Conservative medical and surgical management of interstitial ectopic pregnancy

Lau, Susie; Tulandi, Togas

doi:10.1016/s0015-0282(99)00242-3

Cited by 364 publications

(370 citation statements)

References 39 publications

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“…Under laparoscopic vision interstitial pregnancy appears lateral to the round ligament. The interstitial pregnancy may remain asymptomatic until 7-16 weeks of gestation [13] because of the proximal segment of the tube, as surrounded by muscle, has a significantly greater capacity to expand before rupture than the distal tubal tract. The main complication is a conspicuous bleeding also due to presence of the vascular anastomosis of the uterine and the ovarian arteries in this region, with consequent possible hysterectomy.…”

Section: Ectopic Pregnancymentioning

confidence: 99%

Diagnosis of emergencies/urgencies in gynecology and during the first trimester of pregnancy

Zucchini¹,

Marra²

2014

J Ultrasound

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Several surgical and/or medical emergencies/ urgencies may occur in gynecologic patients and in pregnant women during the first trimester. Particularly, ectopic pregnancies, ruptured or hemorrhagic ovarian cysts, ovarian or adnexal torsions, threatened or inevitable miscarriages, phlogistic gynecological disorders, complications involving the uterine fibroids, endometriosis, and spontaneous uterine rupture are possible acute complications. The diagnosis is suspected on the basis of symptoms (acute pelvic and/or abdominal pain, with or without vaginal bleeding or discharge, until acute abdomen with peritonitis), by means physical evaluation (abdominal, pelvic, and bimanual gynecological examinations), by means of transabdominal (TAS) and/or transvaginal (TVS) sonography, and laboratory tests. However, the diagnosis is often not that simple, especially when the symptoms and clinical signs are minimal, and ultrasound (US) examination is not diriment. The differential diagnosis of abdominal/pelvic pain is broad and includes primarily gastrointestinal and urogenital disorders. Generally, TAS should usually be used in conjunction with TVS for evaluation of the female pelvis. If the US examination is not conclusive, CT or MRI, especially in pregnant patients, should be considered.Riassunto Diverse emergenze/urgenze chirurgiche e/o mediche possono interessare le pazienti ginecologiche e le gravide al primo trimestre. In particolare, le gravidanze ectopiche, le cisti ovariche rotte o torte, le torsioni ovariche o annessiali, le minacce d'aborto o gli aborti inevitabili, le patologie infiammatorie ginecologiche, i fibromi uterini complicati, l'endometriosi e la rottura uterina spontanea rappresentano possibili complicanze acute. La diagnosi può essere sospettata in base alla sintomatologia (algie pelviche e/o addominali acute, con eventuali perdite vaginali, fino a un quadro di addome acuto con peritonite), alla visita (valutazione addominale, pelvica ed esplorazione ginecologica bimanuale), all'ecografia transaddominale (TAS) e/o transvaginale (TVS), e agli esami di laboratorio. Tuttavia, la diagnosi spesso non è semplice, soprattutto quando i sintomi e i segni clinici sono lievi e l'ecografia non è dirimente. La diagnosi differenziale del dolore addominale/ pelvico comprende un'ampia varietà di disordini, in particolare gastrointestinali e urogenitali. Generalmente, la valutazione della pelvi femminile dovrebbe essere eseguita mediante ecografia sia transaddominale che transvaginale. Se l'esame ecografico non consente di fare diagnosi, dovrebbero essere presi in considerazione la TC o, specialmente nelle donne gravide, la RMI.

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Section: Ectopic Pregnancymentioning

confidence: 99%

Diagnosis of emergencies/urgencies in gynecology and during the first trimester of pregnancy

Zucchini¹,

Marra²

2014

J Ultrasound

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“…Otra posible indicación, aunque muy infrecuente, de laparoscopia durante el embarazo es la coexistencia de un embarazo heterotópico (56,57 únicos entre 4 y 20 semanas. La mayoría de las cirugías fueron realizadas durante el primer trimestre.…”

Section: Usos E Indicaciones De La Laparoscopia Durante El Embarazounclassified

Consideraciones Para El Uso De La Laparoscopia Durante El Embarazo

Durruty

et al. 2007

Rev. chil. obstet. ginecol.

