Disturbed Interstitial Pregnancy: A First Case of Successful Treatment Using a Mini-Laparoscopic Approach

Tantchev, Latchezar; Kotzev, Andrey; Yordanov, Angel

doi:10.3390/medicina55050215

Cited by 3 publications

(2 citation statements)

References 15 publications

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“…There is no unanimity also on the best surgical procedure for interstitial ectopic pregnancy. The evolution of minimally invasive surgery has provided us with more therapeutic options for the treatment of ectopic pregnancies [16,22]. The surgical laparotomy treatment is the only appropriate route in case of unstable hemodynamic women with a rupture suspicion or recurrent IP [3].…”

Section: Resultsmentioning

confidence: 99%

Conservative Treatment of Interstitial Ectopic Pregnancy with the Combination of Mifepristone and Methotrexate: Our Experience and Review of the Literature

Stabile

Romano

Buonomo

et al. 2020

BioMed Research International

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Introduction. Interstitial pregnancy (IP) is an ectopic pregnancy (EP) located in the portion of the fallopian tube that penetrates the uterine muscular layer. Incidence increased in the last two decades with the widespread use of the assisted reproductive techniques. It is estimated in 1-6% of all the EPs, with a maternal mortality rate of 2.0-2.5%. Clinical presentation, gestational age at diagnosis, beta-human chorionic gonadotropin (β-hCG) levels, ultrasound features, and patient preference, should be considered to determine the best management: surgical, medical treatment, or close observation. We report two cases of IP successfully managed with systemic MTX and Mifepristone: in one case β-hCG was >10.000 mIU/mL and a vital embryo was present. Materials and Methods. A literature search was carried out on MEDLINE, EMBASE, and PUBMED. We identified two cases of IP referred to the Institute for Maternal and Child Burlo Garofolo, Trieste. Data related to clinical presentation, β-hCG, and ultrasound scan at the moment of the diagnosis were recorded. In one of the cases, the β-hCG level was >10.000 mIU/mL, and a vital embryo was testified at an ultrasound scan. The patient was asymptomatic and she was treated using multidose systemic Methotrexate (MTX) combined with Mifepristone. In the second case, in the presence of a clinically stable patient with β−hCG>10.000 mIU/mL, it was chosen that the administration of Mifepristone combined with a double dose of MTX. β-hCG levels and ultrasound examinations were performed weekly until a complete resolution of the IP. Results. In the first case, β-hCG dropped down in 5 days and became undetachable in 30 days. In the second case, β-hCG became undetectable in 47 days. The first-line therapy in asymptomatic women could be addressed to a combined protocol, consisting of a systemic multidose MTX regimen with a single oral dose of Mifepristone. Conclusions. Clinical management of IP remains a debated topic. In selected cases, a systemic multidose MTX regimen combined with a single oral dose of Mifepristone could be considered also in the presence of high serum β-hCG.

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Section: Resultsmentioning

confidence: 99%

Conservative Treatment of Interstitial Ectopic Pregnancy with the Combination of Mifepristone and Methotrexate: Our Experience and Review of the Literature

Stabile

Romano

Buonomo

et al. 2020

BioMed Research International

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“…The advances in minimally invasive surgery have provided more therapeutic options for the treatment of ectopic pregnancies, including the combination of systemic and local hysteroscopic administration of MTX [ 9 , 14 , 20 , 21 , 22 , 23 , 24 ]. This is an interesting and promising approach, but this type of treatment requires both implementation in the clinics (including the equipment) and skilled gynecologists to be carried out safely.…”

Section: Discussionmentioning

confidence: 99%

Interstitial Ectopic Pregnancy—Case Reports and Medical Management

et al. 2023

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The term intramural (interstitial) ectopic pregnancy refers to a pregnancy developing outside the uterine cavity, with a gestational sac implanted into the interstitial part of the Fallopian tube, surrounded by a layer of the myometrium. The prevalence rate of interstitial pregnancy (IP) is 2–4% of all ectopic pregnancies. Surgery is the primary treatment for interstitial ectopic pregnancy; the pharmacological management of ectopic pregnancy, including IP, in asymptomatic patients includes systemic administration of methotrexate. In this report, we present two cases of this rare pregnancy type, reviewing our management technique and treatment ways presented in the literature. In our patients, the management was initially conservative and included methotrexate, administered as intravenous bolus injection, regular beta-human chorionic gonadotropins (β-HCG) level measurements in peripheral blood, and monitoring of the patient’s general condition. Due to signs of intra-abdominal bleeding in patient A and inadequate β-HCG level reduction in patient B, both patients eventually underwent laparoscopic cornual resection. Pregnancy, implanted into the interstitial part of the Fallopian tube and surrounded by myometrial tissue with myometrial invasion of the trophoblast, poses a serious diagnostic challenge to modern gynecology due to particularly low sensitivity and specificity of symptoms, and may require both pharmacological and surgical treatment.

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Ectopic Pregnancy and Its Long-Term Results

2020

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The aim: The purpose of this study was to assess the long-term outcomes of restoration of reproductive function after surgical and medical treatment of ectopic pregnancy, taking into consideration the patency of the fallopian tubes and the incidence of uterine pregnancy. Materials and methods: A two-stage experimental approach was used to address research objectives. In the first stage, a retrospective analysis of 615 histories of patients with ectopic pregnancy has been performed. In a second stage – we examined 140 patients, which were divided into three groups, depending on the type of treatment. The first group consisted of patients with a disturbed ectopic pregnancy, who were treated with laparotomy and tubectomy. The second group included patients with exacerbated ectopic pregnancy, who were operated by laparoscopic access. Lastly, the third group comprised of women with ectopic pregnancy who were treated with methotrexate. The main source of information used for clinical and anamnestic analysis was “medical card-patient” (f. 003 / o). Results: The number of patients diagnosed with ectopic pregnancy increased from 2005 to 2015. In 2005 and 2006, the laparotomy operations were 86.88% and 83.33%, but conservative management only 13,16% and 16,67%, respectively. In 2015, the number of patients treated with methotrexate was more than half (51.35%) compared with 2010 and 2005 increased to 16.97% and 38.19% respectively, and laparotomy operations decreased from 86.88% in year 2005 to 18.92% in year 2015. Conclusions: The data showed that in women who underwent medical treatment with cytostatic, the patency of the fallopian tubes was significantly better than after surgical treatment. In cases of interrupted ectopic pregnancy for which laparotomy with the removal of the motor tube was applied, infertility of tubal peritoneal genesis developed in 60% of cases, which is consistent with the existing literature. Statistical analysis of the structure of ectopic pregnancy showed that in 2005 dominated interrupted ectopic pregnancy, due to late diagnostic and hospitalisation, that led to urgent laparotomy operations rather than conservative treatment.

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Disturbed Interstitial Pregnancy: A First Case of Successful Treatment Using a Mini-Laparoscopic Approach

Cited by 3 publications

References 15 publications

Conservative Treatment of Interstitial Ectopic Pregnancy with the Combination of Mifepristone and Methotrexate: Our Experience and Review of the Literature

Conservative Treatment of Interstitial Ectopic Pregnancy with the Combination of Mifepristone and Methotrexate: Our Experience and Review of the Literature

Interstitial Ectopic Pregnancy—Case Reports and Medical Management

Ectopic Pregnancy and Its Long-Term Results

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