1
|
Mraihi F, Buzzaccarini G, D’Amato A, Laganà AS, Basly J, Mejri C, Hafsi M, Chelli D, Ghali Z, Bianco B, Barra F, Etrusco A. Cornual Pregnancy: Results of a Single-Center Retrospective Experience and Systematic Review on Reproductive Outcomes. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:186. [PMID: 38276065 PMCID: PMC10819158 DOI: 10.3390/medicina60010186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 01/14/2024] [Accepted: 01/18/2024] [Indexed: 01/27/2024]
Abstract
Background and Objectives: Cornual pregnancies (CPs) are rare forms of ectopic pregnancy. When abortion does not occur, it can be a life-threatening condition for the mother and can also impair future fertility. We present our experience in the diagnosis and management of CPs. A systematic review was also conducted to investigate the reproductive outcomes after treatment. Materials and Methods: Between January 2010 and December 2022, we performed a retrospective, cross-sectional, single-center, and descriptive data collection and analysis (ClinicalTrial ID: NCT06165770). The search for suitable articles published in English was carried out using the following databases (PROSPERO ID: CRD42023484909): MEDLINE, EMBASE, Global Health, The Cochrane Library (Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and Cochrane Methodology Register), Health Technology Assessment Database, Web of Science, and search register such as ClinicalTrial. Only studies describing the impact of CP treatment on fertility were selected. Results: Two studies were included in the systematic review. Seventeen patients suffering from CPs were selected. In our series, a pelvic ultrasound allowed for the diagnosis of a cornual localization in 35.30% of cases. Thirteen women (76.47%) underwent immediate surgical management. The laparoscopic approach was the most used (76.92%), with a laparotomic conversion rate of 30%. Four patients (23.52%) received medical treatment with methotrexate. After treatment, two patients managed to achieve pregnancy. Conclusions: CP is a rare form of ectopic pregnancy that can quickly become life-threatening for the mother. Ultrasound does not lead to a precise diagnosis in all cases. In the absence of complications and emergencies, laparoscopy is an approach that could be considered valid. For selected asymptomatic patients, medical treatment may be a valid alternative. The data from the studies included in the systematic review, although demonstrating a superiority of medical treatment in terms of future pregnancies, are heterogeneous and do not allow us to reach a definitive conclusion.
Collapse
Affiliation(s)
- Fathi Mraihi
- Gynecology and Obstetrics Unit “D”, Maternity and Neonatology Center, Tunis University Hospital, Tunis 1001, Tunisia; (F.M.); (J.B.); (C.M.); (M.H.); (D.C.); (Z.G.)
| | - Giovanni Buzzaccarini
- Department of Obstetrics and Gynecology, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, 20132 Milan, Italy;
| | - Antonio D’Amato
- 1st Unit of Obstetrics and Gynecology, Department of Interdisciplinary Medicine, University of Bari, 70124 Bari, Italy;
| | - Antonio Simone Laganà
- Unit of Obstetrics and Gynecology, “Paolo Giaccone” Hospital, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy;
| | - Jihene Basly
- Gynecology and Obstetrics Unit “D”, Maternity and Neonatology Center, Tunis University Hospital, Tunis 1001, Tunisia; (F.M.); (J.B.); (C.M.); (M.H.); (D.C.); (Z.G.)
| | - Chaima Mejri
- Gynecology and Obstetrics Unit “D”, Maternity and Neonatology Center, Tunis University Hospital, Tunis 1001, Tunisia; (F.M.); (J.B.); (C.M.); (M.H.); (D.C.); (Z.G.)
| | - Montasar Hafsi
- Gynecology and Obstetrics Unit “D”, Maternity and Neonatology Center, Tunis University Hospital, Tunis 1001, Tunisia; (F.M.); (J.B.); (C.M.); (M.H.); (D.C.); (Z.G.)
