Surgical Expression of an Un-Ruptured 12-Week Interstitial Ectopic Pregnancy (original) (raw)

Mathews Journal of Gynecology & Obstetrics Surgical Expression of an Un-Ruptured 12-Week Interstitial Ectopic Pregnancy Woojin Chong1, Nicolae Tudorica2, Erika Banks3 1Department of Obstetrics, Gynecology and Reproductive Science. Mount Sinai Medical Center/Icahn School of Medicine, 1176 5th Ave, KP Building 9th Floor. New York, NY 10029. USA. 2Kaiser Permanente, Downey Medical Center. 9333 Imperial Hwy STE H30R69 Downey, CA 90242-2812. USA. 3Department of Obstetrics, Gynecology and Women’s Health. Montefiore Medical Center/Albert Einstein Collage of Medicine, 1825 Eastchester Road. Bronx, NY 10461. USA. Corresponding Author: Woojin Chong, Department of Obstetrics, Gynecology and Reproductive Science. Mount Sinai Medical Center/Icahn School of Medicine, 1176 5th Ave, KP Building 9th Floor. Mailbox #1170. New York, NY 10029. USA, Email: wwwoojin@gmail.com

The diagnosis and management of interstitial ectopic pregnancies: a review

Gynecological Surgery, 2019

The objective of this article is to review the published literature on the diagnosis and management of interstitial pregnancies (IPs). IPs account for 2–6% of all ectopic pregnancies and have the potential to cause life-threatening haemorrhage resulting in a 2–5% mortality rate. There is little consensus on the best practice for diagnosing and managing interstitial pregnancies. By reviewing the published data, we set out to determine what the best evidence-based practice for the management of interstitial ectopic pregnancies is, what protocols can be used and whether this improves post-operative outcomes and future fertility rates.

Management of Undisturbed Ectopic Pregnancy: A comprehensive Review

2021

Ectopic pregnancy occurs when a fertilized ovum implants outside of the uterine cavity. In the United States, the estimated prevalence of ectopic pregnancy is 1% to 2%, and ruptured ectopic pregnancy accounts for 2.7% of pregnancy-related deaths. Risk factors include a history of pelvic inflammatory disease, cigarette smoking, fallopian tube surgery, previous ectopic pregnancy, and infertility. Ectopic pregnancy should be considered in any patient presenting early in pregnancy with vaginal bleeding or lower abdominal pain in whom intrauterine pregnancy has not yet been established. The definitive diagnosis of ectopic pregnancy can be made with ultrasound visualization of a yolk sac and/or embryo in the adnexa. However, most ectopic pregnancies do not reach this stage. More often, patient symptoms combined with serial ultrasonography and trends in beta human chorionic gonadotropin levels are used to make the diagnosis. Pregnancy of unknown location refers to a transient state in whic...

Update on ectopic pregnancy

Canadian Medical Association journal, 1983

Ectopic pregnancy is the leading cause of maternal death in the first trimester. Its incidence is increasing, probably owing to the increasing incidence of pelvic inflammatory disease. Although up to 15% of patients have been reported to present in shock, a large number seek care earlier because of pelvic pain and irregular menses. With strong clinical suspicion and the use of culdocentesis, assays of the beta subunit of human chorionic gonadotropin in the blood and ultrasonography, the diagnosis can be made before rupture occurs. Although the woman's subsequent fertility has traditionally been poor, some improvement has been achieved with the use of conservative surgical techniques. Early diagnosis facilitates this approach.

Challenges in the diagnosis and management of interstitial and cornual ectopic pregnancies

Middle East Fertility Society Journal, 2013

Interstitial ectopic pregnancy is a term loosely used in the literature to describe three different entities. The first is the true interstitial ectopic pregnancy, which occurs in the interstitial or intramural segment of the Fallopian tubes. The term cornual ectopic pregnancy should be reserved for pregnancy in women with a single uterine horn, a bicornuate uterus, or a septate uterus. Angular pregnancy is a term that is rarely used and should be limited to a pregnancy in one of the angles of the uterus, but not inside the Fallopian tube.

