Interstitial Pregnancy after Ipsilateral Salpingectomy: Analysis of 46 Cases and a Literature Review
| Autor: | Meng Yi Gao, Fei Yun Zheng, Hua Zhu |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Adult
medicine.medical_specialty medicine.medical_treatment Fertilization in Vitro Salpingectomy 03 medical and health sciences Postoperative Complications 0302 clinical medicine Pregnancy Risk Factors Laparotomy Humans Medicine Laparoscopy Salpingostomy Hydrosalpinx Retrospective Studies 030219 obstetrics & reproductive medicine In vitro fertilisation Ectopic pregnancy medicine.diagnostic_test business.industry Obstetrics and Gynecology Embryo Transfer medicine.disease Embryo transfer Surgery Methotrexate Pregnancy Interstitial 030220 oncology & carcinogenesis Female Interstitial pregnancy business |
| Zdroj: | Journal of Minimally Invasive Gynecology. 27:613-617 |
| ISSN: | 1553-4650 |
| Popis: | Study Objective To investigate the relationship between previous ipsilateral salpingectomy and interstitial pregnancy, and report on our experience of laparoscopic cornuostomy for interstitial pregnancy. Design A single-center, retrospective review. Setting A university-based hospital. Patients Patients who had a previous ipsilateral salpingectomy diagnosed with interstitial pregnancy and treated from July 2010 to September 2018. Interventions Laparoscopy or laparotomy as treatment for interstitial pregnancy following ipsilateral salpingectomy. Measurement and Main Results 414 cases of interstitial pregnancy were identified of which 46 (11.1%) were following ipsilateral salpingectomy; 20 of the 46 patients (43.5%) were pregnant by in vitro fertilization and embryo transfer. Ipsilateral salpingectomy was the result of ectopic pregnancy in 40 patients, hydrosalpinx in 5 patients, and torsion of ovarian tumor in 1 patient. The laparoscopic approach was used to treat 78.3% of patients with history of previous salpingectomy. Patients who underwent previous ipsilateral salpingectomy by laparoscopy had a shorter interval from salpingectomy to interstitial pregnancy (24 months vs. 60 months, p=.038) compared with patients who had ipsilateral salpingectomy managed by laparotomy. Laparoscopic cornuostomy was carried out in 38 cases (82.6%); 12 had fetal cardiac activity, 15 had ruptured, and 16 used prophylactic methotrexate (MTX) intraoperatively. Median size of the ectopic mass was 2.5 cm (1.0–5.0 cm). At the time of laparoscopic cornuostomy, more cases of interstitial pregnancies with intact ectopic mass cases 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 not administered prophylactic MTX experienced persistent ectopic pregnancy (PEP) . Conclusions Patients with 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 PEP, especially in patients with ruptured masses and high human gonadotropin levels. |
| Databáze: | OpenAIRE |
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