| | - Dalenda Chelli
- Gynecology and Obstetrics Unit “D”, Maternity and Neonatology Center, Tunis University Hospital, Tunis 1001, Tunisia; (F.M.); (J.B.); (C.M.); (M.H.); (D.C.); (Z.G.)
| | - Zaineb Ghali
- Gynecology and Obstetrics Unit “D”, Maternity and Neonatology Center, Tunis University Hospital, Tunis 1001, Tunisia; (F.M.); (J.B.); (C.M.); (M.H.); (D.C.); (Z.G.)
| | - Bianca Bianco
- Discipline of Sexual and Reproductive Health and Populational Genetics, Department of Collective Health, Faculdade de Medicina do ABC/Centro Universitário FMABC, Santo André 09060-870, SP, Brazil;
| | - Fabio Barra
- Unit of Obstetrics and Gynecology, P.O. “Ospedale del Tigullio”-ASL4, Via G. B. Ghio 9, Metropolitan Area of Genoa, 16043 Chiavari, Italy;
- Department of Health Sciences (DISSAL), University of Genoa, Via Antonio Pastore 1, 16132 Genova, Italy
| | - Andrea Etrusco
- Unit of Obstetrics and Gynecology, “Paolo Giaccone” Hospital, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy;
| |
Collapse
|
2
|
Zhang Y, Chen X, Lin Y, Lian C, Xiong X. Study on diagnosis and management strategies on heterotopic pregnancy: a retrospective study. J OBSTET GYNAECOL 2023; 43:2152660. [PMID: 36534044 DOI: 10.1080/01443615.2022.2152660] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Heterotopic pregnancy (HP) is a rare but potentially life-threatening event with a high risk of maternal death, which also jeopardise the coexisting intrauterine pregnancy (IUP), thus an early accurate diagnosis and prompt treatment can decrease adverse complications. We aimed to explore the early predictors for pregnancy outcomes of HP. We reviewed patients with HP following assisted reproductive technology in our institution between January 2013 and December 2020. The relationships between pregnancy outcomes and clinical features were analysed by logistic regression. We found that 29 patients (72.5%) of HP were accurately diagnosed by transvaginal ultrasonography (TVS). Eighteen patients in the surgery group had live births, three of whom delivered preterm. Additionally, the miscarriage rate was lower for patients with IUP cardiac activity than those without (16.7% vs. 90.0%, p < .001). Further by logistic regression analysis, an IUP with cardiac activity at HP diagnosis was identified as favourable independent predictor of live birth (p < .001). Therefore, early diagnosis and prompt surgical intervention are recommended to prevent the development of HP.Impact of statementWhat is already known on this subject? Heterotopic pregnancy (HP) has long been thought to be a rare but potentially life-threatening event with a high risk of complications. The early diagnosis of HP is challenging due to the co-existence of a viable intrauterine pregnancy (IUP) and the absence of typical clinical symptoms.What do the results of this study add? This stduy showed that symptoms combined with routine transvaginal ultrasonography (TVS) scans reduce the rates of misdiagnosis of HP and prompt surgical intervention after diagnosis may minimise the incidence of miscarriage of the IUP.What are the implications of these findings for clinical practice and/or further research? An IUP with cardiac activity at HP diagnosis is a predictor of a favourable prognosis of HP, and laparoscopy under general anaesthesia is effective and safe during the first trimester of pregnancy. Awareness, assessment and early interventions in view of symptoms combined with routine TVS is recommended to reduce the risk of miscarriage and ensure a favourable live birth rate.
Collapse
Affiliation(s)
- Yan Zhang
- Department of Obstetrics and Gynecology, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Xiujuan Chen
- Department of Obstetrics and Gynecology, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Yuan Lin
- Department of Obstetrics and Gynecology, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Chengying Lian
- Department of Obstetrics and Gynecology, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Xiumei Xiong
- Department of Obstetrics and Gynecology, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| |
Collapse
|
3
|
Li X, Cai P, Ouyang Y, Gong F. Heterotopic Interstitial Pregnancy: Early Ultrasound Diagnosis of 179 Cases After In Vitro Fertilization-Embryo Transfer. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:915-922. [PMID: 36173144 DOI: 10.1002/jum.16103] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 09/09/2022] [Accepted: 09/10/2022] [Indexed: 06/16/2023]
Abstract
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.
