Treatment Of Interstitial Pregnancy Research Articles

Laparoscopic cornual resection for interstitial pregnancy - a case report

Purpose: Ectopic pregnancy is defined as the implantation of a fertilized egg outside of the uterine endometrium. Previous research has reported an increase in the incidence of ectopic pregnancy and estimated that this condition occurs in 1.5 to 2.5% of pregnancies (1). In cases of ectopic pregnancy, the fertilized egg most often implants in the fallopian tubes. In some cases, it can also implant at the site where the fallopian tube and the uterus join; this is a condition referred to as interstitial pregnancy (2). Rupture of interstitial pregnancy can have catastrophic consequences with a mortality rate of up to 2% (2, 3).
 Case report: Here, we report the case of a 33-years-old patient with an interstitial pregnancy in the right uterine horn. We successfully performed laparoscopic surgery with a harmonic scalpel and preliminary coagulation of the uterine artery without any complications. Following surgery, the pregnancy was normal and was carried to term.
 Conclusions: Previously, the treatment of interstitial pregnancy was mostly performed surgically by open surgery including resection of the affected horn of the uterus (4). However, several successful clinical cases of laparoscopic surgery have now been reported (5-8). In our opinion, laparoscopic resection, with a harmonic scalpel and preliminary coagulation of the uterine artery, represents a safe and efficient techniqueand should be used more regularly in the treatment of interstitial pregnancy.

Interstitial Pregnancy and Laparoscopic Cornual Resection

Video Objective We describe the diagnosis and treatment of interstitial pregnancy, discuss methods of surgical intervention, and demonstrate a laparoscopic cornual resection. Setting The patient was a 30 year old G5P3013 incidentally found to have an 8 week live interstitial pregnancy on ultrasound at a tertiary medical center. Interventions We performed a laparoscopic cornual resection and repair using dilute vasopressin, harmonic and bipolar energy, and barbed sutures for repair. Conclusion Interstitial ectopic pregnancy is rare and challenging to diagnose. Treatment depends on gestational age, clinical picture, and surgical expertise. Both cornual resection and cornuotomy are described for treatment. Many techniques can be used for hemostasis, including vasopressin, surgical energy devices, compression of the interstitium, and temporary occlusion of the uterine vessels.

Interstitial Pregnancy after Ipsilateral Salpingectomy: Analysis of 46 Cases and a Literature Review

To investigate the relationship between previous ipsilateral salpingectomy and interstitial pregnancy and report on our experience of laparoscopic cornuostomy for interstitial pregnancy. Single-center, retrospective review. University-based hospital. All patients who had undergone ipsilateral salpingectomy previously, diagnosed with interstitial pregnancy and treated between July 2010 and September 2018. Laparoscopy or laparotomy as a treatment for interstitial pregnancy after ipsilateral salpingectomy. A total of 414 cases of interstitial pregnancy were identified, of which 46 (11.1%) were after ipsilateral salpingectomy. Of the 46 patients, 20 (43.5%) became pregnant by in vitro fertilization and embryo transfer. Ipsilateral salpingectomy was the result of an ectopic pregnancy in 40 patients, hydrosalpinx in 5 patients, and torsion of an ovarian tumor in 1 patient. The laparoscopic approach was used to treat 78.3% of patients with history of previous salpingectomy. Patients who underwent ipsilateral salpingectomy by laparoscopy previously had a shorter interval from salpingectomy to interstitial pregnancy (24 months vs 60 months; p = .038) compared with patients who underwent ipsilateral salpingectomy by laparotomy. Laparoscopic cornuostomy was performed in 38 patients (82.6%); 12 had fetal cardiac activity, 15 had ruptured masses, and 16 used prophylactic methotrexate (MTX) intraoperatively. The median size of the ectopic mass was 2.5 cm (1.0-5.0 cm). At the time of laparoscopic cornuostomy, more patients with interstitial pregnancies with intact ectopic masses were administered prophylactic MTX (81.3% vs 45.5%; p = .043). Only 1 patient with a ruptured ectopic mass, high preoperative human chorionic gonadotropin levels, and without prophylactic MTX administration experienced a persistent ectopic pregnancy. Patients with a history of ipsilateral salpingectomy should be cautioned regarding the possibility of interstitial pregnancy. Laparoscopic cornuostomy appears to be an appropriate treatment for interstitial pregnancy in patients wishing to preserve fertility, and the use of concomitant prophylactic MTX may reduce the risk of persistent ectopic pregnancy, especially in patients with ruptured masses and high human chorionic gonadotropin levels.

