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Balulescu L, Brasoveanu S, Pirtea M, Balint O, Ilian A, Grigoras D, Olaru F, Margan MM, Alexandru A, Pirtea L. The Efficiency of a Uterine Isthmus Tourniquet in Minimizing Blood Loss during a Myomectomy-A Prospective Study. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1979. [PMID: 38004028 PMCID: PMC10672779 DOI: 10.3390/medicina59111979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/24/2023] [Accepted: 11/07/2023] [Indexed: 11/26/2023]
Abstract
Background and Objectives: The objective of this study was to assess the effectiveness of using a peri-cervical tourniquet in reducing blood loss during a laparoscopic myomectomy. Materials and Methods: This prospective study evaluated the impact of performing a concomitant tourniquet placement during a laparoscopic myomectomy (LM). A total of 60 patients were randomly allocated to one of two groups: 30 patients who underwent an LM with a tourniquet placement (the TLM group) and 30 patients who benefited from a standard LM (the SLM group). This study's main objective was to evaluate the impact of tourniquet use on perioperative blood loss, which is quantified as the difference in the pre- and postoperative hemoglobin levels (Delta Hb) and the postoperative blood transfusion rate. Results: The mean Delta Hb was statistically lower in the TLM group compared to the SLM group: 1.38 g/dL vs. 2.41 g/dL (p < 0.001). The rate of postoperative iron perfusion in the TLM group was significantly lower compared to the SLM group (4 vs. 13 patients; p = 0.02). All four patients that required a blood transfusion were from the SLM group. On average, the peri-cervical tourniquet fastening time was 10.62 min (between 7 and 15 min), with no significant impact on the overall operative time: 98.50 min for the TLM group compared to 94.66 min for the SLM group. Conclusions: Fastening a tourniquet during a laparoscopic myomectomy is a valuable technique to effectively control intraoperative bleeding and enhance surgical outcomes.
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Affiliation(s)
- Ligia Balulescu
- Department of Obstetrics and Gynecology, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania; (L.B.); (M.P.); (O.B.); (A.I.); (D.G.); (F.O.); (L.P.)
| | - Simona Brasoveanu
- Department of Obstetrics and Gynecology, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania; (L.B.); (M.P.); (O.B.); (A.I.); (D.G.); (F.O.); (L.P.)
| | - Marilena Pirtea
- Department of Obstetrics and Gynecology, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania; (L.B.); (M.P.); (O.B.); (A.I.); (D.G.); (F.O.); (L.P.)
| | - Oana Balint
- Department of Obstetrics and Gynecology, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania; (L.B.); (M.P.); (O.B.); (A.I.); (D.G.); (F.O.); (L.P.)
| | - Aurora Ilian
- Department of Obstetrics and Gynecology, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania; (L.B.); (M.P.); (O.B.); (A.I.); (D.G.); (F.O.); (L.P.)
| | - Dorin Grigoras
- Department of Obstetrics and Gynecology, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania; (L.B.); (M.P.); (O.B.); (A.I.); (D.G.); (F.O.); (L.P.)
| | - Flavius Olaru
- Department of Obstetrics and Gynecology, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania; (L.B.); (M.P.); (O.B.); (A.I.); (D.G.); (F.O.); (L.P.)
| | - Madalin-Marius Margan
- Department of Functional Sciences, Discipline of Public Health, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania;
| | - Alexandru Alexandru
- General Medicine, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania;
| | - Laurentiu Pirtea
- Department of Obstetrics and Gynecology, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania; (L.B.); (M.P.); (O.B.); (A.I.); (D.G.); (F.O.); (L.P.)