Collapse
Affiliation(s)
- Xihong Li
- Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha City, China
- Clinical Research Centre For Reproduction and Genetics in Hunan Province, Changsha City, China
| | - Pei Cai
- Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha City, China
- Clinical Research Centre For Reproduction and Genetics in Hunan Province, Changsha City, China
| | - Yan Ouyang
- Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha City, China
- Clinical Research Centre For Reproduction and Genetics in Hunan Province, Changsha City, China
| | - Fei Gong
- Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha City, China
- Clinical Research Centre For Reproduction and Genetics in Hunan Province, Changsha City, China
| |
Collapse
|
4
|
Chen S, Zhu Y, Xie M. Comparison of laparoscopic and open approach in the treatment of heterotopic pregnancy following embryo transfer. Front Surg 2022; 9:1006194. [PMID: 36386500 PMCID: PMC9663481 DOI: 10.3389/fsurg.2022.1006194] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 10/06/2022] [Indexed: 01/25/2023] Open
Abstract
PURPOSE Heterotopic pregnancy (HP) is a rare disease with the coexistence of an intrauterine and ectopic embryos. There is no consensus on the optimal treatment of HP at present. This research aimed to compare the perioperative and pregnancy outcomes of laparoscopic (LA) and open approach (OA) in patients with HP after embryo transfer. METHODS Women with HP receiving surgical treatment (LA or OA) were retrospectively recruited in this study between October 2006 and December 2020. The demographic, perioperative and obstetric data were collected and compared between LA and OA group. RESULTS Totally, 86 patients were included in this study. Among these patients, 62 underwent LA and 24 underwent OA. There was an increase in the adoption of LA between the 2006-2012 period and the 2013-2020 period [25% (6/24) vs. 90% (56/62), p < 0.001]. Compared with OA, patients treated by LA had much less blood loss [20 (10-50) vs. 30 (20-50) ml, p = 0.036] and fewer days of hospital stay [5.0 (4.0-7.3) vs. 9.5 (7-15.3) days, p < 0.001], but a relatively higher cost (15,580 ± 3196¥ vs. 11,717 ± 3820¥, p < 0.001). During the laparoscopic procedure, no one needed to be converted to open surgery. However, the rates of first trimester miscarriage, preterm, cesarean section, birth weight, 1- and 5-min Apgar were similar between LA and OA group (all p > 0.05). CONCLUSIONS Compared with open approach, laparoscopy was shown to provide a comparable pregnancy outcomes and a better performance on perioperative outcomes in the treatment of HP patients with embryo transfer.
