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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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Wu WF, Yi JS, Xie X, Liu CB. Risk factor for interstitial pregnancy following ipsilateral salpingectomy? A retrospective matched case control study. BMC Pregnancy Childbirth 2023; 23:826. [PMID: 38037027 PMCID: PMC10687775 DOI: 10.1186/s12884-023-06132-0] [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: 06/23/2023] [Accepted: 11/15/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Interstitial pregnancy may still happen even after ipsilateral salpingectomy, resulting in massive hemorrhage. Therefore, the purpose of the study is to identify risk factors associated with interstitial pregnancy following ipsilateral salpingectomy and discuss possible prevention. METHODS We conducted a retrospective cohort study in a single, large, university-affiliated hospital. Data of 29 patients diagnosed with interstitial pregnancy following ipsilateral salpingectomy from January 2011 to November 2020 were assigned into the case group (IP group). Whereas there were 6151 patients with intrauterine pregnancy after unilateral salpingectomy in the same period. A sample size of 87 control patients was calculated to achieve statistical power (99.9%) and an α of 0.05. The age, BMI and previous salpingectomy side between the two group were adjusted with PSM at a ratio of 1:3. After PSM, 87 intrauterine pregnancy patients were successfully matched to 29 IP patients. RESULTS After PSM, parous women were more common and intrauterine operation was more frequent in the IP group compared with control group (P<0.05). There was only one patient undergoing IVF-ET in the IP group as compared with 29 cases in the control group (3.4% vs. 33.3%, P<0.05). Salpingectomy was performed on 5 patients in the IP group and 4 patients in the control group due to hydrosalpinx (P<0.05). Logistic regression indicated that hydrosalpinx was the high risk factor of interstitial pregnancy following ipsilateral salpingectomy (OR = 8.175). CONCLUSIONS Hydrosalpinx appears to be an independent factor contributing to interstitial pregnancy following ipsilateral salpingectomy in subsequent pregnancy.
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Affiliation(s)
- Wei-Fang Wu
- Department of Obstetrics and Gynecology, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, 18, Daoshan Rd, 350001, Fuzhou, Fujian, China.
| | - Jing-Song Yi
- Department of Obstetrics and Gynecology, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, 18, Daoshan Rd, 350001, Fuzhou, Fujian, China
| | - Xi Xie
- Department of Obstetrics and Gynecology, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, 18, Daoshan Rd, 350001, Fuzhou, Fujian, China
| | - Chao-Bin Liu
- Department of Obstetrics and Gynecology, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, 18, Daoshan Rd, 350001, Fuzhou, Fujian, China.
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Dhanju G, Goubran A, Zimolag L, Chartrand R, Matthew F, Breddam A. Distinguishing between cornual, angular and interstitial ectopic pregnancy: A case report and a brief literature review. Radiol Case Rep 2023; 18:2531-2544. [PMID: 37235077 PMCID: PMC10208802 DOI: 10.1016/j.radcr.2023.04.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/09/2023] [Accepted: 04/15/2023] [Indexed: 05/28/2023] Open
Abstract
For all clinical purposes, cornual, angular, and interstitial pregnancies are considered ectopic pregnancies that can have grave consequences for the patient. In this article, we describe and distinguish 3 types of ectopic pregnancies in the cornual region of the uterus. The authors advocate using the "cornual pregnancy" term only for ectopic pregnancies in malformed uteruses. We describe an ectopic pregnancy in a 25-year-old G2P1 patient in the cornual region of the uterus that was missed twice sonographically in the second trimester and had almost fatal consequences in the patient. Radiologists and sonographers should be aware of the sonographic diagnosis of angular, cornual and interstitial pregnancies. Whenever possible, first-trimester transvaginal ultrasound scanning is crucial for diagnosing these 3 types of ectopic pregnancies in the cornual region. In the second and third trimesters, ultrasound tends to become equivocal; hence alternate imaging, such as MRI, might add additional value to the management of the patient. A case report assessment and a comprehensive literature review comprising 61 case reports of ectopic pregnancy in the second and third trimesters are diligently undertaken in the Medline, Embase and Web of Science databases. The major strength of our study is that it is one of the few studies that describe a literature review of ectopic pregnancy in the cornual region exclusively in the second and third trimesters.