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Management of interstitial pregnancy in the era of laparoscopy: a meta-analysis of 855 case studies compared with traditional techniques. Obstet Gynecol Sci 2021; 64:156-173. [PMID: 33539687 PMCID: PMC7990998 DOI: 10.5468/ogs.20299] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 12/27/2020] [Indexed: 11/08/2022] Open
Abstract
Interstitial pregnancy is a rare, life-threatening condition that requires high clinical suspicion for diagnosis. Most cases are discovered after complications have occurred. Many authors have described laparoscopic management. Although previous systematic reviews have compared the attributes and complications associated with interstitial pregnancy, we endeavored to complete the first systematic review and meta-analysis to compare the laparoscopic treatment of interstitial pregnancy with the open approach in the modern age of laparoscopic surgery. We systematically searched PubMed, ClinicalTrials.gov, Scopus, Web of Science, and Cochrane until June 2020 using relevant keywords and screened them for eligibility. We found a statistically significant difference in blood loss between laparoscopic and open surgery (168 mL compared to 1,163 mL). Further, cumulative meta-analysis has revealed that blood loss in laparoscopy has been decreasing over time from 1991 to 2020. Laparoscopic patients took less operative time (63.2 minutes) compared to laparotomy patients (78.2 minutes). Patients in the laparoscopic group spent less time hospitalized (3.7 days) compared to laparotomy patients (5.2 days). Our findings add strength to the position that laparoscopic approaches to interstitial pregnancy can be considered first-line in most situations. The laparoscopic approach was found to have a mean blood loss of 168 mL, and this blood loss seems to decrease over time. Increased gravidity and duration of amenorrhea are positive factors that increase bleeding during the procedure. We are unable to find enough high-quality data to significantly compare successful pregnancy following surgery or risk of mortality in these populations.
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Santos LTR, Oliveira SCDS, Rocha LGA, Sousa NDS, Figueiredo RDS. Interstitial Pregnancy: Case Report of Atypical Ectopic Pregnancy. Cureus 2020; 12:e8081. [PMID: 32542136 PMCID: PMC7292689 DOI: 10.7759/cureus.8081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Interstitial or cornual implantation of the blastocyst is rare, accounting for 2% to 3% of ectopic pregnancies, being considered not viable. The important complications of interstitial pregnancy are uterine rupture and massive bleeding, which usually occur before 12 weeks of pregnancy. The authors report a case of a 36-year-old woman with complaints of transvaginal bleeding and abdominal pain associated with amenorrhea for seven weeks and positive beta-human chorionic gonadotropin (HCG). Transvaginal ultrasound and exploratory laparotomy were performed, confirming the diagnosis of interstitial ectopic pregnancy. The patient underwent a salpingectomy and cornual resection on the left, evolving with clinical improvement and hospital discharge.
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Affiliation(s)
| | | | | | | | - Rosenildo de Sousa Figueiredo
- Obstetrics and Gynecology, Santa Casa de Misericórdia Hospital, Sobral, BRA.,Obstetrics and Gynecology, Sao Camilo Hospital, Tiangua, BRA
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4
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Fertility Outcome after Cornual Resection for Interstitial Pregnancies. J Minim Invasive Gynecol 2019; 26:865-870. [DOI: 10.1016/j.jmig.2018.08.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 08/19/2018] [Accepted: 08/29/2018] [Indexed: 12/20/2022]
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Ranji GG, Usha Rani G, Varshini S. Ectopic Pregnancy: Risk Factors, Clinical Presentation and Management. J Obstet Gynaecol India 2018; 68:487-492. [PMID: 30416277 DOI: 10.1007/s13224-017-1075-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 11/04/2017] [Indexed: 11/25/2022] Open
Abstract
Background Ectopic pregnancy is increasing in incidence. Nevertheless, there is wide availability of tools for early diagnosis and advances in management. Though it is not a leading cause of maternal mortality, it significantly causes morbidity and jeopardizes reproductive outcome in women desirous of fertility. Aims To determine incidence, risk factors, symptoms, signs, type of ectopic pregnancy and management. Settings and Design This is a one-year prospective, descriptive study conducted in Department of Obstetrics and Gynaecology, Sri Ramachandra Medical College and Research Institute, Porur, Chennai. Results There were 119 ectopic pregnancies during the study period. The incidence of ectopic pregnancy is 2.81/100 deliveries. Ectopic pregnancy was common in 26-30 years, the minimum age at diagnosis was 18 years and maximum age was 40 years. Fourteen women had previous one ectopic pregnancy. Four had previous two ectopic pregnancies. Previous cesarean and treatment for infertility were the commonest risk factors. The classic triad was present in only 27.7% of patients. Fourteen patients presented with shock. Five women were diagnosed even before they missed their periods. Success rate of medical treatment with methotrexate is 83.33%. Tubal pregnancy was the commonest type, and ampulla was the commonest site. Right side was affected more than left side. Thirty-three patients (27.7%) required blood transfusion. Seven developed morbidity. After 1-year follow-up of 68 women who were desirous of fertility, five women have become pregnant subsequently with intrauterine gestation.
