Transfemoral temporary aortic balloon occlusion in surgical treatment of second trimester intramural ectopic pregnancy

Li, Shuhong; Liu, Honjie; Li, Xiaoyan; Liu, Zhifen; Li, Yan; Li, Ning

doi:10.1111/jog.12968

Cited by 10 publications

(8 citation statements)

References 9 publications

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“…The probability of hysterectomy has decreased in recent years (75% of hysterectomy reported before the 2010s), which may be attributed to early diagnosis and progress in management. Some patients in their second trimester were treated with a combination of aorta balloon occlusion or uterine artery embolization (7,12). Hence, it may be advisable that patients with a high risk of hysterectomy develop a prearranged plan and undergo a more comprehensive preoperative evaluation and procedures such as uterine artery embolization, uterine artery ligation, and aorta balloon occlusion.…”

Section: Discussionmentioning

confidence: 99%

“…These non-specific symptoms can sometimes lead to the misdiagnosis of intramural ectopic pregnancy as myoma, or choriocarcinoma (6). Besides, in previous studies, some patients experiencing intramural ectopic pregnancies reported no discomfort (7), and even the serum β-HCG was negative in one reported case (8). Due to the rarity of intramural ectopic pregnancy, data comprising mainly of case reports on the clinical characteristics, treatment options, and subsequent fertility outcomes in patients are limited.…”

Section: Introductionmentioning

confidence: 99%

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Intramural Ectopic Pregnancy: Clinical Characteristics, Risk Factors for Uterine Rupture and Hysterectomy

Chen

Gao

et al. 2021

Front. Med.

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Background: Intramural ectopic pregnancy is defined as the gestational sac (GS) is entirely within the myometrium, separate from the endometrial cavity and fallopian tubes, which is unsustainable and potentially life-threatening. The data investigating the clinical characteristics, management strategy, and fertility outcomes after treatment of intramural ectopic pregnancies are very limited due to its extreme rarity.Methods: To investigate the clinical characteristics, treatment options, and fertility outcomes in patients with intramural ectopic pregnancy, a retrospective study included 56 patients was conducted. We also used logistic regression to identify potential risk factors for uterine rupture and hysterectomy in these patients.Results: The mean age of patients was 31.1 years, with an average gestational age (GA) of 10.0 weeks, and the majority of the patient cohort (83.9%) had uterine or endometrial surgical history. 55.4% of the intramural pregnancy was diagnosed by preoperative imaging examination and 67.7% was detected by ultrasound. There was no dominant predisposed zone of the GS. Common treatment strategies included laparotomy surgery (41.1%) and laparoscopic surgery (35.7%), followed by methotrexate (7.1%) and expectant management (5.4%). Uterine rupture occurred in 9 patients and 8 patients underwent a hysterectomy, but no maternal demise was found. Logistic regression showed that a GA >10 weeks predicted a significantly higher risk of uterine rupture (Odds ratio [OR] 8.000, 95% confidence interval [CI] 1.456–43.966, P = 0.017) and hysterectomy (OR 12.333, 95% CI 2.125–71.565, P = 0.005), and GS located in the fundus also predicted higher probability of uterine rupture (OR 7.000,95% CI 1.271–38.543, P = 0.025). Among the ten patients who had a desire for fertility, 6 of them succeeded and 4 of them successfully delivered with a GA ≥ 34 weeks.Conclusion: GA > 10 weeks was the risk factor for both uterine rupture and hysterectomy, while patients with GS located in the uterine fundus had a significantly higher risk of uterine rupture. The fertility outcomes were moderate after treatment. The management strategies should be individualized according to disease conditions and the desire for fertility, and early diagnosis is essential for optimizing clinical outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Intramural Ectopic Pregnancy: Clinical Characteristics, Risk Factors for Uterine Rupture and Hysterectomy

Chen

Gao

et al. 2021

Front. Med.

