Laparoscopic Management of a 13 Week Interstitial Ectopic Pregnancy
Ariel K. Dubin, MD, Eve F. Zaritsky, MD, Miya P. Yamamoto, MD
Department of Obstetrics and Gynecology, Kaiser Permanente Santa Clara, Santa Clara, California (Dr Dubin); Department of Obstetrics and Gynecology, Kaiser Permanente Oakland, Oakland, California (Dr Zaritsky); Department of Obstetrics and Gynecology, Kaiser Permanente San Leandro, San Leandro, California (Dr Yamamoto).
Introduction: Interstitial pregnancies account for approximately 2% to 4% of all ectopic pregnancies; however, without timely diagnosis and treatment, they are associated with a high rate of morbidity and mortality. The traditional surgical approach has been laparotomy with cornual wedge resection or even hysterectomy. With advances in laparoscopic surgery, new surgical techniques have been reported: cornuostomy incision with removal of pregnancy contents, cornual wedge resection, and combined laparoscopic and hysteroscopic suction removal. However, these laparoscopic techniques have been described mostly in first-trimester interstitial pregnancies with smaller mass sizes.
Case Description: We report a case of a successfully treated interstitial pregnancy of a 35-year-old woman in her second trimester with a mass diameter of 8 cm via laparoscopic cornual wedge resection. The surgery had minimal blood loss, aided by myometrial injection of dilute vasopressin, systematic electrocautery ligation, and continuous barbed suture closure of the remaining myometrium and serosa. The patient had an uneventful postoperative course and has recovered fully.
Discussion: With advances in laparoscopic techniques, laparoscopy has become a viable surgical treatment of interstitial pregnancy. However, few case descriptions of successful laparoscopic management of pregnancies that have progressed into the second trimester exist. This is due to several factors: the rarity of these pregnancies to progress past the first trimester without uterine rupture, the size of second-trimester pregnancies, and the technical difficulty encountered with such large resections. In our case report, we share our successful experience of laparoscopic management of an 8-cm-diameter interstitial pregnancy at 13 weeks’ gestation.
Key Words: Ectopic pregnancy, Interstitial pregnancy, Laparoscopy, Laparoscopic cornual wedge resection.