Conservative management of interstitial pregnancies: experience of a single centre

The aim of this study was to compare the effect of local intracavitary methotrexate (MTX) injection and laparoscopic (L/S) cornuostomy in the treatment of interstitial pregnancy (IP) in terms of clinical and reproductive outcome. The data of patients with IP (n:10) who were treated between September 2011 and December 2016 with either an intra-amniotic MTX injection (n:7) or L/S cornuostomy (n:3) were retrospectively evaluated. All cases (7/7) in the local injection group and two (2/3) in the L/S group were successfully treated with the initial treatment. One case (1/3, 33%) in L/S group needed systemic MTX due to an elevated β-hCG. No serious complication or secondary surgical intervention was observed in the study group. Five (71.4%) women in MTX group and two (66%) women in the L/S group had pregnancy after index case (p > .05). Post-treatment (hysterosalpingography) HSG results revealed that tubal patency was significantly higher in the MTX group (7/7 (100%) vs. 0/3 (0%) p < .05). Conservative treatment of IP with both methods was generally successful with regard to maternal morbidity and reproductive function. However, local MTX was superior for tubal patency compared to L/S cornuostomy. Since this is a retrospective study including a small study population, our results should be confirmed with larger prospective studies.Impact StatementWhat is already known on this subject? Earlier diagnosis of an interstitial pregnancy (IP) enables clinicians to pursue more conservative treatment modalities that can prevent morbidity (severe bleeding, rupture and massive transfusion, etc.) and loss of fertility. MTX treatment and conservative laparoscopic surgical procedures are gaining importance. High serum β-hCG levels and positive foetal cardiac activity are known as unfavourable pre-treatment prognostic predictors for systemic MTX treatment in patients with an ectopic pregnancy. Local MTX treatment is widely used for caeserean scar pregnancies or cervical pregnancies. L/S cornuostomy is an attractive alternative to L/S cornual resection, because it preserves the normal uterine myometrium.What the results of this study add? In the present study, we showed that the local MTX and laparoscopic cornuostomy were successful methods in IP patients and did not impair the fertility potential of the patients. We also demonstrated that local MTX application is superior to L/S cornuostomy in terms of the post-treatment tubal patency and this fact should be kept in mind when tailoring the treatment in patients desiring pregnancy.What the implications are of these findings for clinical practice and/or further research? The value of local MTX injection in cases with IP and high β-hCG levels should be further clarified.

Successful treatment of interstitial pregnancy with high level of β-human chorionic gonadotropin using methotrexate injection

Successful treatment of interstitial pregnancy with high level of β-human chorionic gonadotropin using methotrexate injection

Comparison of Laparoscopic Cornual Resection and Cornuotomy for Interstitial Pregnancy

Study ObjectiveTo compare the clinical efficacy and safety of laparoscopic cornuotomy and cornual resection in the treatment of interstitial pregnancy. DesignRetrospective chart review between 2006 and 2014 (Canadian Task Force classification II-2). SettingTwo academic tertiary care hospitals. PatientsSeventy-five patients with interstitial pregnancy treated by laparoscopy. Measurement and Main ResultsIn the 75 patients, 53 who underwent cornual resection and 22 who underwent cornuotomy, we evaluated operating time, changes in hemoglobin levels after surgery, the rate of major complications, and the incidence of persistent interstitial pregnancy. The mean operating time was significantly shorter for cornuotomy than for cornual resection (59.36 ± 19.32 minutes vs. 77.11 ± 23.97 minutes, respectively). Changes in hemoglobin level after the operation, rates of major complications, and the incidence of persistent interstitial pregnancy were not significantly different in the 2 surgery groups. ConclusionLaparoscopic cornuotomy yielded clinical results comparable to those of cornual resection. Laparoscopic cornuotomy may reduce the time of operation, and had the same incidence of persistent interstitial pregnancy as cornual resection.

Future research and developments in hysteroscopy

Hysteroscopy has become an important tool to evaluate intrauterine pathology. In most cases, the pathology can be diagnosed and treated in the office or outpatient setting. The ability to use normal saline as a distending medium allows the procedure to be performed using bipolar energy. During hysteroscopic myomectomy, visualization can remain unobstructed with the use of a hysteroscopic morcellator. Its use is also associated with decreased operating time. The use of Essure(®) to block the proximal fallopian tube by a hysteroscopic approach is an approved procedure for tubal sterilization. However, it has been increasingly used to prevent hydrosalpinx fluid from entering the uterine cavity in women undergoing invitro fertilization. The hysteroscopic approach has also been used to treat a variety of conditions such as treatment of interstitial pregnancy, caesarean scar pregnancy and retained placenta. However, the number of cases is still relatively small, and no randomized trial has ever been conducted. One of the potentially important developments is the use of falloposcopy to obtain distal tubal cytology as a screening for ovarian cancer. The technique remains to be refined.

