Ectopic Pregnancy of the Tubal Stump in ART Patients, Two Case Reports and a Review of the Literature

Piccioni Mg,Riganelli L,Merlino L,Mariani M,Donfrancesco C,Caccetta J,Vena F,Savone D,Aragona C

doi:10.21767/2471-8041.100067

Abstract

Background: An ectopic pregnancy (EP) is the development of an embryo outside of the uterus. A heterotopic pregnancy (HP) is a multiple pregnancy with different sites of implantation, where one is intrauterine. These conditions have arisen also by the use of assisted reproduction techniques (ART), in addition to other causes. Case presentation: We consider two cases of interstitial gestation in patients with previous omolateral salpingectomy for ectopic pregnancies, and a review of the literature. The correct diagnosis was achieved for both patients by the use of ultrasound transvaginal examination. The first patient received a treatment of methotrexate (MTX) before performing a successful removal of the tubal stump, while the second one was managed directly with surgery.No postoperative complications occurred and they were discharged on the second day, postoperatively. Conclusion: In women with first trimester pregnancy and a reported surgical history of a previous salpingectomy, transvaginal ultrasound examination should be performed in order to correctly and promptly identify the implantation site. When a salpingectomy becomes necessary, its complete resection should be performed, in order to prevent or significantly lower an EP occurrence in the tubal stump.

Highlights

Ectopic pregnancy represents a potentially serious medical and surgical condition for women during the reproductive age, with the possibility to evolve in an emergency obstetrical situation caused by the rupture and internal bleeding leading to hypovolemic shock and maternal death during the first trimester of gestation [1,2]
Its reported incidence is around 1.3% to 2% of natural pregnancies [3] and around 1.7% for pregnancies occurring with assisted reproductive technologies (ART), following a recent review performed in the USA [2], and a documented 2.5 to 5-fold increased risk toward spontaneously conceived pregnancies [4]
We present a systematic revision of interstitial pregnancies that occurred in tubal stump Table 1 and a review about ectopic pregnancy (EP) in unusual sites in women having had previous salpingectomies Table 2

Summary

Introduction

Ectopic pregnancy represents a potentially serious medical and surgical condition for women during the reproductive age, with the possibility to evolve in an emergency obstetrical situation caused by the rupture and internal bleeding leading to hypovolemic shock and maternal death during the first trimester of gestation [1,2]. Infact HP is quite rare among the general population (1/7,963-1/30,000) [7], while its incidence in ART pregnancies vary between 1/100 to 1/3,600[8] In this case report we illustrate two rare clinical cases of interstitial EP occurring into the proximal tubal stump in women subjected to monolateral salpingectomy for a history of ectopic pregnancy. Histological examination confirmed the diagnosis of ectopic interstitial pregnancy of the right tubal stump. Confirmed the diagnosis of an ectopic interstitial pregnancy in the right tubal stump. A 25-year-old patient referred to our Gynecological and Obstetric Emergency Department for acute and sudden pain arisen in the past few hours and localized in the right iliac fossa Her past medical and surgical history was not significant except for a laparoscopic monolateral right salpingectomy for EP.

Discussion

Conclusion

Findings

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