Nontubal ectopic pregnancies: overview of diagnosis and treatment

Sokalska, Anna; Rambhatla, Anupama; Dudley, Christina; Bhagavath, Bala

doi:10.1016/j.fertnstert.2023.07.014

Cited by 7 publications

(3 citation statements)

References 61 publications

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“…The embryonic placement within the lateral wall endometrial thickness of the uterus in angular pregnancies results in a continuous intracavitary endometrial line surrounding the embryo [ 5 ]. While the embryo may develop within the uterus in some instances, unfavorable conditions may lead to its abortion [ 6 ]. Placental localization typically adheres to the uterine wall in the second and third trimesters, but in cases of advanced gestational age, a thickened placenta in an asymmetrically confined area of the uterine angle should raise suspicion for angular pregnancy.…”

Section: Introductionmentioning

confidence: 99%

Angular Pregnancy: A Case Report

Jainani,

Shitole,

Ramyapriya

et al. 2024

Cureus

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Angular pregnancy, a rare condition, marked by implantation positioned medially to the uterotubal junction within the lateral angle of the endometrial cavity poses a risk of severe complications, such as uterine rupture, placental retention, postpartum hemorrhage, and even necessitating hysterectomy, all of which can be fatal. Distinguishing angular pregnancy from other emergent conditions, particularly interstitial and cornual pregnancies, is crucial due to similar presentations and difference in embryo viability, risk, and management. While angular pregnancies can progress to term, they are associated with an elevated complication rate. Here, we present a case of primigravida with angular pregnancy who opted for evacuation under hysteroscopic guidance subsequent to unsuccessful pregnancy.

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Section: Introductionmentioning

confidence: 99%

Angular Pregnancy: A Case Report

Jainani,

Shitole,

Ramyapriya

et al. 2024

Cureus

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“…While a new nomenclature has been suggested by the latest European Society of Human Reproduction and Embryology (ESHRE) guidelines [ 5 ], earlier cases, including those from our presenting cohort, were classified according to the old nomenclatures. Historically and in our study, we refer to non-tubal ectopic pregnancy to include both interstitial pregnancies and ectopic pregnancies implanting in sites other than the fallopian tubes [ 6 , 7 ]. While interstitial pregnancies are strictly speaking located anatomically within the fallopian tube, they tend to present differently from ectopic pregnancies implanted in the other portions of the tube.…”

Section: Introductionmentioning

confidence: 99%

“…The management of interstitial pregnancies also share more similarities to Caesarean scar pregnancies (CSP) or cervical pregnancies when compared to other tubal ectopic pregnancies. Interstitial pregnancies have therefore been included in this cohort, as with earlier studies [ 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

A 20 year experience in the management of non-tubal ectopic pregnancies in a tertiary hospital – a retrospective review

Lai,

Ko,

2024

Reprod Health

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Background Non-tubal ectopic pregnancies account for < 10% of all ectopic pregnancies. Due to its rarity and wide variation in clinical practice, there is no guideline or consensus for its management. We reported our 20-year experience in the management of non-tubal ectopic pregnancies in a tertiary hospital. Methods This is a retrospective review of all women admitted for non-tubal ectopic pregnancies from January 2003 to December 2022 in a tertiary hospital. Women with non-tubal ectopic pregnancies diagnosed by ultrasound or operation were included for analysis. Results Within the study period, 180 women were diagnosed to have non-tubal ectopic pregnancies at a mean gestation of 6.8 weeks. 16.7% (30/180) were conceived via assisted reproduction. Medical treatment was the first-line management option for 81 women, of which 75 (92.1%) women received intralesional methotrexate administered under transvaginal ultrasound guidance. The success rate of intralesional methotrexate ranges from 76.5% to 92.3%. Intralesional methotrexate was successful even in cases with a positive fetal pulsation or with high human chorionic gonadotrophin levels up to 252605U/L. Twenty seven women were managed expectantly and 40 underwent surgery. Nine (11.1%), two (6.1%), and one (2.3%) women required surgery due to massive or recurrent bleeding following medical, expectant, or surgical treatment. Hysterotomy and uterine artery embolization were necessary to control bleeding in one Caesarean scar and one cervical pregnancy. Conclusions Intralesional methotrexate is more effective than systemic methotrexate and should be considered as first line medical treatment for non-tubal ectopic pregnancies. It has a high success rate in the management of unruptured non-tubal ectopic pregnancies even in the presence of fetal pulsations or high human chorionic gonadotrophin levels, but patients may require a prolonged period of monitoring. Close surveillance and readily available surgery were required due to the risk of heavy post-procedural intra-abdominal bleeding.

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Multimodal management of ectopic hepatic pregnancy: a systematic review of the literature

Beck,

Sehouli,

Leppig

et al. 2024

Arch Gynecol Obstet

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Purpose Ectopic pregnancies with implantation in the upper abdomen are exceptionally rare. Here we provide a systematic review of hepatic ectopic pregnancies and the corresponding management strategies. Furthermore, this report details a case of ectopic hepatic pregnancy, successfully treated with primary methotrexate (MTX) followed by a two-staged robotic-assisted resection. Methods Two independent investigators performed a systematic review using the online search engine PubMed and MEDLINE database. The search utilized the following terms: ‘Hepatic Ectopic Pregnancy,’ ‘Hepatic Extrauterine Pregnancy,’ ‘Hepatic Abdominal Pregnancy,’ and ‘Ectopic Liver Pregnancy.’ Cross-referencing was employed to identify possible additional publications. Findings Forty-seven case reports on hepatic pregnancies were identified. Of these, 40 provided manuscripts in the English language. Most patients with hepatic pregnancy presented with mild to moderate abdominal pain, while only a minority exhibited signs of hemodynamically relevant intraperitoneal hemorrhage. Most cases were managed through open surgical removal, although in recent years, there has been an increase in laparoscopically managed cases. Conservative approaches using methotrexate are seldom employed. Conclusion Hepatic pregnancies present a rare and challenging clinical scenario. Until now, these cases have usually been treated primarily with open explorative surgery. As reported in this case, primary conservative treatment approaches with MTX before surgery hold promise as a strategy to reduce surgery-related bleeding and morbidity, particularly for asymptomatic or oligosymptomatic patients.

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Nontubal ectopic pregnancies: overview of diagnosis and treatment

Cited by 7 publications

References 61 publications

Angular Pregnancy: A Case Report

Angular Pregnancy: A Case Report

A 20 year experience in the management of non-tubal ectopic pregnancies in a tertiary hospital – a retrospective review

Multimodal management of ectopic hepatic pregnancy: a systematic review of the literature

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