Management of interstitial pregnancy in the era of laparoscopy: a meta-analysis of 855 case studies compared with traditional techniques

Abstract

Interstitial pregnancy is a rare, life-threatening condition that requires high clinical suspicion for diagnosis. Most cases are discovered after complications have occurred. Many authors have described laparoscopic management. Although previous systematic reviews have compared the attributes and complications associated with interstitial pregnancy, we endeavored to complete the first systematic review and meta-analysis to compare the laparoscopic treatment of interstitial pregnancy with the open approach in the modern age of laparoscopic surgery. We systematically searched PubMed, ClinicalTrials.gov, Scopus, Web of Science, and Cochrane until June 2020 using relevant keywords and screened them for eligibility. We found a statistically significant difference in blood loss between laparoscopic and open surgery (168 mL compared to 1,163 mL). Further, cumulative meta-analysis has revealed that blood loss in laparoscopy has been decreasing over time from 1991 to 2020. Laparoscopic patients took less operative time (63.2 minutes) compared to laparotomy patients (78.2 minutes). Patients in the laparoscopic group spent less time hospitalized (3.7 days) compared to laparotomy patients (5.2 days). Our findings add strength to the position that laparoscopic approaches to interstitial pregnancy can be considered first-line in most situations. The laparoscopic approach was found to have a mean blood loss of 168 mL, and this blood loss seems to decrease over time. Increased gravidity and duration of amenorrhea are positive factors that increase bleeding during the procedure. We are unable to find enough high-quality data to significantly compare successful pregnancy following surgery or risk of mortality in these populations.

Diagnosis pitfall of interstitial pregnancy: a case report of a term pregnancy with abnormal placentation

“…The selected method of surgery has variations based on the duration and outcome of the surgery as laparoscopic cornuostomy is introduced as the method of choice [ 8 ]. Although this method increases the risk of developing rupture uterus in the future pregnancy [ 10 ], laparoscopic approach is introduced to be the first line of therapy in a recent meta-analysis with the benefit of average bleeding of 168 cc that depends on the gravidity and duration of the amenorrhea that the patient has [ 11 ]. Focusing on the operative management of IP, especially the retained tissues, the benefit of hysteroscopy is recently confirmed by using morcellation techniques to avoid some complications [ 12 ].…”

Endoscopic Approach to Ectopic Pregnancy

“…Three therapeutic approaches have been described: close surveillance of the ectopic pregnancy if not associated with hemodynamic instability, medical management, and surgical management. The choice hinges on various factors such as the patient's clinical status, the gestational age at the time of diagnosis, the presence of contraindications of medical treatment, and the patient's preference [21].…”

“…An expectant approach (surveillance) is reserved for patients with decreasing β-hCG levels and that remain clinically stable. Medical treatment with local and/ or systemic methotrexate is indicated in young nulliparous women wishing to preserve their future fertility if the interstitial pregnancy has not ruptured, if the gestational sac measures 35 mm or more in diameter, a β-hCG level of 5000 mUI/ mL or below, and the absence of embryonic cardiac activity; the rate of success is 80% [21][22][23][24].…”

“…The endoscopic options are: laparoscopic horn resection, wedge horn resection (in combination with an ipsilateral salpingectomy), hornostomy/salpingostomy (incision in the horn region, and removal of the gestational sac or horn evacuation), and mini-horn excision. The most frequently used and described techniques are laparoscopic horn excision and hornostomy [21,24,26].…”

Interstitial and Cornual Ectopic Pregnancy: Updates in Diagnosis and Management

“…Laparoscopic management of interstitial and cornual pregnancy is becoming widely accepted as a first-line management option. A recent systematic review and meta-analysis of interstitial pregnancy demonstrated laparoscopy was associated with an almost 10-fold decrease in blood loss, decreased operative time, and decreased hospital stay compared with the traditional management of laparotomy 19. Moawad et al6 reported a cumulative success rate of 85% (164/192 patients) with use of laparoscopic techniques to treat interstitial ectopic pregnancy.…”