Primary hepatic pregnancy: report of a case treated with laparoscopic approach and review of the literature

Garzon, Simone; Raffaelli, Ricciarda; Montin, Umberto; Ghezzi, Fabio

doi:10.1016/j.fertnstert.2018.05.020

Cited by 19 publications

(9 citation statements)

References 40 publications

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“…In our study period, 228 women were admitted at the University Hospital of Verona with a diagnosis of clinically suspected EP. Twelve of 228 (5.2%) were excluded from the study population due to extra tubal location of the ectopic pregnancy, in particular 2 (0.9%) had ovarian, 3 (1.3%) cervical, 1 (0.4%) interstitial, 1 (0.4%) subhepatic [21], 1 (0.4%) uterine isthmic and 4 (1.7%) cornual locations. Twelve of 228 (5.2%) women had a history of tubal EP but were excluded from the study because the previous hospitalization was elsewhere and information was not available, or because the previous EP was not during the study period.…”

Section: Resultsmentioning

confidence: 99%

Fertility and reproductive outcome after tubal ectopic pregnancy: comparison among methotrexate, surgery and expectant management

Baggio

Garzon

Russo

et al. 2020

Arch Gynecol Obstet

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Purpose To compare fertility and reproductive outcome after surgical, medical, and expectant management for tubal ectopic pregnancy (EP). Methods 133 of 228 patients, who were managed between January 2012 and December 2017 for a tubal EP, tried to conceive immediately after treatment: 86 out of 173 (49.7%) underwent surgical treatment; 38 (21.9%) were treated with methotrexate (MTX), and 49 (28.3%) had expectant management. Clinical data were retrieved by medical records, fertility outcomes were obtained by phone follow-up. The cumulative incidence (CI) of intrauterine clinical pregnancy (CP), miscarriage, live birth (LB), and recurrent EP, and the time between treatment and first intrauterine CP were compared between women treated with MTX, surgery and expectant management. Results The CI of intrauterine CP starting from 12 months after the EP was 65.3% for the expectant management, 55.3% for the MTX group, and 39.5% for surgery (p = 0.012). Post-hoc analysis showed expectant management having higher intrauterine CP and LB, and shorter time between treatment and first intrauterine CP compared to surgery (p < 0.05). The CI of recurrent EP was comparable between the 3 groups. The analysis stratified per βhCG cut-off of 1745 mUI/mL and EP mass cut-off of 25 mm reported consistent results. Conclusions Women successfully managed by expectation appear to have better reproductive outcomes compared to women who underwent surgery, with the shortest time to achieve a subsequent intrauterine CP. Therefore, if safely applicable the expectant management should be considered in the case of tubal EP. The fact that the chosen treatment was primarily guided by the βhCG value and EP mass diameter based on the protocol, which is intrinsically related to the characteristics of the EP, represents the main limitation of the present study. Indeed, we cannot completely exclude that the observed differences between treatments are related to the EP itself instead of the treatment.

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Section: Resultsmentioning

confidence: 99%

Fertility and reproductive outcome after tubal ectopic pregnancy: comparison among methotrexate, surgery and expectant management

Baggio

Garzon

Russo

et al. 2020

Arch Gynecol Obstet

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“…In cases where pheochromocytoma is diagnosed in the later weeks of gestation, elective cesarean section could be performed followed by adrenalectomy (16). Therefore, it is of paramount importance to make diagnosis of pheochromocytoma as early as possible (18), although minimally invasive approach to the retroperitoneum could allow to preserve pregnancy (23,25). Moreover, early diagnosis is of paramount importance because administration of corticosteroids could have a detrimental effect on maternal-fetal condition.…”

Section: Discussionmentioning

confidence: 99%

Late diagnosis of pheochromocytoma in pregnancy with poor fetal outcome

et al. 2021

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Pheochromocytomas are rare tumors producing catecholamines that could be a cause of secondary hypertension. On that basis, pheochromocytoma can occur as an extremely rare cause of hypertension in pregnancy and if diagnosed late can lead to adverse maternal-fetal outcome. In this case report we describe a case of pheochromocytoma affected pregnancy with poor fetal outcome. A 27-year-old pregnant woman was admitted for severe pre-eclampsia due to pre-gestational hypertension that was diagnosed during the first trimester. Due to high and uncontrolled maternal blood pressure and the worsened maternal-fetal condition after the admission induction of fetal lung maturity and emergency cesarean section were performed, but with poor fetal outcome. Later, an adrenal gland mass was identified using abdominal ultrasound and confirmed by computed tomography. After surgical adrenalectomy blood pressure of the patient was normalized. Pheochromocytoma should be considered as a possible cause of hypertensive disorder during pregnancy, particularly in cases of severe and unresponsive hypertension in order to provide for timely and appropriate treatment.

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“…Before December 1988, ten cases of hepatic pregnancy [5,[9][10][11][12][13][14][15][16][17] had been reported, two of which were diagnosed preoperatively by X-ray [16,17], accounting for 20%, and eight of which were diagnosed during intraoperative exploration or after postoperative pathology, accounting for 80%. From January 1989 to December 2018, 23 cases of hepatic pregnancy have been reported, including 18 cases [5,8,9,11,[18][19][20][21][22][23][24][25][26][27][28][29][30][31] diagnosed preoperatively by ultrasonography (78.3%), two cases by other imaging modalities (including one by CT [2] and one by CT combined with MRI [32]), accounting for 8.7%, and three cases diagnosed by emergency laparotomy [33,34] or laparoscopy [3], accounting for 13.0%. A description of the 18 cases diagnosed by abdominal ultrasound is presented in Table 1.…”

Section: Discussionmentioning

confidence: 99%

Application of ultrasound in hepatic pregnancy: a case report and literature review

Li,

Zhou,

Cheng

2021

Clin. Exp. Obstet. Gynecol.

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As an ectopic pregnancy, hepatic pregnancy is extremely rare. Early diagnosis and treatment may prevent acute bleeding caused by the invasion of trophoblasts into maternal hepatic vessels. Here, we report a case of hepatic pregnancy diagnosed by ultrasonography in early pregnancy. Diagnostic laparoscopy, followed by laparotomy, was carried out and the intrahepatic mass was excised, and pathological results confirmed the ultrasonographic findings. Based on a current literature review, this report aims to investigate the ultrasonic features of hepatic pregnancy and summarize the application of ultrasonography in the diagnosis and treatment of hepatic pregnancy.

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Primary hepatic pregnancy: report of a case treated with laparoscopic approach and review of the literature

Cited by 19 publications

References 40 publications

Fertility and reproductive outcome after tubal ectopic pregnancy: comparison among methotrexate, surgery and expectant management

Fertility and reproductive outcome after tubal ectopic pregnancy: comparison among methotrexate, surgery and expectant management

Late diagnosis of pheochromocytoma in pregnancy with poor fetal outcome

Application of ultrasound in hepatic pregnancy: a case report and literature review

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