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Dabreteau T, Puchar A, Nyangoh Timoh K, Fauconnier A, Legendre G, Touboul C, Lavoué V, Thubert T, Lecarpentier E, Haddad B, Dabi Y. Interstitial pregnancy management: A multicentric analysis of 98 patients from the FRANCOGENT group comparing surgery and medical treatment. Int J Gynaecol Obstet 2024; 165:125-130. [PMID: 37937363 DOI: 10.1002/ijgo.15239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 08/29/2023] [Accepted: 10/24/2023] [Indexed: 11/09/2023]
Abstract
OBJECTIVE To evaluate the outcomes associated with each therapeutic option for patients diagnosed with interstitial pregnancy (IP). METHODS We conducted a multicentric retrospective cohort study within the departments of Gynecology and Obstetrics involved in the Francogent research group. Women treated for an interstitial pregnancy between January 2008 to December 2019 were included. Three therapeutic options were evaluated: surgical treatment (ST); in situ methotrexate combined with systemic methotrexate (IS-MTX); and systemic methotrexate (IM-MTX). Success of first-line treatment was defined by hCG negativation (<5I U/L). Secondary outcomes included the need for secondary surgical procedure, secondary medical treatment, emergency surgery, postoperative complications, duration of hospitalization, and delay before hCG negativation. RESULTS A total of 98 patients were managed for IP: 42 (42.9%) patients had IM-MTX; 34 (34.7%) had IS-MTX; and 22 (22.4%) had ST. First-line treatment was successful in all patients of the ST group (22/22, 100%), in 31% of patients within the IM-MTX group (13/42) and 70.6% (24/34) in the IS-MTX group. The sole parameter associated with the risk of treatment failure was the mode of methotrexate administration. The size of the gestational sac or the presence of fetal heartbeat was not associated with decreased medical treatment (IS or IM-MTX) efficiency. CONCLUSION Either ST or IS-MTX are good options for IP treatment associated with high success rates. A single-dose regimen of IM-MTX is less efficient than IS-MTX or ST. Symptomatic patients with severity criteria should always undergo emergency surgery. IP remains a high-risk condition that should be managed, whenever possible, in referral centers to potentialize the chances of favorable outcomes.
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Affiliation(s)
- Thomas Dabreteau
- Department of Obstetrics and Gynecology, CHI Creteil, Creteil, France
| | - Anne Puchar
- Department of Obstetrics and Gynecology, Tenon Hospital, AP-HP, Sorbonne University, Paris, France
| | | | - Arnaud Fauconnier
- Department of Obstetrics and Gynecology, Intercommunal Hospital of Poissy/Saint-Germain-en-Laye, Poissy, France
| | - Guillaume Legendre
- Department of Obstetrics and Gynecology, Angers University Hospital, Angers, France
| | - Cyril Touboul
- Department of Obstetrics and Gynecology, Tenon Hospital, AP-HP, Sorbonne University, Paris, France
| | - Vincent Lavoué
- Department of Obstetrics and Gynecology, Rennes University Hospital, Rennes, France
| | - Thibault Thubert
- Department of Obstetrics and Gynecology, Nantes University Hospital, Nantes, France
| | | | - Bassam Haddad
- Department of Obstetrics and Gynecology, CHI Creteil, Creteil, France
| | - Yohann Dabi
- Department of Obstetrics and Gynecology, Tenon Hospital, AP-HP, Sorbonne University, Paris, France
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Ungureanu CO, Stanculea FC, Iordache N, Georgescu TF, Ginghina O, Mihailov R, Vacaroiu IA, Georgescu DE. Ruptured Recurrent Interstitial Ectopic Pregnancy Successfully Managed by Laparoscopy. Diagnostics (Basel) 2024; 14:506. [PMID: 38472978 DOI: 10.3390/diagnostics14050506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 02/13/2024] [Accepted: 02/16/2024] [Indexed: 03/14/2024] Open
Abstract
Ectopic pregnancies are a frequently encountered cause of first-trimester metrorrhagia. They occur when an embryo is implanted and grows outside the normal uterine space. Uncommonly, the embryo can be implanted in the intramural portion of the uterine tube, a condition referred to as interstitial localization. This specific type of ectopic pregnancy may have an unpredictable course, potentially leading to severe uterine rupture and catastrophic bleeding if not promptly diagnosed and managed. We present a rare case of a multiparous 36-year-old female patient who underwent pelvic ultrasonography in the emergency department for intense pelvic pain associated with hypotension and moderate anemia. A history of right salpingectomy for a ruptured tubal ectopic pregnancy 10 years previously was noted. High beta-HCG levels were also detected. A pelvic ultrasound allowed us to suspect a ruptured ectopic interstitial pregnancy at 8 weeks of amenorrhea. An association with hemoperitoneum was suspected, and an emergency laparoscopy was performed. The condition was confirmed intraoperatively, and the patient underwent a right corneal wedge resection with suture of the uterine myometrium. The postoperative course was uneventful, and the patient was discharged on the fourth day postoperatively. Interstitial ectopic pregnancy is a rare yet extremely perilous situation. Timely ultrasound-based diagnosis is crucial as it can enable conservative management with Methotrexate. Delayed diagnosis can lead to uterine rupture with consecutive surgery based on a transection of the pregnancy and cornual uterine resection.
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Affiliation(s)
- Claudiu Octavian Ungureanu
- Department of Surgery, "Carol Davila" University of Medicine and Pharmacy, 37, Dionisie Lupu Street, 020021 Bucharest, Romania
- General Surgery Department, "Sf. Ioan" Clinical Emergency Hospital, 13 Vitan-Bârzeşti Road, 042122 Bucharest, Romania
| | - Floris Cristian Stanculea
- Department of Surgery, "Carol Davila" University of Medicine and Pharmacy, 37, Dionisie Lupu Street, 020021 Bucharest, Romania
- General Surgery Department, "Sf. Ioan" Clinical Emergency Hospital, 13 Vitan-Bârzeşti Road, 042122 Bucharest, Romania
| | - Niculae Iordache
- Department of Surgery, "Carol Davila" University of Medicine and Pharmacy, 37, Dionisie Lupu Street, 020021 Bucharest, Romania
- General Surgery Department, "Sf. Ioan" Clinical Emergency Hospital, 13 Vitan-Bârzeşti Road, 042122 Bucharest, Romania
| | - Teodor Florin Georgescu
- Department of Surgery, "Carol Davila" University of Medicine and Pharmacy, 37, Dionisie Lupu Street, 020021 Bucharest, Romania
- General Surgery Department, Clinical Emergency Hospital Bucharest, SplaiulIndependentei nr 168, Sect 5, 050098 Bucharest, Romania
| | - Octav Ginghina
- Department of Surgery, "Carol Davila" University of Medicine and Pharmacy, 37, Dionisie Lupu Street, 020021 Bucharest, Romania
- General Surgery Department, "Prof. Dr. Alexandru Trestioreanu" Oncological Institute, 022328 Bucharest, Romania
| | - Raul Mihailov
- General Surgery Department, "Sf. Andrei" Clinical Emergency Hospital, 177 Braila Street, 800578 Galati, Romania
| | - Ileana Adela Vacaroiu
- Department of Surgery, "Carol Davila" University of Medicine and Pharmacy, 37, Dionisie Lupu Street, 020021 Bucharest, Romania
- Nephrology and Dialysis Clinic, "Sf. Ioan" Emergency Clinical Hospital, Sos. Vitan-Barzesti nr 12, 042122 Bucharest, Romania
| | - Dragos Eugen Georgescu
- Department of Surgery, "Carol Davila" University of Medicine and Pharmacy, 37, Dionisie Lupu Street, 020021 Bucharest, Romania
- General Surgery Department, "Dr. I. Cantacuzino" Clinical Hospital, 5-7 I. Movila Street, 022904 Bucharest, Romania
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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.
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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;
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McDougall AA, Rouabhi S, Magama Z, Odejinmi F. Laparoscopic myomectomy to facilitate laparoscopic resection of a bleeding interstitial ectopic pregnancy. BMJ Case Rep 2022; 15:e250584. [PMID: 36137642 PMCID: PMC9511600 DOI: 10.1136/bcr-2022-250584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Interstitial pregnancies present a diagnostic and management challenge and are associated with significant bleeding risk. We present a case of an interstitial ectopic pregnancy where there was a diagnostic delay due to the presence of uterine fibroids and where a laparoscopic myomectomy was required in order to perform laparoscopic resection of the ruptured interstitial pregnancy.This case demonstrates the possibilities at laparoscopy for ectopic pregnancy, highlights the benefit of a structured 'buddy' system between gynaecology surgeons and brings attention to the paucity of literature on the unique management challenges of ectopic pregnancy in the presence of leiomyoma.
