Comparison of laparoscopic and open approach in the treatment of heterotopic pregnancy following embryo transfer

Abstract

PurposeHeterotopic pregnancy (HP) is a rare disease with the coexistence of an intrauterine and ectopic embryos. There is no consensus on the optimal treatment of HP at present. This research aimed to compare the perioperative and pregnancy outcomes of laparoscopic (LA) and open approach (OA) in patients with HP after embryo transfer.MethodsWomen with HP receiving surgical treatment (LA or OA) were retrospectively recruited in this study between October 2006 and December 2020. The demographic, perioperative and obstetric data were collected and compared between LA and OA group.ResultsTotally, 86 patients were included in this study. Among these patients, 62 underwent LA and 24 underwent OA. There was an increase in the adoption of LA between the 2006–2012 period and the 2013–2020 period [25% (6/24) vs. 90% (56/62), p < 0.001]. Compared with OA, patients treated by LA had much less blood loss [20 (10–50) vs. 30 (20–50) ml, p = 0.036] and fewer days of hospital stay [5.0 (4.0–7.3) vs. 9.5 (7–15.3) days, p < 0.001], but a relatively higher cost (15,580 ± 3196¥ vs. 11,717 ± 3820¥, p < 0.001). During the laparoscopic procedure, no one needed to be converted to open surgery. However, the rates of first trimester miscarriage, preterm, cesarean section, birth weight, 1- and 5-min Apgar were similar between LA and OA group (all p > 0.05).ConclusionsCompared with open approach, laparoscopy was shown to provide a comparable pregnancy outcomes and a better performance on perioperative outcomes in the treatment of HP patients with embryo transfer.

The risk factors for miscarriage of viable intrauterine pregnancies in patients with heterotopic pregnancy after surgical intervention

“…A growing body of literature has demonstrated that treating the extrauterine pregnancy via invasive surgery has no effect on the risk of miscarriage of the concomitant alive IUP. [17–20] Our study showed that the average pregnancy loss rate for HP within 2 weeks of surgery was 12.3% (13/106), which was similar to the 12% to 17% miscarriage rate reported in previous studies. [1,11,13,21,22] Moreover, considering that spontaneous abortion occurs in 11% to 65% of viable IUPs, surgical intervention for HP is considered safe and does not augment the risk factors for miscarriage of viable IUPs in patients with HP.…”

Fetal Reduction by Potassium Chloride Infusion in Unruptured Heterotopic Pregnancy: A Comprehensive Review

“…Expectant management has also been noted as a strategy to avoid potential complications related to surgery, with the transabdominal sonographic-guided aspiration of ectopic gestational embryos identified as having the best maternal outcome [ 13 ]. Furthermore, laparoscopic surgery has been reported as a safe and effective treatment for removing ectopic pregnancy without compromising the IUP [ 50 ]. These diverse findings contribute valuable insights into the nuanced considerations in managing multifetal pregnancies and HP, highlighting the importance of tailored approaches based on individual cases.…”

“…Depending on the specific clinical scenario, KCl dosing is subject to variation. For intravenous administration, the infusion rate should generally not exceed 10-20 mmol per hour, with higher rates potentially necessitating cardiac monitoring [49][50][51]. It is imperative to administer KCl via a volumetric infusion pump, and regular checks of the infusion site for redness and inflammation are recommended.…”

Spontaneous heterotopic pregnancy

“…În general, este recunoscut faptul că factorul de risc pentru apariția SH include: boli inflamatorii ale organelor pelvine, proces aderențial în bazinul mic, hidrosalpinx, antecedente de sarcini tubare, intervenții chirurgicale la trompele uterine, TRA [3,7,17]. Odată cu utilizarea pe scară largă a TRA, s-a observat că transferul de embrioni multipli este considerat un factor de risc major pentru apariția SH [18,19]. În același timp, ≈ 30% dintre pacientele cu SH nu au avut factori de risc [1,2,16].…”

“…(2020) au sugerat că evoluția normală a sarcinii intrauterine se observă indiferent de metodele de rezolvare a sarcinii ectopice -laparotomie sau laparoscopie [6]. Dovada acestei concluzii a fost un studiu din China, unde, la compararea intervențiilor laparoscopice (n=62) și laparotomice (n=24) pentru SH, s-a constatat că rata de finalizare a unei sarcini intrauterine cu o naștere cu copil viu a fost de 94% față de 96%, respectiv [19] . Cu toate acestea, într-un studiu realizat de Li J. și coaut., (2020), frecvența întreruperii sarcinii intrauterine după laparotomie a fost zero, după intervenții laparoscopice 22.2%, ceea ce a permis autorilor să spună că laparoscopia poate fi considerată ca un factor de risc potențial pentru avortul spontan [30].…”