Grossesses interstitielles : traitement chirurgical, fertilité et devenir obstétrical. L’expérience rouennaise

ObjectivePresenting our experience concerning interstitial pregnancies (IP) surgical management and to evaluate our patients’ subsequent long-term fertility. Patients and methodTwenty patients underwent surgical treatment of IP in our department over 15years. In this retrospective study, we present symptoms that led to diagnosis, treatments, fertility and obstetrical outcome. ResultsMean gestational age at diagnosis was 8SA, with a median BHCG rate of 7411IU/L, and a patient mean age of 30years. Ninety percent of patients had at least one risk factor for ectopic pregnancy. Pain or bleeding were the most common symptoms at admission, 4 patients were admitted in an hypovolemic shock status. Location of the interstitial ectopic pregnancy was discovered during surgery in 45 % of cases. Six patients had a large hemoperitoneum bigger than 1L, 5 patients had an IP of uterine stump after salpingectomy for a previous ectopic pregnancy. The most used surgical technique was in 60 % of cases the excision by Endo GIA stapling® with salpingectomy. Regarding fertility, 12 patients wished pregnancy in the aftermath of the intervention, 10 had at least one pregnancy, among them there is an ectopic contralateral ampullary pregnancy, and a contralateral recurrence of interstitial pregnancy. Four patients were delivered by cesarean section and 4 patients were delivered vaginally, some several times. No uterine rupture occured. Discussion and conclusionInterstitial pregnancy is a rare ectopic pregnancy. Its diagnosis is difficult and may involve maternal life-threatening and fertility. In subsequent pregnancies, the clinician has to be careful concerning the risks of interstitial pregnancy recurrence and uterine rupture.

Treatment of Interstitial Pregnancy by Laparoscopic Cornual Resection

A 40-year old woman with an apparently normal pregnancy underwent a transvaginal ultrasound at 6 weeks of amenorrhea, and a gestational sac was observed in the interstitial part of the tube on the right side. The patient did not present any symptoms. The abdominal and bimanual internal examinations were normal. Laparoscopy showed an uncomplicated right interstitial pregnancy (Fig. 1). A 1:100 vasopressin solution was injected in the myometrium surrounding the cornual mass followed by a resection in a V-shaped manner with a monopolar scalpel.

The value of laparoscopy alone or combined with hysteroscopy in the treatment of interstitial pregnancy: analysis of 22 cases

The purpose of this study was to investigate the value of laparoscopy alone or combined with hysteroscopy in treating clinically stable interstitial pregnancy. Clinically stable women with interstitial pregnancy were enrolled in the study. They were treated either with laparoscopy or with a combination of laparoscopy and hysteroscopy and suction. Of 22 cases, 15 were treated with laparoscopy. Five out of seven cases were successfully treated with hysteroscopy and suction using an 8 F pediatric catheter. Two cases converted to a resection of the uterine cornua and salpingectomy with laparoscopy and laparotomy, respectively, secondary to cornual uterine perforation. Laparoscopy alone or combined with hysteroscopy can treat clinically stable interstitial pregnancy successfully. Transcervical suction using an 8 F pediatric catheter placed through the cornual end under laparoscopic and hysteroscopic guidance, preserving the uterus and fallopian tube, is an effective option for management of interstitial pregnancy in selected patients.

Combined hysteroscopy and laparoscopy in the treatment of interstitial pregnancy

Traditional management of interstitial pregnancy involves laparotomy with cornual resection. Increasingly sensitive human chorionic gonadotropin assays and ultrasonography has led to earlier diagnosis of interstitial pregnancy. We report two cases of interstitial pregnancy treated with a combined hysteroscopic and laparoscopic approach. Early diagnosis of interstitial pregnancy can lead to conservative treatment options. (Am J Obstet Gynecol 2003;188:1113-4.)

Endoscopic treatment of interstitial pregnancy

Endoscopic treatment of interstitial pregnancy

OC199: Factors influencing success of conservative treatment of interstitial pregnancy

OC199: Factors influencing success of conservative treatment of interstitial pregnancy

Laparoscopic cornuostomy in the treatment of interstitial pregnancy with subsequent hysterosalpingography.

