Hyperosmolar Glucose Injection for the Treatment of Heterotopic Ovarian Pregnancy

Allison, Jana L; Aubuchon, Mira; Leasure, Jacqueline D.; Schust, Danny J.

doi:10.1097/aog.0b013e31824f6379

Cited by 19 publications

(15 citation statements)

References 14 publications

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“…Sonographically guided local injection of KCl into the heart of the ectopic fetus can induce cardiac asystole with resolution of EP [ 154 , 155 ]. Hyperosmolar glucose can also be injected into the gestation sac causing local dehydration, necrosis of the trophoblastic tissue and resolution of EP [ 156 , 157 ]. These agents are not associated with fetal malformation but careful consideration should be given before use of hyperosmolar glucose since high doses could increase the risk of bleeding [ 158 ].…”

Section: Resultsmentioning

confidence: 99%

Ectopic pregnancy secondary to in vitro fertilisation-embryo transfer: pathogenic mechanisms and management strategies

Refaat

Dalton

Ledger

2015

Reprod Biol Endocrinol

113

108

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BackgroundEctopic pregnancy (EP) is the leading cause of maternal morbidity and mortality during the first trimester and the incidence increases dramatically with in vitro fertilisation and embryo transfer (IVF-ET). The co-existence of an EP with a viable intrauterine pregnancy (IUP) is known as heterotopic pregnancy (HP) affecting about 1% of patients during assisted conception. EP/HP can cause significant morbidity and occasional mortality and represent diagnostic and therapeutic challenges, particularly during fertility treatment. Many risk factors related to IVF-ET techniques and the cause of infertility have been documented. The combination of transvaginal ultrasound (TVS) and serum human chorionic gonadotrophin (hCG) is the most reliable diagnostic tool, with early diagnosis of EP/HP permitting conservative management. This review describes the risk factors, diagnostic modalities and treatment approaches of EP/HP during IVF-ET and also their impact on subsequent fertility treatment.MethodsThe scientific literature was searched for studies investigating EP/HP during IVF-ET. Publications in English and within the past 6 years were mostly selected.ResultsA history of tubal infertility, pelvic inflammatory disease and specific aspects of embryo transfer technique are the most significant risk factors for later EP. Early measurement of serum hCG and performance of TVS by an expert operator as early as gestational week 5 can identify cases of possible EP. These women should be closely monitored with repeated ultrasound and hCG measurement until a diagnosis is reached. Treatment must be customised to the clinical condition and future fertility requirements of the patient. In cases of HP, the viable IUP can be preserved in the majority of cases but requires early detection of HP. No apparent negative impact of the different treatment approaches for EP/HP on subsequent IVF-ET, except for risk of recurrence.ConclusionsEP/HP are tragic events in a couple’s reproductive life, and the earlier the diagnosis the better the prognosis. Due to the increase incidence following IVF-ET, there is a compelling need to develop a diagnostic biomarker/algorithm that can predict pregnancy outcome with high sensitivity and specificity before IVF-ET to prevent and/or properly manage those who are at higher risk of EP/HP.

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Section: Resultsmentioning

confidence: 99%

Ectopic pregnancy secondary to in vitro fertilisation-embryo transfer: pathogenic mechanisms and management strategies

Refaat

Dalton

Ledger

2015

Reprod Biol Endocrinol

113

108

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“…Ovarian HPs are similarly rare; live birth after local hyperosmolar glucose injection has been reported, as well as after laparoscopic wedge resection; surgical intervention carries the theoretical risk of interrupting hormonal support of the coexisting IUP by the corpus luteum [233, 234]. …”

Section: Reviewmentioning

confidence: 99%

Incidence, diagnosis and management of tubal and nontubal ectopic pregnancies: a review

Panelli

Phillips

Brady

2015

Fertil Res and Pract

208

251

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BackgroundEctopic pregnancy is a potentially life-threatening condition occurring in 1-2 % of all pregnancies. The most common ectopic implantation site is the fallopian tube, though 10 % of ectopic pregnancies implant in the cervix, ovary, myometrium, interstitial portion of the fallopian tube, abdominal cavity or within a cesarean section scar.FindingsDiagnosis involves a combination of clinical symptoms, serology, and ultrasound. Medical management is a safe and effective option in most clinically stable patients. Patients who have failed medical management, are ineligible, or present with ruptured ectopic pregnancy or heterotopic pregnancy are most often managed with excision by laparoscopy or, less commonly, laparotomy. Management of nontubal ectopic pregnancies may involve medical or surgical treatment, or a combination, as dictated by ectopic pregnancy location and the patient's clinical stability. Following tubal ectopic pregnancy, the rate of subsequent intrauterine pregnancy is high and independent of treatment modality.ConclusionThis review describes the incidence, risk factors, diagnosis, and management of tubal and non-tubal ectopic and heterotopic pregnancies, and reviews the existing data regarding recurrence and future fertility.

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“…Specific treatment of the abnormally implanted gestation will vary depending on its location, and stable patients have been managed using a variety of surgical methods [80,81] or direct injection of KCl transvaginally or transabdominally [13]. Direct injection of hypertonic saline [82] or hyperosmolar glucose [83] into the ectopic gestation has also been used to treat heterotopic pregnancies and, like KCl, is not associated with fetal malformations [84]. Although local injection of MTX has been used to treat heterotopic pregnancies [85], systemic MTX cannot be used in patients who desire to continue the concurrent intrauterine pregnancy.…”

Section: Complications and Managementmentioning

confidence: 99%

Imaging Unusual Pregnancy Implantations: Rare Ectopic Pregnancies and More

Dibble

Lourenço

2016

American Journal of Roentgenology

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Hyperosmolar Glucose Injection for the Treatment of Heterotopic Ovarian Pregnancy

Abstract: Gestational sac aspiration and injection of hyperosmolar glucose into an ovarian ectopic pregnancy was simple and efficacious without compromising a coexisting intrauterine pregnancy.

Cited by 19 publications

References 14 publications

Ectopic pregnancy secondary to in vitro fertilisation-embryo transfer: pathogenic mechanisms and management strategies

Ectopic pregnancy secondary to in vitro fertilisation-embryo transfer: pathogenic mechanisms and management strategies

Incidence, diagnosis and management of tubal and nontubal ectopic pregnancies: a review

Imaging Unusual Pregnancy Implantations: Rare Ectopic Pregnancies and More

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