Cornual wedge resection for interstitial pregnancy and postoperative outcome

Liao, Chi-Yuan; Tse, Jessica; Sung, Shu-Yi; Chen, Shuhui; Tsui, Wen-Huei

doi:10.1111/ajo.12497

Cited by 42 publications

(37 citation statements)

References 11 publications

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“…Although this technique may increase the incidence of persistent and recurrent interstitial pregnancy, it can potentially maintain patient fertility and decrease their risk for future uterine rupture. 11 Being at a site of rich vascular supply, measures should be taken to minimize the blood loss intraoperatively. To achieve this, intramyometrial vasopressin used intraoperatively has an extremely important role.…”

Section: Discussionmentioning

confidence: 99%

A case report on ruptured interstitial ectopic pregnancy: diagnostic dilemma

Sharma

Gokhale

Agrawal

2019

Int J Reprod Contracept Obstet Gynecol

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The ectopic pregnancy occurs when implantation of the blastocyst takes place in a site other than the endometrium of the uterine cavity. Interstitial ectopic pregnancies are gestations that implant within the proximal, intramural portion of the fallopian tubes with high vascularity. Ectopic pregnancy in the interstitial part of the fallopian tubes can be lifethreatening considering the thin myometrial tissue surrounding the gestational sac and high vascularization which may result in catastrophic haemorrhage when interstitium is ruptured. Being a hazardous type of ectopic pregnancy, it becomes extremely important to diagnose and manage it. This condition presents a challenge for clinical as well as radiological diagnosis. Generally, a case of interstitial ectopic pregnancy has typical radiological features distinguishing it from other ectopic. The ultrasonographic finding of interstitial line has better sensitivity (80%) and specificity (98%) than eccentric gestational sac location (sensitivity, 40%; specificity, 88%) and myometrial thinning (sensitivity, 40%; specificity, 93%) for the diagnosis of interstitial ectopic pregnancy. Ultrasound is the mainstay of diagnosis, but magnetic resonance imaging can be helpful in unusual or complicated cases. Interstitial ectopic pregnancy rupturing into the leaves of broad ligament and creating a tamponade effect to alter the clinical presentation is a rare event which presents as a diagnostic challenge. Here authors present a case of ruptured interstitial ectopic pregnancy confined to the leaves of broad ligament, with atypical presentation and radiological features which led to difficulty in diagnosing the interstitial ectopic pregnancy. After laparoscopic confirmation of ruptured interstitial ectopic pregnancy, the patient was managed successfully by laparoscopic cornual resection.

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Section: Discussionmentioning

confidence: 99%

A case report on ruptured interstitial ectopic pregnancy: diagnostic dilemma

Sharma

Gokhale

Agrawal

2019

Int J Reprod Contracept Obstet Gynecol

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“…Blood loss during surgery can be minimised by injecting vasopressin around the ectopic site 9. There are concerns regarding uterine rupture in this scarred uterus in future pregnancy; thus, caesarean delivery is recommended by some authors to avoid uterine rupture during labour which was found to be as high as 30% 10. It is very important to monitor the future pregnancy by serial ultrasonography to ensure its proper location and the repaired surgical area remains intact.…”

Section: Discussionmentioning

confidence: 99%

Cornual ectopic pregnancy: laparoscopic management step by step

et al. 2018

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Cornual (interstitial) ectopic pregnancy is an uncommon type of ectopic pregnancy which is located in the interstitial part of the fallopian tube. It accounts for 2%-4% of all ectopic pregnancies. Cornual pregnancies often pose a diagnostic and therapeutic challenge with a significant high morbidity and mortality as a result of massive intraperitoneal bleeding. A case of unruptured cornual ectopic pregnancy in a patient with abnormal uterine bleeding is reported which was successfully managed laparoscopically.

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“…While cornual ('wedge') resection preserves patients' future fertility, it may carry the risk of uterine rupture due to the loss of myometrium and extensive uterine scarring ([31],). Liao et al reported an incidence of subsequent uterine rupture and dehiscence after wedge resection of 30% [32]. This is considerably higher than the uterine rupture rates post myomectomies, which typically range from 0.49 to 0.70% in subsequent pregnancies [32] However, an alternate study has not shown increased risk of uterine rupture in subsequent pregnancy although, in this cohort, the caesarean rate was 60% versus 30% of patients without a history of ectopic pregnancy (P = 0.137) [33].…”

Section: Surgical Managementmentioning

confidence: 99%

“…Cornuostomy excises the IP, while preserving uterine architecture and maintaining fertility ( [34]). Cornuostomy is considered to cause less tubal damage than cornual resection and may have better pregnancy outcomes in future (including fewer cases of uterine rupture) [32]. The risk of persistent ectopic pregnancy (i.e.…”

Section: Surgical Managementmentioning

confidence: 99%

The diagnosis and management of interstitial ectopic pregnancies: a review

Brincat

Bryant‐Smith

2019

Gynecol Surg

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The objective of this article is to review the published literature on the diagnosis and management of interstitial pregnancies (IPs). IPs account for 2-6% of all ectopic pregnancies and have the potential to cause life-threatening haemorrhage resulting in a 2-5% mortality rate. There is little consensus on the best practice for diagnosing and managing interstitial pregnancies. By reviewing the published data, we set out to determine what the best evidencebased practice for the management of interstitial ectopic pregnancies is, what protocols can be used and whether this improves post-operative outcomes and future fertility rates.

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Cornual wedge resection for interstitial pregnancy and postoperative outcome

Abstract: There is debate regarding the recommended surgical technique to treat interstitial pregnancies; cornual resection and cornuotomy are both important considerations. Choice of the technique employed continues to require careful consideration.

Cited by 42 publications

References 11 publications

A case report on ruptured interstitial ectopic pregnancy: diagnostic dilemma

A case report on ruptured interstitial ectopic pregnancy: diagnostic dilemma

Cornual ectopic pregnancy: laparoscopic management step by step

The diagnosis and management of interstitial ectopic pregnancies: a review

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