Laparoscopic Management of a Heterotopic Pregnancy in the Tubal Stump

Abstract

To demonstrate how a heterotopic tubal stump pregnancy can be safely managed with laparoscopy, preserving the intrauterine pregnancy. Design: Stepwise demonstration of the technique by means of a video tutorial. Setting: The management of pregnancies in the tubal stump after salpingectomy involves either a surgical intervention or systemic therapy. In case of a simultaneous intrauterine pregnancy, although the prognosis for the fetus remains good with live births in approximately 70% of the cases, the surgical management of the tubal stump pregnancy is challenging owing to the risk of bleeding from the uterine horn [1−5]. We present an effective and reproducible laparoscopic technique on the basis of a 31-year-old patient with 2 prior right fallopian tube pregnancies, which were later treated with salpingectomy. The patient is now presenting in the sixth week of gestation after transfer from 2 oocytes with a pregnancy in the tubal stump and a concomitant vital intrauterine pregnancy. Interventions: The key steps of laparoscopic surgery include (1) continuous absorbable monofilament suture on the uterine horn around the tubal stump to achieve hemostasis and exposure of the proximal part of the tube, (2) removal of ectopic pregnancy, and (3) closure of the excision site with continuous absorbable polyfilament suture. The instillation of vasoconstrictive substances and the use of electrical coagulation should be avoided. Conclusion: The demonstrated laparoscopic technique is a feasible method of removal of a tubal stump pregnancy without interfering with the vital intrauterine pregnancy. The blood loss can be minimized, and laparotomy can be avoided.

Heterotopic Pregnancy Secondary to in vitro Fertilization-Embryo Transfer: Risk Factors and Pregnancy Outcomes

“…A coexisting intrauterine gestation makes the ectopic pregnancy in HP more difficult to diagnose. However, delay in diagnosis may increase the probability of tubal rupture, resulting in hemorrhagic shock and emergency blood transfusion ( 3 ). Therefore, enhanced follow-up care should be performed in patients considered to be at high risk for HP.…”

Laparoscopic resection of a salpingectomy stump remnant during early pregnancy: the diagnostic challenge posed in diagnosing a heterotopic stump pregnancy

“…First, the implantation at the tubal stump occurs by a fertilised ovum through a chemotactic fistula formed at the stump 7. Alternatively, the implantation occurs by the fertilised ovum translocating from the contralateral tube 10. In either instance, for patients in early pregnancy who have undergone previous salpingectomy, it is necessary to consider the possibility of tubal stump pregnancy and, where there is a clinical suspicion, this should be screened for with transvaginal ultrasonography.…”

Pitfalls in Diagnosing Heterotopic Pregnancy in Sub-Saharan Africa: A Case Report at the Yaounde University Teaching Hospital (Cameroon)

“…Surgery (laparoscopy or laparotomy) is the main mean of management of HP [ 7 ]. The principle is to safeguard the intrauterine pregnancy and preserve fertility.…”