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Affiliation(s)
- Gurinder Dhanju
- Department of Public Health, University of Saskatchewan, 105 Administration Place, Saskatoon, SK S7N 5A2, Canada
- Department of Ultrasound, St. Boniface Hospital, Winnipeg, Manitoba, Canada
| | - Ashraf Goubran
- Department of Ultrasound, St. Boniface Hospital, Winnipeg, Manitoba, Canada
| | - Lukasz Zimolag
- Department of Ultrasound, St. Boniface Hospital, Winnipeg, Manitoba, Canada
| | - Robyn Chartrand
- Department of Ultrasound, St. Boniface Hospital, Winnipeg, Manitoba, Canada
| | - Frankel Matthew
- Department of Ultrasound, St. Boniface Hospital, Winnipeg, Manitoba, Canada
| | - Alli Breddam
- Department of Ultrasound, St. Boniface Hospital, Winnipeg, Manitoba, Canada
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Lei R, Liang J, Ling X, Xu J, Liang S, Zhou H, Zhang B. Use of Laparoscopic Slip Knot with Purse-String Suture in Surgical Management of Unruptured Heterotopic Interstitial Pregnancies. Med Sci Monit 2020; 26:e921185. [PMID: 31893477 PMCID: PMC6977598 DOI: 10.12659/msm.921185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background The aim of this study was to investigate the advantages and disadvantages of using laparoscopic slip knot with purse-string suture technique in the surgical management of unruptured heterotopic interstitial pregnancies compared with other surgical strategies. Material/Methods We retrospectively analyzed data on 13 patients with unruptured heterotopic interstitial pregnancies who underwent laparoscopy in our hospital between May 2012 and August 2018. The control group consisted of 10 patients who underwent cornual resection or cornuostomy with conventional sutures and knots. The study group consisted of 3 patients whose surgical plans involved use of the slip knot with purse-string suture technique followed by cornuostomy. We evaluated the surgical records and video to comparatively analyze their operation duration, intraoperative blood loss, and pregnancy outcomes. Results The average volume of intraoperative blood loss was 76.67±25 ml in the study group and 215.00±110 ml in the control group. On average, the intraoperative blood loss volume in the study group was 138 ml less than in the control group and the difference was statistically significant (P<0.05). There was no statistically significant difference in the live birth rate and operation time between the 2 groups (P>0.05). The duration of hemostasis in the study group was 11 min shorter than in the control group, while the duration of cornual electrocoagulation in the study group was 18.5 s shorter. Both groups achieved thorough hemostasis without the help of vasopressin and avoided use of embryo-killing drugs such as methotrexate. Neither group required second surgery or developed postoperative complications such as uterus rupture or persistent ectopic pregnancy. Conclusions This strategy is safe and reliable for gestational sac clearance while simultaneously preventing any potential harm to the intrauterine embryo. It is particularly suitable for unruptured HIP patients who have a strong desire to preserve their intrauterine embryos.
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Affiliation(s)
- Ruilin Lei
- Department of Gynecologic Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China (mainland)
| | - Jinxiao Liang
- Department of Gynecologic Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China (mainland)
| | - Xiaoting Ling
- Department of Gynecologic Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China (mainland)
| | - Jing Xu
- Department of Gynecologic Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China (mainland)
| | - Sihua Liang
- Operating Room, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China (mainland)
| | - Hui Zhou
- Department of Gynecologic Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China (mainland)
| | - Bingzhong Zhang
- Department of Gynecologic Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China (mainland)
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Chronic cornual ectopic pregnancy presenting as large cornual mass after in vitro fertilization-embryo transfer: A case report. LAPAROSCOPIC, ENDOSCOPIC AND ROBOTIC SURGERY 2019. [DOI: 10.1016/j.lers.2019.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Abdelazim IA, Shikanova S, Bekzhanova M. Regarding "Laparoscopic Management 4 Cases of Recurrent Cornual Ectopic Pregnancy and Review of Literature,". J Minim Invasive Gynecol 2018; 26:774. [PMID: 30572016 DOI: 10.1016/j.jmig.2018.11.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 11/15/2018] [Indexed: 10/27/2022]
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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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Egger E. Recurrent Interstitial Pregnancy: a Review of the Literature. Geburtshilfe Frauenheilkd 2017; 77:335-339. [PMID: 28552996 DOI: 10.1055/s-0043-100107] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Interstitial pregnancies account for 2-4 % of all ectopic pregnancies. Despite its rarity, various treatment options exist. However, no gold standard has yet been defined and data regarding recurrence of interstitial pregnancies in subsequent pregnancies after different treatments are sparse. This makes it very difficult to provide adequate patient counselling for treatment options with regards to the treatment-related risk of recurrence. The present literature review demonstrates that recurrent interstitial pregnancy is a rare condition and more likely when additional anatomy-related risk factors for ectopic pregnancies are present, such as hydrosalpinges, blocked tubes, endometriosis, fibroids or prior tubal ectopic pregnancies. Therefore, at first appearance and in absence of additional anatomy-related risk factors, methotrexate intravenously, intramuscularly or into the amnion may be the first choice. In case of anatomical risk factors, cornual wedge resection seems to be first choice. In case of recurrence, cornual wedge resection is particularly justified in patients with anatomical alterations of the salpinges. The role of conservative surgical treatments in recurrence as cornuotomy, salpingectomy, endoloop ligation and resection and curettage under laparoscopic guidance remains unclear due to sparse data.
