-339. [PMID: 28552996 DOI: 10.1055/s-0043-100107] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Interstitial pregnancies account for 2-4 % of all ectopic pregnancies. Despite its rarity, various treatment options exist. However, no gold standard has yet been defined and data regarding recurrence of interstitial pregnancies in subsequent pregnancies after different treatments are sparse. This makes it very difficult to provide adequate patient counselling for treatment options with regards to the treatment-related risk of recurrence. The present literature review demonstrates that recurrent interstitial pregnancy is a rare condition and more likely when additional anatomy-related risk factors for ectopic pregnancies are present, such as hydrosalpinges, blocked tubes, endometriosis, fibroids or prior tubal ectopic pregnancies. Therefore, at first appearance and in absence of additional anatomy-related risk factors, methotrexate intravenously, intramuscularly or into the amnion may be the first choice. In case of anatomical risk factors, cornual wedge resection seems to be first choice. In case of recurrence, cornual wedge resection is particularly justified in patients with anatomical alterations of the salpinges. The role of conservative surgical treatments in recurrence as cornuotomy, salpingectomy, endoloop ligation and resection and curettage under laparoscopic guidance remains unclear due to sparse data.
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Affiliation(s)
- Eva Egger
- University of Bonn, Department of Obstetrics and Gynecology/CIO, Bonn, Germany.,Florence Nightingale Hospital, Department of Obstetrics and Gynecology, Düsseldorf, Germany
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9
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Kolanska K, Cohen J, Zanini-Grandon AS, Belghiti J, Bornes M, Daraï E. [How I do… in situ methotrexate injection in the treatment of intramyometrial pregnancy]. GYNECOLOGIE, OBSTETRIQUE & FERTILITE 2016; 44:435-436. [PMID: 27426691 DOI: 10.1016/j.gyobfe.2016.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 06/09/2016] [Indexed: 06/06/2023]
Affiliation(s)
- K Kolanska
- Service de gynécologie-obstétrique, hôpital Tenon, Assistance publique des Hôpitaux de Paris, GRC 6-UPMC centre expert en endométriose (C3E), UMRS 938, université Pierre-et-Marie-Curie-Paris-6, 75020 Paris, France
| | - J Cohen
- Service de gynécologie-obstétrique, hôpital Tenon, Assistance publique des Hôpitaux de Paris, GRC 6-UPMC centre expert en endométriose (C3E), UMRS 938, université Pierre-et-Marie-Curie-Paris-6, 75020 Paris, France.
| | - A S Zanini-Grandon
- Service de gynécologie-obstétrique, hôpital Tenon, Assistance publique des Hôpitaux de Paris, GRC 6-UPMC centre expert en endométriose (C3E), UMRS 938, université Pierre-et-Marie-Curie-Paris-6, 75020 Paris, France
| | - J Belghiti
- Service de gynécologie-obstétrique, hôpital Tenon, Assistance publique des Hôpitaux de Paris, GRC 6-UPMC centre expert en endométriose (C3E), UMRS 938, université Pierre-et-Marie-Curie-Paris-6, 75020 Paris, France
| | - M Bornes
- Service de gynécologie-obstétrique, hôpital Tenon, Assistance publique des Hôpitaux de Paris, GRC 6-UPMC centre expert en endométriose (C3E), UMRS 938, université Pierre-et-Marie-Curie-Paris-6, 75020 Paris, France
| | - E Daraï
- Service de gynécologie-obstétrique, hôpital Tenon, Assistance publique des Hôpitaux de Paris, GRC 6-UPMC centre expert en endométriose (C3E), UMRS 938, université Pierre-et-Marie-Curie-Paris-6, 75020 Paris, France
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10
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Cohen J, Kolanska K, Zanini-Grandon AS, Belghiti J, Thomassin-Naggara I, Bazot M, Bornes M, Daraï E. Treatment of Intramyometrial Pregnancy by In Situ Injection of Methotrexate. J Minim Invasive Gynecol 2016; 24:335-337. [PMID: 27241811 DOI: 10.1016/j.jmig.2016.05.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 05/17/2016] [Accepted: 05/19/2016] [Indexed: 11/18/2022]
Abstract
Intramyometrial ectopic pregnancies are rare, and various management modalities have been described. We report a patient with intramyometrial pregnancy who was successfully treated by in situ injection of methotrexate (MTX) after the failure of 2 intramuscular injections of MTX. We emphasize the difficult management of intramyometrial pregnancy and show that in situ MTX injection may be indicated for this particular type of ectopic pregnancy.
