Laparoscopic cornuotomy for interstitial pregnancy and postoperative course

Abstract

Interstitial pregnancy can be selectively treated by laparoscopic cornuotomy with local methotrexate injection, if managed carefully.

Cornual wedge resection for interstitial pregnancy and postoperative outcome

“…However, increased risk for persistent ectopic and recurrent interstitial pregnancy are reported with this technique. Watanabe et al . presented 13 cases (of 19 total cases of interstitial pregnancies) treated by cornuotomy with or without local methotrexate injection.…”

Magnetic resonance imaging for diagnosis and management of unruptured interstitial pregnancy

“…With the development of surgical instruments and the advent of surgical procedures, abdominal hysterectomy, which is the traditional method of management of interstitial pregnancy with loss of fertility, has been replaced by more conservative strategies enabling uterine preservation . However, the most appropriate technique to treat interstitial pregnancy remains undetermined and a variety of therapeutic options, including laparoscopic surgery, medical methotrexate treatment, uterine artery embolization, transcervical aspiration and resection, or forceps extraction, have been individually implemented without a clear management consensus to date.…”

“…Although this increased distensibility allows for painless growth of interstitial pregnancy (Fig. b, arrow) for a longer period of time than ectopic pregnancy in other tubal portions, interstitial pregnancy may eventually cause sudden life‐threatening hemorrhage once rupture occurs in this highly vascularized area without early diagnosis and prompt management …”

“…Until recently, imaging studies for the diagnosis of interstitial pregnancy have mostly been performed by ultrasonography . However, as some interstitial pregnancies can be misdiagnosed as intrauterine pregnancy solely by ultrasonography due to its inherently limited resolution and field of view, correct diagnosis of interstitial pregnancy remains a challenging issue for gynecologists, especially in an emergency setting .…”

The diagnosis and management of interstitial ectopic pregnancies: a review

“…The smaller the gestational sac, the harder it is to ensure that the entire interstitial pregnancy has been excised, thereby increasing the risk of persistent interstitial pregnancy [37]. A larger ectopic pregnancy does not appear to be an indication for cornual resection (rather than cornuostomy): MacRae et al and Watanabe et al performed cornuostomies for larger interstitial GSs [13,38]. However, this conflicts with the advice given by Cucinella who notes that cornual resection was preferred in cases of advanced gestational age and/or when ectopic size was > 4 cm in diameter [34].…”