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Affiliation(s)
- Eva Egger
- University of Bonn, Department of Obstetrics and Gynecology/CIO, Bonn, Germany.,Florence Nightingale Hospital, Department of Obstetrics and Gynecology, Düsseldorf, Germany
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Bayyarapu VB, Gundabattula SR. Diagnosis and Management of 'Cornual' Pregnancies from 2002 to 2015 at a Tertiary Referral Centre in South India: Insights from Introspection. J Obstet Gynaecol India 2017; 67:414-420. [PMID: 29162955 DOI: 10.1007/s13224-017-0983-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 03/17/2017] [Indexed: 11/28/2022] Open
Abstract
Purpose Interstitial, angular and rudimentary horn pregnancies have all been referred to as cornual pregnancies despite definite diagnostic criteria. Angular pregnancies can be followed up expectantly under close surveillance while interstitial and rudimentary horn pregnancies are terminated by medical or surgical methods. This study aimed to assess accuracy of ultrasound in the diagnosis of 'cornual pregnancy' and evaluate management. Methods Data pertaining to clinical features, ultrasound findings and treatment modalities of the aforementioned conditions between January 2002 and December 2015 at a tertiary perinatal centre were retrieved from the medical records. The ultrasound images and surgical videos were reviewed by the authors. Results Of 62 cases, 35 were interstitial, 26 were angular/eccentric intrauterine, and 1 was a rudimentary horn pregnancy. The accuracy of ultrasonography in the diagnosis of interstitial and angular pregnancies was 71.0 and 46.8%, respectively. Medical management was successful in 33.3% of interstitial pregnancies. Fifteen women with interstitial pregnancy had subsequent pregnancies and nine (75.0%) were Caesarean deliveries. Rupture and recurrence rates of interstitial pregnancy were 34.2 and 2.9%, respectively. The rudimentary horn pregnancy was managed by laparoscopic excision followed by a subsequent term delivery. Conclusion This study identified frequent occurrences of imprecise nomenclature that resulted in mismanagement of a few potentially viable angular pregnancies. It is imperative for clinicians and sonologists to use unambiguous nomenclature and avoid the term 'cornual pregnancy' altogether.
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Affiliation(s)
- Vijaya B Bayyarapu
- Department of Gynaecology, Fernandez Hospital, 4-1-1230, Bogulkunta, Hyderabad, Telangana 500001 India
| | - Sirisha R Gundabattula
- Department of Gynaecology, Fernandez Hospital, 4-1-1230, Bogulkunta, Hyderabad, Telangana 500001 India
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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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Hemostatic Techniques for Laparoscopic Management of Cornual Pregnancy: Double-Impact Devascularization Technique. J Minim Invasive Gynecol 2016; 23:1016-7. [PMID: 27117718 DOI: 10.1016/j.jmig.2016.03.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 03/03/2016] [Indexed: 11/22/2022]
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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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Manea C, Pavlidou E, Urias AA, Bouquet de la Jolinière J, Dubuisson JB, Feki A. Laparoscopic management of interstitial pregnancy and fertility outcomes after ipsilateral salpingectomy - three case reports. Front Surg 2014; 1:34. [PMID: 25593958 PMCID: PMC4286981 DOI: 10.3389/fsurg.2014.00034] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 08/18/2014] [Indexed: 12/01/2022] Open
Abstract
Background: Interstitial pregnancy after ipsilateral salpingectomy is a rare event with potentially serious consequences. Optimal management strategy remains uncertain and debated. In addition, fertility sparing is determinant of the treatment choice. Cases: Here, we report three cases of interstitial pregnancy occurring after homolateral salpingectomy. We expose the therapeutic option held in all three situations, which associated laparoscopic procedure followed by intramuscular methotrexate injection with successful outcome for all patients. We also report the fertility outcome for the first patient, discussing the timing and mode of delivery. Cesarean section at term was performed for this patient. Conclusion: In these three situations, we obtained a successful result using a minimally invasive surgical approach combined with systemic methotrexate injection. Cesarean section at term for subsequent intrauterine pregnancy seems to be the safest delivery strategy, although no clear data exist in literature.