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Affiliation(s)
- G Geovin Ranji
- Department of Obstetrics and Gynaecology, Sri Ramachandra Medical College and Research Institute, Chennai, 600097 India
| | - G Usha Rani
- Department of Obstetrics and Gynaecology, Sri Ramachandra Medical College and Research Institute, Chennai, 600097 India
| | - Sri Varshini
- Department of Obstetrics and Gynaecology, Sri Ramachandra Medical College and Research Institute, Chennai, 600097 India
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Dagar M, Srivastava M, Ganguli I, Bhardwaj P, Sharma N, Chawla D. Interstitial and Cornual Ectopic Pregnancy: Conservative Surgical and Medical Management. J Obstet Gynaecol India 2017; 68:471-476. [PMID: 30416274 DOI: 10.1007/s13224-017-1078-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 11/06/2017] [Indexed: 10/18/2022] Open
Abstract
Background Interstitial and cornual ectopic pregnancy is rare, accounting for 2-4% of ectopic pregnancies and remains the most difficult type of ectopic pregnancy to diagnose due to low sensitivity and specificity of symptoms and imaging. The classic triad of ectopic pregnancy-abdominal pain, amenorrhea and vaginal bleeding-occurs in less than 40% of patients. The site of implantation in the intrauterine portion of fallopian tube and invasion through the uterine wall make this pregnancy difficult to differentiate from an intrauterine pregnancy on ultrasound. The high mortality in this type of pregnancy is partially due to delay in diagnosis as well as the speed of hemorrhage. Methods Three cases of interstitial pregnancy were retrospectively analyzed. Result Successful laparoscopic cornuostomy and removal of products of conception were performed in two cases, while one case was successfully managed by local injection with KCL and methotrexate followed by systemic methotrexate. Conclusion Early diagnosis and timely management are key to the management of interstitial and cornual ectopic pregnancy. With expertise in ultrasound imaging and advances in laparoscopic skills progressively, conservative medical and surgical measures are being used to treat interstitial and cornual ectopic pregnancy successfully.
