Laparoscopic management of a primary posterior cul-de-sac abdominal ectopic pregnancy.

Autor:	Cagino K; Department of Obstetrics and Gynecology, New York Presbyterian Hospital-Weill Cornell Medicine, New York, New York., Pereira N; The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, New York, New York., Fields JC; Department of Obstetrics and Gynecology, New York Presbyterian Hospital-Weill Cornell Medicine, New York, New York., Fenster TB; Department of Obstetrics and Gynecology, New York Presbyterian Hospital-Weill Cornell Medicine, New York, New York. Electronic address: taf2011@med.cornell.edu.
Jazyk:	angličtina
Zdroj:	Fertility and sterility [Fertil Steril] 2021 Aug; Vol. 116 (2), pp. 605-607. Date of Electronic Publication: 2021 Apr 21.
DOI:	10.1016/j.fertnstert.2021.03.042
Abstrakt:	Objective: To report a case of laparoscopic management of a primary posterior cul-de-sac abdominal ectopic pregnancy (AEP). Design: Video article. Setting: Academic medical center. Patient(s): A 40-year-old G5P3013 woman at approximately 7 weeks of pregnancy was referred to our emergency department because of abnormally rising β-human chorionic gonadotropin levels. Transvaginal ultrasonography revealed a cystic structure measuring 2.8 × 1.6 ×1.9 cm in the posterior cul-de-sac distinct from the cervix. The mass was noted to have peripheral hypervascularity and a thickened wall. A moderate amount of complex free fluid was noted adjacent to the mass. The patient's baseline β-human chorionic gonadotropin level and hematocrit were 6,810.7 mIU/mL and 42.4%, respectively. Intervention(s): Laparoscopy for suspected AEP. Main Outcome Measure(s): Laparoscopic excision of a primary AEP. Result(s): Diagnostic laparoscopy revealed a normal uterus, normal right ovary, normal left ovary with a corpus luteal cyst, and normal bilateral fallopian tubes without dilatation or hemorrhage. The AEP was noted in the right posterior cul-de-sac and was excised from the underlying peritoneum. The left lateral aspect of the AEP extended into the posterior vaginal wall. The patient was admitted for overnight observation, and her postoperative hematocrit was 35.1%. Conclusion(s): AEPs are extremely rare and account for 1% of all ectopic pregnancies. Approximately 90% of AEPs require surgical management. Historically, AEPs were treated with laparotomy because of the high risk of hemorrhage and hemodynamic instability. However, as exemplified by the current case, laparoscopy is a safe and feasible option for surgical management of AEPs. (Copyright © 2021 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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