Collapse
Affiliation(s)
- Shengfu Chen
- Department of Obstetrics and Gynecology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yingying Zhu
- Clinical Research Design Division, Clinical Research Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China,Correspondence: Meiqing Xie Yingying Zhu
| | - Meiqing Xie
- Department of Obstetrics and Gynecology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China,Correspondence: Meiqing Xie Yingying Zhu
| |
Collapse
|
5
|
Delgado SI, Koythong T, Guan X. Minimally invasive surgical management of a cornual ectopic pregnancy, with and without a concurrent intrauterine pregnancy. Fertil Steril 2021; 116:1189-1190. [PMID: 34233842 DOI: 10.1016/j.fertnstert.2021.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 05/25/2021] [Accepted: 06/03/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To describe techniques for resection of a cornual heterotopic pregnancy. DESIGN This video demonstrates a surgical technique for excision of a cornual heterotopic pregnancy with narrative video footage using two case examples. SETTING The incidence of cornual heterotopic pregnancy is unknown; however, the incidence of heterotopic pregnancy itself has increased through the use of assisted reproductive technologies and the majority of cornual heterotopic pregnancies occur after assisted reproductive technologies use. These cases have been treated traditionally using exploratory laparotomy and cornual wedge resection with good outcomes. With advancements in minimally-invasive surgical techniques, laparoscopic resection of cornual heterotopic pregnancies has been demonstrated to be safe and feasible. PATIENT(S) A patient with an 8-week cornual heterotopic pregnancy and a patient with a 10-week cornual ectopic pregnancy. INTERVENTIONS Laparoscopic resection of the cornual ectopic pregnancy. MAIN OUTCOME MEASURE(S) Feasibility of a "purse-string" technique for the resection of a heterotopic cornual pregnancy. RESULT(S) Robotic-assisted laparoscopic resection of a cornual heterotopic pregnancy can be performed with minimal blood loss with the use of the "purse-string" technique in settings where vasopressin cannot be used for hemostasis. This technique includes the use of a 2-0 V-Loc suture in a circumferential fashion around the ectopic pregnancy, which allows for faster suturing and immediate tension at the myometrium. The same suture is then used to close the defect, which allows for a simpler and efficient closure with minimal entry into the myometrium. CONCLUSION(S) In this video, we demonstrate the successful resection of cornual heterotopic pregnancy using a "purse-string" surgical technique. This technique allows for minimal blood loss in cases where additional techniques for hemostasis cannot be used, such as injection of vasopressin and uterine artery ligation.
Collapse
Affiliation(s)
- Stephanie I Delgado
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
| | - Tamisa Koythong
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
| | - Xiaoming Guan
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas.
| |
Collapse
|
6
|
Košec V, Čukelj M, Djaković I, Butorac D. UTERINE RUPTURE IN THIRD TRIMESTER OF PREGNANCY FOLLOWING CORNUAL RESECTION DUE TO ECTOPIC PREGNANCY. Acta Clin Croat 2021; 60:153-155. [PMID: 34588737 PMCID: PMC8305347 DOI: 10.20471/acc.2021.60.01.23] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 12/20/2017] [Indexed: 11/24/2022] Open
Abstract
Uterine rupture during pregnancy is a critical obstetric complication associated with maternal and fetal mortality and morbidity. The risk is increased in patients with a history of previous uterine surgery including cesarean section, myomectomy, salpingectomy, as well as uterine and placental anomalies and polyhydramnios. It can also occur spontaneously. We present a case of uterine rupture in the early third trimester in a woman who had undergone previous laparoscopic removal of the left fallopian tube due to sactosalpinx and laparotomic removal of left uterine horn due to ectopic pregnancy.
Collapse
Affiliation(s)
| | - Marijo Čukelj
- Department of Gynecology and Obstetrics, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Ivka Djaković
- Department of Gynecology and Obstetrics, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Dražan Butorac
- Department of Gynecology and Obstetrics, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| |
Collapse
|
7
|
Management of interstitial pregnancy in the era of laparoscopy: a meta-analysis of 855 case studies compared with traditional techniques. Obstet Gynecol Sci 2021; 64:156-173. [PMID: 33539687 PMCID: PMC7990998 DOI: 10.5468/ogs.20299] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 12/27/2020] [Indexed: 11/08/2022] Open
Abstract
Interstitial pregnancy is a rare, life-threatening condition that requires high clinical suspicion for diagnosis. Most cases are discovered after complications have occurred. Many authors have described laparoscopic management. Although previous systematic reviews have compared the attributes and complications associated with interstitial pregnancy, we endeavored to complete the first systematic review and meta-analysis to compare the laparoscopic treatment of interstitial pregnancy with the open approach in the modern age of laparoscopic surgery. We systematically searched PubMed, ClinicalTrials.gov, Scopus, Web of Science, and Cochrane until June 2020 using relevant keywords and screened them for eligibility. We found a statistically significant difference in blood loss between laparoscopic and open surgery (168 mL compared to 1,163 mL). Further, cumulative meta-analysis has revealed that blood loss in laparoscopy has been decreasing over time from 1991 to 2020. Laparoscopic patients took less operative time (63.2 minutes) compared to laparotomy patients (78.2 minutes). Patients in the laparoscopic group spent less time hospitalized (3.7 days) compared to laparotomy patients (5.2 days). Our findings add strength to the position that laparoscopic approaches to interstitial pregnancy can be considered first-line in most situations. The laparoscopic approach was found to have a mean blood loss of 168 mL, and this blood loss seems to decrease over time. Increased gravidity and duration of amenorrhea are positive factors that increase bleeding during the procedure. We are unable to find enough high-quality data to significantly compare successful pregnancy following surgery or risk of mortality in these populations.