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Affiliation(s)
- Jonathan Cohen
- Department of Obstetrics, Gynecology, and Reproductive Medicine, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, GRC6-UPMC, Centre Expert en Endométriose (C3E), UMR S938, Université Pierre et Marie Curie Paris 6, Paris, France.
| | - Kamila Kolanska
- Department of Obstetrics, Gynecology, and Reproductive Medicine, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, GRC6-UPMC, Centre Expert en Endométriose (C3E), UMR S938, Université Pierre et Marie Curie Paris 6, Paris, France
| | - Anne-Sophie Zanini-Grandon
- Department of Obstetrics, Gynecology, and Reproductive Medicine, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, GRC6-UPMC, Centre Expert en Endométriose (C3E), UMR S938, Université Pierre et Marie Curie Paris 6, Paris, France
| | - Jeremie Belghiti
- Department of Obstetrics, Gynecology, and Reproductive Medicine, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, GRC6-UPMC, Centre Expert en Endométriose (C3E), UMR S938, Université Pierre et Marie Curie Paris 6, Paris, France
| | - Isabelle Thomassin-Naggara
- Department of Radiology, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, GRC6-UPMC, Centre Expert en Endométriose (C3E), UMR S938, Université Pierre et Marie Curie Paris 6, Paris, France
| | - Marc Bazot
- Department of Radiology, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, GRC6-UPMC, Centre Expert en Endométriose (C3E), UMR S938, Université Pierre et Marie Curie Paris 6, Paris, France
| | - Marie Bornes
- Department of Obstetrics, Gynecology, and Reproductive Medicine, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, GRC6-UPMC, Centre Expert en Endométriose (C3E), UMR S938, Université Pierre et Marie Curie Paris 6, Paris, France
| | - Emile Daraï
- Department of Obstetrics, Gynecology, and Reproductive Medicine, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, GRC6-UPMC, Centre Expert en Endométriose (C3E), UMR S938, Université Pierre et Marie Curie Paris 6, Paris, France
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11
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Hemostatic Techniques for Laparoscopic Management of Cornual Pregnancy: Double-Impact Devascularization Technique. J Minim Invasive Gynecol 2016; 23:274-80. [DOI: 10.1016/j.jmig.2015.09.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 09/02/2015] [Accepted: 09/03/2015] [Indexed: 11/18/2022]
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Nikodijevic K, Bricou A, Benbara A, Moreaux G, Nguyen C, Carbillon L, Poncelet C, Boujenah J. [Cornual pregnancy: Management and subsequent fertility]. ACTA ACUST UNITED AC 2015; 44:11-6. [PMID: 26678164 DOI: 10.1016/j.gyobfe.2015.10.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Accepted: 10/14/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Cornual pregnancy is a rare entity, representing 2% of ectopic pregnancies. Its management is poorly codified and often guided by the clinical situation. The aim of our study was to describe the management of cornual pregnancies, subsequent fertility, and obstetric outcomes according to the management. METHODS Observational retrospective unicentric study. Nineteen patients hospitalized for cornual pregnancy between 2006 and 2015 were included. The data was collected with medical records and a phone standardized questionnaire. Patients were managed according to hemodynamic status by either systemic or local methotrexate injection or surgical corneal resection. RESULTS Among the 19 patients, 32% (6) were treated by systemic injection (one failure treated by surgical treatment) and 68% (13) underwent surgical treatment by cornual resection. The median HCG rate decrease was 33 days (16-62). Among the twelve patients with a desire for a new pregnancy, 7 (58%) became pregnant without assisted reproductive technology (2 following medical treatment and 5 following surgical resection). Histological analysis of uterine horn showed proximal fallopian tube lesions in 76.9% of case (chronic salpingitis, endosalpingiosis and adenomyosis). CONCLUSION Cornual pregnancies are at high risk of hemorrhagic rupture. Ectopic recidive may occur. Fertility and obstetrical outcomes following cornual pregnancy are not affected whatever the initial treatment. Other studies are needed to aid clinical management according to HCG level and ultrasound features.
