Recurrent Uterine Rupture After Laparoscopic Surgery for Interstitial Ectopic Pregnancy

Spontaneous rupture of the uterus following salpingectomy: a case report and literature review

Laparoscopic salpingectomy (LPSC) is the main treatment for ectopic pregnancy, which leads to spontaneous uterine rupture (UR) during pregnancy. We report the characteristics of a woman who had spontaneous UR during pregnancy with a history of salpingectomy. We experienced a 31-year-old woman with a UR in pregnancy with a history of LPSC twice. The patient had a successful pregnancy. We also performed a literature review including cases with spontaneous UR after LPSC. Twenty-seven case reports of 48 women were included in our review. Thirty-five (83.33%, 35/42) women previously received LPSC and 15 (31.25%) developed interstitial pregnancies. The interval between pregnancy and the last surgery did not affect the frequency of interstitial pregnancy and gestational age. Fetal outcomes in patients with UR at the third trimester were better than those at the first and second trimesters. We suggest that close observation and timely treatment by experienced clinicians lead to good outcomes of pregnant women with suspected UR.

Interstitial pregnancy: a 'road map' of surgical treatment based on a systematic review of the literature

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.