Collapse
|
8
|
Shang J, Peng R, Zheng J, Lin M. The indicator of clinical outcomes for patients with heterotopic pregnancy following in-vitro fertilization with embryo transfer. Taiwan J Obstet Gynecol 2020; 58:827-832. [PMID: 31759536 DOI: 10.1016/j.tjog.2019.09.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2019] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE To explore the early predictors for pregnancy outcomes in patients with heterotopic pregnancy (HP) following in-vitro fertilization with embryo transfer (IVF-ET). MATERIAL AND METHODS This retrospective study reviewed 81 patients with HP following IVF-ET in our institution between January 2003 and September 2017. The relationships between clinical outcomes and general characteristics, sonographic features and different management options were analyzed by logistic regression analysis. RESULTS The gestational age at the time of diagnosis was 50.9 ± 12.3 days. Among these cases, 76 were accurately diagnosed by TVS, 1 was misdiagnosed as adnexal torsion by TVS, and 4 were confirmed to have IUPs after the surgical treatment. Hence, the sensitivity of TVS for detecting HP was 93.8% (76/81). However, forty-seven patients (58.0%) had suspected HP when they underwent the initial TVS. Among these patients, live births occurred for 60 patients, 11 of whom delivered preterm. The miscarriage rate was 58.3% (14/24) for patients without IUP cardiac activity at HP diagnosis, and 12.3% (7/57) for patients with IUP cardiac activity; a significant correlation was identified (χ2 = 18.651, P < 0.001). Additionally, the abortion rate of patients following fresh non-donor embryo was higher than patients after frozen-thawed embryo (χ2 = 10.437, P = 0.001). Further by logistic regression analysis, patients following frozen-thawed embryo and an IUP with cardiac activity at HP diagnosis were identified as two independent factors of pregnancy outcome. (OR = 0.060, 95%CI = 0.008-0.471, P = 0.007; OR = 0.010, 95%CI = 0.001-0.124, P<0.001). CONCLUSIONS Patients following frozen-thawed embryo and an IUP with cardiac activity at HP diagnosis could be the independent predictors for a favorable prognosis.
Collapse
Affiliation(s)
- Jianhong Shang
- Department of Ultrasonic Medicine, Fetal Medical Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
| | - Ruan Peng
- Department of Ultrasonic Medicine, Fetal Medical Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ju Zheng
- Department of Ultrasonic Medicine, Fetal Medical Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Meifang Lin
- Department of Ultrasonic Medicine, Fetal Medical Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| |
Collapse
|
9
|
Li YY, Duan LY, Chi FL, Li KM. Transvaginal Reduction of a Heterotopic Cornual Pregnancy with Conservation of Intrauterine Pregnancy. ACTA ACUST UNITED AC 2020; 34:221-225. [PMID: 31601305 DOI: 10.24920/003485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Here we report a case of heterotopic cornual pregnancy after in vitro fertilization who was diagnosed at 6 weeks after frozen embryos transfer. The heterotopic pregnancy was successfully terminated by transvaginal ultrasound-guided selective fetal reduction. At 38+1 weeks, she underwent a cesarean section and delivered a healthy 3300 g male infant with Apgar score of 10-10' evaluated at 1 min and 5 min.