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Affiliation(s)
- Mamta Dagar
- Sir Ganga Ram Hospital Marg, Rajinder Nagar, New Delhi, 110060 India
| | - Mala Srivastava
- Sir Ganga Ram Hospital Marg, Rajinder Nagar, New Delhi, 110060 India
| | - Indrani Ganguli
- Sir Ganga Ram Hospital Marg, Rajinder Nagar, New Delhi, 110060 India
| | - Punita Bhardwaj
- Sir Ganga Ram Hospital Marg, Rajinder Nagar, New Delhi, 110060 India
| | - Nidhish Sharma
- Sir Ganga Ram Hospital Marg, Rajinder Nagar, New Delhi, 110060 India
| | - Deepak Chawla
- Sir Ganga Ram Hospital Marg, Rajinder Nagar, New Delhi, 110060 India
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Comparison of Laparoscopic Cornual Resection and Cornuotomy for Interstitial Pregnancy. J Minim Invasive Gynecol 2017; 24:397-401. [DOI: 10.1016/j.jmig.2016.11.016] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 11/29/2016] [Accepted: 11/30/2016] [Indexed: 11/18/2022]
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8
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EL-Agwany A. Laparoscopy for interstitial pregnancy: Conservative treatment by cornuotomy. APOLLO MEDICINE 2016. [DOI: 10.1016/j.apme.2016.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Hishikawa K, Fukuda T, Inoue H, Kohata Y, Monma M, Ochiai N, Kubo Y, Watanabe R, Ako S, Aihara Y, Kusaka T. Laparoscopic Management of Abdominal Pregnancy with Local Injection of Vasopressin Solution: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2016; 17:637-40. [PMID: 27587187 PMCID: PMC5012457 DOI: 10.12659/ajcr.898554] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Patient: Female, 32 Final Diagnosis: Abdominal pregnancy Symptoms: Severe abdominal pain Medication: — Clinical Procedure: Laparoscopic treatment Specialty: Obstetrics and Gynecology
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Affiliation(s)
- Kenji Hishikawa
- Department of Obstetrics and Gynecology, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Takanori Fukuda
- Department of Obstetrics and Gynecology, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Hiromi Inoue
- Department of Obstetrics and Gynecology, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Yutaka Kohata
- Department of Obstetrics and Gynecology, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Mika Monma
- Department of Obstetrics and Gynecology, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Naomi Ochiai
- Department of Obstetrics and Gynecology, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Yuina Kubo
- Department of Obstetrics and Gynecology, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Remi Watanabe
- Department of Obstetrics and Gynecology, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Shiho Ako
- Department of Obstetrics and Gynecology, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Yuri Aihara
- Department of Obstetrics and Gynecology, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Takeshi Kusaka
- Department of Obstetrics and Gynecology, Shonan Kamakura General Hospital, Kanagawa, Japan
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10
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Wang J, Huang D, Lin X, Saravelos SH, Chen J, Zhang X, Li T, Zhang S. Incidence of Interstitial Pregnancy After In Vitro Fertilization/Embryo Transfer and the Outcome of a Consecutive Series of 38 Cases Managed by Laparoscopic Cornuostomy or Cornual Repair. J Minim Invasive Gynecol 2016; 23:739-47. [DOI: 10.1016/j.jmig.2016.02.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 02/23/2016] [Accepted: 02/27/2016] [Indexed: 10/22/2022]
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Hemostatic Techniques for Laparoscopic Management of Cornual Pregnancy: Double-Impact Devascularization Technique. J Minim Invasive Gynecol 2016; 23:274-80. [DOI: 10.1016/j.jmig.2015.09.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 09/02/2015] [Accepted: 09/03/2015] [Indexed: 11/18/2022]
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Sargin MA, Tug N, Ayas S, Yassa M. Is interstitial pregnancy clinically different from cornual pregnancy? A case report. J Clin Diagn Res 2015; 9:QD05-6. [PMID: 26023605 PMCID: PMC4437121 DOI: 10.7860/jcdr/2015/12198.5836] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 03/20/2015] [Indexed: 11/24/2022]
Abstract
Interstitial pregnancy is a rare form of ectopic pregnancy with significant risk for morbidity. A 32-year-old woman, was brought to the emergency department with severe abdominal pain and syncope. There was no history of menolipsis and usage of any contraceptive methods. Serum ß hCG arrival was 11224 IU/L. Trans-vaginal ultrasound scan showed an empty uterus with a displaced 16 × 26 mm gestation sac on the left corn of the uterine cavity which surrounded by a thin myometrium. Free abdominal fluid and coagulum were also detected in the cul-de-sac. She was haemodynamically unstable. A ruptured ectopic pregnancy was diagnosed in the left uterine cornu during emergency laparotomy. Cornual resection was performed. Interstitial and cornual pregnancies should be considered as two different clinical situations. It is important to enhance the clinician's suspicion about interstitial/cornual pregnancy. Thus, more detailed examination by transvaginal ultrasonography may contribute for accurate localization and diagnosis.