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Affiliation(s)
| | - Schahrazed Rouabhi
- Obstetrics and Gynaecology, North Middlesex University Hospital NHS Trust, London, UK
| | - Zwelihe Magama
- Obstetrics and Gynaecology, Whipps Cross University Hospital NHS Trust, London, UK
| | - Funlayo Odejinmi
- Obstetrics and Gynaecology, Whipps Cross University Hospital NHS Trust, London, UK
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Technical Notes Surgical treatment of a ruptured interstitial pregnancy. J Gynecol Obstet Hum Reprod 2022; 51:102403. [PMID: 35525482 DOI: 10.1016/j.jogoh.2022.102403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 04/24/2022] [Accepted: 04/26/2022] [Indexed: 11/21/2022]
Abstract
Non-tubal ectopic pregnancies represent fewer than 10% of all ectopic pregnancies. However, they are associated with a high rate of mortality due to late diagnosis and uterine horn rupture which requires radical emergency surgical management. Cornuectomy via laparoscopy is a treatment of choice. We provide here a simple description of laparoscopic cornuectomy using an Endo GIA stapling system: the Endo GIA® automatic forceps. It has the advantage of removing the mass, suturing, and achieving satisfactory haemostasis in a single step.
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Tang S, Du T, Huang J, Ye H, Zhao M, Lin J, Kuang Y. Effect of previous wedge resection for interstitial pregnancy on pregnancy and neonatal outcomes following frozen-thawed embryo transfer (FET) cycles of IVF/ICSI: a retrospective study. Reprod Biol Endocrinol 2022; 20:23. [PMID: 35105356 PMCID: PMC8805226 DOI: 10.1186/s12958-022-00896-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 01/17/2022] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE The present study aimed to evaluate pregnancy and neonatal outcomes in women, with a previous history of wedge resection for interstitial pregnancy, in frozen-thawed embryo transfer (FET) cycles of IVF/ICSI. METHODS The present study involved a retrospective case-control assessment of 75 cases and 375 control subjects over 6 years in a single center. To compare pregnancy and neonatal outcomes between cases, treated using wedge resection, and controls without any previous history of ectopic pregnancy, propensity score matching (1:5) was utilized. The study also compared subgroups in the case group. RESULTS Women with previous wedge resection exhibited higher rates of ectopic pregnancy and uterine rupture rate as compared to control subjects (9.1% vs 1.3%, P = 0.025 and 4.5% vs 0%, P = 0.035, respectively). No statistically significant differences were recorded between the two cohorts with regard to clinical pregnancy rate, live birth rate, and neonatal outcomes. For pregnancy type subgroup analysis, Z-score and rates of large for gestational age were recorded to be significantly lower in twin pregnancy subgroup when compared with singleton pregnancy subgroup (0.10 (- 0.59, 0.25) vs 0.50 (- 0.97, 1.39), P = 0.005; 4.5% vs 26.1%, P = 0.047, respectively). CONCLUSION The results of the present study indicated that previous wedge resection correlated to a higher risk of ectopic pregnancy and uterine rupture. However, it might not be related to an increased risk of adverse neonatal outcomes. The study recommended cesarean section in these patients. Further studies are required to verify the validity of current recommendations.
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Affiliation(s)
- Shengluan Tang
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Rd, Shanghai, 200011, China
| | - Tong Du
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Rd, Shanghai, 200011, China
| | - Jialyu Huang
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Rd, Shanghai, 200011, China
| | - Hongjuan Ye
- Department of Reproductive Medicine Center, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Ming Zhao
- Shanghai Towako Hospital, No. 477, Fute West 1st Road, Shanghai, China
| | - Jiaying Lin
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Rd, Shanghai, 200011, China.
| | - Yanping Kuang
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Rd, Shanghai, 200011, China.
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Complete Rupture of the Pregnant Uterus: A 10-year Retrospective Descriptive Study. Curr Med Sci 2021; 42:177-184. [PMID: 34729680 DOI: 10.1007/s11596-021-2460-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 01/14/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The goal of this work is to analyze the incidence, etiology, clinical characteristics, maternal and neonatal outcomes of complete uterine rupture during pregnancy. METHODS The information of complete uterine rupture between June 2010 and May 2020 was investigated retrospectively at a tertiary center, and included demographic data, delivery characteristics, intraoperative findings, and maternal and neonatal outcomes. The prevalence rate of uterine rupture in the early group (hospitalized from June 2010 to May 2015) and late group (June 2015 to May 2020) was compared and analyzed. RESULTS There were 37 (0.056%) cases of complete uterine rupture in 66 092 births, including 27 (0.041%) of scar uterus and 10 (0.015%) of non-scarred uterus. High-risk factors for scarred uterine rupture included: previous cesarean section (13, 48.1%), myomectomy (8, 29.6%), corneal pregnancy resection (6, 22.2%), history of uterine rupture (1, 3.7%), and uterus perforation during abortion (1, 3.7%). Compared to the early group, the number of uterine ruptures caused by previous cesarean section was significantly reduced in the late group. Of the 10 patients with non-scarred uterine rupture, 3 (30%) occurred during delivery and 7 (70%) were spontaneous. Among the 37 complete rupture patients, 3 (8.1%) died of uterine scar rupture, 19 (51.3%) cases were reported with fetal/newborn deaths, 5 (13.5%) cases underwent hysterectomy and the rest were treated with uterine repair. CONCLUSION Complete uterine rupture often has catastrophic effect on pregnancy outcomes. Obstetrics doctors should be vigilant to identify the risk factors and clinical presentations of uterine rupture during pregnancy. Strict prenatal management is beneficial to improve pregnancy outcomes.
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Ho PL, Tung J, Shahul Hameed Mohamed S, Chern BSM. Interstitial Ectopic Pregnancy and Laparoscopic Removal of the Interstitial Portion of the Tube: the New Frontier? J Med Cases 2021; 11:229-233. [PMID: 34434401 PMCID: PMC8383687 DOI: 10.14740/jmc3317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 06/19/2019] [Indexed: 11/13/2022] Open
Abstract
We present a case of a 40-year-old lady with 9 weeks of amenorrhea diagnosed with an interstitial pregnancy and multiple uterine fibroids. She underwent laparoscopic salpingectomy including the interstitial part of fallopian tube with products of conception without myomectomy and cornuostomy. Intra-operative blood loss was minimal. She was followed up post-operatively with weekly serum beta human chorionic gonadotropin (serum β-hCG), which down-trended optimally at day 23 of surgery. Histopathology confirmed ectopic pregnancy with underlying salpingitis isthmica nodosa. Patient recovered well.
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Affiliation(s)
- Ping Ling Ho
- Department of Obstetrics and Gynaecology, KK Women's and Children's Hospital, Singapore
| | - Janice Tung
- Department of Obstetrics and Gynaecology, KK Women's and Children's Hospital, Singapore
| | | | - Bernard Su Min Chern
- Department of Minimally Invasive Surgery, KK Women's and Children's Hospital, Singapore
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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: 1.0] [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.
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Panwar A, Kriplani A, Lata K, Kriplani I, Sharma S, Tomar SS. Laparoscopic Management of Interstitial Ectopic Pregnancy Coexistent with a Fibroid: A Cause or a Chance? J Gynecol Surg 2020. [DOI: 10.1089/gyn.2020.0042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Akshita Panwar
- Department of Minimally Invasive Gynaecology, Paras Hospitals, Gurugram, Haryana, India
| | - Alka Kriplani
- Department of Minimally Invasive Gynaecology, Paras Hospitals, Gurugram, Haryana, India
| | - Kusum Lata
- Department of Minimally Invasive Gynaecology, Paras Hospitals, Gurugram, Haryana, India
| | - Isha Kriplani
- Department of Reproductive Medicine, Fortis La Femme, New Delhi, Delhi, India
| | - Seema Sharma
- Department of Minimally Invasive Gynaecology, Paras Hospitals, Gurugram, Haryana, India
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Ben-David A, Meyer R, Mohr-Sasson A, Mashiach R. Nonsurgical Management of Interstitial Pregnancies: Feasibility and Predictors of Treatment Failure. J Minim Invasive Gynecol 2020; 27:625-632. [DOI: 10.1016/j.jmig.2019.06.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 05/24/2019] [Accepted: 06/10/2019] [Indexed: 10/26/2022]
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12
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Liu Y, Wu Y. Intramyometrial pregnancy after cryopreserved embryo transfer: a case report. BMC Pregnancy Childbirth 2020; 20:90. [PMID: 32041575 PMCID: PMC7011315 DOI: 10.1186/s12884-020-2784-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 01/31/2020] [Indexed: 02/07/2023] Open
Abstract
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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Affiliation(s)
- Yuan Liu
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai Jiaotong University School of Meidicine, Shanghai, China
| | - Yu Wu
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai Jiaotong University School of Meidicine, Shanghai, China.