Collapse
Affiliation(s)
- Ying-Ya Li
- Center of Reproductive Medicine, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai 201204, China
| | - Li-Yan Duan
- Center of Reproductive Medicine, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai 201204, China
| | - Feng-Li Chi
- Center of Reproductive Medicine, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai 201204, China
| | - Kun-Ming Li
- Center of Reproductive Medicine, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai 201204, China
| |
Collapse
|
10
|
Interstitial Pregnancy after Ipsilateral Salpingectomy: Analysis of 46 Cases and a Literature Review. J Minim Invasive Gynecol 2019; 27:613-617. [PMID: 31589932 DOI: 10.1016/j.jmig.2019.04.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 04/09/2019] [Accepted: 04/29/2019] [Indexed: 11/24/2022]
Abstract
STUDY OBJECTIVE To investigate the relationship between previous ipsilateral salpingectomy and interstitial pregnancy and report on our experience of laparoscopic cornuostomy for interstitial pregnancy. DESIGN Single-center, retrospective review. SETTING University-based hospital. PATIENTS All patients who had undergone ipsilateral salpingectomy previously, diagnosed with interstitial pregnancy and treated between July 2010 and September 2018. INTERVENTIONS Laparoscopy or laparotomy as a treatment for interstitial pregnancy after ipsilateral salpingectomy. MEASUREMENTS AND MAIN RESULTS A total of 414 cases of interstitial pregnancy were identified, of which 46 (11.1%) were after ipsilateral salpingectomy. Of the 46 patients, 20 (43.5%) became pregnant by in vitro fertilization and embryo transfer. Ipsilateral salpingectomy was the result of an ectopic pregnancy in 40 patients, hydrosalpinx in 5 patients, and torsion of an ovarian tumor in 1 patient. The laparoscopic approach was used to treat 78.3% of patients with history of previous salpingectomy. Patients who underwent ipsilateral salpingectomy by laparoscopy previously had a shorter interval from salpingectomy to interstitial pregnancy (24 months vs 60 months; p = .038) compared with patients who underwent ipsilateral salpingectomy by laparotomy. Laparoscopic cornuostomy was performed in 38 patients (82.6%); 12 had fetal cardiac activity, 15 had ruptured masses, and 16 used prophylactic methotrexate (MTX) intraoperatively. The median size of the ectopic mass was 2.5 cm (1.0-5.0 cm). At the time of laparoscopic cornuostomy, more patients with interstitial pregnancies with intact ectopic masses were administered prophylactic MTX (81.3% vs 45.5%; p = .043). Only 1 patient with a ruptured ectopic mass, high preoperative human chorionic gonadotropin levels, and without prophylactic MTX administration experienced a persistent ectopic pregnancy. CONCLUSION Patients with a history of ipsilateral salpingectomy should be cautioned regarding the possibility of interstitial pregnancy. Laparoscopic cornuostomy appears to be an appropriate treatment for interstitial pregnancy in patients wishing to preserve fertility, and the use of concomitant prophylactic MTX may reduce the risk of persistent ectopic pregnancy, especially in patients with ruptured masses and high human chorionic gonadotropin levels.