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Affiliation(s)
- Mehmet Akif Sargin
- Specialist, Department of Obstetrics and Gynecology, Fatih Sultan Mehmet Research and Training Hospital, Istanbul, Turkey
| | - Niyazi Tug
- Associate Professor , Department of Obstetrics and Gynecology, Fatih Sultan Mehmet Research and Training Hospital, Istanbul, Turkey
| | - Selçuk Ayas
- Associate Professor, Department of Obstetrics and Gynecology, Zeynep Kamil Maternity and Pediatric Research and Training Hospital, Istanbul, Turkey
| | - Murat Yassa
- Assistant Doctor, Department of Obstetrics and Gynecology, Fatih Sultan Mehmet Research and Training Hospital, Istanbul, Turkey
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Manea C, Pavlidou E, Urias AA, Bouquet de la Jolinière J, Dubuisson JB, Feki A. Laparoscopic management of interstitial pregnancy and fertility outcomes after ipsilateral salpingectomy - three case reports. Front Surg 2014; 1:34. [PMID: 25593958 PMCID: PMC4286981 DOI: 10.3389/fsurg.2014.00034] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 08/18/2014] [Indexed: 12/01/2022] Open
Abstract
Background: Interstitial pregnancy after ipsilateral salpingectomy is a rare event with potentially serious consequences. Optimal management strategy remains uncertain and debated. In addition, fertility sparing is determinant of the treatment choice. Cases: Here, we report three cases of interstitial pregnancy occurring after homolateral salpingectomy. We expose the therapeutic option held in all three situations, which associated laparoscopic procedure followed by intramuscular methotrexate injection with successful outcome for all patients. We also report the fertility outcome for the first patient, discussing the timing and mode of delivery. Cesarean section at term was performed for this patient. Conclusion: In these three situations, we obtained a successful result using a minimally invasive surgical approach combined with systemic methotrexate injection. Cesarean section at term for subsequent intrauterine pregnancy seems to be the safest delivery strategy, although no clear data exist in literature.
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Affiliation(s)
- Cristina Manea
- Department of Obstetrics and Gynecology, Hôpital Cantonal Fribourgeois , Fribourg , Switzerland
| | - Evangelia Pavlidou
- Department of Obstetrics and Gynecology, Geneva University Hospitals , Geneva , Switzerland
| | - Aline Andrey Urias
- Department of Obstetrics and Gynecology, Geneva University Hospitals , Geneva , Switzerland
| | | | - Jean Bernard Dubuisson
- Department of Obstetrics and Gynecology, Hôpital Cantonal Fribourgeois , Fribourg , Switzerland
| | - Anis Feki
- Department of Obstetrics and Gynecology, Hôpital Cantonal Fribourgeois , Fribourg , Switzerland
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Watanabe T, Watanabe Z, Watanabe T, Fujimoto K, Sasaki E. Laparoscopic cornuotomy for interstitial pregnancy and postoperative course. J Obstet Gynaecol Res 2014; 40:1983-8. [DOI: 10.1111/jog.12422] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2013] [Accepted: 02/17/2014] [Indexed: 12/01/2022]
Affiliation(s)
- Tadashi Watanabe
- Department of Obstetrics and Gynecology; NTT East Japan Tohoku Hospital; Sendai Japan
| | - Zen Watanabe
- Department of Obstetrics and Gynecology; NTT East Japan Tohoku Hospital; Sendai Japan
| | - Takanori Watanabe
- Department of Obstetrics and Gynecology; Sendai City Hospital; Sendai Japan
| | - Kumiko Fujimoto
- Department of Obstetrics and Gynecology; Saka General Hospital; Tagajo Japan
| | - Etsuko Sasaki
- Etsuko Sasaki Clinic of Obstetrics and Gynecology; Sendai Japan
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Cucinella G, Calagna G, Rotolo S, Granese R, Saitta S, Tonni G, Perino A. Interstitial pregnancy: a 'road map' of surgical treatment based on a systematic review of the literature. Gynecol Obstet Invest 2014; 78:141-9. [PMID: 25060047 DOI: 10.1159/000364869] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 05/27/2014] [Indexed: 11/19/2022]
Abstract
An electronic search concerning the surgical approach in cases of interstitial pregnancy from January 2000 to May 2013 has been carried out. Fifty three studies have been retrieved and included for statistical analysis. Conservative and radical surgical treatments in 354 cases of interstitial pregnancy are extensively described. Hemostatic techniques have been reported as well as clinical criteria for the medical approach. Surgical outcome in conservative versus radical treatment were similar. When hemostatic techniques were used, lower blood losses and lower operative times were recorded. Conversion to laparotomy involved difficulties in hemostasis and the presence of persistent or multiple adhesions. Laparoscopic injection of vasopressin into the myometrium below the cornual mass was the preferred approach.