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Laparoscopic Management of 42 Cases of Tubal Stump Pregnancy and Postoperative Reproductive Outcomes. J Minim Invasive Gynecol 2019; 27:618-624. [PMID: 31726111 DOI: 10.1016/j.jmig.2019.04.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 04/05/2019] [Accepted: 04/26/2019] [Indexed: 01/06/2023]
Abstract
STUDY OBJECTIVE Tubal stump pregnancy is a rare variant of ectopic pregnancy. The aim of this study was to evaluate laparoscopic surgery for tubal stump pregnancy and to investigate postoperative pregnancy outcomes. DESIGN Retrospective study. SETTING University-affiliated hospital. PATIENTS Patients (n = 42) diagnosed with tubal stump pregnancy. INTERVENTIONS Data were extracted from the electronic medical records system of the hospital. MEASUREMENTS AND MAIN RESULTS Patients diagnosed with tubal stump pregnancy between June 2010 and July 2018 were included. Data included demographic characteristics, gravidity and parity, history of pelvic surgery, clinical features, and treatment. All procedures were laparoscopic. Postoperative pregnancy outcomes were identified from electronic medical records or by telephone. Patients' mean age was 30 (range, 21-39) years. Twelve of 42 tubal stump pregnancies (28.6%) had ruptured ectopic pregnancy at the time of operation. The remaining 30 cases had intact stump pregnancy during surgery. Patients were followed for a mean of 31 (range, 10-60) months. Follow-up data were available for 33 of 39 patients (3 with heterotopic tubal stump pregnancy were not included in follow-up data because all resulted in a live births and had no desire for future pregnancy). Eighteen of 28 patients (64.3%) who attempted conception had intrauterine pregnancies (IUPs) during the follow-up period; of these 18 IUPs, 14 (77.8%) resulted in live births. There was 1 case of uterine rupture in a singleton pregnancy at 20+5 weeks that resulted in fetal death. Three of 18 IUPs (16.7%) ended in the first trimester with spontaneous abortions. CONCLUSION Laparoscopic surgery is a feasible option for tubal stump pregnancy and is associated with favorable pregnancy outcomes.
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Fertility Outcome after Cornual Resection for Interstitial Pregnancies. J Minim Invasive Gynecol 2019; 26:865-870. [DOI: 10.1016/j.jmig.2018.08.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 08/19/2018] [Accepted: 08/29/2018] [Indexed: 12/20/2022]
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Laparoscopic management of cornual pregnancy: A case report. JOURNAL OF SURGERY AND MEDICINE 2019. [DOI: 10.28982/josam.522344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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16
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Chen PL, Lin HH, Hsiao SM. Predictors of subsequent pregnancy in women who underwent laparoscopic cornuostomy or laparoscopic wedge resection for interstitial pregnancy. J Chin Med Assoc 2019; 82:138-142. [PMID: 30839505 DOI: 10.1097/jcma.0000000000000016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The ideal surgical procedure for interstitial pregnancy remains undetermined. The aim of this study was to assess whether surgical method is a factor in predicting subsequent pregnancy in women with interstitial pregnancy who underwent laparoscopic cornuostomy or laparoscopic wedge resection. METHODS Medical records of all women with interstitial pregnancy who underwent laparoscopic cornuostomy or laparoscopic wedge resection between March 2008 and October 2017 in a medical center were reviewed. Cox regression analysis was performed to identify factors predicting subsequent pregnancy. RESULTS Forty patients underwent laparoscopic cornuostomy (n = 14) or laparoscopic wedge resection (n = 26) for the treatment of interstitial pregnancy. Twelve women become pregnant during follow-up. Laparoscopic cornuostomy was associated with shorter operation time (coefficient = -19.1 minutes, 95% CI = -36.9 to -1.3 minutes, p = 0.04, multivariable analysis) than that of laparoscopic wedge resection. Furthermore, laparoscopic cornuostomy (hazard ratio = 6.3, p = 0.03), parity (hazard ratio = 0.18, p = 0.008), and preoperative rupture of the cornus (hazard ratio = 13.3, p = 0.005) were independent predictors of subsequent pregnancy. CONCLUSION Laparoscopic cornuostomy was associated with a higher probability of subsequent pregnancy and a shorter operation time. Thus, compared with laparoscopic wedge resection, laparoscopic cornuostomy might be a better surgical procedure for women with interstitial pregnancy, particularly for women who wish to become pregnant later. However, because of the retrospective nature and small sample size of this study, some well-defined/designed prospective studies including more patients are needed to verify our results.
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Affiliation(s)
- Pei-Ling Chen
- Department of Obstetrics and Gynecology, Far Eastern Memorial Hospital, New Taipei City, Taiwan, ROC
| | - Ho-Hsiung Lin
- Department of Obstetrics and Gynecology, Far Eastern Memorial Hospital, New Taipei City, Taiwan, ROC
- Department of Obstetrics and Gynecology, National Taiwan University College of Medicine and National Taiwan University Hospital, Taipei, Taiwan, ROC
| | - Sheng-Mou Hsiao
- Department of Obstetrics and Gynecology, Far Eastern Memorial Hospital, New Taipei City, Taiwan, ROC
- Department of Obstetrics and Gynecology, National Taiwan University College of Medicine and National Taiwan University Hospital, Taipei, Taiwan, ROC
- Graduate School of Biotechnology and Bioengineering, Yuan Ze University, Taoyuan, Taiwan, ROC
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Pluchino N. Author's Reply. J Minim Invasive Gynecol 2018; 26:575. [PMID: 30553037 DOI: 10.1016/j.jmig.2018.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Accepted: 12/08/2018] [Indexed: 11/30/2022]
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Garzon S, Laganà AS, Pomini P, Raffaelli R, Ghezzi F, Franchi M. Laparoscopic reversible occlusion of uterine arteries and cornuostomy for advanced interstitial pregnancy. MINIM INVASIV THER 2018; 28:359-362. [PMID: 30514139 DOI: 10.1080/13645706.2018.1547764] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
During laparoscopic enucleation of an interstitial pregnancy, adequate hemostatic control is of paramount importance due to the high vascularization of the uterine cornus. However, no consensus or guidance exists regarding the optimal hemostatic technique. We report laparoscopic reversible uterine arteries occlusion as hemostatic technique during laparoscopic enucleation by cornuostomy of an interstitial pregnancy at advanced gestational age (46 × 40 mm gestational sac). Preliminary identification of the uterine arteries and bilateral reversible occlusion by Hem-o-Lok clips allowed bleeding control during surgery. The laparoscopic procedure was performed without complications and with limited blood loss. The reported case reinforces the feasibility of this minimally invasive technique in interstitial pregnancy.
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Affiliation(s)
- Simone Garzon
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Verona, Italy
| | - Antonio Simone Laganà
- Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
| | - Paola Pomini
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Verona, Italy
| | - Ricciarda Raffaelli
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Verona, Italy
| | - Fabio Ghezzi
- Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
| | - Massimo Franchi
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Verona, Italy
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Pramayadi CT, Bramantyo A, Gunardi ER. Successful Procedure in Conservative Management of Interstitial (Cornual) Ectopic Pregnancy. Gynecol Minim Invasive Ther 2018; 7:172-174. [PMID: 30306037 PMCID: PMC6172874 DOI: 10.4103/gmit.gmit_9_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 06/08/2018] [Accepted: 06/29/2018] [Indexed: 11/16/2022] Open
Abstract
A 35-year-old woman presented with spotting and lower abdominal pain. Follow-up sonography was suggestive of interstitial ectopic pregnancy. Laparoscopic cornuostomy was carried out. Before incision, diluted vasopressin was injected around the site of interstitial pregnancy. Removal of the conceptual tissues was conducted smoothly through a 1.5 cm incision. The overall blood loss was 50 mL. The operative time was 50 min, and there were no intraoperative complications. We successfully performed laparoscopic cornuostomy, which was followed by an unremarkable postoperative course. Laparoscopic surgery is a safe and effective minimally invasive surgical intervention for interstitial ectopic pregnancy if performed by the experienced surgeon. Local vasopressin injection is a good alternative for bleeding control in conservative laparoscopic surgery.