Conservative medical and surgical management of interstitial ectopic pregnancy

Fertility and Sterility, 1999

Objective: To review the definition and diagnosis of interstitial and heterotopic interstitial pregnancy and to evaluate the conservative management of these conditions. Design: A MEDLINE computer search was used to identify relevant studies. The mean values for the duration of amenorrhea, serum ␤-hCG level, size of the ectopic mass, and success rates of the various treatment modalities were calculated from the raw data in the original publications.

Diagnosis and Management of Intramural Ectopic Pregnancy

2013

Background: Intramural pregnancy is a rare form of ectopic pregnancy where the embryo is implanted within the myometrium, separate from the endometrial cavity. Preoperative diagnosis of intramural pregnancy is difficult and it can easily be misdiagnosed for other diseases such as intrauterine pregnancy or gestational trophoblastic disease. Medical therapy and surgery are used to treat intramural pregnancy, with surgery often being performed via laparotomy and also including hysterectomy. Case: We present a case of intramural pregnancy that was misdiagnosed and wrongly managed by a local hospital. It was finally diagnosed correctly and managed in our hospital by combining hysteroscopy and laparoscopy under the guidance of intra-abdominal ultrasound. Our experience again highlights the difficulty in diagnosing intramural pregnancy preoperatively due to the lack of standard diagnostic criteria. This can in turn lead to inappropriate treatments. Earlier surgical intervention would allow faster diagnosis and also simultaneous treatment of the disease. The majority of intramural ectopic pregnancies have high blood flow that can cause severe hemorrhage and are therefore treated by medication or laparotomy and hysterectomy. Conclusion: Our experience reveals that a minimally invasive procedure is also safe and effective in select cases where advanced endoscopic expertise is available.

Interstitial Ectopic Pregnancy—Case Reports and Medical Management

Medicina

The term intramural (interstitial) ectopic pregnancy refers to a pregnancy developing outside the uterine cavity, with a gestational sac implanted into the interstitial part of the Fallopian tube, surrounded by a layer of the myometrium. The prevalence rate of interstitial pregnancy (IP) is 2–4% of all ectopic pregnancies. Surgery is the primary treatment for interstitial ectopic pregnancy; the pharmacological management of ectopic pregnancy, including IP, in asymptomatic patients includes systemic administration of methotrexate. In this report, we present two cases of this rare pregnancy type, reviewing our management technique and treatment ways presented in the literature. In our patients, the management was initially conservative and included methotrexate, administered as intravenous bolus injection, regular beta-human chorionic gonadotropins (β-HCG) level measurements in peripheral blood, and monitoring of the patient’s general condition. Due to signs of intra-abdominal bleedin...

Ectopic pregnancy – Review of 80 cases

Medical Journal Armed Forces India, 2017

Background: Ectopic pregnancy or extrauterine pregnancy will invariably result in abortion or rupture. Though there are risk factors for ectopic pregnancy, but at times the condition can occur without any apparent predisposing factor. Cases admitted with provisional diagnosis of ectopic pregnancy were included in this prospective study. Methods: Eighty suspected cases of ectopic pregnancy were incorporated in the study. The management was done based on standard practice. All the cases underwent urine pregnancy test, routine blood investigations including blood group, and transvaginal ultrasound. Serial bhCG was measured in cases where the diagnosis was not clear initially. Results: Incidence of ectopic was 2.46 per 100 deliveries; there was no apparent risk factor in 28.7% and many cases had more than one risk factor. 'Triad' of ectopic was present in only 21 cases. Sixteen cases were asymptomatic and two were admitted as emergency. Ultrasound findings were inconsistent and wide ranging. In 37 doubtful cases, bhCG was measured serially. There was one case of suspected interstitial pregnancy confirmed on laparoscopy. Twenty-seven cases were managed medically, and 9 were managed expectantly. Fortysix cases were managed surgically either by laparoscopy or by laparotomy. Salpingectomy was performed in 37 cases, and salpingostomy in 7 cases either laparoscopically or by laparotomy. Conclusion: Ectopic pregnancy can be managed by laparotomy, operative laparoscopy, and medically and occasionally by observation alone. Management must be customized to the clinical condition and needs of future fertility of the patient.

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