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Affiliation(s)
- K Nikodijevic
- Service de gynécologie-obstétrique, université Paris XIII-Bobigny, CHU Jean-Verdier, avenue du 14-Juillet, 93140 Bondy, France
| | - A Bricou
- Service de gynécologie-obstétrique, université Paris XIII-Bobigny, CHU Jean-Verdier, avenue du 14-Juillet, 93140 Bondy, France
| | - A Benbara
- Service de gynécologie-obstétrique, université Paris XIII-Bobigny, CHU Jean-Verdier, avenue du 14-Juillet, 93140 Bondy, France
| | - G Moreaux
- Service de gynécologie-obstétrique, université Paris XIII-Bobigny, CHU Jean-Verdier, avenue du 14-Juillet, 93140 Bondy, France
| | - C Nguyen
- Service de gynécologie-obstétrique, université Paris XIII-Bobigny, CHU Jean-Verdier, avenue du 14-Juillet, 93140 Bondy, France; Université Paris 13, Sorbonne Paris cité, UFR SMBH, 93140 Bobigny, France
| | - L Carbillon
- Service de gynécologie-obstétrique, université Paris XIII-Bobigny, CHU Jean-Verdier, avenue du 14-Juillet, 93140 Bondy, France; Université Paris 13, Sorbonne Paris cité, UFR SMBH, 93140 Bobigny, France
| | - C Poncelet
- Service de gynécologie-obstétrique, université Paris XIII-Bobigny, CHU Jean-Verdier, avenue du 14-Juillet, 93140 Bondy, France; Université Paris 13, Sorbonne Paris cité, UFR SMBH, 93140 Bobigny, France
| | - J Boujenah
- Service de gynécologie-obstétrique, université Paris XIII-Bobigny, CHU Jean-Verdier, avenue du 14-Juillet, 93140 Bondy, France; Université Paris 13, Sorbonne Paris cité, UFR SMBH, 93140 Bobigny, France.
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Panelli DM, Phillips CH, Brady PC. Incidence, diagnosis and management of tubal and nontubal ectopic pregnancies: a review. FERTILITY RESEARCH AND PRACTICE 2015; 1:15. [PMID: 28620520 PMCID: PMC5424401 DOI: 10.1186/s40738-015-0008-z] [Citation(s) in RCA: 104] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 09/29/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND Ectopic pregnancy is a potentially life-threatening condition occurring in 1-2 % of all pregnancies. The most common ectopic implantation site is the fallopian tube, though 10 % of ectopic pregnancies implant in the cervix, ovary, myometrium, interstitial portion of the fallopian tube, abdominal cavity or within a cesarean section scar. FINDINGS Diagnosis involves a combination of clinical symptoms, serology, and ultrasound. Medical management is a safe and effective option in most clinically stable patients. Patients who have failed medical management, are ineligible, or present with ruptured ectopic pregnancy or heterotopic pregnancy are most often managed with excision by laparoscopy or, less commonly, laparotomy. Management of nontubal ectopic pregnancies may involve medical or surgical treatment, or a combination, as dictated by ectopic pregnancy location and the patient's clinical stability. Following tubal ectopic pregnancy, the rate of subsequent intrauterine pregnancy is high and independent of treatment modality. CONCLUSION This review describes the incidence, risk factors, diagnosis, and management of tubal and non-tubal ectopic and heterotopic pregnancies, and reviews the existing data regarding recurrence and future fertility.
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Affiliation(s)
- Danielle M. Panelli
- Department of Obstcpetrics and Gynecology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St., Boston, MA 02115 USA
| | - Catherine H. Phillips
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA USA
| | - Paula C. Brady
- Department of Obstcpetrics and Gynecology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St., Boston, MA 02115 USA
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14
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Watanabe T, Watanabe Z, Watanabe T, Fujimoto K, Sasaki E. Laparoscopic cornuotomy for interstitial pregnancy and postoperative course. J Obstet Gynaecol Res 2014; 40:1983-8. [DOI: 10.1111/jog.12422] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2013] [Accepted: 02/17/2014] [Indexed: 12/01/2022]
Affiliation(s)
- Tadashi Watanabe
- Department of Obstetrics and Gynecology; NTT East Japan Tohoku Hospital; Sendai Japan
| | - Zen Watanabe
- Department of Obstetrics and Gynecology; NTT East Japan Tohoku Hospital; Sendai Japan
| | - Takanori Watanabe
- Department of Obstetrics and Gynecology; Sendai City Hospital; Sendai Japan
| | - Kumiko Fujimoto
- Department of Obstetrics and Gynecology; Saka General Hospital; Tagajo Japan
| | - Etsuko Sasaki
- Etsuko Sasaki Clinic of Obstetrics and Gynecology; Sendai Japan
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Sagiv R, Debby A, Keidar R, Kerner R, Golan A. Interstitial pregnancy management and subsequent pregnancy outcome. Acta Obstet Gynecol Scand 2013; 92:1327-30. [DOI: 10.1111/aogs.12239] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2011] [Accepted: 08/01/2013] [Indexed: 11/29/2022]
