A systematic review of ectopic pregnancy after hysterectomy

Shao, E.; Hopper, K D; McKnoulty, Matthew; Kothari, Alka

doi:10.1002/ijgo.12385

Cited by 11 publications

(13 citation statements)

References 32 publications

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“…Although tubal disruption techniques (electrical, surgical and mechanical) have traditionally been the most common techniques for permanent contraception [3,4], total BS has gained popularity with a significant increase in performed procedures over the last decade [3,9,[18][19][20]. Pregnancy after tubal disruption techniques, ectopic pregnancy after hysterectomy and ectopic pregnancy after assisted reproductive technology following total BS has been reported [2,21,22]. A systematic review of ectopic pregnancy after hysterectomy described 57 pregnancies in the past 72 years [21].…”

Section: Discussionmentioning

confidence: 99%

“…Pregnancy after tubal disruption techniques, ectopic pregnancy after hysterectomy and ectopic pregnancy after assisted reproductive technology following total BS has been reported [2,21,22]. A systematic review of ectopic pregnancy after hysterectomy described 57 pregnancies in the past 72 years [21]. Similarly, a review of the literature described 20 cases of ectopic pregnancy following in vitro fertilization following total BS [22].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Spontaneous Pregnancy after Total Bilateral Salpingectomy: A Systematic Review of Literature

Baltus

Brown

Molakatalla

et al. 2022

Journal of Minimally Invasive Gynecology

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Spontaneous Pregnancy after Total Bilateral Salpingectomy: A Systematic Review of Literature

Baltus

Brown

Molakatalla

et al. 2022

Journal of Minimally Invasive Gynecology

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“…It has previously been reported that many of these patients who present soon after the hysterectomy procedure are often diagnosed with postoperative complications leading to a delay in the diagnosis of ectopic pregnancy. 4 …”

Section: Discussionmentioning

confidence: 99%

“…This diagnosis is often challenging as presenting symptoms are non-specific. There have been multiple reported cases in the literature of ectopic pregnancies occurring post hysterectomy, 1 , 4 , 8 , 16 with the majority occurring during the time interval directly following the procedure. 1 This case demonstrates how point-of-care ultrasound (POCUS) helped to diagnose a patient with a post-hysterectomy ectopic pregnancy.…”

Section: Introductionmentioning

confidence: 99%

Ultrasound in the Emergency Department Identifies Ectopic Pregnancy Post Hysterectomy: A Case Report

Cohen

Shi

Keraney

et al. 2022

Clinical Practice and Cases in Emergency Medicine

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Introduction: Ruptured ectopic pregnancy is one of the leading causes of maternal death. Point-of-care ultrasound (POCUS) has been shown to be highly sensitive for excluding ectopic pregnancy. Ectopic pregnancy after a hysterectomy is a rare but life-threatening occurrence. We present a case where POCUS helped to diagnose a post-hysterectomy ectopic pregnancy. Case report: A 36-year-old female with a prior surgical history of hysterectomy without oophorectomy presented to the emergency department with lower abdominal pain. A POCUS revealed free fluid in the right upper quadrant with an unremarkable gallbladder. Subsequently, the pelvic POCUS noted free fluid as well as a heterogeneous structure in the right adnexa. The clinician ordered a serum beta human chorionic gonadotropin level, which was 173.2 international units per milliliter (lU/mL) (negative: < 5m IU/ml). Transvaginal ultrasound revealed a right adnexal echogenic structure with surrounding vascularity and moderate, complex free fluid suggestive of hemorrhage. Given the concern for possible ectopic pregnancy, obstetrics took the patient to the operating room where a right tubal ectopic pregnancy was confirmed. Conclusion: A ruptured ectopic pregnancy is a life-threatening condition that requires rapid diagnosis. Ectopic pregnancy post hysterectomy is an uncommon occurrence infrequently considered in the differential diagnosis of lower abdominal pain, leading to considerable delays in diagnosis. Although uncommon, emergency clinicians must consider this diagnosis in female patients with lower abdominal pain.