Collapse
|
11
|
Kwon B, Kang S, Lee HJ, Kim M, Lee YH, Im J, Moon MJ, Ahn EH, Kim YR. Non-surgical management and obstetric outcomes of heterotopic interstitial pregnancies. MINIM INVASIV THER 2019; 29:375-379. [PMID: 31432733 DOI: 10.1080/13645706.2019.1653924] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: To assess the effectiveness and safety of non-surgical management for six heterotopic interstitial pregnancies.Material and methods: We retrospectively analyzed the data of six women diagnosed with heterotopic interstitial pregnancies who underwent non-surgical treatment at the CHA Bundang Medical Center between January 2007 and December 2017. Three heterotopic interstitial pregnancies were treated with sono-guided potassium chloride (KCl) injections. Two cases were managed expectantly. One heterotopic quadruplet pregnancy with twin, left interstitial, and tubal pregnancy was treated by sono-guided KCl injection and laparoscopic left salpingectomy. Complications and outcomes were measured.Results: Three cases were treated with sono-guided KCl injection and the intrauterine pregnancy continued to term. Intrauterine pregnancies were vaginally delivered without complications. One case that was treated expectantly was delivered at full term, while the other case resulted in spontaneous abortion. Quadruplet heterotopic pregnancy was successfully managed with sono-guided KCl injection and laparoscopic salpingectomy. Intrauterine twin pregnancy was successfully delivered by elective cesarean section at 37 + 0 weeks of gestation with healthy babies. Conclusions: KCl injection under ultrasonographic guidance could be a safer and more effective treatment option than surgical treatment in hemodynamically stable patients with fetal cardiac activity in interstitial pregnancy. Expectant management could be an option for patients with no fetal cardiac activity.
Collapse
Affiliation(s)
- Boram Kwon
- Department of Obstetrics and Gynecology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Sukho Kang
- Department of Obstetrics and Gynecology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Hyun Jung Lee
- Department of Obstetrics and Gynecology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Migang Kim
- Department of Obstetrics and Gynecology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Yoon Hee Lee
- Department of Obstetrics and Gynecology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Jisun Im
- Department of Obstetrics and Gynecology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Myoung Jin Moon
- Department of Obstetrics and Gynecology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Eun Hee Ahn
- Department of Obstetrics and Gynecology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Young Ran Kim
- Department of Obstetrics and Gynecology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| |
Collapse
|
12
|
Prevention, diagnosis, and management of interstitial pregnancy: A review of the literature. LAPAROSCOPIC, ENDOSCOPIC AND ROBOTIC SURGERY 2019. [DOI: 10.1016/j.lers.2018.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
|
13
|
Laparoscopic management of an ectopic pregnancy after in vitro fertilization and embryo transfer at CHRACERH: A case report. LAPAROSCOPIC, ENDOSCOPIC AND ROBOTIC SURGERY 2018. [DOI: 10.1016/j.lers.2018.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
|
14
|
Jiang Y, Chen J, Zhou H, Zheng M, Han K, Ling J, Zhu X, Tang X, Li R, Hong Y. Management and obstetric outcomes of 17 heterotopic interstitial pregnancies. BMC Pregnancy Childbirth 2018; 18:78. [PMID: 29587664 PMCID: PMC5870515 DOI: 10.1186/s12884-018-1700-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 03/15/2018] [Indexed: 12/19/2022] Open
Abstract
Background Heterotopic interstitial pregnancy is a rare variant of heterotopic pregnancies, and it poses challenges in treating the heterotopic pregnancy and preserving the intrauterine pregnancy. However, there is no clear consensus regarding the optimal management. The aim of this study was to investigate the pregnancy outcomes of women diagnosed with heterotopic interstitial pregnancy. Methods A total of 17 women diagnosed with heterotopic interstitial pregnancy between July 2010 and December 2015 were included. General characteristics of each patient, including age, gravidity and parity, history of pelvic inflammatory disease or surgery, and especially the corresponding therapeutic interventions, were retrospectively analyzed. Moreover, pregnancy outcomes were further followed by face-to-face interview. Results Of the 17 patients, 10 (58.5%) underwent surgical treatment (7 laparoscopic cornual resection, and 3 laparotomy); and 3 cases simultaneously terminated the intrauterine pregnancy by suction evacuation. Compared with laparotomy, laparoscopic cornual section showed shorter operative time (median 40 vs. 70 min), less blood loss (150 vs. 400 ml) and shorter hospital stay (2 vs. 4 days). In addition, 4 (23.5%) patients underwent selective embryo reduction under transvaginal ultrasound guidance. Expectant management was chosen in the remaining 3 patients. In the follow-up study, other than a case of missed miscarriage, the other 13 women who remained committed to their pregnancies all delivered healthy babies either by caesarean section or vaginal birth. No congenital anomalies were reported, and all the infants were in good growth and development. Conclusions Laparoscopic cornual resection is a feasible approach with favorable surgical and long-term pregnancy outcomes. Additionally, medical or expectant management may be a viable treatment option for selected symptom-free patient. Although the survival of the intrauterine pregnancy could not always be assured, the prognosis for a woman with heterotopic interstitial pregnancy is generally good.
