A Systematic Review and Meta-analysis of Laparotomy Compared with Laparoscopic Management of Cornual Pregnancy

Abstract

Background Interstitial pregnancy is a rare but life-threatening condition accounting for 1-4% of all types of tubal ectopic pregnancies. It can be managed by open and minimally invasive surgical techniques. Our goal was to compare laparoscopic and open surgery for managing interstitial pregnancy. Search Strategy We searched PubMed, Scopus, Web of Science, and Cochrane up to May 2020. Selection Criteria 1) Women with interstitial pregnancy, 2) Intervention: laparoscopic surgery, 3) Comparator: open surgery, 4) Outcomes: Hospital stay, operation time, pain scale, blood loss. Secondary outcomes: any other reported 5) Study designs: interventional and observational. Data collection and analysis Data was extracted from the relevant articles and was pooled as mean difference (MD) or relative risk (RR) with a 95% confidence interval (CI). Main Results We included six studies, three of which provided eligible data. The duration of hospital stay was lower in the laparoscopic surgery group (MD = -1.42, 95% CI [-1.72, -0.76], P < 0.0001). There was no significant difference in operative time (MD = 5.90, 95% CI [-11.30, 23.09], P = 0.50, blood loss (MD = -9.43, 95% CI [-214.18, 195.32], P = 0.93), complications (RR = 1.54, 95% CI [0.20, 11.85], P = 0.68), or blood transfusions (RR = 0.77, 95% CI [0.50, 1.25], P = 0.30). Conclusion Laparoscopic surgery is associated with shorter hospital stay, with no difference in terms of blood loss, post-, and intraoperative complications, and need for blood transfusion compared with laparotomy.

A Case Report of Massive Intraperitoneal Hemorrhage from Rare Cornual Pregnancy

“…[1][2][3][4] Although cornual pregnancy is sometimes used interchangeably with interstitial pregnancy, the latter is distinguished by a gestational sac within the myometrium not specific to the cornual region. [1][2][3][4][5] These constitute 2-4% of all ectopic pregnancies. [5][6][7][8][9] Cornual pregnancy carries a 2.5% mortality rate but disproportionately accounts for 20% of maternal deaths from ectopic pregnancy.…”

“…[1][2][3][4][5] These constitute 2-4% of all ectopic pregnancies. [5][6][7][8][9] Cornual pregnancy carries a 2.5% mortality rate but disproportionately accounts for 20% of maternal deaths from ectopic pregnancy. 4,7,10 Compared to more common tubal pregnancies, the ability of the cornual uterine tissue to stretch allows pregnancies to progress undetected for weeks longer prior to rupture.…”

“…4,8,13 Most cited surgical cases are past this threshold, requiring either laparoscopic cornual resection or hysterectomy, although some are successfully treated with outpatient methotrexate. [4][5][6][7][8][9]13…”

“… 1 – 5 These constitute 2–4% of all ectopic pregnancies. 5 – 9 Cornual pregnancy carries a 2.5% mortality rate but disproportionately accounts for 20% of maternal deaths from ectopic pregnancy. 4 , 7 , 10 …”

Endoscopic Approach to Ectopic Pregnancy

“…The frequency of interstitial pregnancy ranges between 2 and 4% of all ectopic pregnancies, and carries a seven-fold increase in morbimortality compared with other types of tubal pregnancies; this results from the pregnancy's asymptomatic nature until weeks 7 to 16, and that is later suddenly manifested as a massive intraperitoneal hemorrhage, pain, and shock. Its incidence has increased in the past two decades as a result of pelvic inflammatory disease, assisted reproduction techniques, the use of intrauterine devices, adhesions, and previous tubal surgeries [19,20].…”