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Douysset X, Verspyck E, Diguet A, Marpeau L, Chanavaz-Lacheray I, Rondeau S, Resch B, Sergent F. [Interstitial pregnancy: experience at Rouen's hospital]. ACTA ACUST UNITED AC 2013; 42:216-21. [PMID: 23602139 DOI: 10.1016/j.gyobfe.2012.09.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Accepted: 09/13/2012] [Indexed: 01/14/2023]
Abstract
OBJECTIVE Presenting our experience concerning interstitial pregnancies (IP) surgical management and to evaluate our patients' subsequent long-term fertility. PATIENTS AND METHOD Twenty patients underwent surgical treatment of IP in our department over 15 years. In this retrospective study, we present symptoms that led to diagnosis, treatments, fertility and obstetrical outcome. RESULTS Mean gestational age at diagnosis was 8SA, with a median BHCG rate of 7411 IU/L, and a patient mean age of 30 years. Ninety percent of patients had at least one risk factor for ectopic pregnancy. Pain or bleeding were the most common symptoms at admission, 4 patients were admitted in an hypovolemic shock status. Location of the interstitial ectopic pregnancy was discovered during surgery in 45 % of cases. Six patients had a large hemoperitoneum bigger than 1L, 5 patients had an IP of uterine stump after salpingectomy for a previous ectopic pregnancy. The most used surgical technique was in 60 % of cases the excision by Endo GIA stapling(®) with salpingectomy. Regarding fertility, 12 patients wished pregnancy in the aftermath of the intervention, 10 had at least one pregnancy, among them there is an ectopic contralateral ampullary pregnancy, and a contralateral recurrence of interstitial pregnancy. Four patients were delivered by cesarean section and 4 patients were delivered vaginally, some several times. No uterine rupture occured. DISCUSSION AND CONCLUSION Interstitial pregnancy is a rare ectopic pregnancy. Its diagnosis is difficult and may involve maternal life-threatening and fertility. In subsequent pregnancies, the clinician has to be careful concerning the risks of interstitial pregnancy recurrence and uterine rupture.
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Affiliation(s)
- X Douysset
- Pôle gynécologique et obstétricale, CHU Charles-Nicolle, 1, rue de Germont, 76000 Rouen, France; Clinique universitaire de gynécologie-obstétrique, université Joseph-Fourrier et CHU de Grenoble, boulevard de la Chantourne, 38700 La Tronche, France.
| | - E Verspyck
- Pôle gynécologique et obstétricale, CHU Charles-Nicolle, 1, rue de Germont, 76000 Rouen, France
| | - A Diguet
- Pôle gynécologique et obstétricale, CHU Charles-Nicolle, 1, rue de Germont, 76000 Rouen, France
| | - L Marpeau
- Pôle gynécologique et obstétricale, CHU Charles-Nicolle, 1, rue de Germont, 76000 Rouen, France
| | - I Chanavaz-Lacheray
- Maternité du Belvédère, 72, rue Louis-Pasteur, 76130 Mont Saint-Aignan, France
| | - S Rondeau
- Clinique pédiatrique, CHU Charles-Nicolle, 1, rue de Germont, 76000 Rouen, France
| | - B Resch
- Pôle gynécologique et obstétricale, CHU Charles-Nicolle, 1, rue de Germont, 76000 Rouen, France
| | - F Sergent
- Clinique universitaire de gynécologie-obstétrique, université Joseph-Fourrier et CHU de Grenoble, boulevard de la Chantourne, 38700 La Tronche, France
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Siow A, Ng S. Laparoscopic management of 4 cases of recurrent cornual ectopic pregnancy and review of literature. J Minim Invasive Gynecol 2011; 18:296-302. [PMID: 21441075 DOI: 10.1016/j.jmig.2011.02.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2010] [Revised: 02/01/2011] [Accepted: 02/02/2011] [Indexed: 12/20/2022]
Abstract
The objectives of this retrospective case series were to report our experience with laparoscopic management of recurrent cornual ectopic pregnancy in a tertiary care center and to present a review of the literature. Four patients experienced recurrent cornual ectopic pregnancy, and 1 patient had 2 consecutive recurrences. Laparoscopic surgery was performed to treat recurrent cornual ectopic pregnancy in all 4 patients. These 4 cases together with 10 cases collated from the literature review confirm that this entity is rare. Cornual ectopic pregnancy can recur as early as 4 months and as late as 5 years after the first ectopic pregnancy. There seems to be no correlation between the treatment method of the first ectopic pregnancy and the risk of recurrence. The etiology of recurrent cornual ectopic pregnancy is not fully understood, although it shares similar risk factors with tubal ectopic pregnancy. Both medical therapy and surgery are used to treat recurrent cornual ectopic pregnancy, with surgery often performed via laparotomy. These 4 cases constitute the largest case series of recurrent cornual ectopic pregnancy treated laparoscopically. Our experience with laparoscopic management of recurrent cornual ectopic pregnancy in a tertiary care center reveals that it is effective and safe.