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Affiliation(s)
- Gaspare Cucinella
- Department of Obstetrics and Gynecology, University Hospital 'Paolo Giaccone', Palermo, Italy
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Shah A, Curtiss NL, Edwards RGA, Salman G, Sadoon S. Laparoscopic management of an interstitial pregnancy in a sub-fertility patient: a case report depicting the challenges to diagnose and manage this rare condition. Eur J Obstet Gynecol Reprod Biol 2014; 179:255-6. [PMID: 24857312 DOI: 10.1016/j.ejogrb.2014.04.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Revised: 04/19/2014] [Accepted: 04/22/2014] [Indexed: 10/25/2022]
Affiliation(s)
- Abhijeet Shah
- Specialty Training Registrar, Obstetrics & Gynaecology Department, Medway Foundation Hospitals NHS Trust, Gillingham, Kent ME7 5NY, UK.
| | - Natasha L Curtiss
- Specialty Training Registrar, Obstetrics & Gynaecology Department, Medway Foundation Hospitals NHS Trust, Gillingham, Kent ME7 5NY, UK
| | - Robin G A Edwards
- Specialty Training Registrar, Obstetrics & Gynaecology Department, Medway Foundation Hospitals NHS Trust, Gillingham, Kent ME7 5NY, UK
| | - Ghada Salman
- Obstetrics & Gynaecology Consultant, University College London Hospital, 235 Euston Road, Greater London NW1 2BU, UK
| | - Sadoon Sadoon
- Obstetrics & Gynaecology Consultant, Medway Foundation Hospitals NHS Trust, Gillingham, Kent ME7 5NY, UK
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17
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Challenges in the diagnosis and management of interstitial and cornual ectopic pregnancies. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2013. [DOI: 10.1016/j.mefs.2013.01.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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18
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Zhang K, Yuan P. Laparoscopy-assisted vaginal cornual resection for the treatment of large interstitial pregnancy. J Laparoendosc Adv Surg Tech A 2013; 23:783-6. [PMID: 23859746 DOI: 10.1089/lap.2013.0177] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To present the experience of laparoscopy-assisted vaginal cornual resection for the treatment of two cases of large interstitial pregnancy. SUBJECTS AND METHODS Surgeons performed laparoscopic cornual resection initially for the first case but encountered torrential hemorrhage, which was controlled immediately by conversion to the vaginal approach. Following this experience, laparoscopy-assisted vaginal cornual resection was performed directly after laparoscopic inspection for the second case. RESULTS Both cases were treated successfully by laparoscopy-assisted vaginal cornual resection. Hemostasis and uterine repair seem to be easier by the laparoscopy-assisted vaginal route than by the purely laparoscopic approach. No similar case has been reported in the literature. CONCLUSIONS Our experience suggests that laparoscopy-assisted vaginal cornual resection may be a preferable alternative to laparoscopy in treating a large interstitial pregnancy. More studies are needed to confirm this finding.
