Successful expectant management for a cornual heterotopic pregnancy

Sentilhes, Loïc; Bouet, Pierre‐Emmanuel; Gromez, Alexis; Poilblanc, Mathieu; Lefebvre-Lacœuille, C.; Descamps, Philippe

doi:10.1016/j.fertnstert.2008.09.072

Cited by 35 publications

(47 citation statements)

References 9 publications

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“…Thus, early diagnosis is very important. However, the diagnosis of cornual HP is not simple or easy [1,4,6]. The ultrasonographic findings of the cornual HP in this patient showed two gestational sacs.…”

Section: Discussionmentioning

confidence: 70%

“…The risk factors for HP are endometriosis, periadnexal adhesion, tubal surgeries, and ART procedures that include a transfer near the uterine horn, excessive pressure in the syringe during transfer, and an excessive number of transferred embryos [1,3,4]. A HP should be considered in women who have had ART, whose chorionic gonadotropin level increases continuously after dilatation and curettage or spontaneous abortion, whose uterine fundus is larger than predicted for menstrual dates, who have more than one corpus luteum in a natural conception, or in whom vaginal bleeding is absent in the presence of signs and symptoms of ectopic gestation [5].…”

Section: Discussionmentioning

confidence: 99%

“…In particular, the biggest advantage of vaginal ultrasonographic guided drug administration is that anesthesia and surgery can be avoided. However, surgical treatment has to be used in cases where there is a risk of excessive bleeding if the ectopic mass ruptures, where abnormal location makes access for drug administration difficult, or where intrauterine gestation is close [4,7]. In addition, a cornual HP should be treated to maintain a normal intra-uterine pregnancy.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, systemic methotrexate injection or potassium chloride (KCl) injection into the cornual sac or the fetal heart by a hysteroscopic approach are difficult to perform. Surgical treatment of a cornual HP include laparotomic or laparoscopic cornual resection, and cornuostomy [4]. A laparoscopic cornual resection has advantages such as short recovery time, less need for antibiotics and analgesics, and fewer surgical wounds compared with a laparotomic cornual resection [8].…”

Section: Discussionmentioning

confidence: 99%

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A live birth after laparoscopic cornual resection for cornual heterotopic pregnancy after IVF-ET

Lee

Eom

Koh

et al. 2012

Korean J Obstet Gynecol

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A 28-year-old Korean woman with a history of both salpingectomies due to two prior tubal pregnancies at other institutions conceived a heterotopic cornual pregnancy after in vitro fertilization-embryo transfer. The patient was referred to the emergency department with an abrupt onset of lower abdominal pain at the 7th gestational week. We performed an emergent laparoscopic right cornual resection. The subsequent antenatal course was unremarkable. There were no obstetric or surgery-related complications. The patient delivered a healthy baby of 3,340 g via Cesarean section due to failure to progress at term. Copyright © 2012. Korean Society of Obstetrics and GynecologyHeterotopic pregnancy (HP) is a rare complication of pregnancy in which intra-uterine and extra-uterine gestation occur simultaneously. The prevalence rate of HP is as rare as 1 in 30,000 natural gestations but increases to 1 in 100 pregnancies in women who have undergone an assisted reproductive technology (ART) procedure [1]. The incidence of cornual HP is estimated to be as high as 1 in 3,600 in vitro fertilization (IVF) pregnancies [2]. Cornual HP has a high risk of uterine rupture and is difficult to diagnose early. The main issue in the treatment of a cornual HP is to be as minimally invasive as possible to preserve the developing intrauterine pregnancy. We report the case of a cornual heterotopic pregnant woman who delivered a healthy baby after a successful laparoscopic cornual resection for a cornual HP that developed after the women underwent IVF-embryo transfer (ET). Case ReportA 28-year-old Korean woman, gravida 2, para 0, underwent IVF-ET because she had undergone two prior salpingectomies for tubal pregnancies at other centers. She was referred to the emergency department because she had experienced an abrupt onset of lower abdominal pain at the 7th gestational week. At initial presentation, her vital signs were stable and physical examination of the abdomen presented lower abdominal tenderness and rebound tenderness. A transvaginal ultrasonogram showed free fluid in the cul-de-sac and two gestational sacs (Fig. 1). One gestational sac was present in the right cornual area and the other was in the uterine cavity. Two separate yolk sacs and fetal parts were noted in each gestational sacs, but there were no fetal heart tones. We performed emergent laparoscopic surgery including right cornual resection. To minimize exposure of the fetus to anesthetic agents, general anesthesia was started after completion of the preparations of all laparoscopic surgical instruments and operation-related procedures. After the trocar was inserted, carbon dioxide pressure was CASE REPORT Korean J Obstet Gynecol 2012;55(8):610-613 http://dx

