Interstitial Pregnancy: A ‘Road Map' of Surgical Treatment Based on a Systematic Review of the Literature

Abstract

An electronic search concerning the surgical approach in cases of interstitial pregnancy from January 2000 to May 2013 has been carried out. Fifty three studies have been retrieved and included for statistical analysis. Conservative and radical surgical treatments in 354 cases of interstitial pregnancy are extensively described. Hemostatic techniques have been reported as well as clinical criteria for the medical approach. Surgical outcome in conservative versus radical treatment were similar. When hemostatic techniques were used, lower blood losses and lower operative times were recorded. Conversion to laparotomy involved difficulties in hemostasis and the presence of persistent or multiple adhesions. Laparoscopic injection of vasopressin into the myometrium below the cornual mass was the preferred approach.

Early Diagnosis of Interstitial Pregnancy Associated to Assisted Reproductive Techniques Case Report

“…However, diagnostic suspicion should be made in patients with known risk factors and those who undergo assisted reproductive techniques with serial biochemical and ultrasonography controls, since early treatment allows more conservative treatments that reduce the morbidity and mortality rate. Diagnosis is accomplished by quantifying the beta fraction of the human chorionic gonadotropin, vaginal ultrasonography and sometimes even laparoscopy [9][10][11]. The "interstitial line" sign, part of the Trish criteria for ultrasound diagnosis was originally described by Ackerman (Table 2) [9,[11][12][13].…”

“…Furthermore, patients who are submitted to any of these treatments should undergo caesarean section because of the risk of uterine rupture [7,8,13,14]. As first line of treatment, the Royal College of Obstetricians and Gynaecologists (RCOG) recommends methotrexate in patients with hCG-β <5000 UI/mL and ectopic pregancy smaller than 3.5 cm to 4 cm [9,10] and minimal symptoms. However, in this case, because of the hCG-β levels and presence of cardiac activity, a surgical approach was preferred.…”

Robotic versus laparoscopic sacrocolpopexy for apical prolapse: a case-control study

“…We analyzed 20 patients undergone to sacrocolpopexy for symptomatic apical prolapse performed with robotic approach by one surgical team experienced in gynaecological (6)(7)(8) and laparoscopic surgery (9, 10) with appropriately training and mentoring in robotic surgery. Data on age, body mass index (BMI), medical history (11), surgery type and timing, blood loss, morbidity, hospital stay and readmission rate were collected and compared with a selected sample of 20 patients with equivalent characteristics treated with laparoscopic approach by the same team.…”

Novel laparoscopic cornual resection of interstitial pregnancy using the Endo GIA™ Universal Stapler (Medtronic): A series of 12 cases

“…Laparoscopic surgical techniques comprise cornual resection and cornuostomy (with or without salpingectomy), the latter involving a dorsal incision using diathermy, followed by removal of the pregnancy and insertion of haemostatic stitches. Intra‐operative bleeding remains a crucial issue necessitating laparoscopic suturing skills, and several haemostatic techniques have been reported in the literature, including the use of endoscopic loop and placement of an encircling suture.…”