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“…A histerectomia total é o procedimento cirúrgico realizado por via abdominal e/ou vaginal, que remove a totalidade uterina, culmina com a fixação e síntese integral da cúpula vaginal com os ligamentos uterinos, sem restar quaisquer pontos e/ou áreas de comunicação entre a vagina e a cavidade peritoneal. 1 Os seguimentos pós-operatórios destas pacientes podem ser longamente assintomáticos, porém, queixas e/ou raras complicações tardias na cúpula vaginal isoladas ou associadas entre si, podem surgir, como: hematomas, granulomas, queloides, herniação, formações vasculares, 2, 3 endometriose, 3 infecções focais, 4 gestação abdominal, 5 neoplasias 6 e/ou fístulas tardias entre a cavidade peritoneal e a cúpula vaginal. 3,4,6,7 A ocorrência de sangramentos irregulares ou cíclicos semelhantes a fluxos menstruais, nestas pacientes histerectomizadas são raros, podendo surgir meses ou anos após a cirurgia bem-sucedida.…”

Section: Introductionunclassified

Fístula tardia entre a cúpula vaginal pós-histerectomia total e a cavidade uterina: Revisão de literatura - relato de caso

Novo¹,

Santos²,

Oliveira³

et al. 2021

Lat. Americ. J. of Develop.

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Sangramentos irregulares ou cíclicos tardios semelhantes a fluxos menstruais, em pacientes com histerectomia total anterior são muito raros, podendo surgir meses ou anos após a cirurgia. Há poucos casos citados na literatura. Estes eventos são consequentes da associação de endometriose e fístulas com a cúpula vaginal promovendo subsequente eliminação sanguínea pela vulva. Neste estudo, há revisão da literatura pertinente à fístula tardia entre cúpula vaginal pós-histerectomia total e a cavidade abdominal. Há 4 casos descritos, aos quais associa-se o relato atual. Descreve-se paciente com 44 anos, histerectomia total há 7 anos (mioma uterino), sangramento genital tardio simulando perdas menstruais, após 2 anos de cirurgia. RNM de 11/2017 identificou volumoso endometrioma ovariano E (641,6 cm³), com fistulização peritônio-vaginal. Em 02/2018 após tentativa cirúrgica frustrada em virtude de múltiplas aderências pélvicas, e a seguir de contraceptivos orais, não resolutivas, optou-se por ser medicada com dienogeste. Fluxos sanguinolentos cessaram em 08/2018, retornaram em 01/2019. RNM de 03/2019 revelou gradual redução volumétrica do endometrioma (volume = 143 cm³), mas, não resolução deste caso. Iniciou-se, a seguir, a administração de gosserrelina (análogo sintético GnRH) por 6 meses. Retornou após tratamento com fogachos incômodos, sem sangramentos, anexo E com volume de 124 cm³, preferindo retornar tratamento com dienogeste contínuo. Apresentou-se este relato de caso pela sua extrema raridade, aliada à valorização da queixa dolorosa pélvica, associando-se aos sangramentos genitais periódicos, sugerindo conteúdos menstruais, bem como à grande dimensão do endometrioma ovariano, e, também, à condução do caso voltado para o acompanhamento direcionado a sua real patologia.

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A systematic review of ectopic pregnancy after hysterectomy

Abstract: A high index of suspicion and a low threshold for performing a β-hCG pregnancy test is recommended in all women presenting with clinical symptoms of ectopic pregnancy, regardless of the hysterectomy status. This could lead to earlier diagnosis and fewer complications.

Cited by 11 publications

References 32 publications

Spontaneous Pregnancy after Total Bilateral Salpingectomy: A Systematic Review of Literature

Spontaneous Pregnancy after Total Bilateral Salpingectomy: A Systematic Review of Literature

Ultrasound in the Emergency Department Identifies Ectopic Pregnancy Post Hysterectomy: A Case Report

Fístula tardia entre a cúpula vaginal pós-histerectomia total e a cavidade uterina: Revisão de literatura - relato de caso

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