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Section: Discussionmentioning

confidence: 70%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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A live birth after laparoscopic cornual resection for cornual heterotopic pregnancy after IVF-ET

Lee

Eom

Koh

et al. 2012

Korean J Obstet Gynecol

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“…Proper and early diagnosis decreases the intra-and postoperative complications [8]. The ectopic pregnancy is usually tubal but could be ovarian, cervical, cornual or abdominal.…”

Section: Discussionmentioning

confidence: 99%

Heterotopic Pregnancy with Tubal Rupture Accompanied with Severe Anemia: Case Presentation

Papamargaritis¹,

Sofoudis²,

Kotsonis³

et al. 2015

Int J Gynecol Clin Pract

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Ruptured ectopic pregnancy represents an emergency gynecological procedure. Performing the major cause of maternal death among first trimester pregnancies. Although the mortality incidence decreases, the incidence of ectopic pregnancy is constantly increasing. The simultaneously existence of endometrial and ectopic pregnancy represent a rare condition requiring specific treatment. In cases with severe anemia an urgent management is mandatory. We present a case of heterotopic pregnancy with tubal rupture accompanied with severe anemia successfully surgically treated.

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Heterotopic Interstitial Pregnancy: Early Ultrasound Diagnosis of 179 Cases After In Vitro Fertilization‐Embryo Transfer

Cai

Ouyang

2022

J of Ultrasound Medicine

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Objectives-What is the role of transvaginal sonography (TVS) in the early diagnosis of hectopic interstitial pregnancy (HIP) after in vitro fertilization-embryo transfer (IVF-ET)?Methods-A retrospective observational study was conducted from January 2005 to December 2018. Routine two-dimensional and three-dimensional TVS were used to confirm clinical pregnancy. Women were diagnosed with HIP when an intrauterine gestational sac was combined with an extrauterine chorionic sac, which was at least 1 cm away from the uterine cavity and surrounded by a thin myometrial layer (<5 mm). Surgery and pathology results were the gold standard for diagnosing interstitial pregnancy. Non-surgical patients were excluded from the study. The performance of TVS and the pregnancy outcomes of intrauterine pregnancies (IUPs) were evaluated.Results-A total of 97,161 women underwent IVF treatment and TVS examinations in our hospital during this study. Of these, 194 patients were diagnosed with HIP, with an incidence of 0.2% (194/97,161). Surgical and pathological findings confirmed 179 interstitial pregnancies, of which 174 were diagnosed by TVS, 4 were missed, and 1 was misdiagnosed. The sensitivity of TVS diagnosis was 97.8% and the positive predictive value was 99.4%. The mean time to diagnosis was 31 days after transplantation. One hundred and thirty-nine cases of HIP (77.7%) were diagnosed at the time of initial TVS examination. In 132 patients (73.7%), IUPs resulted in live births.Conclusions-In our practice, most HIPs following IVF-ET can be accurately diagnosed by TVS, which facilitates early management of interstitial pregnancies and enables high live birth rates for IUPs.

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Successful expectant management for a cornual heterotopic pregnancy

Cited by 35 publications

References 9 publications

A live birth after laparoscopic cornual resection for cornual heterotopic pregnancy after IVF-ET

A live birth after laparoscopic cornual resection for cornual heterotopic pregnancy after IVF-ET

Heterotopic Pregnancy with Tubal Rupture Accompanied with Severe Anemia: Case Presentation

Heterotopic Interstitial Pregnancy: Early Ultrasound Diagnosis of 179 Cases After In Vitro Fertilization‐Embryo Transfer

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