Laparoscopic Management of Interstitial Pregnancy and Fertility Outcomes after Ipsilateral Salpingectomy â€“ Three Case Reports

Manea, Cristina; Pavlidou, Evangelia; Urias, Aline Andrey; Joliniere, J. Bouquet De; Dubuisson, Jean; Féki, Anis

doi:10.3389/fsurg.2014.00034

Cited by 13 publications

(10 citation statements)

References 33 publications

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“…How to evaluate the risk of uterine rupture at second trimester? Since there was only one report of a pregnancy that occurred 2 months after surgery for interstitial pregnancy, 1 no one knows the outcome of this patient's pregnancy (including uterine rupture). We had had many discussions with patients since it might be unethical to continue pregnancy in cases where uterine rupture is life threatening.…”

Section: Discussionmentioning

confidence: 99%

“…There exists no consensus on the duration of contraception needed after surgery for interstitial tubal pregnancies. Table 1 illustrates the outcomes of pregnancies after surgery for interstitial tubal pregnancies 1–4 . Some reports on pregnancies after surgery for interstitial tubal pregnancies have been published, but only a few of them have included the time of pregnancy.…”

Section: Discussionmentioning

confidence: 99%

“…Table 1 illustrates the outcomes of pregnancies after surgery for interstitial tubal pregnancies. [1][2][3][4] Some reports on pregnancies after surgery for interstitial tubal pregnancies have been published, but only a few of them have included the time of pregnancy.…”

Section: Discussionmentioning

confidence: 99%

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Threatened uterine rupture following laparoscopic surgery in interstitial tubal pregnancy

Arakaki

Mekaru

Shimoji

et al. 2020

J of Obstet and Gynaecol

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Contraception is recommended for a certain period following a hysterotomy; however, no consensus exists on the required duration of contraception. A 21‐year‐old female was brought to the emergency room in a state of shock due to intraperitoneal bleeding. An emergency laparoscopic cornuostomy indicated for ruptured interstitial pregnancy was performed. Despite contraception, the patient got pregnant 1.5 months after surgery. At 16 weeks of gestation, threatened uterine rupture was suspected, as magnetic resonance imaging (MRI) revealed hematogenous amniotic fluid and a subchorionic hematoma near the interstitial portion of the fallopian tube. An MRI at 21 weeks showed hematoma shrinkage and disappearance of the hematogenous amniotic fluid. At 37 weeks, an elective cesarean section was performed, which resulted in a live birth. Pregnancy shortly after surgery is a risk factor for uterine rupture. In such cases, MRI could be useful in the evaluation of threatened uterine ruptures.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Threatened uterine rupture following laparoscopic surgery in interstitial tubal pregnancy

Arakaki

Mekaru

Shimoji

et al. 2020

J of Obstet and Gynaecol

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“…[ 7 14 ] Elective LSCS after laparoscopic cornual resection is strongly recommended by most studies to reduce the risk of uterine rupture in labor. [ 11 15 ] In our study, three women were monitored closely and delivered through elective cesarean section at 37–38-week period of amenorrhea. There was no case of uterine ruptured or dehiscence reported.…”

Section: Discussionmentioning

confidence: 99%

Comparative study on surgical outcomes between laparoscopic and open cornuotomy in urban tertiary center of Malaysia