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Affiliation(s)
- Cepi Teguh Pramayadi
- Department of Obstetrics and Gynecology, Division of Reproductive Health, Faculty of Medicine, Dr. Cipto Mangunkusumo National General Hospital, University of Indonesia, Jakarta, Indonesia
| | - Alvin Bramantyo
- Department of Obstetrics and Gynecology, Division of Reproductive Health, Faculty of Medicine, Dr. Cipto Mangunkusumo National General Hospital, University of Indonesia, Jakarta, Indonesia
| | - Eka Rusdianto Gunardi
- Department of Obstetrics and Gynecology, Division of Reproductive Health, Faculty of Medicine, Dr. Cipto Mangunkusumo National General Hospital, University of Indonesia, Jakarta, Indonesia
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Buskmiller C. The Ethics of Interstitial and Cesarean Scar Ectopic Pregnancies: Four Case Studies and a Review of the Literature. LINACRE QUARTERLY 2018; 85:252-269. [PMID: 30275610 PMCID: PMC6161235 DOI: 10.1177/0024363918788858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Catholic bioethicists have extensively addressed extrauterine tubal pregnancies, which represent the great majority of ectopic pregnancies. However, additional management options have been developed for the other 7-10 percent of ectopic pregnancies. Using two cases of interstitial pregnancy and two cases of cesarean scar pregnancy (CSP) seen at a Catholic tertiary care center, this article discusses options including expectant management, systemic methotrexate, intragestational methotrexate, intragestational potassium chloride, uterine artery embolization, dilation and curettage (D&C), vasopressin use, cornuostomy, cornual wedge resection, CSP evacuation, CSP scar excision, CSP salvage, and hysterectomy. Cornual wedge resection, vasopressin use, and CSP scar excision are morally acceptable; less clearly licit are aspiration of gestational sac contents, cornuostomy, gestational excision for CSPs, and methotrexate. Certainly illicit are any techniques leading to direct abortion such as D&Cs on live embryos or fetuses, double-balloon catheter placement, and use of potassium chloride. Summary: An ectopic pregnancy is any pregnancy outside the uterus. These are dangerous because the pregnancy can burst out of its abnormal location and cause life-threatening internal bleeding. Most are in the part of the fallopian tube outside the uterus, but there are other types, including interstitial pregnancies (located in the part of the tube tunneling through the uterine wall) and cesarean scar pregnancies (buried in the uterine scar where the cut for a C-section was made). This article lists the ways that physicians prevent women from dying from interstitial and cesarean scar pregnancies and proposes which treatments are morally acceptable.
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Affiliation(s)
- Cara Buskmiller
- Department of Obstetrics, Gynecology, and Women’s Health, St. Louis University, St. Louis, MO, USA
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21
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Wu X, Jiang W, Xu H, Ye X, Xu C. Characteristics of uterine rupture after laparoscopic surgery of the uterus: clinical analysis of 10 cases and literature review. J Int Med Res 2018; 46:3630-3639. [PMID: 29916299 PMCID: PMC6136024 DOI: 10.1177/0300060518776769] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Objective An increasing trend of uterine rupture (UR) after laparoscopic surgery of the
uterus (LSU) has been observed. Although the overall incidence is extremely
low, UR may have catastrophic outcomes. Therefore, investigation of its
potential risk factors is important. Methods We retrospectively reviewed the medical data of 10 women who developed UR
after LSU performed at our hospital from October 2003 to October 2016 and
conducted a literature review. Results All cases of UR occurred during the third trimester of pregnancy. The
surgeries contributing to UR were laparoscopic myomectomy, adhesion
decomposition, and salpingectomy, resulting in unfavorable outcomes
especially for the fetus. Diathermy was routinely used for hemostasis, and
multilayer suturing was not adequately performed in many cases. The
posterior wall was the most common site of UR in most cases. Silent rupture
with unremarkable symptoms was not rare. Similar risk factors were
identified in the literature review. Conclusions Excessive use of energy equipment and the lack of multilayer suturing were
the most common characteristics of UR after LSU. A history of LSU should
always be considered a risk factor for UR.
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Affiliation(s)
- Xiaoyi Wu
- 1 Department of Obstetrics and Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai 200011, People's Republic of China
| | - Wei Jiang
- 1 Department of Obstetrics and Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai 200011, People's Republic of China
| | - Huan Xu
- 1 Department of Obstetrics and Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai 200011, People's Republic of China
| | - Xuping Ye
- 1 Department of Obstetrics and Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai 200011, People's Republic of China
| | - Congjian Xu
- 1 Department of Obstetrics and Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai 200011, People's Republic of China.,2 Department of Obstetrics and Gynecology, Shanghai Medical School, Fudan University, Shanghai 200032, People's Republic of China.,3 Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai 200011, People's Republic of China
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Uludag SZ, Kutuk MS, Dolanbay M, Ozgun MT, Eliyeva G, Altun O. Conservative management of interstitial pregnancies: experience of a single centre. J OBSTET GYNAECOL 2018. [DOI: 10.1080/01443615.2017.1417979] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Semih Zeki Uludag
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Mehmet Serdar Kutuk
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Mehmet Dolanbay
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Mahmut Tuncay Ozgun
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Gunel Eliyeva
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Ozguc Altun
- Departments of Obstetrics & Gynecology, Kayseri Education & Research Hospital, Kayseri, Turkey
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Hoyos LR, Vilchez G, Allsworth JE, Malik M, Rodriguez-Kovacs J, Adekola H, Awonuga AO. Outcomes in subsequent pregnancies after wedge resection for interstitial ectopic pregnancy: a retrospective cohort study. J Matern Fetal Neonatal Med 2018; 32:2354-2360. [DOI: 10.1080/14767058.2018.1437411] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Luis R. Hoyos
- Department of Obstetrics & Gynecology, Wayne State University/Hutzel Women’s Hospital, Detroit, MI, USA
| | - Gustavo Vilchez
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, University of Missouri – Kansas City School of Medicine, Kansas City, MO, USA
| | | | - Mokerrum Malik
- Department of Obstetrics & Gynecology, Wayne State University/Hutzel Women’s Hospital, Detroit, MI, USA
| | - Javier Rodriguez-Kovacs
- Department of Obstetrics & Gynecology, Wayne State University/Hutzel Women’s Hospital, Detroit, MI, USA
| | - Henry Adekola
- Division of Maternal–Fetal Medicine, Department of Obstetrics & Gynecology, Hurley Medical Center, Michigan State University, Flint Campus, Detroit, MI, USA
| | - Awoniyi O. Awonuga
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics & Gynecology, Wayne State University/Hutzel Women’s Hospital, Detroit, MI, USA
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Ghazali WAHW, Abidin NHZ, Muda AM, Hamid HA. Comparative Study on Surgical Outcomes between Laparoscopic and Open Cornuotomy in Urban Tertiary Center of Malaysia. Gynecol Minim Invasive Ther 2018; 7:22-26. [PMID: 30254930 PMCID: PMC6135147 DOI: 10.4103/gmit.gmit_7_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
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. CONCLUSION Laparoscopic 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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Affiliation(s)
| | | | - Aisyah Munirah Muda
- Department of Obstetrics and Gynecology, Putrajaya Hospital, Putrajaya, Selangor, Malaysia
| | - Habibah Abdul Hamid
- Department of Gynecology, Faculty of Medicine & Health Sciences, Universiti Putra Malaysia (UPM), Serdang, Selangor, Malaysia
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Dagar M, Srivastava M, Ganguli I, Bhardwaj P, Sharma N, Chawla D. Interstitial and Cornual Ectopic Pregnancy: Conservative Surgical and Medical Management. J Obstet Gynaecol India 2017; 68:471-476. [PMID: 30416274 DOI: 10.1007/s13224-017-1078-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 11/06/2017] [Indexed: 10/18/2022] Open
Abstract
Background Interstitial and cornual ectopic pregnancy is rare, accounting for 2-4% of ectopic pregnancies and remains the most difficult type of ectopic pregnancy to diagnose due to low sensitivity and specificity of symptoms and imaging. The classic triad of ectopic pregnancy-abdominal pain, amenorrhea and vaginal bleeding-occurs in less than 40% of patients. The site of implantation in the intrauterine portion of fallopian tube and invasion through the uterine wall make this pregnancy difficult to differentiate from an intrauterine pregnancy on ultrasound. The high mortality in this type of pregnancy is partially due to delay in diagnosis as well as the speed of hemorrhage. Methods Three cases of interstitial pregnancy were retrospectively analyzed. Result Successful laparoscopic cornuostomy and removal of products of conception were performed in two cases, while one case was successfully managed by local injection with KCL and methotrexate followed by systemic methotrexate. Conclusion Early diagnosis and timely management are key to the management of interstitial and cornual ectopic pregnancy. With expertise in ultrasound imaging and advances in laparoscopic skills progressively, conservative medical and surgical measures are being used to treat interstitial and cornual ectopic pregnancy successfully.