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Affiliation(s)
- Cristina Manea
- Department of Obstetrics and Gynecology, Hôpital Cantonal Fribourgeois , Fribourg , Switzerland
| | - Evangelia Pavlidou
- Department of Obstetrics and Gynecology, Geneva University Hospitals , Geneva , Switzerland
| | - Aline Andrey Urias
- Department of Obstetrics and Gynecology, Geneva University Hospitals , Geneva , Switzerland
| | | | - Jean Bernard Dubuisson
- Department of Obstetrics and Gynecology, Hôpital Cantonal Fribourgeois , Fribourg , Switzerland
| | - Anis Feki
- Department of Obstetrics and Gynecology, Hôpital Cantonal Fribourgeois , Fribourg , Switzerland
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15
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Pedroso C, Lermann R, Amaral N, Condeço P. Interstitial pregnancy rupture at 15 weeks of pregnancy. BMJ Case Rep 2014; 2014:bcr-2014-203979. [PMID: 25155486 DOI: 10.1136/bcr-2014-203979] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Ectopic pregnancy occurs when the developing blastocyst becomes implanted outside the uterine cavity. Interstitial pregnancy is a rare type, representing 2-3%, of all ectopic pregnancies. It is located outside the uterine cavity in the segment of the fallopian tube that penetrates the muscular layer of the uterus. Therefore, it is a difficult and challenging diagnosis. We report a case of a 19-year-old girl who was admitted to our emergency department because of a ruptured interstitial pregnancy at 15 weeks of gestation.
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Affiliation(s)
- Célia Pedroso
- Resident of Obstetrics and Gynecology of Alfredo da Costa Maternity, Centro Hospitalar Lisboa Central, Lisbon, Portugal
| | - Rita Lermann
- Medical Doctor of Obstetrics and Gynecology, Emergency Department of Beatriz Ângelo Hospital, Loures, Portugal
| | - Njila Amaral
- Medical Doctor of Obstetrics and Gynecology, Emergency Department of Beatriz Ângelo Hospital, Loures, Portugal
| | - Pedro Condeço
- Medical Doctor of Obstetrics and Gynecology, Emergency Department of Beatriz Ângelo Hospital, Loures, Portugal
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16
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Watanabe T, Watanabe Z, Watanabe T, Fujimoto K, Sasaki E. Laparoscopic cornuotomy for interstitial pregnancy and postoperative course. J Obstet Gynaecol Res 2014; 40:1983-8. [DOI: 10.1111/jog.12422] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2013] [Accepted: 02/17/2014] [Indexed: 12/01/2022]
Affiliation(s)
- Tadashi Watanabe
- Department of Obstetrics and Gynecology; NTT East Japan Tohoku Hospital; Sendai Japan
| | - Zen Watanabe
- Department of Obstetrics and Gynecology; NTT East Japan Tohoku Hospital; Sendai Japan
| | - Takanori Watanabe
- Department of Obstetrics and Gynecology; Sendai City Hospital; Sendai Japan
| | - Kumiko Fujimoto
- Department of Obstetrics and Gynecology; Saka General Hospital; Tagajo Japan
| | - Etsuko Sasaki
- Etsuko Sasaki Clinic of Obstetrics and Gynecology; Sendai Japan
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17
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Cucinella G, Calagna G, Rotolo S, Granese R, Saitta S, Tonni G, Perino A. Interstitial pregnancy: a 'road map' of surgical treatment based on a systematic review of the literature. Gynecol Obstet Invest 2014; 78:141-9. [PMID: 25060047 DOI: 10.1159/000364869] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 05/27/2014] [Indexed: 11/19/2022]
Abstract
An electronic search concerning the surgical approach in cases of interstitial pregnancy from January 2000 to May 2013 has been carried out. Fifty three studies have been retrieved and included for statistical analysis. Conservative and radical surgical treatments in 354 cases of interstitial pregnancy are extensively described. Hemostatic techniques have been reported as well as clinical criteria for the medical approach. Surgical outcome in conservative versus radical treatment were similar. When hemostatic techniques were used, lower blood losses and lower operative times were recorded. Conversion to laparotomy involved difficulties in hemostasis and the presence of persistent or multiple adhesions. Laparoscopic injection of vasopressin into the myometrium below the cornual mass was the preferred approach.
