Laparoscopic resection of a salpingectomy stump remnant during early pregnancy: the diagnostic challenge posed in diagnosing a heterotopic stump pregnancy

In this report, we present a case of a woman admitted in her first trimester of pregnancy with significant intraperitoneal haemorrhage from a left tubal stump remnant occurring concurrent to a viable intrauterine pregnancy. The patient was resuscitated and treated successfully with laparoscopic removal of her stump remnant to achieve haemostasis. However, despite extensive investigation, the pathology of her haemorrhagic stump remained inconclusive. Stump ectopic pregnancy is an established phenomenon, although it presents a diagnostic challenge when occurring as a heterotopic pregnancy. Further, persisting trophoblastic tissue is a rare but established feature of incomplete removal of ectopic pregnancy post salpingectomy. Here, we discuss challenges of diagnosis in such cases and present a case report of a presumed stump remnant heterotopic pregnancy from spontaneous conception.

Fertility and reproductive outcomes following high-energy pelvic fractures: A systematic review and meta-analysis

BACKGROUND

There is a need to decipher the effect of pelvic fractures (PFs) upon female fertility and live birth rate, as data including treatment regimens in large, unselected populations remain scarce.

OBJECTIVES

To assess the effect of high energy PFs upon female fertility and live birth rate.

SEARCH STRATEGY

Literature search for relevant studies was performed up to March 2022 in five databases: Embase, MEDLINE, CAB Abstracts, ClinicalTrials.gov, and Google Scholar.

SELECTION CRITERIA

Retrospective studies assessing live birth, infertility, and dyspareunia rates following PFs.

DATA COLLECTION AND ANALYSIS

Data were extracted from studies independently by two authors. The quality of the included studies was assessed using the Newcastle-Ottawa Scale (NOS) for observational studies.

MAIN RESULTS

A total of 763 female patients of median age 27.8 years (95% CI 22-38 years) were included with median follow up of 5 years. Among PF patients, infertility hazard ratio (HR) 1.18 (95% CI 0.76-1.84, P = 0.47; I²  = 18%) and dyspareunia HR 0.60 (95% CI 0.34-1.08, P = 0.09; I²  = 66%), did not significantly differ from the age-matched literature-reported rates among non-PF patients.

CONCLUSIONS

No significant differences of live birth, infertility, and dyspareunia rates across patients with PFs were found compared with non-PF counterparts.