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Affiliation(s)
- Mamta Dagar
- Sir Ganga Ram Hospital Marg, Rajinder Nagar, New Delhi, 110060 India
| | - Mala Srivastava
- Sir Ganga Ram Hospital Marg, Rajinder Nagar, New Delhi, 110060 India
| | - Indrani Ganguli
- Sir Ganga Ram Hospital Marg, Rajinder Nagar, New Delhi, 110060 India
| | - Punita Bhardwaj
- Sir Ganga Ram Hospital Marg, Rajinder Nagar, New Delhi, 110060 India
| | - Nidhish Sharma
- Sir Ganga Ram Hospital Marg, Rajinder Nagar, New Delhi, 110060 India
| | - Deepak Chawla
- Sir Ganga Ram Hospital Marg, Rajinder Nagar, New Delhi, 110060 India
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Chen PL, Jhuang JY, Lin HH, Hsiao SM. Successful treatment of gestational trophoblastic neoplasia in the uterine cornus with laparoscopic cornuostomy and postoperative methotrexate injection. Taiwan J Obstet Gynecol 2017; 56:261-263. [PMID: 28420522 DOI: 10.1016/j.tjog.2016.09.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2016] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE Management of cornual gestational trophoblastic neoplasia (GTN) has never been reported. Here, we describe the first case of cornual GTN. CASE REPORT A 32-year-old woman was diagnosed with left cornual GTN after evacuation of a complete mole. Laparoscopic cornuostomy was performed with intramural vasopression injection and barbed sutures. Histopathology revealed hydropic chorionic villi. Complete hydatidiform mole was diagnosed, and treated with adjuvant methotrexate, to address the poor decline of β-human chorionic gonadotropin levels during follow-up. The β- human chorionic gonadotropin levels declined to < 1 mIU/mL 9 months after cornuostomy. She successfully conceived 16 months after cornuostomy, and underwent cesarean section at 37 gestational weeks due to concomitant severe preeclampsia. CONCLUSION Cornual GTN can be successfully managed with laparoscopic cornuostomy and adjuvant methotrexate.
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Affiliation(s)
- Pei-Ling Chen
- Department of Obstetrics and Gynecology, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Jie-Yang Jhuang
- Department of Pathology, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Ho-Hsiung Lin
- Department of Obstetrics and Gynecology, National Taiwan University College of Medicine and National Taiwan University Hospital, Taipei, Taiwan
| | - Sheng-Mou Hsiao
- Department of Obstetrics and Gynecology, Far Eastern Memorial Hospital, New Taipei City, Taiwan; Graduate School of Biotechnology and Bioengineering, Yuan Ze University, Taoyuan, Taiwan.
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Hortu İ, Akman L, Akdemir A, Ergenoğlu M, Yeniel Ö, Şendağ F. Management of Ectopic Pregnancy In Unusual Location: Five-Year Experience In A Single Center. JOURNAL OF CLINICAL AND EXPERIMENTAL INVESTIGATIONS 2017. [DOI: 10.5799/jcei.343197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Phillips CH, Wortman JR, Ginsburg ES, Sodickson AD, Doubilet PM, Khurana B. First-trimester emergencies: a radiologist's perspective. Emerg Radiol 2017; 25:61-72. [PMID: 28948411 DOI: 10.1007/s10140-017-1556-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 09/13/2017] [Indexed: 12/27/2022]
Abstract
The purpose of this article is to help the practitioner ensure early diagnosis and response to emergencies in the first trimester by reviewing anatomy of the developing embryo, highlighting the sonographic appearance of common first-trimester emergencies, and discussing key management pathways for treating emergent cases. First-trimester fetal development is a stepwise process that can be challenging to evaluate in the emergency department (ED) setting. This is due, in part, to the complex anatomy of early pregnancy, subtlety of the sonographic findings, and the fact that fewer than half of patients with ectopic pregnancy present with the classic clinical findings of a positive pregnancy test, vaginal bleeding, pelvic pain, and tender adnexa. Ultrasound (US) has been the primary approach to diagnostic imaging of first-trimester emergencies, with magnetic resonance imaging (MRI) and computed tomography (CT) playing a supportive role in a small minority of cases. Familiarity with the sonographic findings diagnostic of and suspicious for early pregnancy failure, ectopic pregnancy, retained products of conception, gestational trophoblastic disease, failed intrauterine devices, and complications associated with assisted reproductive technology (ART) is critical for any emergency radiologist. Evaluation of first-trimester emergencies is challenging, and knowledge of key imaging findings and familiarity with management pathways are needed to ensure early diagnosis and response.
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Affiliation(s)
- Catherine H Phillips
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
| | - Jeremy R Wortman
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Elizabeth S Ginsburg
- Department of Infertility and Reproductive Surgery, Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Aaron D Sodickson
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Peter M Doubilet
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Bharti Khurana
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
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Alalade AO, Smith FJE, Kendall CE, Odejinmi F. Evidence-based management of non-tubal ectopic pregnancies. J OBSTET GYNAECOL 2017. [PMID: 28631522 DOI: 10.1080/01443615.2017.1323852] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Recent advances in ultrasonography and the use of other modalities including magnetic resonance imaging scans have led to the early and more accurate diagnosis of non-tubal ectopic pregnancies (NTE). As a result, the management of these pregnancies has evolved. This article addresses the management options currently available for NTE. While surgical management remains the mainstay of treatment for ovarian, abdominal and cornual ectopics, there is growing evidence that some of these can be managed medically. Many authors have utilised a combination of medical and surgical approaches in the management of cervical and caesarean section (CS) scar ectopic pregnancies with good outcome. The availability of dedicated early pregnancy units has further improved diagnosis and more importantly the follow-up care for these patients. The rarity of cases and the difficulty of ethically organising randomised trials for NTE remain a problem in formulating consistent pathways for optimum management of women with NTE.
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Affiliation(s)
- Aderemi Olaoluwa Alalade
- a Department of Obstetrics and Gynaecology , Wrexham Maelor Hospital, Betsi Cadwaladr University Health Board , Wrexham , UK
| | - Fredrick John Ennis Smith
- b Cochrane Medical Education Centre, Institute of Medical Education, Cardiff University School of Medicine, Cardiff University , Cardiff , UK
| | - Charlotte Emma Kendall
- b Cochrane Medical Education Centre, Institute of Medical Education, Cardiff University School of Medicine, Cardiff University , Cardiff , UK
| | - Funlayo Odejinmi
- c Department of Obstetrics and Gynaecology, Barts Health NHS Trust , Whipps Cross University Hospital , London , England
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Dendas W, Schobbens JC, Mestdagh G, Meylaerts L, Verswijvel G, Van Holsbeke C. Management and outcome of heterotopic interstitial pregnancy: Case report and review of literature. ULTRASOUND : JOURNAL OF THE BRITISH MEDICAL ULTRASOUND SOCIETY 2017; 25:134-142. [PMID: 29410688 DOI: 10.1177/1742271x17710965] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Accepted: 04/24/2017] [Indexed: 12/20/2022]
Abstract
Objective To report a case of heterotopic interstitial pregnancy after in vitro fertilization-embryo transfer (IVF-ET), presenting with a second trimester uterine rupture. To review the clinical presentations, risk factors, treatment options, and outcome of heterotopic interstitial pregnancies. Methods We describe the clinical presentation, management, and outcome of a patient with a heterotopic interstitial pregnancy, diagnosed following second trimester rupture of the interstitial pregnancy. We reviewed all published cases of heterotopic interstitial pregnancies. Results A 35-year-old pregnant woman with a past history of right adnexectomy and 16 weeks pregnant with dichorionic diamniotic twins following IVF-ET, was admitted to our department with unexplained recurrent abdominal pain and anemia. Further investigation showed a hemoperitoneum and because of hypovolemic shock an emergency laparotomy was performed, with diagnosis of a ruptured heterotopic interstitial pregnancy. The uterine defect was sutured using simple interrupted sutures. The intrauterine pregnancy progressed uneventful afterwards.We found 86 cases in the published literature, reporting on heterotopic interstitial pregnancies. 80.2% (69/86) occurred after IVF-ET. History of uni- or bilateral salpingectomy is a major risk factor, present in 39.5% (34/86). 37.2% (32/86) presented with cornual rupture. Surgery was performed in 53.5% (46/86) of cases. Medical management was possible in case of unruptured, early diagnosed heterotopic interstitial pregnancy (32.6% (28/86)). Watchful waiting was only possible when the interstitial pregnancy miscarried (5.8% (5/86)). The live birth rate of the intrauterine pregnancy, when viable at presentation, was 70.0% (56/80). The live birth rate of the interstitial pregnancy was only 4.7% (4/86). Conclusions The majority of cases are diagnosed by detailed ultrasound in the setting of early follow-up after IVF-ET and are asymptomatic at diagnosis. Yet, a substantial number of patients present with cornual rupture. Risk factors are IVF-ET and a history of salpingectomy. Depending on clinical presentation, treatment options include watchful waiting, medical treatment, or surgery. Unfortunately, the interstitial pregnancy is generally lost, and only has a chance of survival in case of presentation at a viable gestational age. The outcome of the coexisting intrauterine pregnancy is generally good.
