Successful management of unruptured interstitial pregnancy in 17 consecutive cases by using laparoscopic surgery

• Published in: Australian & New Zealand journal of obstetrics & gynaecology Vol. 52; no. 4; pp. 387 - 390
• Main Authors: Zuo, Xulei, Shen, Aiqun, Chen, Meixin
• Format: Journal Article
• Language: English
• Published: Australia Blackwell Publishing Ltd 01.08.2012
• Subjects: Abortifacient Agents, Nonsteroidal - therapeutic use; Adult; Blood Loss, Surgical - prevention & control; electrosurgery; Female; Gestational Age; Humans; interstitial pregnancy; laparoscopy; Laparoscopy - adverse effects; Laparoscopy - methods; Methotrexate - therapeutic use; Postoperative Period; Pregnancy; Pregnancy, Ectopic - drug therapy; Pregnancy, Ectopic - surgery; Retrospective Studies; Treatment Outcome
• ISSN: 0004-8666; 1479-828X
• DOI: 10.1111/j.1479-828X.2012.01455.x

Aims To analyse the optimal laparoscopic surgical techniques for the treatment of interstitial pregnancy to minimise bleeding during the operative procedure and the safety of the subsequent pregnancy. Methods Advanced bipolar coagulator was used to achieve haemostasis. Results The mean gestational age was 55 ± 5.1 days. All 17 women with an interstitial pregnancy were successfully treated by laparoscopic surgery without any complication. No surgery was converted to laparotomy. The mean pre‐operative beta‐human chorionic gonadotropin (β‐hCG) serum concentration was 14 696 ± 11 705 mIU/mL. This value decreased to 1911 ± 1769 mIU/mL at 3‐day post‐operation. Among women who underwent laparoscopic surgery, a cornual resection was performed in 16 (94.1%) cases. One (5.8%) woman underwent a laparoscopic evacuation of the conceptus and received a local injection of 10 mg methotrexate. The volume of blood loss was <25 mL in 16 cases. However, one woman experienced a rupture at the beginning of the operation and lost 250 mL of blood. The mean hospital stay was 4.5 days. Four of the nine women who chose to retain their reproductive function had subsequent normal pregnancies, but all received an elective caesarean delivery prior to labour. Conclusions The laparoscopic management of women with unruptured interstitial pregnancy can frequently be performed without haemorrhage or complication using advanced bipolar coagulation. The small sample of successful subsequent pregnancies demonstrates the safety and effectiveness of this technique, but this finding should be confirmed by further investigations.