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Affiliation(s)
- Anthony Siow
- Minimally Invasive Surgery Centre, KK Women's and Children's Hospital, Singapore.
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18
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Moon HS, Kim SG, Park GS, Choi JK, Koo JS, Joo BS. Efficacy of bleeding control using a large amount of highly diluted vasopressin in laparoscopic treatment for interstitial pregnancy. Am J Obstet Gynecol 2010; 203:30.e1-6. [PMID: 20451893 DOI: 10.1016/j.ajog.2010.02.030] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2009] [Revised: 11/25/2009] [Accepted: 02/10/2010] [Indexed: 12/27/2022]
Abstract
OBJECTIVE We sought to report the safety and effectiveness of bleeding control using a large amount of highly diluted vasopressin in laparoscopic management of interstitial pregnancy. STUDY DESIGN This was an uncontrolled retrospective review of 20 patients who were laparoscopically treated for interstitial pregnancy using a large amount of highly diluted vasopressin. For hemostasis, 1 ampule of vasopressin was diluted in 1000 mL of normal saline (1000-fold) and 150-250 mL of diluted vasopressin was injected in the uterus below interstitial pregnancy. RESULTS Mean patient age and gestational age was 33.5 years and 6.7 weeks, respectively. Mean blood loss was 24 mL. The mean serum human chorionic gonadotropin level was 10,950, 4065, and 959 mIU/mL on the day of operation and postoperative days 1 and 4, respectively. CONCLUSION Laparoscopic management of interstitial pregnancy using a large amount of highly diluted vasopressin is safe and effective in hemostasis with minimal blood loss and no complications.
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Tamarit G, Lonjedo E, González M, Tamarit S, Domingo S, Pellicer A. Combined use of uterine artery embolization and local methotrexate injection in interstitial ectopic pregnancies with poor prognosis. Fertil Steril 2010; 93:1348.e1-4. [DOI: 10.1016/j.fertnstert.2009.03.087] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2009] [Revised: 03/12/2009] [Accepted: 03/24/2009] [Indexed: 10/19/2022]
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Moawad NS, Mahajan ST, Moniz MH, Taylor SE, Hurd WW. Current diagnosis and treatment of interstitial pregnancy. Am J Obstet Gynecol 2010; 202:15-29. [PMID: 20096253 DOI: 10.1016/j.ajog.2009.07.054] [Citation(s) in RCA: 165] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2009] [Revised: 07/04/2009] [Accepted: 07/20/2009] [Indexed: 01/01/2023]
Abstract
The incidence of interstitial pregnancy is rising. Traditional treatment with laparotomy, hysterectomy, or cornual wedge resection is associated with high morbidity and detrimental effects on future fertility. A diverse array of alternate treatments has been introduced over the last 3 decades, with the common goal of achieving a minimally invasive, standardized management strategy. This has been facilitated by impressive strides towards prompt diagnosis, both radiologically and chemically. In this review, we explore the current state of the art diagnostic criteria and the clinically significant diverse therapeutic options with supporting literature. Finally, we propose a structured, best-practice management plan for the once-lethal interstitial pregnancy, based on the current literature.
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Affiliation(s)
- Nash S Moawad
- Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Hospital of the University of Pittsburgh Medical Center, PA, USA.
