Video laparoscopic intervention for an interstitial pregnancy after failure of clinical treatment
Keywords:
Pregnancy, ectopic, Laparoscopy, Ultrasonography, Prenatal care, MethotrexateAbstract
CONTEXT: Interstitial pregnancy is a rare form of ectopic pregnancy for which the best therapeutic course of action has yet to be determined. Surgical intervention entails a high risk of hemorrhage due to the great vascularization of the cornual region of the uterus. Case descriptions facilitate the analysis of results and aid clinicians in determining the most appropriate course of action in these situations. CASE REPORT: In a patient with an ultrasound diagnosis of interstitial pregnancy, clinical treatment using methotrexate was chosen. However, after one week, there was a marked decline in the serum level of the β subunit of chorionic gonadotropin hormone, although an ultrasound examination revealed embryonic cardiac activity. A second dose of the chemotherapy was administered. Embryonic cardiac activity persisted 48 hours later. Video laparoscopy was performed to achieve right-side cornual resection, which resulted in satisfactory resolution of the case.
Downloads
References
Tulandi T, Al-Jaroudi D. Interstitial pregnancy: results generated from the Society of Reproductive Surgeons Registry. Obstet Gynecol. 2004;103(1):47-50.
Lau S, Tulandi T. Conservative medical and surgical management of interstitial ectopic pregnancy. Fertil Steril. 1999;72(2):207-15.
Bouyer J, Coste J, Fernandez H, Pouly JL, Job-Spira N. Sites of ectopic pregnancy: a 10 year population-based study of 1800 cases. Hum Reprod. 2002;17(12):3224-30.
Gynecol. 2010;202(1):15-29.
MacRae R, Olowu O, Rizzuto MI, Odejinmi F. Diagnosis and laparoscopic management of 11 consecutive cases of cornual ectopic pregnancy. Arch Gynecol Obstet. 2009;280(1):59-64.
Elito Junior J, Camano L. Unruptured tubal pregnancy: different treatments for early and late diagnosis. Sao Paulo Med J. 2006;124(6):321-4.
Araujo Júnior E, Zanforlin Filho SM, Pires CR, et al. Three-dimensional transvaginal sonographic diagnosis of early and asymptomatic interstitial pregnancy. Arch Gynecol Obstet. 2007;275(3):207-10.
Jermy K, Thomas J, Doo A, Bourne T. The conservative management of interstitial pregnancy. BJOG. 2004;111(11):1283-8.
Patel MD. “Rule out ectopic”: Asking the right questions, getting the right answers. Ultrasound Q. 2006;22(2):87-100.
Kirk E, Bourne T. The nonsurgical management of ectopic pregnancy. Curr Opin Obstet Gynecol. 2006;18(6):587-93.
Smorgick N, Vaknin Z, Pansky M, et al. Combined local and systemic methotrexate treatment of viable ectopic pregnancy: outcomes of 31 cases. J Clin Ultrasound. 2008;36(9):545-50.
Lin YS, Chen CL, Yuan CC, Wang PH. Successful rescue of an early interstitial pregnancy after failed systemic methotrexate treatment: a case report. J Reprod Med. 2007;52(4):332-4.
Tang A, Baartz D, Khoo SK. A medical management of interstitial ectopic pregnancy: a 5-year clinical study. Aust N Z J Obstet Gynaecol. 2006;46(2):107-11.
Dudley PS, Heard MJ, Sangi-Haghpeykar H, Carson SA, Buster JE. Characterizing ectopic pregnancies that rupture despite treatment with methotrexate. Fertil Steril. 2004;82(5):1374-8.
Chou MM, Tseng JJ, Yi YC, Chen WC, Ho ES. Diagnosis of an interstitial pregnancy with 4-dimensional volume contrast imaging. Am J Obstet Gynecol. 2005;193(4):1551-3.
Chetty M, Elson J. Treating non-tubal ectopic pregnancy. Best Pract Res Clin Obstet Gynaecol. 2009;23(4):529-38.
Cassik P, Ofili-Yebovi D, Yazbek J, et al. Factors influencing the success of conservative treatment of interstitial pregnancy. Ultrasound Obstet Gynecol. 2005;26(3):279-82.
Ciavattini A, Cerè I, Tsiroglou D, Caselli FM, Tranquilli AL. Angular- interstitial pregnancy treated with minimally invasive surgery after adjuvant methotrexate medical therapy. JSLS; 2007;11(1):123-6.
Deruelle P, Lucot JP, Lions C, Robert Y. Management of interstitial pregnancy using selective uterine artery embolization. Obstet Gynecol. 2005;106(5 Pt 2):1165-7.
Cai Z, Wang F, Cao H, Xia Q. Transcervical suction of interstitial pregnancy under laparoscopic and hysteroscopic guidance. J Minim Invasive Gynecol. 2009;16(6):761-4.
Fujioka S, Yamashita Y, Kawabe S, et al. A case of a methotrexate- resistant ectopic pregnancy in which dactinomycin was effective as a second-line chemotherapy. Fertil Steril. 2009;91(3):929.e13-5.
Tamarit G, Lonjedo E, González M, et al. Combined use of uterine artery embolization and local methotrexate injection in interstitial ectopic pregnancies with poor prognosis. Fertil Steril. 2010;93(4):1348.e1-4.
Takeda A, Koyama K, Imoto S, et al. Successful management of interstitial pregnancy with fetal cardiac activity by laparoscopic- assisted cornual resection with preoperative transcatheter uterine artery embolization. Arch Gynecol Obstet. 2009;280(2):305-8.