Laparoscopic Uterine Vessels Occlusion for the Treatment of Interstitial Pregnancy

Abstract

Interstitial pregnancy is a rare form of ectopic pregnancy, but it results in significant maternal morbidity and mortality. In this paper, describe a case of interstitial pregnancy that was successfully managed by laparoscopic occlusion of the ipsilateral ascending branch of uterine artery and the communication of the ovarian artery. It would help to minimize the active bleeding and allow removing the gestation sac, placental tissue, and repair the interstitial tube. In this case, the operative bleeding was 80 mL only, and the operative time was 70 minutes. The patient shared good postoperative recovery, and serum beta human chorionic gonadotropin decreased to below normal levels within 1 month after the operation. This procedure should be considered as a treatment option for unruptured interstitial pregnancy and may allow for conserving the patient's uterus and fallopian tube and preserving the future fertility.

Laparoscopic temporary clipping of uterine and ovarian arteries for the treatment of interstitial ectopic pregnancy

“…These women want to preserve their future fertility for planning future pregnancies. Based on this patient's desire, a new technique "laparoscopic permanent occlusion of unilateral ascending branch of uterine artery and the communication of the ovarian artery" was described by Cheng et al They suggested that this technique may minimize blood loss and allow treating interstitial ectopic pregnancy conservatively [9]. The present authors believe that the permanent closure of uterine artery may interfere with the future fertility potential by decreasing the blood supply of uterus.…”

Laparoscopic systemic devascularization of uterine cornu for cornual resection in interstitial pregnancy

“…It may also cause angina, myocardial infarction, hypertension and bradycardia ( 4 ) . Occlusion of the ascending branch of the uterine artery may be performed to decrease bleeding, ( 6 ) although it might not be completely successful ( 4 ) . Other methods reported to control bleeding are suture loop tourniquets, stapler or endoloop ( 7 ) .…”

Use of Transvaginal Ultrasound in the Management of an Interstitial Pregnancy

“…Methods described include injection of vasopressin into the myometrium below the cornual bulge, 4 preemptive placement of sutures beneath the pregnancy, 5 the use of an automatic stapler, 6 and ligation of the ascending branch of the uterine artery. 7 Suture closure of the uterine defect is the primary method of attaining hemostasis and helps decrease the risk for uterine rupture in an ensuing pregnancy. 1 small, a distinct bulge may not be obvious, making it difficult to determine the location to make the hysterotomy.…”