Tubal Stump Pregnancy in ART Patients Two cases of ectopic stump pregnancy after IVF-ET
Journal Title: Biomedical Journal of Scientific & Technical Research (BJSTR) - Year 2018, Vol 10, Issue 5
Abstract
Ectopic pregnancy (EP) is a complication of pregnancy in which the embryo attaches outside the uterus. The rate of ectopic pregnancy is about 1 and 2% that of live births, though it may be as high as 4% among those using assisted reproductive technology (ART). We present two cases of interstitial stump pregnancies in patients who previously underwent salpingectomy for ectopic pregnancies, and a review of the literature. One patient has been treated with methotrexate (MTX) before the removal of the tubal stump, while the second has gone directly to laparoscopic (LPS) surgery. Transvaginal ultrasound examination is essential for early and accurate management of this condition. It should be quickly performed to rule out a stump interstitial pregnancy in women who conceive by ART after bilateral salpingectomy. A correct attitude towards this condition is not yet internationally standardized and both medical and surgical options should be promptly considered. Ectopic pregnancies (EP) represent the most serious complication of the first trimester of pregnancy. In the vast majority of the cases the embryo prematurely implants itself in the fallopian tube before arriving in the uterine cavity. Only in approximately 2% of the cases EP occur in different regions such as the cervix, the ovary or the abdominal cavity [1-5]. An atypical and insidious severe event is that the embryo migrates from the uterine cavity to the contralateral tube. We report two cases in which the EP occurred in a fallopian stump after in vitro fertilization (IVF) in women subjected to monolateral salpingectomy for a history of ectopic pregnancy. We present also a review of literature about interstitial pregnancies in tubal stump (Table 1) and a review about EP in unusual sites in women with previous salpingectomy (Table 2) [6-10]. A 36 years old patient referred to our center to ascertain implantation after IVF-ET at the 58th gestational day. The patient had a history of right salpingectomy for GEU. HCG was 2293 IU/L. Obstetrical examination showed a small uterus with no pain. Ultrasound revealed no intrauterine pregnancy, but a gestational sac of 14 mm adjacent to the right uterine cornu with no signs of embryo viability. Power and color Doppler revealed the presence of the vascular ring with a strong peri-trophoblastic vascular activity (Figures 1 & 3). After careful counseling it was decided to attempt medical management using the single dose regimen with i.m. MTX (50mg/m2). Four days after treatment the patient complained strong abdominal pains, low blood pressure and severe anemia. Laparoscopy was carried out and the right tubal stump was removed. Histological examination confirmed the diagnosis of ectopic pregnancy of the right tubal stump. The patient was discharged on day 2 postoperatively and no short- or long-term complications were reported [11-17]. A 25 years old patient referred to our emergency Department for pain in the right iliac fossa. She was at 7 weeks of gestation after embryo transfer achieved by ICSI. The patient had a history of right salpingectomy for GEU. Pelvic examination revealed pain in the right adnexal area and US showed a gestational sac of 11 x 10 mm with no signs of embryonic viability in the right interstitial tubal stump (Figures 4 & 5) and hemoperitoneum. HCG was 8839 IU/L. The patient was subjected to an emergency laparoscopy and the right tubal stump was removed. Histological examination confirmed the diagnosis of ectopic pregnancy in the right tubal stump. The patient was discharged on day 2 postoperatively and no short- or long-term complications were reported.
Authors and Affiliations
Di Tucci Chiara, Schiavi Michele Carlo, Iacobelli Valentina, Donfrancesco Cristina, Piccioni Maria Grazia, Perniola Giorgia, Muzii Ludovico, Benedetti Panici Pierluigi
Keywords
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- EP ID EP587275
- DOI 10.26717/BJSTR.2018.10.002026
- Views 160
- Downloads 0
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