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Federación Mexicana de Ginecología y Obstetricia, A.C.

2018, Number 10

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Ginecol Obstet Mex 2018; 86 (10)

Ectopic abdominal pregnancy in a patient hysterectomized

Ruiz-Campo L, Abad-Rubio C, Hernández-Aragón M, Sánchez-Lalana E, Lafalla-Bernad O, Pérez-Ruiz FJ

Language: Spanish
References: 14
Page: 675-681
PDF size: 554.86 Kb.


ABSTRACT

Background: Abdominal ectopic pregnancy is a rare condition in obstetrics, especially if there is a history of hysterectomy. Symptoms are usually nonspecific and the diagnosis is often delayed by low clinical suspicion, with consequent increase in maternal morbi-mortality.
Clinic case: 33 year-old patient with 3 previous cesareans and subtotal hysterectomy postpartum for placenta accreta, referred by abdominal pain and vaginal bleeding. In the gynecological ultrasound, a gestational sac was visualized with an embryo according to 12 + 4 weeks, with positive heartbeat. Urgent laparotomy was indicated for acute abdomen and suspicion of abdominal ectopic pregnancy, showing a gestational sac of 7 centimeters adhered to sigma and cervical stump with a bleeding broken zone to abdominal cavity that enclosed left annex, reason why resection of ectopic gestation and left annexectomy was performed in collaboration with General Surgery Service. The postoperative period was without consequences and the patient was satisfactorily discharged.
Conclusions: It is important to include this entity within the differential diagnosis of acute abdomen women of childbearing age, even if a previous hysterectomy has been performed.


REFERENCES

  1. Saad Aldin E, et al. Late post-hysterectomy ectopic pregnancy. Emer Med Australas 2012;24:239-43. https://doi. org/10.1111/j.1742-6723.2012.01543.x

  2. Fylstra DL. Ectopic pregnancy after hysterectomy: a review and insight into etiology and prevention. Fertil Steril 2009;94(2):431-35. doi: https://doi.org/10.1016/j. fertnstert.2009.03.039

  3. Sobczyka O, et al. Ectopic pregnancy 6 years after subtotal hysterectomy: A case report. J Gynecol Obstet Hum Reprod 2018;47(2):95-97. https://doi.org/10.1016/j. jogoh.2017.11.007

  4. Wendeler P. Ein fall von tubenschwangerschaft nach exstirpatio uteri vaginalis. Monatsschr Geburtsch Gynakol 1895;2(Suppl):210.

  5. Villegas E, et al. Tubal ectopic pregnancy two years after laparoscopic supracervical hysterectomy. BMC Women´s Health 2014:14:69. https://doi.org/10.1186/1472-6874-14-69

  6. Babikian S, et al. Ruptured ectopic pregnancy presenting 3 years after supracervical hysterectomy. J Ultrasound Med 2008;27(7):1087-90.

  7. Brown WD, et al. Ectopic pregnancy after cesarean hysterectomy. Obstet Gynecol 2002;99(5 Pt 2):933-934.

  8. Binder DS. Thirteen-week abdominal pregnancy after hysterectomy. J Emerg Med. 2003;25(2):159-161.

  9. Barhate KP, et al. Sonographic diagnosis of ectopic pregnancy 2 years after total hysterectomy. JCU 2009:37(6):347-49. https://doi.org/10.1002/jcu.20580

  10. Hitti E, et al. Rare cause of recurrent late post-hysterectomy ectopic pregnancy. ANZJOG 2010;50(3):303-4. https://doi. org/10.1111/j.1479-828X.2010.01171.x

  11. Bansal S, et al. Is ectopic pregnancy possible after hysterectomy? Fertil Steril 2010;94(1):350.e5-7. doi: https://doi. org/10.1016/j.fertnstert.2009.12.066

  12. Lehner R, et al. Ectopic pregnancy. Arch Gynecol Obstet 2000;263(3):87-92.

  13. Documento de consenso: Embarazo ectópico. Sociedad Española Ginecología y Obstetricia. 2004 [en línea]. Dirección URL: http://tomascabacas.com/documentode- consenso-de-la-sociedad-espanola-de-ginecologiay- obstetricia/.

  14. Jackson P, et al. A successful pregnancy following total hysterectomy. Br J Obstet Gynaecol 1980;87(5):353- 355.




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