Management of Non-Tubal Ectopic Pregnancies: A Single Center Experience.

Guglielmo Stabile,Giulia Zinicola,Francesca Buonomo,Federico Romano,Francesco Paolo Mangino,Giuseppe Ricci

doi:10.3390/diagnostics10090652

Guglielmo Stabile, Giulia Zinicola + Show 4 more

Open Access

https://doi.org/10.3390/diagnostics10090652

Copy DOI

Abstract

Non-tubal ectopic pregnancies (NT-EPs) are rare but potentially life-threatening conditions. The incidence ranges are between 5–8.3% of all ectopic pregnancies. For this retrospective observational study, 16 patients with NT-EP and treated from January 2014 to May 2020 were recruited. Demographic details, symptoms, Beta human chorionic gonadotrophin (β-hCG) levels, ultrasound findings, management and treatment outcomes were presented. In hemodynamically stable patients, diagnosis was made using ultrasounds and β-hCG levels. Laparoscopy was essential to identify and remove the ectopic pregnancy in clinical unstable patients. A radical laparoscopic approach was chosen in one case of cervical pregnancy diagnosed late in the first trimester. Medical treatment and minimally invasive procedure, alone or combined, resulted in effective strategies in asymptomatic women with an early diagnosis of NT-EP. We report cases of cervical pregnancies successfully treated by hysteroscopy alone or combined with medical treatment, the first case of scar pregnancy treated by mini-reseptoscope and curettage and the fifth case of interstitial pregnancy treated with Methotrexate and Mifepristone. In this manuscript we report a single center experience in the management of NT-EPs with the aim of outlining the importance of the early diagnosis for a minimally invasive treatment in order to reduce maternal morbidity and mortality and preserve future fertility.

Highlights

Ectopic pregnancies (EP) account for 2% of all pregnancies and in most of the cases gestational sac (GS) is implanted within the fallopian tube [1]
We report a single-center experience in the management of Non-tubal ectopic pregnancies (NT-EPs) with the aim of outlining and suggesting the best possible strategy for fertility sparing in hemodynamically stable patients
We identified n = 16 NT-EPs divided into four groups on the basis of the implantation site: cervical pregnancies (CP) (n = 6), interstitial pregnancies (IP) (n = 3), cesarean scar pregnancies (ScP) (n = 3), abdominal pregnancies (AbP) (n = 2), ovarian pregnancies (OvP) (n = 2)

Summary

Introduction

Ectopic pregnancies (EP) account for 2% of all pregnancies and in most of the cases gestational sac (GS) is implanted within the fallopian tube [1]. Pregnancy could be rarely revealed in other sites, such us cervix, ovary, abdomen, interstitial portion of the fallopian tube and cesarean scars. The incidence range of non-tubal EP (NT-EP) is between 5% and 8.3% of all EP, and it has increased in the last two decades with the widespread use of assisted reproductive techniques (ARTs) [1]. The frequency of cervical ectopic pregnancies (CPs) accounts for < 1% of all EPs [2], while Cesarean scar pregnancies (ScPs) and interstitial ectopic pregnancies (IPs) may represent up to 4.2% [3] and 2–11% of all EPs, respectively [3,4]. NT-EP may not be associated with tubal pathology [6].

Methods

Discussion

Conclusion