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Affiliation(s)
- Gaspare Cucinella
- Department of Obstetrics and Gynecology, University Hospital 'Paolo Giaccone', Palermo, Italy
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18
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Bayyarapu VB, Gundabattula SR, Pochiraju M, Kavuri K, Kandi S. Laparoscopy for Rudimentary Horn and Interstitial Pregnancy. J Gynecol Surg 2014. [DOI: 10.1089/gyn.2013.0034] [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)
| | | | - Manjula Pochiraju
- Department of Gynaecology, Fernandez Hospital, Bogulkunta, Hyderabad, Andhra Pradesh, India
| | - Kamala Kavuri
- Department of Fetal Medicine and Ultrasound, Fernandez Hospital, Bogulkunta, Hyderabad, Andhra Pradesh, India
| | - Sujatha Kandi
- Department of Fetal Medicine and Ultrasound, Fernandez Hospital, Bogulkunta, Hyderabad, Andhra Pradesh, India
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19
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Berretta R, Merisio C, Dall'Asta A, Verrotti C, Rolla M, Bruni S, Bacchi Modena A. Conservative treatment for interstitial monochorionic twin pregnancy: case report and review of the published work. J Obstet Gynaecol Res 2013; 40:829-32. [PMID: 24319991 DOI: 10.1111/jog.12250] [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: 01/08/2013] [Accepted: 07/25/2013] [Indexed: 11/28/2022]
Abstract
Interstitial pregnancy is considered one of the most hazardous types of ectopic pregnancies, with a mortality rate of 2-2.5%. We describe a case of a viable monochorionic twin pregnancy in a 35-year-old woman successfully treated with systemic methotrexate associated with bilateral uterine arteries' embolization. β-hCG was undetectable 67 days after the first administration of methotrexate and the ultrasonography performed on day 67 showed the remnant of the gestational sac in the right uterine horn, a thin endometrium and a normal myometrial vascularization. Conservative treatment allowed us to avoid surgical treatment and to preserve the patient's fertility.
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Affiliation(s)
- Roberto Berretta
- Department of Obstetrics, Gynaecology and Neonatology, University of Parma, Parma, Italy
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20
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A Case of Live Birth after Uterine Reconstruction for Recurrent Cornual Ectopic Pregnancy following IVF Treatment. Case Rep Obstet Gynecol 2013; 2013:625261. [PMID: 23476844 PMCID: PMC3583060 DOI: 10.1155/2013/625261] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Accepted: 01/08/2013] [Indexed: 11/27/2022] Open
Abstract
We present a case of recurrent ruptured right cornual ectopic pregnancies conceived after IVF. Following the second episode, a sonohysterography was undertaken to identify possible areas of scar weakness that may rupture with uterine distension in a future pregnancy. The scan revealed asymmetrical muscle thickness in the cornual regions, the right (6 mm) being thinner than the left (1.6 cm). Subsequently, an elective laparotomy was undertaken, and the cornua were reconstructed and thickened in several layers by bringing the laterally retracted myometrial fibres onto the reconstruction site. A sono-hysterography after surgery showed satisfactory (3-4 cm) myometrial thickness all around. A further cycle of IVF resulted in a singleton pregnancy. Pelvic scans confirmed normal intrauterine pregnancy without any myometrial thinning. She was delivered by an uneventful elective caesarean section at term. We propose that, in those who intend to have further pregnancies after a cornual ectopic pregnancy, a sono-hysterography is possibly the best investigative tool to assess myometrial integrity. This case demonstrates that in women with areas of muscle weakness it is possible to successfully perform an interval elective reconstructive surgery on the uterus that can result in an uneventful pregnancy and birth.
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