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Affiliation(s)
- Wendy Dendas
- Department of Obstetrics and Gynecology, ZOL Genk, Belgium.,Department of Obstetrics and Gynecology, University Hospital KU Leuven Gasthuisberg, Belgium
| | | | - Greet Mestdagh
- Department of Obstetrics and Gynecology, ZOL Genk, Belgium
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Nadi M, Richard C, Filipuzzi L, Bergogne L, Douvier S, Sagot P. [Interstitial, angular and cornual pregnancies: Diagnosis, treatment and subsequent fertility]. ACTA ACUST UNITED AC 2017; 45:340-347. [PMID: 28552754 DOI: 10.1016/j.gofs.2017.05.002] [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] [Received: 01/12/2017] [Accepted: 04/19/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Interstitial, angular and corneal pregnancies are not very frequent and often mistaken, each with its own definition and prognosis. The objective of this work is to relate 10 years experience of ectopic pregnancies at the UH in Dijon, based on the latest data from the literature in term of diagnosis, management and subsequent fertility. METHOD This is a retrospective study carried out at the UH of Dijon from 01/01/2005 to 01/01/2015. From the medical records of each patient who presented a corneal, interstitial or angular pregnancy, we identified the risk factors for ectopic pregnancy (EG), the diagnostic and therapeutic means used, and the subsequent obstetrical events. RESULTS In 10 years, 532 EG were managed including 10 interstitials, one angular and nine cornual. The main risk factors were previous EG (50%), salpingectomy (55%), curettage (45%) and smoking (40%). The localization of the EG was done in 75% by the endo-vaginal sonography, in 25% in peroperative. Thirty-five percent were treated with methotrexate, 20% had surgery and 40% had both. Seventy-five percent of patients had at least one ulterior pregnancy. In the case of caesarean section, no dehiscence of the corneal scar was identified. CONCLUSION This study shows the presence of medical antecedents which are risk factors of the tubular EG. A methotrexate protocol should be proposed first. Even after corneal surgery, vaginal delivery may remain possible.
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Affiliation(s)
- M Nadi
- Service de gynécologie-obstétrique, centre hospitalier de Mâcon, 350, boulevard Louis-Escande, 71000 Mâcon, France
| | - C Richard
- Service de gynécologie-obstétrique, médecine fœtale et reproduction humaine, CHU de Dijon, 14, rue Paul-Gaffarel, BP 77908, 21079 Dijon cedex, France.
| | - L Filipuzzi
- Service de chirurgie gynécologique et oncologique, CHU de Dijon, 14, rue Paul-Gaffarel, BP 77908, 21079 Dijon cedex, France
| | - L Bergogne
- Service de chirurgie gynécologique et oncologique, CHU de Dijon, 14, rue Paul-Gaffarel, BP 77908, 21079 Dijon cedex, France
| | - S Douvier
- Service de chirurgie gynécologique et oncologique, CHU de Dijon, 14, rue Paul-Gaffarel, BP 77908, 21079 Dijon cedex, France
| | - P Sagot
- Service de gynécologie-obstétrique, médecine fœtale et reproduction humaine, CHU de Dijon, 14, rue Paul-Gaffarel, BP 77908, 21079 Dijon cedex, France
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Comparison of Laparoscopic Cornual Resection and Cornuotomy for Interstitial Pregnancy. J Minim Invasive Gynecol 2017; 24:397-401. [DOI: 10.1016/j.jmig.2016.11.016] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 11/29/2016] [Accepted: 11/30/2016] [Indexed: 11/18/2022]
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Loh AZH, Ng YW. Single-Incision Laparoscopic Surgery: Excision of Cornual Ectopic Pregnancy Made Simple Using ENDOLOOP. J Gynecol Surg 2017. [DOI: 10.1089/gyn.2016.0047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Alvona Zi Hui Loh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ying Woo Ng
- Department of Obstetrics and Gynaecology, Division of Benign Gynaecology, National University Hospital, Singapore, Singapore
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Abbas AM, Fawzy FM, Ali MN, Ali MK. An unusual case of uterine rupture at 39 weeks of gestation after laparoscopic cornual resection: A case report. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2016. [DOI: 10.1016/j.mefs.2015.07.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Nirgianakis K, Papadia A, Grandi G, McKinnon B, Bolla D, Mueller MD. Laparoscopic management of ectopic pregnancies: a comparison between interstitial and "more distal" tubal pregnancies. Arch Gynecol Obstet 2016; 295:95-101. [PMID: 27581585 DOI: 10.1007/s00404-016-4191-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 08/26/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND/AIMS Laparoscopy is an established, safe, and feasible management option for tubal pregnancies, even in women with significant hemoperitoneum. In case of interstitial pregnancy, however, a laparoscopic surgical approach is still a matter of debate. The objective of this study is to evaluate the safety and feasibility of a laparoscopic approach to interstitial pregnancies. METHODS A total of 92 women with ectopic pregnancy who underwent a surgical management from April 2009 to August 2015 were reviewed. Clinical and surgical outcomes of confirmed interstitial pregnancies (n = 10) (IP group) were compared with those of "more distal" tubal pregnancies (n = 79) (TP group). RESULTS Although there were no differences between the two groups in gestational age, ß-hCG values were significantly higher in the IP group (p = 0.005). All patients with IP were treated by laparoscopic wedge resection. The rate of surgical complications (p = 0.413) and subsequent MTX treatment (p = 0.531) were not significantly different between groups. Operating room (OR) time (p = 0.007) was higher in the IP than in the TP group. After stratification for the presence of hemoperitoneum this difference remained, with patients in the IP group having longer OR time (p = 0.034) and additionally higher intra-operative blood loss (EBL) (p = 0.013). On the other hand, in the absence of hemoperitoneum no differences between the two groups were observed. CONCLUSIONS In experienced hands, the laparoscopic management of interstitial pregnancies seems to be as safe and feasible as that of other tubal pregnancies. However, it could be technically more challenging, especially in case of hemoperitoneum.
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Affiliation(s)
- Konstantinos Nirgianakis
- Department of Obstetrics and Gynecology, Inselspital Bern, University of Berne, Effingerstrasse 102, 3010, Berne, Switzerland.