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RESUMENLos avances en laparoscopia tanto tecnológicos como médicos han hecho posible ampliar el espectro de patologías ginecológicas susceptibles de ser manejados por esta vía. Condiciones médicas consideradas previamente como una contraindicación a esta vía, como el embarazo, son susceptibles de ser manejadas con seguridad y eficacia manteniendo los beneficios que esta técnica ofrece. El presente artículo revisa las indicaciones, recomendaciones, ventajas y desventajas de su uso durante el embarazo.PALABRAS CLAVES: Laparoscopia, embarazo, cirugía laparoscópica no ginecológica SUMMARYTechnological and medical advances in laparoscopic surgery have made feasible to extent its use to a wide variety of gynecological pathologies. Clinical conditions considered earlier as a contraindication for its use, such as pregnancy, are now susceptible to be managed securely and efficiently with this technique and maintaining all the advantages described for it. The present publication reviews the main indications, recommendations to follow, benefits and disadvantages of its use during pregnancy.KEY WORDS: Laparoscopy, pregnancy, non-gynecologic laparoscopic surgery Documentos INTRODUCCIÓNLos avances acaecidos en las últimas dos dé-cadas en cirugía laparoscópica han hecho posible realizar por esta vía procedimientos quirúrgicos tradicionalmente considerados exclusividad de la laparotomía. Más importante aún, manteniendo la eficacia de las técnicas clásicas abiertas, esta vía ofrece menor morbilidad gracias a técnicas mínima-mente invasivas (1). A los avances tecnológicos, se agrega la mayor experiencia que los cirujanos han adquirido en el uso de esa técnica, permitiendo su aplicación en patologías cada vez más complejas o en situaciones clínicas consideradas, en años previos, como de alto riesgo. Dentro de ellas, las patologías que afectan a la paciente embarazada. Esta condición, hasta hace poco tiempo, era considerado una contraindicación absoluta para la cirugía laparoscópica (2). Diversas razones se argüían para ello. Entre ellas, desde dificultades téc-nicas para la realización de las punciones por la presencia de un útero grávido, hasta complicaciones en el manejo hemodinámico y anestésico, como también el posible efecto negativo del pneumoperitoneo sobre la madre y el feto. La experiencia médica acumulada con el uso de la laparoscopia durante el embarazo (tanto por obstetras, cirujanos y/o anestesistas), avala la eficacia y seguridad técnica del abordaje laparoscópico aplicado a esta condición, y demuestra que los beneficios demostrados para la cirugía laparoscópica son aplicables también a la paciente embarazada (3).El objetivo de este trabajo es revisar las indicaciones y las recomendaciones para el uso de la

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“…1 The myometrial layer surrounding this portion of the tube allows an interstitial pregnancy to expand and remain asymptomatic for much longer than a true tubal ectopic pregnancy. 2 The rich vascular supply in this region, in conjunction with a larger gestation, has the potential for rupture and catastrophic hemorrhage. 1 As a result, a high index of suspicion, diagnostic accuracy, and timely management are of utmost importance.…”

Section: Introductionmentioning

confidence: 99%

Use of Transvaginal Ultrasound in the Management of an Interstitial Pregnancy

Eghdami¹,

Elguero

Patel

et al. 2015

CRSLS

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An interstitial pregnancy is an ectopic pregnancy that is implanted in the interstitial segment of the fallopian tube and embedded within the muscular layer of the uterus. Because of the rich vascular supply of this region, maintaining hemostasis during surgical management of interstitial pregnancies is a recognized challenge. Visualizing the entirety of the gestational sac beneath the uterine serosa can also present a challenge, especially in cases of uncomplicated interstitial ectopic pregnancies. Here we present a case in which intraoperative transvaginal ultrasound was used to assist with a laparoscopic cornual wedge resection in a 24-year-old woman with a confirmed interstitial pregnancy. The use of intraoperative transvaginal ultrasound during the laparoscopy helped accurately delineate the location and extent of invasion of the interstitial pregnancy. It guided the placement of the uterine incision and helped ensure that the entire gestational sac and products of conception had been removed. This case demonstrates that transvaginal ultrasound can be used as an intraoperative tool to enhance surgical safety and minimize patient risk.

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Conservative medical and surgical management of interstitial ectopic pregnancy

Cited by 364 publications

References 39 publications

Diagnosis of emergencies/urgencies in gynecology and during the first trimester of pregnancy

Diagnosis of emergencies/urgencies in gynecology and during the first trimester of pregnancy

Consideraciones Para El Uso De La Laparoscopia Durante El Embarazo

Use of Transvaginal Ultrasound in the Management of an Interstitial Pregnancy

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