BJOG: An International Journal of Obstetrics & GynaecologyVolume 104, Issue 8 p. 955-956 Laparoscopic cornuostomy in the treatment of interstitial pregnancy with subsequent hysterosalpingography Zvi Katz MD, Zvi Katz MD Department of Obstetrics and Gynecology, Kaplan Hospital, Rehovot, IsraelSearch for more papers by this authorSamuel Lurie, Corresponding Author Samuel Lurie MD Department of Obstetrics and Gynecology, Kaplan Hospital, Rehovot, IsraelCorrespondence: Dr S. Lurie, Department of Obstetrics and Gynecology, Kaplan Hospital, Rehovot, Israel.Search for more papers by this author Zvi Katz MD, Zvi Katz MD Department of Obstetrics and Gynecology, Kaplan Hospital, Rehovot, IsraelSearch for more papers by this authorSamuel Lurie, Corresponding Author Samuel Lurie MD Department of Obstetrics and Gynecology, Kaplan Hospital, Rehovot, IsraelCorrespondence: Dr S. Lurie, Department of Obstetrics and Gynecology, Kaplan Hospital, Rehovot, Israel.Search for more papers by this author First published: 19 August 2005 https://doi.org/10.1111/j.1471-0528.1997.tb14360.xCitations: 17Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume104, Issue8August 1997Pages 955-956 RelatedInformation

Endoscopic treatment of interstitial pregnancy

Endoscopic treatment of interstitial pregnancy

Laparoscopic Management of Interstitial Pregnancy

Abstract Background: Interstitial pregnancy (IP) accounts for two to four percent of all ectopic pregnancies. There have been two accepted surgical methods of treatment for IP in the past; either cornual resection or hysterectomy. Recently, less radical surgery by means of hysterotomy or laparoscopic excision has been described. Cases: We report here three cases of unruptured interstitial pregnancy and describe a new laparoscopic technique for the conservative management of IP. The elements of the technique are: infiltration with vasopressor solution, sharp incision of the myometrium, and healing by secondary intention. Conclusion: Our study suggests that the principles of operative laparoscopic surgery may be applied, as one would for a linear salpingotomy, to properly selected patients with unruptured interstitial pregnancies with consistency and safety. This needs to be confirmed in subsequent studies. Introduction: Les grossesses interstitielles (GI) représentent 2 à 4 pour 100 des grossesses ectopiques. Deux méthodes de traitement chirurgical étaient acceptées jusqu’ici en cas de GI: la résection de la corne utérine et l’hystérectomie. On a décrit récemment des méthodes chirurgicales moins radicales: l’hystérotomie et l’excision laparoscopique. Cas: Les auteurs rapportent ici trois cas de grossesses interstitielles sans rupture et décrivent une nouvelle technique laparoscopique conservatrice pour le traitement des GI. Les éléments de la technique sont les suivants: infiltration par une solution de vasopresseur, incision du myomètre et cicatrisation par deuxième intention. Conclusion: L’étude suggère qu’il est possible d’appliquer les principes de la chirurgie laparoscopique, comme pour une salpingotomie linéaire, à des patientes sélectionnées avec soin présentant une grossesse interstitielle sans rupture, de manière constante et en toute sécurité. D’autres études seront nécessaires pour le confirmer.

Successful laparoscopic removal of an interstitial ectopic pregnancy

This presentation describes the successful laparoscopic removal of an interstitial ectopic pregnancy. Interstitial pregnancy is rare (2%-4% of tubal pregnancies). Due to its location, rupture usually results in hemorrhagic shock. Current treatments include cornual resection, hysterectomy, local injection of potassium chloride or methotrexate, and systemic methotrexate. The laparoscopic treatment of interstitial pregnancy has not been reported with the exception of Reich et al (1988). A 38 year-old gravida 4 para 3 underwent cornual resection, while preserving the tube, for a right interstitial 9-week pregnancy using the single umbilical puncture approach. The operating time was 45 minutes and blood loss 50 ml. The patient was discharged at 24 hours and had an uneventful postoperative course.

Treatment of interstitial pregnancy with methotrexate via hysteroscopy

We present a case in which treatment of interstitial pregnancy with local MTX administration was performed successfully through hysteroscopic vision, without the need to operate. Decreased gestational sac dimension and increased or low beta-hCG level ( < 1,400 mIU/mL) facilitates the success rate. The follow-up showed disappearance of the gestational sac and decrease of beta-hCG levels to < 10 mIU/mL. We conclude that local MTX administration via hysteroscopy after tubal ostium visualization is feasible. The procedure should be considered in women during the reproductive age, especially in rare cases of interstitial pregnancy.