Laparoscopic Management of a 13 Week Interstitial Ectopic Pregnancy

SLS — Thu, 08 Jan 2015 15:25:23 +0000

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).

ABSTRACT

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.

Download (PDF, Unknown)

The post Laparoscopic Management of a 13 Week Interstitial Ectopic Pregnancy first appeared on CRSLS.

Broad Ligament Ectopic Pregnancy

SLS — Sun, 16 Nov 2014 21:52:25 +0000

Charleen Sze-yan Cheung, MBBS, Vincent Y.T. Cheung, MBBSDepartment of Obstetrics and Gynaecology, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China (both authors).

ABSTRACTBroad ligament ectopic pregnancy is a rare form of ectopic pregnancy. A 30-year-old nulliparous woman with a history of right salpingectomy for tubal pregnancy presented with vaginal spotting at 6 weeks’ amenorrhea. Pelvic sonography revealed a possible viable right tubal stump pregnancy. On laparoscopy, a 3-cm broad ligament ectopic pregnancy was found. Laparoscopic removal of the gestational tissues followed by suturing placed at the bleeding implantation site was performed. Seventeen recent cases of broad ligament ectopic pregnancy were reviewed. With advances in sonography and laparoscopic skills, more cases can be diagnosed in the first trimester and can be safely managed laparoscopically.

Key Words: Broad ligament ectopic, Ectopic pregnancy, Intraligamentary pregnancy, Laparoscopy, Sonography

Download (PDF, 85KB)

The post Broad Ligament Ectopic Pregnancy first appeared on CRSLS.

Ectopic pregnancy - CRSLS

Laparoscopic Management of a 13 Week Interstitial Ectopic Pregnancy

Broad Ligament Ectopic Pregnancy