Mitral valve surgery and pregnancy
Volume 163 Number 2
Laparoscopic diagnosis and treatment of interstitial ectopic pregnancy: A case report Resad Pasic, MD, and Walter M. Wolfe, MD Louisville, Kentucky The laparoscope was used to diagnose and treat an interstitial pregnancy that had been overlooked on ultrasonographic examination. (AM J CSSTET GVNECOL 1990;163:587-8.)
Key words: Interstitial pregnancy, ectopic pregnancy, laparoscope
Interstitial implantation is one of the rarest sites of ectopic gestation. To our knowledge, this is the first published report of the laparoscopic treatment of an interstitial pregnancy. Case report The patient, a 25-year-old women, gravida 3, para I, was first seen at the clinic with a 6-week history of amenorrhea and steady bleeding but without any pain. Initial assay result of ~-subunit of human chorionic gonodotropin (~-hCG) was 4034 mIU 1m!. Vaginal probe ultrasonography revealed an empty uterine cavity and a sonolucent area, 2.7 x 3.2 cm, with irregular borders in the right adnexa. She had no history of pelvic inflammatory disease. In 1981 she underwent a left salpingo-oophorectomy for removal of a fibrothecoma in the left ovary and a curettage in 1983 because of possible spontaneous, first-trimester abortion. In 1987 she underwent a curettage followed by a laparoscopic, right, linear salpingostomy for removal of a probable ectopic pregnancy. The patient was admitted to the hospital 2 days after her clinic visit. The [3-hCG level was 4400 mIU I ml; blood pressure, 114/80 mm Hg; pulse,60 beats/min; temperature, normal; hematocrit, 39.1%; and hemoglobin, 12.9 gm/d!. The result of general physical examination was unremarkable. The abdomen was soft and distended with diffuse tenderness, and bowel sounds were absent. Pelvic examination disclosed evidence of bleeding; the cervix was long and closed, and the uterus was midplane, 6 to 8 weeks' size. No adnexal mass was palpated. We performed a curettage that produced no tissue or placental villi. Because we suspected an ectopic pregFrom the Department of Obstetrics and Gynecology, School of Medicine, University of Louisville. Received for publication September 18, 1989; revised February 12, 1990; accepted March 8, 1990. Reprint requests: Walter M. Wolfe, MD, Associate Professor, Department of Obstetrics and Gynecology, University of Louisville, Louisville, KY 40292. 6/1 /20738
nancy, we performed a diagnostic laparoscopy. Chromotubation, performed to identify a fistulous tract or to confirm patency, showed a non patent right tube and no dye spilling into the abdomen. Laparoscopic examination revealed multiple adhesions covering the left cornual portion of the uterus and a dilated area near the fimbriated end of the right tube suggestive of an ectopic pregnancy. This was removed by endocoagulation of the mesosalpinx and proximal end of the tube and sent for pathologic examination, the results of which were negative. Removal of the adhesions covering the left cornu revealed a 1 to 2 cm protrusion of the uterine wall that appeared to contain blue dye. After vasopressin solution was injected, a left cornual incision, I cm long, was performed to remove the products of conception, as confirmed by pathologic examination. Hemostasis was achieved by endocoagulation. After the surgical procedure, we carefully examined the ultrasonogram and discovered a sonolucent area in the left cornual region that had been overlooked previously (Fig. 1). Eight months after the operation, the patient has had no complications related to the procedure. Comment
Although nontubal ectopic pregnancies represent
Volume 163 Number 2
Laparoscopic diagnosis and treatment of interstitial ectopic pregnancy: A case report Resad Pasic, MD, and Walter M. Wolfe, MD Louisville, Kentucky The laparoscope was used to diagnose and treat an interstitial pregnancy that had been overlooked on ultrasonographic examination. (AM J CSSTET GVNECOL 1990;163:587-8.)
Key words: Interstitial pregnancy, ectopic pregnancy, laparoscope
Interstitial implantation is one of the rarest sites of ectopic gestation. To our knowledge, this is the first published report of the laparoscopic treatment of an interstitial pregnancy. Case report The patient, a 25-year-old women, gravida 3, para I, was first seen at the clinic with a 6-week history of amenorrhea and steady bleeding but without any pain. Initial assay result of ~-subunit of human chorionic gonodotropin (~-hCG) was 4034 mIU 1m!. Vaginal probe ultrasonography revealed an empty uterine cavity and a sonolucent area, 2.7 x 3.2 cm, with irregular borders in the right adnexa. She had no history of pelvic inflammatory disease. In 1981 she underwent a left salpingo-oophorectomy for removal of a fibrothecoma in the left ovary and a curettage in 1983 because of possible spontaneous, first-trimester abortion. In 1987 she underwent a curettage followed by a laparoscopic, right, linear salpingostomy for removal of a probable ectopic pregnancy. The patient was admitted to the hospital 2 days after her clinic visit. The [3-hCG level was 4400 mIU I ml; blood pressure, 114/80 mm Hg; pulse,60 beats/min; temperature, normal; hematocrit, 39.1%; and hemoglobin, 12.9 gm/d!. The result of general physical examination was unremarkable. The abdomen was soft and distended with diffuse tenderness, and bowel sounds were absent. Pelvic examination disclosed evidence of bleeding; the cervix was long and closed, and the uterus was midplane, 6 to 8 weeks' size. No adnexal mass was palpated. We performed a curettage that produced no tissue or placental villi. Because we suspected an ectopic pregFrom the Department of Obstetrics and Gynecology, School of Medicine, University of Louisville. Received for publication September 18, 1989; revised February 12, 1990; accepted March 8, 1990. Reprint requests: Walter M. Wolfe, MD, Associate Professor, Department of Obstetrics and Gynecology, University of Louisville, Louisville, KY 40292. 6/1 /20738
nancy, we performed a diagnostic laparoscopy. Chromotubation, performed to identify a fistulous tract or to confirm patency, showed a non patent right tube and no dye spilling into the abdomen. Laparoscopic examination revealed multiple adhesions covering the left cornual portion of the uterus and a dilated area near the fimbriated end of the right tube suggestive of an ectopic pregnancy. This was removed by endocoagulation of the mesosalpinx and proximal end of the tube and sent for pathologic examination, the results of which were negative. Removal of the adhesions covering the left cornu revealed a 1 to 2 cm protrusion of the uterine wall that appeared to contain blue dye. After vasopressin solution was injected, a left cornual incision, I cm long, was performed to remove the products of conception, as confirmed by pathologic examination. Hemostasis was achieved by endocoagulation. After the surgical procedure, we carefully examined the ultrasonogram and discovered a sonolucent area in the left cornual region that had been overlooked previously (Fig. 1). Eight months after the operation, the patient has had no complications related to the procedure. Comment
Although nontubal ectopic pregnancies represent
