Orlando Megan S, Ehrenberg Stacey, Singh Katherine A, Kho Rosanne M
Department of Obstetrics and Gynecology, Obstetrics and Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, Ohio; Department of Obstetrics and Gynecology, University of Colorado, Aurora, Colorado.
Department of Obstetrics and Gynecology, Obstetrics and Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, Ohio.
Fertil Steril. 2023 Apr;119(4):699-700. doi: 10.1016/j.fertnstert.2023.01.044. Epub 2023 Feb 2.
To present a multidisciplinary approach to localize and resect suspected interstitial ectopic pregnancies. Interstitial ectopic pregnancies are distinct from eccentric intracavitary pregnancies and are defined by ultrasound-based criteria, including an empty uterine cavity, gestational sac located >1 cm from the cavity, thin overlying myometrium <5 mm, and the interstitial line sign.
Case report.
Academic medical center.
PATIENT(S): Here, we present the case of a 28-year-old patient at 6 weeks of gestation by last menstrual period who presented to the emergency department with spotting. Initial pelvic ultrasound findings demonstrated a gestational sac and yolk sac that were believed to be located eccentrically within the uterine cavity. Follow-up imaging was performed 2 weeks later that revealed the pregnancy was located at the uterotubal junction and distinct from the endometrial cavity, consistent with an interstitial ectopic. The patient had ongoing light spotting with mild cramping, a benign clinical exam, and normal laboratory findings. Accurate assessment of pregnancy location is critical given that the mortality rate from interstitial pregnancies is twice that of other ectopics. In contrast, live birth rates for eccentric intracavitary pregnancies may be up to 69%, and some clinicians consider expectant management of asymptomatic patients in the first trimester.
The patient was recommended for inpatient admission with expedited surgical management of interstitial ectopic pregnancy. On laparoscopic entry, the pregnancy was not well-visualized because it did not deform the uterine serosa.
We present a surgical approach to suspected interstitial ectopic pregnancy that is not well-visualized at the time of laparoscopy.
The following principles are explored: the use of multiple minimally invasive modalities (laparoscopy and hysteroscopy) to perform a thorough evaluation of the pregnancy location; incorporation of intraoperative ultrasound; temporary vessel ligation and injection of intramyometrial vasopressin; complete enucleation of the products of conception; and closure of the myometrial defect.
We emphasize the benefits of a multidisciplinary approach for the localization and resection of interstitial ectopic pregnancy. This patient was discharged home in good condition with no complications.
介绍一种多学科方法来定位和切除可疑的间质部异位妊娠。间质部异位妊娠与偏心性宫腔内妊娠不同，通过基于超声的标准来定义，包括子宫腔空虚、妊娠囊距宫腔>1 cm、覆盖的肌层薄<5 mm以及间质线征。
病例报告。
学术医疗中心。
在此，我们报告一例28岁患者，根据末次月经计算妊娠6周，因点滴出血就诊于急诊科。最初的盆腔超声检查发现一个妊娠囊和卵黄囊，据信位于子宫腔内偏心位置。2周后进行的后续影像学检查显示妊娠位于子宫输卵管交界处，与子宫内膜腔不同，符合间质部异位妊娠。患者持续有少量点滴出血和轻度腹痛，临床检查良性，实验室检查结果正常。鉴于间质部妊娠的死亡率是其他异位妊娠的两倍，准确评估妊娠位置至关重要。相比之下，偏心性宫腔内妊娠的活产率可能高达69%，一些临床医生考虑对孕早期无症状患者进行期待治疗。
建议患者住院，对间质部异位妊娠进行快速手术治疗。腹腔镜进入时，由于妊娠未使子宫浆膜变形而无法清晰观察到。
我们提出一种针对腹腔镜检查时未清晰观察到的可疑间质部异位妊娠的手术方法。
探讨了以下原则：使用多种微创方式（腹腔镜和宫腔镜）对妊娠位置进行全面评估；术中使用超声；临时血管结扎和肌层内注射血管加压素；完整摘除妊娠产物；关闭肌层缺损。
我们强调多学科方法在间质部异位妊娠定位和切除中的益处。该患者出院时情况良好，无并发症。