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22
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Moon HS, Koo JS. The outcomes of pregnancy following laparoscopic cornuotomy for interstitial pregnancy. Fertil Steril 2009; 92:e24; author reply e25. [PMID: 19646593 DOI: 10.1016/j.fertnstert.2009.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2009] [Revised: 04/03/2009] [Accepted: 04/03/2009] [Indexed: 11/29/2022]
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23
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Trivedi AN, Roman J. A case report of a laparoscopically treated cornual pregnancy as a result of spontaneous conception after prior salpingectomy for tubal pregnancy. J OBSTET GYNAECOL 2009; 18:602-3. [PMID: 15512197 DOI: 10.1080/01443619866534] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
- A N Trivedi
- Department of Obstetrics and Gynaecology, Waikato Hospital, Hamilton, New Zealand
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Choi YS, Eun DS, Choi J, Shin KS, Choi JH, Park HD. Laparoscopic cornuotomy using a temporary tourniquet suture and diluted vasopressin injection in interstitial pregnancy. Fertil Steril 2009; 91:1933-7. [DOI: 10.1016/j.fertnstert.2008.02.013] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2007] [Revised: 02/04/2008] [Accepted: 02/04/2008] [Indexed: 11/27/2022]
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Su CF, Tsai HJ, Chen GD, Shih YT, Lee MS. Uterine rupture at scar of prior laparoscopic cornuostomy after vaginal delivery of a full-term healthy infant. J Obstet Gynaecol Res 2008; 34:688-91. [DOI: 10.1111/j.1447-0756.2008.00908.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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27
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Tratamiento médico del embarazo ectópico instersticial: descripción de un caso clínico. ACTA ACUST UNITED AC 2007. [DOI: 10.1016/s0304-5013(07)73171-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Deruelle P, Closset E, Lions C, Lucot JP. Conservation de la fertilité après embolisation sélective d'une grossesse cornuale. ACTA ACUST UNITED AC 2006; 34:914-6. [PMID: 16979367 DOI: 10.1016/j.gyobfe.2006.06.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2006] [Accepted: 06/05/2006] [Indexed: 11/22/2022]
Abstract
Subsequent pregnancy following an interstitial pregnancy is rare. The risk of uterine rupture may be increased in this situation. Uterine selective embolization has been proposed as an effective treatment. However, no further pregnancy has ever been described after this method of management. We are reporting a case of subsequent pregnancy following interstitial pregnancy managed by embolization. The pregnancy was uneventful. A healthy male infant was delivered by C-section. This case supports the hypothesis that selective embolization for interstitial pregnancy may respect fertility. However, as actual risk of uterine rupture in subsequent pregnancies remains unknown, a C-section is advised.
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Affiliation(s)
- P Deruelle
- Clinique d'obstétrique, hôpital Jeanne-de-Flandre, CHRU de Lille, 1, rue Eugène-Avinée, 59037 Lille cedex, France.
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Deruelle P, Closset E. Management of Interstitial Pregnancy Using Selective Uterine Artery Embolization. Obstet Gynecol 2006; 107:427-8. [PMID: 16449137 DOI: 10.1097/01.aog.0000199425.78203.e4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Jaeger C, Reich A, Kreienberg R, Flock F. Suitable laparoscopic surgery in the treatment of ectopic interstitial pregnancy. ACTA ACUST UNITED AC 2005. [DOI: 10.1007/s10397-005-0151-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Deruelle P, Lucot JP, Lions C, Robert Y. Management of Interstitial Pregnancy Using Selective Uterine Artery Embolization. Obstet Gynecol 2005; 106:1165-7. [PMID: 16260556 DOI: 10.1097/01.aog.0000164070.13978.87] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Interstitial pregnancy is a rare and dangerous form of ectopic pregnancy which is treated by surgery, medical treatment, or both. Management options are not standardized. Currently, conservative nonsurgical treatment seems to be an alternative method in case of interstitial pregnancy. CASE A right interstitial pregnancy was diagnosed in a 28-year-old woman. She was successfully treated by 2 courses of systemic methotrexate (1 mg/kg) 24 hours apart followed by selective uterine artery embolization. The postembolization course was uneventful, and no rupture occurred. Ten weeks after embolization, human chorionic gonadotropin level was negative. CONCLUSION Uterine embolization associated with methotrexate can be used successfully in treating selected cases of early interstitial pregnancy. We hypothesize that this procedure combined with methotrexate could reduce hemorrhagic risk.
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Affiliation(s)
- Philippe Deruelle
- Service de Gynécologie, Hôpital Jeanne de Flandre, Universitaire de Lille, France.
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Grimbizis GF, Tsalikis T, Mikos T, Zepiridis L, Athanasiadis A, Tarlatzis BC, Bontis JN. Case report: Laparoscopic treatment of a ruptured interstitial pregnancy. Reprod Biomed Online 2004; 9:447-51. [PMID: 15511347 DOI: 10.1016/s1472-6483(10)61282-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Interstitial pregnancy is a rare but life-threatening condition. A case of a 28-year-old woman with a partially ruptured interstitial pregnancy treated with operative laparoscopy is presented. A laparoscopic cornual resection and a left salpingectomy were performed uneventfully. Serum beta-human chorionic gonadotrophin concentrations were measured serially at weekly intervals until resolved on day 20 postoperatively. It seems, therefore, that laparoscopic treatment is still an effective option for management even in ruptured interstitial pregnancy, preserving the anatomical integrity of the uterus and future fertility, and that rupture of interstitial ectopic pregnancy is not a contra-indication for laparoscopy.