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Affiliation(s)
- Kui Zhang
- Department of Obstetrics and Gynaecology, No. 451 Hospital of the PLA, Xi'an, Shaanxi, China
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19
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Review of Vasopressin Use in Gynecologic Surgery. J Minim Invasive Gynecol 2012; 19:422-33. [DOI: 10.1016/j.jmig.2012.03.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2011] [Revised: 03/14/2012] [Accepted: 03/21/2012] [Indexed: 11/24/2022]
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The value of laparoscopy alone or combined with hysteroscopy in the treatment of interstitial pregnancy: analysis of 22 cases. Arch Gynecol Obstet 2011; 285:727-32. [DOI: 10.1007/s00404-011-2060-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2011] [Accepted: 08/02/2011] [Indexed: 11/26/2022]
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Open cornual resection versus laparoscopic cornual resection in patients with interstitial ectopic pregnancies. Eur J Obstet Gynecol Reprod Biol 2011; 156:78-82. [DOI: 10.1016/j.ejogrb.2010.12.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2010] [Revised: 11/01/2010] [Accepted: 12/15/2010] [Indexed: 11/17/2022]
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Günenç Z, Bingöl B, Celik A, Bozkurt S, Ozekici U. Laparoscopic surgery of interstitial (cornual) pregnancy, a case report. J Turk Ger Gynecol Assoc 2010; 11:102-4. [PMID: 24591909 DOI: 10.5152/jtgga.2010.09] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2009] [Accepted: 09/17/2009] [Indexed: 11/22/2022] Open
Abstract
We report a successful laparoscopic management of an interstitial pregnancy of a 24- year-old single woman, treated by cornuostomy. The patient was first managed with methotrexate treatment. After the 2. methotrexate administration, the patient suffered from low abdominal pain, and intraabdominal bleeding signs were reported by transvaginal ultrasonograpy. The hemoglobin level was decreased from 12.8 gr/dl to 11.8 gr/dl and the beta hCG level was increased from 8,314 mIU/l to 11,541 mIU/l. The laparoscopic approach to interstitial pregnancy was presented and other management strategies such as medical treatment and laparotomy have been reviewed.
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Affiliation(s)
- Ziya Günenç
- Department of Obstetrics and Gynecology, Maltepe University, Istanbul, Turkey
| | - Banu Bingöl
- Department of Obstetrics and Gynecology, Bilim University Gayrettepe Florence Nightingale Hospital, Istanbul, Turkey
| | - Aygen Celik
- Department of Obstetrics and Gynecology, Maltepe University, Istanbul, Turkey
| | - Serpil Bozkurt
- Department of Obstetrics and Gynecology, Maltepe University, Istanbul, Turkey
| | - Umit Ozekici
- Department of Obstetrics and Gynecology, Maltepe University, Istanbul, Turkey
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Moawad NS, Mahajan ST, Moniz MH, Taylor SE, Hurd WW. Current diagnosis and treatment of interstitial pregnancy. Am J Obstet Gynecol 2010; 202:15-29. [PMID: 20096253 DOI: 10.1016/j.ajog.2009.07.054] [Citation(s) in RCA: 151] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2009] [Revised: 07/04/2009] [Accepted: 07/20/2009] [Indexed: 01/01/2023]
Abstract
The incidence of interstitial pregnancy is rising. Traditional treatment with laparotomy, hysterectomy, or cornual wedge resection is associated with high morbidity and detrimental effects on future fertility. A diverse array of alternate treatments has been introduced over the last 3 decades, with the common goal of achieving a minimally invasive, standardized management strategy. This has been facilitated by impressive strides towards prompt diagnosis, both radiologically and chemically. In this review, we explore the current state of the art diagnostic criteria and the clinically significant diverse therapeutic options with supporting literature. Finally, we propose a structured, best-practice management plan for the once-lethal interstitial pregnancy, based on the current literature.
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Affiliation(s)
- Nash S Moawad
- Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Hospital of the University of Pittsburgh Medical Center, PA, USA.
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