| | - Andrea Papadia
- Department of Obstetrics and Gynecology, Inselspital Bern, University of Berne, Effingerstrasse 102, 3010, Berne, Switzerland
| | - Giovanni Grandi
- Department of Obstetrics and Gynecology, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico of Modena, 41124, Modena, Italy
| | - Brett McKinnon
- Department of Obstetrics and Gynecology, Inselspital Bern, University of Berne, Effingerstrasse 102, 3010, Berne, Switzerland
| | - Daniele Bolla
- Department of Obstetrics and Gynecology, Inselspital Bern, University of Berne, Effingerstrasse 102, 3010, Berne, Switzerland
| | - Michael D Mueller
- Department of Obstetrics and Gynecology, Inselspital Bern, University of Berne, Effingerstrasse 102, 3010, Berne, Switzerland
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Kim MJ, Jung YW, Cha JH, Seok HH, Han JE, Seong SJ, Kim YS. Successful management of heterotopic cornual pregnancy with laparoscopic cornual resection. Eur J Obstet Gynecol Reprod Biol 2016; 203:199-203. [DOI: 10.1016/j.ejogrb.2016.04.026] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 04/17/2016] [Accepted: 04/23/2016] [Indexed: 12/20/2022]
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Liao CY, Tse J, Sung SY, Chen SH, Tsui WH. Cornual wedge resection for interstitial pregnancy and postoperative outcome. Aust N Z J Obstet Gynaecol 2016; 57:342-345. [DOI: 10.1111/ajo.12497] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 05/27/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Chi-Yuan Liao
- Department of Obstetrics and Gynecology; Mennonite Christian Hospital; Hualien Taiwan
| | - Jessica Tse
- Department of Medicine; Boston University School of Medicine; Boston Massachusetts USA
| | - Shu-Yi Sung
- Department of Obstetrics and Gynecology; Mennonite Christian Hospital; Hualien Taiwan
| | - Shu-Hui Chen
- Department of Obstetrics and Gynecology; Mennonite Christian Hospital; Hualien Taiwan
| | - Wen-Huei Tsui
- Department of Life Science; Fu Jen Catholic University; New Taipei City Taiwan
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Hunt SP, Talmor A, Vollenhoven B. Management of non-tubal ectopic pregnancies at a large tertiary hospital. Reprod Biomed Online 2016; 33:79-84. [DOI: 10.1016/j.rbmo.2016.03.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 03/31/2016] [Accepted: 03/31/2016] [Indexed: 01/06/2023]
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Hemostatic Techniques for Laparoscopic Management of Cornual Pregnancy: Double-Impact Devascularization Technique. J Minim Invasive Gynecol 2016; 23:274-80. [DOI: 10.1016/j.jmig.2015.09.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 09/02/2015] [Accepted: 09/03/2015] [Indexed: 11/18/2022]
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Nikodijevic K, Bricou A, Benbara A, Moreaux G, Nguyen C, Carbillon L, Poncelet C, Boujenah J. [Cornual pregnancy: Management and subsequent fertility]. ACTA ACUST UNITED AC 2015; 44:11-6. [PMID: 26678164 DOI: 10.1016/j.gyobfe.2015.10.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Accepted: 10/14/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Cornual pregnancy is a rare entity, representing 2% of ectopic pregnancies. Its management is poorly codified and often guided by the clinical situation. The aim of our study was to describe the management of cornual pregnancies, subsequent fertility, and obstetric outcomes according to the management. METHODS Observational retrospective unicentric study. Nineteen patients hospitalized for cornual pregnancy between 2006 and 2015 were included. The data was collected with medical records and a phone standardized questionnaire. Patients were managed according to hemodynamic status by either systemic or local methotrexate injection or surgical corneal resection. RESULTS Among the 19 patients, 32% (6) were treated by systemic injection (one failure treated by surgical treatment) and 68% (13) underwent surgical treatment by cornual resection. The median HCG rate decrease was 33 days (16-62). Among the twelve patients with a desire for a new pregnancy, 7 (58%) became pregnant without assisted reproductive technology (2 following medical treatment and 5 following surgical resection). Histological analysis of uterine horn showed proximal fallopian tube lesions in 76.9% of case (chronic salpingitis, endosalpingiosis and adenomyosis). CONCLUSION Cornual pregnancies are at high risk of hemorrhagic rupture. Ectopic recidive may occur. Fertility and obstetrical outcomes following cornual pregnancy are not affected whatever the initial treatment. Other studies are needed to aid clinical management according to HCG level and ultrasound features.
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Affiliation(s)
- K Nikodijevic
- Service de gynécologie-obstétrique, université Paris XIII-Bobigny, CHU Jean-Verdier, avenue du 14-Juillet, 93140 Bondy, France
| | - A Bricou
- Service de gynécologie-obstétrique, université Paris XIII-Bobigny, CHU Jean-Verdier, avenue du 14-Juillet, 93140 Bondy, France
| | - A Benbara
- Service de gynécologie-obstétrique, université Paris XIII-Bobigny, CHU Jean-Verdier, avenue du 14-Juillet, 93140 Bondy, France
| | - G Moreaux
- Service de gynécologie-obstétrique, université Paris XIII-Bobigny, CHU Jean-Verdier, avenue du 14-Juillet, 93140 Bondy, France
| | - C Nguyen
- Service de gynécologie-obstétrique, université Paris XIII-Bobigny, CHU Jean-Verdier, avenue du 14-Juillet, 93140 Bondy, France; Université Paris 13, Sorbonne Paris cité, UFR SMBH, 93140 Bobigny, France
| | - L Carbillon
- Service de gynécologie-obstétrique, université Paris XIII-Bobigny, CHU Jean-Verdier, avenue du 14-Juillet, 93140 Bondy, France; Université Paris 13, Sorbonne Paris cité, UFR SMBH, 93140 Bobigny, France
| | - C Poncelet
- Service de gynécologie-obstétrique, université Paris XIII-Bobigny, CHU Jean-Verdier, avenue du 14-Juillet, 93140 Bondy, France; Université Paris 13, Sorbonne Paris cité, UFR SMBH, 93140 Bobigny, France
| | - J Boujenah
- Service de gynécologie-obstétrique, université Paris XIII-Bobigny, CHU Jean-Verdier, avenue du 14-Juillet, 93140 Bondy, France; Université Paris 13, Sorbonne Paris cité, UFR SMBH, 93140 Bobigny, France.
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Panelli DM, Phillips CH, Brady PC. Incidence, diagnosis and management of tubal and nontubal ectopic pregnancies: a review. FERTILITY RESEARCH AND PRACTICE 2015; 1:15. [PMID: 28620520 PMCID: PMC5424401 DOI: 10.1186/s40738-015-0008-z] [Citation(s) in RCA: 101] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 09/29/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND Ectopic pregnancy is a potentially life-threatening condition occurring in 1-2 % of all pregnancies. The most common ectopic implantation site is the fallopian tube, though 10 % of ectopic pregnancies implant in the cervix, ovary, myometrium, interstitial portion of the fallopian tube, abdominal cavity or within a cesarean section scar. FINDINGS Diagnosis involves a combination of clinical symptoms, serology, and ultrasound. Medical management is a safe and effective option in most clinically stable patients. Patients who have failed medical management, are ineligible, or present with ruptured ectopic pregnancy or heterotopic pregnancy are most often managed with excision by laparoscopy or, less commonly, laparotomy. Management of nontubal ectopic pregnancies may involve medical or surgical treatment, or a combination, as dictated by ectopic pregnancy location and the patient's clinical stability. Following tubal ectopic pregnancy, the rate of subsequent intrauterine pregnancy is high and independent of treatment modality. CONCLUSION This review describes the incidence, risk factors, diagnosis, and management of tubal and non-tubal ectopic and heterotopic pregnancies, and reviews the existing data regarding recurrence and future fertility.
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Affiliation(s)
- Danielle M. Panelli
- Department of Obstcpetrics and Gynecology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St., Boston, MA 02115 USA
| | - Catherine H. Phillips
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA USA
| | - Paula C. Brady
- Department of Obstcpetrics and Gynecology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St., Boston, MA 02115 USA
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Garretto D, Lee LN, Budorick NE, Figueroa R. Interstitial twin pregnancy: A unique case presentation. JOURNAL OF CLINICAL ULTRASOUND : JCU 2015; 43:447-450. [PMID: 25042069 DOI: 10.1002/jcu.22209] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 03/11/2014] [Accepted: 06/11/2014] [Indexed: 06/03/2023]
Abstract
Early recognition and timely treatment of an interstitial pregnancy is imperative to avoid the high morbidity and mortality of this type of ectopic pregnancy. We report a case of twin interstitial pregnancy that was initially missed on initial sonogram and was subsequently recognized at our institution by transvaginal sonography. The patient underwent open laparoscopic surgery with cornual wedge resection but suffered infundibulopelvic ligament hemorrhage and subsequently required ipsilateral salpingo-oophorectomy. She did well and was discharged home a day later.