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Affiliation(s)
- Grigoris F Grimbizis
- 1st Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Greece, Tsimiski 51, 546 23 Thessaloniki, Greece.
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Tulandi T, Al-Jaroudi D. Interstitial Pregnancy: Results Generated From the Society of Reproductive Surgeons Registry. Obstet Gynecol 2004; 103:47-50. [PMID: 14704243 DOI: 10.1097/01.aog.0000109218.24211.79] [Citation(s) in RCA: 166] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To summarize management of interstitial pregnancy and its outcome among 32 reported cases in the world. METHODS From 1999 to 2002, 32 cases of interstitial pregnancy were reported to the registry of the Society of Reproductive Surgeons. The participants completed a five-page questionnaire regarding when and how diagnosis was made, the characteristics of the pregnancy, treatment modalities, and subsequent reproductive outcome. RESULTS History of ipsilateral salpingectomy was encountered in 37.5% of patients, and the diagnosis was made by ultrasound in 71.4% of the patients. Eight women were treated with methotrexate either systemically (n = 4), locally under ultrasound guidance (n = 2), or under laparoscopic guidance (n = 2). Eleven patients were treated by laparoscopy and 13 by laparotomy. Three patients failed systemic methotrexate treatment and subsequently required surgery. Persistently elevated serum beta human chorionic gonadotropin levels were found in one patient after laparoscopic cornual excision, and she was successfully treated with methotrexate. Fourteen cases (43.7%) of rupture of interstitial pregnancy were found. This included five cases (15.6%) of heterotopic pregnancy; all were the results of in vitro fertilization, and all ruptured at the time of diagnosis. Subsequent pregnancy was achieved in ten patients. No uterine rupture was encountered during pregnancy or labor. CONCLUSION Ipsilateral salpingectomy, previous ectopic pregnancy, and in vitro fertilization are predisposing factors for interstitial pregnancy. Contrary to previous belief, rupture of interstitial pregnancy occurs relatively early in pregnancy. In selected patients, laparoscopic cornual excision is a viable treatment option.
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Affiliation(s)
- Togas Tulandi
- Department of Obstetrics and Gynecology, McGill University, Montreal, Quebec, Canada.
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Moon HS, Choi YJ, Park YH, Kim SG. New simple endoscopic operations for interstitial pregnancies. Am J Obstet Gynecol 2000; 182:114-21. [PMID: 10649165 DOI: 10.1016/s0002-9378(00)70499-6] [Citation(s) in RCA: 105] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Our aim was to report a new approach of endoscopic management (endoloop and encircling suture methods) for interstitial or cornual pregnancy and to determine the safety and effectiveness of these procedures and their effects on subsequent pregnancies. STUDY DESIGN This is an uncontrolled retrospective review of 24 patients treated for interstitial pregnancies through endoscopic operations with 14 to 72 months of follow-up at a large urban medical center. Blood loss, operation time, changes of serum human chorionic gonadotropin levels, the resumption of menstruation, and subsequent pregnancy after operation were analyzed. RESULTS Among 24 interstitial pregnancies, 3 had ruptured at the time of operation and 21 had not ruptured. Treatment consisted of either the vasopressin and electric cauterization method, the endoloop before evacuation of the conceptus method, or the encircling suture before evacuation of the conceptus method. The blood loss and operation time (mean +/- SD) for unruptured cases were 133 +/- 134 mL and 51.6 +/- 7.6 minutes in the vasopressin and electric cauterization group (n = 3), 32 +/- 22 mL and 28.5 +/- 6.4 minutes in the endoloop group (n = 15), and 40 +/- 17 mL and 35.0 +/- 5.0 minutes in the encircling suture group (n = 3). In 3 patients with ruptured pregnancy treated with the endoloop method, the blood loss and operation time (mean +/- SD) were 1100 +/- 854 mL and 82.5 +/- 51.6 minutes. Any of these operative methods resulted in rapid decline of serum human chorionic gonadotropin levels within 1 week with the exception of 1 case, in which the endoloop method was used; this patient needed additional treatment with methotrexate. Seventeen patients desired pregnancy in the future, and 15 eventually became pregnant. One of these 15 pregnancies ended in an ectopic pregnancy on the opposite side 6 months after the interstitial pregnancy. Three ended in a spontaneous abortion, and 11 were delivered by elective cesarean section at term before labor started. Operative records of cesarean section in 8 patients delivered at our institution showed little or no adhesions or defect in the cornual area of the previous operation. CONCLUSION The endoloop method and the encircling suture method are simple, safe, effective, and nearly bloodless. There were no uterine ruptures in the pregnancies subsequent to these methods of endoscopic management.