Collapse
Affiliation(s)
- Yuan Jiang
- Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Nanjing Medical University, Nanjing, 210008, China.,Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, China
| | - Jie Chen
- Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Nanjing Medical University, Nanjing, 210008, China.,Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, China
| | - Huaijun Zhou
- Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Nanjing Medical University, Nanjing, 210008, China.,Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, China
| | - Mingming Zheng
- Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, China
| | - Ke Han
- Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, China
| | - Jingxian Ling
- Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, China
| | - Xianghong Zhu
- Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, China
| | - Xiaoqiu Tang
- Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, China
| | - Rong Li
- Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, China
| | - Ying Hong
- Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Nanjing Medical University, Nanjing, 210008, China. .,Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, China.
| |
Collapse
|
15
|
Xu W, Lin X, Huang D, Zhang S. Laparoscopic treatment of cornual heterotopic pregnancy: A retrospective cohort study. Int J Surg 2018; 53:98-102. [PMID: 29555532 DOI: 10.1016/j.ijsu.2018.03.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 02/27/2018] [Accepted: 03/02/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To report on our experience of laparoscopic cornuostomy or cornual repair for cornual heterotopic pregnancy. STUDY DESIGN A single center, retrospective review of patients who were diagnosed as cornual heterotopic pregnancy, which developed after in vitro fertilization and embryo transfer (IVF/ET) between January 2009 and June 2014. All patients were managed by laparoscopic cornuostomy or cornual repair. RESULTS 14 patients were enrolled and 4 patients were finally confirmed to have a ruptured cornu. 4/4 presented as acute abdominal pain and 3/4 as metrorrhagia. The blood pressure of all the patients were stable. The earliest ruptured patient of this series happened at 23 days after IVF/ET. The hemoglobin levels of the 4 ruptured patients were significantly lower than the other patients (8.6 ± 1.8 g/dl versus 12.2 ± 1.1 g/dl, p < 0.001). Internal bleeding before operation was significantly higher in the ruptured patients than in the intact patients (1050.0 ± 369.8 ml versus 0.0 ± 0.0 ml, p < 0.001). All 14 patients were managed by laparoscopic cornuostomy or cornual repair. No one was converted to laparotomy. Post-operation pregnancy was uneventful. All neonates were delivered by cesarean section with no evident complications. CONCLUSION Laparoscopic cornuostomy or cornual repair appears to be an effective treatment for cornual heterotopic pregnancy, even in ruptured ones. These operations can be safely performed in an institution with well-trained gynecological laparoscopists with experienced support teams.
Collapse
Affiliation(s)
- Wenzhi Xu
- Assisted Reproduction Unit, Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, No. 3 East Qing Chun Road, Hangzhou, 310016, PR China
| | - Xiaona Lin
- Assisted Reproduction Unit, Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, No. 3 East Qing Chun Road, Hangzhou, 310016, PR China
| | - Dong Huang
- Assisted Reproduction Unit, Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, No. 3 East Qing Chun Road, Hangzhou, 310016, PR China
| | - Songying Zhang
- Assisted Reproduction Unit, Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, No. 3 East Qing Chun Road, Hangzhou, 310016, PR China.
| |
Collapse
|
16
|
Lyu J, Ye H, Wang W, Lin Y, Sun W, Lei L, Hao L. Diagnosis and management of heterotopic pregnancy following embryo transfer: clinical analysis of 55 cases from a single institution. Arch Gynecol Obstet 2017; 296:85-92. [DOI: 10.1007/s00404-017-4384-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 04/25/2017] [Indexed: 12/24/2022]
|