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Affiliation(s)
- Diana Garretto
- Department of Obstetrics, Gynecology and Reproductive Medicine, Stony Brook University, Stony Brook, NY
| | - Lan Na Lee
- Department of Obstetrics, Gynecology and Reproductive Medicine, Stony Brook University, Stony Brook, NY
| | - Nancy E Budorick
- Department of Radiology, Stony Brook University, Stony Brook, NY
| | - Reinaldo Figueroa
- Department of Obstetrics, Gynecology and Reproductive Medicine, Stony Brook University, Stony Brook, NY
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Takeda A, Koike W, Hayashi S, Imoto S, Nakamura H. Magnetic resonance imaging for diagnosis and management of unruptured interstitial pregnancy. J Obstet Gynaecol Res 2015; 41:1384-93. [PMID: 26179819 DOI: 10.1111/jog.12718] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 02/24/2015] [Accepted: 02/24/2015] [Indexed: 11/30/2022]
Abstract
AIM The aim of this study was to evaluate the value of magnetic resonance imaging (MRI) for the diagnosis and management of suspicious unruptured interstitial pregnancy. MATERIAL AND METHODS Only patients with unruptured interstitial pregnancy evaluated by MRI and observed for at least a year after surgery were included. Initial evaluation was performed by measurement of serum β-human chorionic gonadotrophin level and ultrasonography. In suspicious cases, emergency MRI was performed to diagnose interstitial pregnancies with the exclusion of rudimentary horn pregnancy and angular pregnancy. Three-dimensional computed tomographic (CT) angiography was additionally performed if the uteroplacental neovascularization needed to be evaluated. Then, management procedures were individually determined along with the need for preoperative transcatheter arterial chemoembolization for immediate devascularization, and for the local or systemic administration of methotrexate. Either laparoscopic cornuostomy or cornual resection was chosen to excise the gestational mass. RESULTS Five consecutive women with unruptured interstitial pregnancy were enrolled. One case each of rudimentary horn pregnancy and angular pregnancy was excluded. Three-dimensional CT angiography was performed in three cases due to increased vascular flow on color Doppler ultrasonography. Preoperative devascularization by transcatheter arterial chemoembolization was performed in two cases, in which a prominent neovascularized gestational mass was identified. Uterine preservation was achieved by cornuostomy or cornual resection in all cases. Two patients with a desire to become pregnant conceived spontaneously thereafter, followed by successful cesarean birth. CONCLUSION This small case series emphasizes that precise localization of gestational products in the interstitial portion of the fallopian tube by MRI can facilitate the minimally invasive management of unruptured interstitial pregnancy for uterine preservation.
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Affiliation(s)
- Akihiro Takeda
- Department of Obstetrics and Gynecology, Gifu Prefectural Tajimi Hospital, Tajimi, Gifu, Japan
| | - Wataru Koike
- Department of Diagnostic Radiology, Gifu Prefectural Tajimi Hospital, Tajimi, Gifu, Japan
| | - Shotaro Hayashi
- Department of Obstetrics and Gynecology, Gifu Prefectural Tajimi Hospital, Tajimi, Gifu, Japan
| | - Sanae Imoto
- Department of Obstetrics and Gynecology, Gifu Prefectural Tajimi Hospital, Tajimi, Gifu, Japan
| | - Hiromi Nakamura
- Department of Obstetrics and Gynecology, Gifu Prefectural Tajimi Hospital, Tajimi, Gifu, Japan
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Single-port laparoscopic surgery for cornual pregnancy after failure of methotrexate treatment. Taiwan J Obstet Gynecol 2015; 54:322. [PMID: 26166351 DOI: 10.1016/j.tjog.2014.12.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2014] [Indexed: 11/22/2022] Open
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Stanirowski PJ, Trojanowski S, Słomka A, Cendrowski K, Sawicki W. Spontaneous rupture of the pregnant uterus following salpingectomy: a literature review. Gynecol Obstet Invest 2015; 80:73-7. [PMID: 25998257 DOI: 10.1159/000398795] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 04/06/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Spontaneous rupture of the uterus is a life-threatening obstetric complication in rare cases associated with previously performed salpingectomy. AIM This paper presents an analysis of uterine rupture cases during pregnancy in patients after surgical removal of the fallopian tubes. METHODS The English and Polish language literature was reviewed for studies published between January 1, 1980 and September 30, 2014 to identify articles that described rupture of the uterus in women with a previous history of salpingectomy. RESULTS Thirteen case reports and case series studies in 18 women were identified. 33% of cases of uterine rupture following salpingectomy occurred during intrauterine pregnancy, whereas the rest was associated with interstitial ectopic pregnancy. Laparoscopic salpingectomy more often resulted in rupture of the uterus during non-ectopic pregnancy as compared to laparotomy (4 vs. 2 cases, respectively). When interstitial pregnancies were excluded, uterine rupture was a cause of fetal death in 67% of reported gestations. There were no cases of maternal mortality. Conservative treatment was the preferred management option, and total hysterectomy was performed in only 2 patients. CONCLUSION Particular attention should be paid to patients with a previous history of salpingectomy due to the risk of uterine rupture throughout the entire pregnancy.
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Affiliation(s)
- Paweł Jan Stanirowski
- Department of Obstetrics, Gynecology and Oncology, Second Faculty of Medicine, Medical University of Warsaw, Mazovian Bródno Hospital, Warsaw, Poland
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Gosavi A, Lim LM, Agarwal A, Fong YF. First ever case of spontaneous triplet cornual pregnancy: management of laparoscopic cornual resection with modified endoloop method. BMJ Case Rep 2015; 2015:bcr-2014-208582. [PMID: 25716043 DOI: 10.1136/bcr-2014-208582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 23-year-old woman, gravida 2 para 0, presented at 8 weeks gestation with a spontaneously conceived triplet cornual ectopic pregnancy. She was at high risk of ectopic pregnancy as she had been previously treated for pelvic inflammatory disease and had also undergone laparoscopic salpingostomy for right-sided ectopic pregnancy. She was clinically stable and her abdomen was soft and non-tender. The diagnosis was made on transvaginal ultrasound scan and this was confirmed on the three-dimensional scan. She was counselled about her treatment options and subsequently underwent laparoscopic cornual resection using the modified endoloop method. The estimated blood loss was 20 ml intraoperatively and the patient recovered well. She subsequently conceived spontaneously with an intrauterine pregnancy and underwent lower segment caesarean section at 37 weeks in view of previous laparoscopic cornual resection. Intraoperatively, the right cornua appeared normal and there was no sign of thinning.
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Affiliation(s)
- Arundhati Gosavi
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore, Singapore
| | - Li Min Lim
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore, Singapore
| | - Anupriya Agarwal
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore, Singapore
| | - Yoke Fai Fong
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore, Singapore
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Tanaka Y, Mimura K, Kanagawa T, Kajimoto E, Takahashi K, Kakigano A, Fujita S, Kinugasa-Taniguchi Y, Endo M, Kimura T. Three-dimensional sonography in the differential diagnosis of interstitial, angular, and intrauterine pregnancies in a septate uterus. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2014; 33:2031-2035. [PMID: 25336492 DOI: 10.7863/ultra.33.11.2031] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Interstitial, angular, and cornual pregnancies and intrauterine pregnancies in an anomalous uterus are separate entities, and the impact of each condition on obstetric outcomes is completely different. However, there is considerable confusion in understanding and managing the natural course of each condition due to a lack of uniform terminology. The single most important factor for differentiating these types of pregnancies is to make an early diagnosis. The differences between interstitial, angular, and cornual pregnancies on 2-dimensional (2D) sonography are subtle. Although magnetic resonance imaging can be used to differentiate these conditions, it is not preferred as the initial assessment tool because of its limited availability and cost-effectiveness. Three-dimensional (3D) sonography has the advantage of providing views of the uterus that cannot be obtained with conventional 2D sonography. We describe 3 cases of interstitial, angular, and intrauterine pregnancies in a septate uterus that were clearly differentiated by 3D sonography. We demonstrate the differences in diagnostic imaging findings and emphasize the importance of 3D sonography in differentiating these entities.
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Affiliation(s)
- Yusuke Tanaka
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kazuya Mimura
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan.
| | - Takeshi Kanagawa
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Etsuko Kajimoto
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kei Takahashi
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Aiko Kakigano
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Satoko Fujita
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | | | - Masayuki Endo
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Tadashi Kimura
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
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Nezhat CH, Dun EC. Laparoscopically-assisted, Hysteroscopic Removal of an Interstitial Pregnancy With a Fertility-Preserving Technique. J Minim Invasive Gynecol 2014; 21:1091-4. [DOI: 10.1016/j.jmig.2014.04.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Revised: 03/21/2014] [Accepted: 04/16/2014] [Indexed: 10/25/2022]
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50
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Wu XQ, Chen HY, Wan L, Quinn M. Abnormal innervation of narrowed, uterine arterioles in cornual ectopic pregnancy. J OBSTET GYNAECOL 2014; 34:652-4. [PMID: 25226402 DOI: 10.3109/01443615.2014.903911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- X Q Wu
- Department of Gynaecology, First Affiliated Hospital of Wenzhou Medical University , Wenzhou, Zhejiang , China
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