Camacho-Ríos CE, Tovar-Galván V, Illanes-Guzmán ES, Vital-Reyes VS

Language: Spanish
References: 15
Page: 701-705
PDF size: 246.79 Kb.

ABSTRACT

Background: The surgical procedure of interstitial pregnancy can be complicated by bleeding that is difficult to control; for this reason, in recent years, techniques that allow hemostatic control to have been used, thus reducing morbidity and mortality related to the procedure.
Objective: To describe the process to establish the diagnosis and decide the conservative surgical treatment in a patient with interstitial pregnancy with a history of homolateral salpingectomy and desire for uterine preservation.
Clinical case: 27-year-old patient, with a history of one childbirth, three miscarriages and a previous ectopic pregnancy, with left salpingectomy. She came for consultation due to a seven-week menstrual delay and acute pelvic pain. In view of the suspicion of ectopic pregnancy, the diagnostic protocol was integrated. The quantification of the β-fraction of chorionic gonadotropin hormone was 8962 mlU/mL, the transvaginal ultrasound reported an image compatible with gestational sac towards the left horn region and probable hemoperitoneum. At exploratory laparotomy, hemoperitoneum and left interstitial pregnancy were found. To preserve fertility, a double ligation of the left uterine artery at the level of the uterine isthmus and the utero-ovarian ligament and resection of the interstitial gestational sac with cornuostomy was performed.
Conclusion: Interstitial pregnancy is an obstetric emergency with a high risk of rupture and hemorrhage, fortunately rare. Ligation of the uterine arteries, prior to surgical ablation of the gestational sac, is an individualized alternative in patients with this complication.

REFERENCES

1. American College of Obstetricians and Gynecologists'Committee on Practice Bulletins -Gynecology. ACOGPractice Bulletin No. 193: Tubal Ectopic Pregnancy.Obstet Gynecol 2018; 131 (3): e91-e103. doi: 10.1097/AOG.0000000000002560

2. Siow A, Ng S. Laparoscopic management of 4 cases ofrecurrent cornual ectopic pregnancy and review of literature.J Minim Invasive Gynecol 2011; 18 (3): 296-302. doi:10.1016/j.jmig.2011.02.002

3. Varun N, Nigam A, Elahi AA, Jain A. Cornual ectopic pregnancy:laparoscopic management step by step. BMJ Case Rep2018; 2018: bcr2017223998. doi: 10.1136/bcr-2017-223998

4. Cho Chou SY, Hsu MI, Chow PK, Chiang HK, Su HW, HsuCS. Recurrent ipsilateral ectopic pregnancy after partialsalpingectomy. Taiwan J Obstet Gynecol 2009; 48 (4): 420-2.doi: 10.1016/S1028-4559(09)60336-3

5. Knight CA, Bridwell RE, Long B, Goss S. Cornual pregnancyafter ipsilateral salpingectomy. Cureus 2021; 13 (8):e17244. doi: 10.7759/cureus.17244

6. Po L, Thomas J, Mills K, Zakhari A, Tulandi T, Shuman M,Page A. Guideline No. 414: Management of pregnancy ofunknown location and tubal and nontubal ectopic pregnancies.J Obstet Gynaecol Can 2021; 43 (5): 614-30.e1.doi: 10.1016/j.jogc.2021.01.002

7. Tinelli R, Stomati M, Surico D, Cicinelli E, Trojano G, AngioniS. Laparoscopic management of a cornual pregnancyfollowing failed methotrexate treatment: case report andreview of literature. Gynecol Endocrinol 2020; 36 (8): 743-45. doi: 10.1080/09513590.2020.1716328

8. Hwang JH, Lee JK, Lee NW, Lee KW. Open cornual resectionversus laparoscopic cornual resection in patientswith interstitial ectopic pregnancies. Eur J Obstet GynecolReprod Biol 2011; 156 (1): 78-82. doi: 10.1016/j.ejogrb.2010.12.014

9. Afifi Y, Mahmud A, Fatma A. Hemostatic techniquesfor laparoscopic management of cornual pregnancy:double-impact devascularization technique. J MinimInvasive Gynecol 2016; 23 (2): 274-80. doi: 10.1016/j.jmig.2015.09.002

10. Lee MH, Im SY, Kim MK, Shin SY, Park WI. Comparisonof Laparoscopic Cornual Resection and Cornuotomy forInterstitial Pregnancy. J Minim Invasive Gynecol 2017; 24(3): 397-401. doi: 10.1016/j.jmig.2016.11.016

11. Di Tizio L, Spina MR, Gustapane S, D'Antonio F, Liberati M.Interstitial Pregnancy: From Medical to Surgical Approach-Report of Three Cases. Case Rep Obstet Gynecol 2018;2018: 2815871. doi: 10.1155/2018/2815871

12. Posadas-Nava A, Moreno-Santillán AA, Celis-GonzálezC, Cruz-Martínez E. Control efectivo de la hemorragiaobstétrica posparto mediante desarterialización selectivauterina. Descripción de la técnica Posadas. Ginecol ObstetMex 2016; 84 (12): 808-13.

13. The technique of suturing the internal organs. Intestinalsuture. www.burgers-king.ru/en/metodika-nalozheniyashvov-na-vnutrennie-organy-kishechnyi-shov.html

14. Khawaja N, Walsh T, Gill B. Uterine artery ligation for themanagement of ruptured cornual ectopic pregnancy.Eur J Obstet Gynecol Reprod Biol 2005; 118 (2): 269. doi:10.1016/j.ejogrb.2004.05.006

15. Raheem M, Afifi Y. Laparoscopic selective ipsilateral uterineartery ligation for the management of a cornual ectopicpregnancy. J Minim Invasive Gynecol 2008; 15 (3): 260-61.doi: 10.1016/j.jmig.2008.02.008