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“…Nevertheless, surgical strategy theoretically increases the danger of uterine rupture in the event of a future pregnancy. Furthermore, uterine artery embolization (UAE) and temporary balloon occlusion have been confirmed effective in embryo atrophy and absorption as well [14].…”

Section: Discussionmentioning

confidence: 99%

Intramural Pregnancy Misdiagnosed as Gestational Trophoblastic Neoplasia: Case Report and Review of the Literature

Zang¹,

Hu²

2021

Obstet Gynecol Cases Rev

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Purpose: To date, only a few cases of intramural pregnancy have been recorded. We aim to report an uncommon case of intramural pregnancy misdiagnosed as gestational trophoblastic neoplasia, emphasizing that earlier surgical intervention may contribute to timely diagnosis and precise treatment.Methods: Relevant articles published over the past five years were identified through a literature searching, and related references in those literatures were also manually searched to find additional articles.Results: Nineteen cases in total including this report were reviewed. Most patients possessed a history of intrauterine operation or uterine surgery. Diagnoses were mainly made by imageological examinations. And surgical procedure tended to be the dominant treatment of such diseases. Conclusions:Intramural pregnancy is considered to be the rarest type of ectopic gestation, where the gestational sac is completely encircled by myometrium. The non-specific clinical manifestations and non-uniform imageological criteria lead to the difficult diagnoses. However, earlier surgical management may contribute to timely diagnosis and precise treatment.

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“…Some of cases were not found until the rupture of the conception [6,10]. There are a few reports that intramyometrial pregnancy lasts longer than 12 weeks' gestation [12,[24][25][26][27]. With no early recognition and treatment, the gestational sac grows to bulge from the serosal surface of the uterus with progressive thinning of the myometrium.…”

Section: Discussionmentioning

confidence: 99%

“…The main concern with laparoscopic treatment of intramural pregnancy is the subsequent risk of uterine rupture and the recurrence of ectopic pregnancy, which happened to the patient in our case. Transfemoral temporary aortic balloon occlusion, reversible Hem-o-Lok clip occlusion of uterine artery and uterine artery embolization (UAE) have also been reported to prevent extensive bleeding [17,26,[33][34][35][36]. Nevertheless, special attention must be paid to reduce complications such as ischemia, reperfusion injury and thromboembolism [37].…”

Section: Discussionmentioning

confidence: 99%

Intramyometrial pregnancy after cryopreserved embryo transfer: a case report

Liu

2020

BMC Pregnancy Childbirth

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Background: Intramyometrial pregnancy is a rare subtype of ectopic pregnancy. The cases following IVF-ET were few reported in recent years. The etiological factors include previous uterine trauma like myomectomy, salpingectomy, dilatation and curettage, assisted reproductive technologies and adenomyosis. Early diagnosis is difficult to make due to its various manifestation. The medical treatment includes conservative management with surgical excision, aortic balloon occlusion, uterine artery embolization, MTX etc. Sometimes hysterectomy was performed due to delayed diagnosis. Case presentation: In this article, we presented a case of a 28 years old woman who had cryopreserved embryo transfer with a history of right side salpingectomy. We suspected it a right adnexa ectopic pregnancy at the first place, especially the right fallopian interstitial or right uterus cornu due to ultrasonography and medical history. The product of conception was discovered embedded in the myometrium and protruding out from the right side of the posterior uterine wall, with seemingly no connection with uterine cavity nor fallopian tubes. The diagnosis of intramural pregnancy was made intraoperatively and validated after pathological report. The interventions were made early enough that exploratory laparoscopy, hysteroscopy and conservative surgical excision were successfully performed at 7 weeks' gestation preserving the fertility. Conclusions: It is important for clinicians to be aware of risk factors of intramural pregnancy and maintain an index of suspicion in ART treatment. Ultrasound and laparoscopy are essential managements for early diagnose which make conservative treatment possible and prevent life-threatening consequences.

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Transfemoral temporary aortic balloon occlusion in surgical treatment of second trimester intramural ectopic pregnancy

Cited by 10 publications

References 9 publications

Intramural Ectopic Pregnancy: Clinical Characteristics, Risk Factors for Uterine Rupture and Hysterectomy

Intramural Ectopic Pregnancy: Clinical Characteristics, Risk Factors for Uterine Rupture and Hysterectomy

Intramural Pregnancy Misdiagnosed as Gestational Trophoblastic Neoplasia: Case Report and Review of the Literature

Intramyometrial pregnancy after cryopreserved embryo transfer: a case report

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