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Affiliation(s)
- H S Moon
- Department of Obstetrics and Gynecology, Center for Reproductive Medicine and Laparoscopic Surgery, Moon Hwa Hospital
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Abstract
OBJECTIVE To review the definition and diagnosis of interstitial and heterotopic interstitial pregnancy and to evaluate the conservative management of these conditions. DESIGN A MEDLINE computer search was used to identify relevant studies. The mean values for the duration of amenorrhea, serum beta-hCG level, size of the ectopic mass, and success rates of the various treatment modalities were calculated from the raw data in the original publications. RESULT(S) A review of 41 patients with interstitial pregnancy who were treated with methotrexate systemically, locally, or in combination revealed an overall success rate of 83%. The mean duration of amenorrhea, mean serum beta-hCG level, and mean size of the ectopic mass were 54 days, 15,127 mIU/mL, and 23 mm, respectively. Among 22 patients with interstitial pregnancy who were treated with conservative laparoscopic techniques, the overall success rate was 100%. In this group, the mean duration of amenorrhea, mean serum beta-hCG level, and mean size of the ectopic mass were 54 days, 7,572 mIU/mL, and 31 mm, respectively. There were nine cases of heterotopic interstitial pregnancy. Seven patients were managed with potassium chloride injected into the ectopic pregnancy, and two patients were treated by laparoscopy. Overall, 67% of the coexisting intrauterine pregnancies resulted in successful deliveries and the remainder ended in spontaneous abortions. CONCLUSION(S) Cornual resection or hysterectomy with a laparotomy should no longer be the first line of treatment for a hemodynamically stable patient with an interstitial pregnancy. In selected cases, methotrexate and laparoscopy can be used successfully in treating early interstitial pregnancy.
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Affiliation(s)
- S Lau
- Department of Obstetrics and Gynecology, McGill University, Montreal, Quebec, Canada
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Michael AM, Awad HH. Medical termination of interstitial ectopic pregnancy using methotrexate and mifipristone. J OBSTET GYNAECOL 1999; 19:324. [PMID: 15512317 DOI: 10.1080/01443619965282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Wilkinson C, Petrucco O, Pachulicz M, Furness M. Interstitial ectopic pregnancy--management with laparoscopically-guided local methotrexate infiltration. Aust N Z J Obstet Gynaecol 1998; 38:434-7. [PMID: 9890227 DOI: 10.1111/j.1479-828x.1998.tb03105.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This case describes the use of ultrasound to diagnose an interstitial ectopic pregnancy and the subsequent management and ultrasound follow-up. Interstitial pregnancy is a rare but potentially life-threatening complication of pregnancy. Management options depend upon the timing of diagnosis, and the desire for maintenance of fertility. Methotrexate injection, under ultrasonographic or laparoscopic guidance, seems to be the management of choice when the ectopic is diagnosed at an early stage.
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Affiliation(s)
- C Wilkinson
- Department of Perinatal Medicine, Women's and Children's Hospital, North Adelaide, South Australia
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Abstract
Uterine rupture is extremely rare in the absence of any of the commonly recognized risk factors. We describe here a case of incomplete uterine rupture in a woman in her first pregnancy who had no previous instrumentation to the genital tract. Her only significant history was that of 2 episodes of minor antepartum haemorrhage occurring prior to induction of labour with artificial rupture of membranes and intravenous oxytocin. The rupture was manifested by 450 mL blood in the peritoneal cavity when an emergency Caesarean section was performed for persistent fetal bradycardia.
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Affiliation(s)
- M M Chin
- Queen Elizabeth Hospital, Woodville, South Australia
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Laird E. Spontaneous uterine rupture during subsequent pregnancy following non-excision of an interstitial ectopic gestation. BRITISH JOURNAL OF OBSTETRICS AND GYNAECOLOGY 1994; 101:1024-5. [PMID: 7999715 DOI: 10.1111/j.1471-0528.1994.tb13059.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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