Ghazali¹,

Abidin²,

Muda³

et al. 2018

Gynecol Minim Invasive Ther

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Study Objective:The objective of the study was to evaluate the prevalence of interstitial ectopic pregnancy and to compare the surgical outcomes of laparoscopic cornuotomy (LC) and laparotomy (open) cornuotomy (OC) of cornual ectopic pregnancy and to analyze its associated factors.Materials and Methods:A cross-sectional study was conducted involving cases of interstitial ectopic in Hospital Putrajaya, Putrajaya, Malaysia, over a 10-year period (2005–2014). Data on sociodemographic, clinical profile, perioperative, and postoperative were obtained from the electronic medical records.Measurement and Main Results:The prevalence of cornual pregnancy was 4.0% (n = 14) out of total 347 cases of all ectopic pregnancies in Putrajaya Hospital. The mean ± standard deviation age of patient in the LC group and OC group was 29.3 ± 5.9 years and 31.4 ± 7.3 years, respectively. The duration of hospitalization and mean operating time were both significantly shorter in the LC group than in the OC group (1.43 ± 0.54 versus 2.57 ± 0.79 and 61.4 ± 15.7 min versus 97.1 ± 38.2 min, respectively, P < 0.05).There were no statistically significant differences between both groups for the estimated blood loss, requirement of blood transfusion, complications, and future fertility.ConclusionLaparoscopic cornual resection (cornuotomy) is a safe and less invasive procedure with a comparable complication rate. It has shown that it is feasibility and should be considered as initial treatment in managing those cases in trained hand surgeons.

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“…She had a withdrawal bleeding 3 weeks after the operation and had another period 5 weeks later. A waiting period of at least 6 months [10,11] was advised to allow maximal healing of the uterus. She conceived 8 months after the IP in the first IVF cycle.…”

Section: Two Casesmentioning

confidence: 99%

Elective uterine artery embolization prior to laparoscopic resection of interstitial pregnancy: two cases and literature review

et al. 2018

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Background: Interstitial pregnancies (IP) can be treated medically or surgically. The most common complication remains hemorrhage. The risk of that may be reduced by elective uterine artery embolization (UAE) prior to surgery, which we applied in two consecutive cases with high vascularization on ultrasound. We also reviewed larger series (n ≥ 10) on medical as well as surgical management of IP on success and complication rates and reviewed the entire literature on UAE. Results: A gravida 5 (two ectopic pregnancies treated by salpingectomy) para 1 (cesarean section complicated by a niche, earlier repaired) presented with an asymptomatic IP. Primary treatment consisted of systemic methotrexate (MTX). Because of raising β-hCG and persisting heart activity 1 week later, she was referred for surgery (β-hCG = 59,000 IU/L; CRL = 10.5 mm). Another gravida 5 para 3 presented with an asymptomatic evolutive IP on dating ultrasound. Because of the size (CRL = 24.5 mm), thin overlaying myometrium, and high β-hCG (121,758 IU/L), we opted for primary surgery. Both IPs were highly vascularized with high flow rates. To prevent bleeding, a bilateral UAE was performed. The surgery was nearly bloodless. In the literature, a wide range of treatment regimens for IP is reported. Larger series report a success rate of 76% for primary systemic MTX, 88% for primary local medical treatment, and 94% for primary surgery. It was not possible to determine reliable hemorrhage or rupture rates following MTX administration. As to laparoscopic surgery, the blood transfusion rate for bleeding was 9% while the conversion rate for hemorrhage was 2%. The use of UAE to reduce the risk for hemorrhage before (n = 2) or after (n = 19) MTX administration was reported in 21 cases. This failed in two cases (90% success rate), and one patient required transfusion (5%). Two cases treated with UAE and primary surgery were reported, yet the exact indication for embolization was not elaborated. Alternative hemostatic techniques during surgical management have been proposed to reduce blood loss and operating time, yet individual outcomes were not identifiable. Conclusion: We report on the use of elective UAE prior to laparoscopic resection of IP, because of signs of strong vascularization on ultrasound. This strategy coincided with a nearly bloodless operation. Literature review suggests that this is one of the effective methods to reduce blood loss intra-operatively.

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Laparoscopic Management of Interstitial Pregnancy and Fertility Outcomes after Ipsilateral Salpingectomy â€“ Three Case Reports

Cited by 13 publications

References 33 publications

Threatened uterine rupture following laparoscopic surgery in interstitial tubal pregnancy

Threatened uterine rupture following laparoscopic surgery in interstitial tubal pregnancy

Comparative study on surgical outcomes between laparoscopic and open cornuotomy in urban tertiary center of Malaysia

Elective uterine artery embolization prior to laparoscopic resection of interstitial pregnancy: two cases and literature review

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