Management of non-tubal ectopic pregnancies associated with cervical and uterine canal: single-centre eight-year experience

Yıl 2021, Cilt: 7 Sayı: 3, 183 - 191, 31.12.2021

Seyhun Sucu , Hüseyin Ozcan

https://doi.org/10.30569/adiyamansaglik.916189

Öz

Aim: To discuss the diagnosis and treatment of non-tubal ectopic pregnancies (NTEP) associated with the cervical and uterine canal.
Materials and Methods: In this cross-sectional retrospective study, we analyzed our hospital records in terms of cervical, angular (or cornual), scar, and cervico-isthmic NTEP from 2009 to 2017 and identified 112 cases between 5 and 13 weeks.
Results: There were 70, 20, 17, and 5 women in the scar, cervical, angular (or cornual), and cervico-isthmic ectopic pregnancy groups; respectively.
The gravity, parity, postoperative hospital stay length, admission complaints, previous cesarean section and treatment methods were compared among the four groups, a significant difference was found.
Conclusion: The surgical approach can be considered as the first-line treatment option in NTEP associated with the cervical and uterine canal. Due to the high potential for complications, early diagnosis and timely referral to tertiary health centres are crucial.

Anahtar Kelimeler

Angular pregnancy, Cervical pregnancy, Cervico-isthmic pregnancy, Ectopic pregnancy, Scar pregnancy

Destekleyen Kurum

No

Proje Numarası

2017/116

Teşekkür

Thanks to everyone who contributed to the article

Servikal ve uterin kanal ile ilişkili tubal olmayan ektopik gebeliklerin yönetimi: tek merkez sekiz yıllık deneyim

Öz

Amaç: Servikal ve uterin kanal ile ilişkili tubal olmayan ektopik gebeliklerin (NTEP) tanı ve tedavisini tartışmak.
Gereç ve Yöntem: Bu kesitsel retrospektif çalışmada, 2009-2017 yılları arasındaki servikal, açısal (veya kornual), skar ve servikoistmik gebelikleri hastane kayıtlarımızdan araştırdık ve 5-13 hafta arasında 112 vaka belirledik.
Bulgular: Skar, servikal, açısal (veya kornual) ve servikoistmik ektopik gebelik gruplarında sırasıyla 70, 20, 17 ve 5 kadın vardı. Dört grup arasında gravite, parite, postoperatif hastanede kalış süresi, başvuru şikayetleri, önceki sezaryen ve tedavi yöntemleri karşılaştırıldığında, anlamlı fark bulundu.
Sonuç: Servikal ve uterus kanalı ile ilişkili NTEP'de cerrahi yaklaşım birinci basamak tedavi seçeneği olarak düşünülebilir. Yüksek komplikasyon potansiyeli nedeniyle erken teşhis ve üçüncü basamak sağlık merkezlerine zamanında sevk çok önemlidir.

Anahtar Kelimeler

Angular gebelik, Servikal gebelik, Serviko-istmik gebelik, Skar gebelik, Ektopik gebelik

Proje Numarası

2017/116

Kaynakça

• Long Y, Zhu H, Hu Y, Shen L, Fu J, Huang W. Interventions for non-tubal ectopic pregnancy. Cochrane Database Syst Rev. 2020; 7. Art. No.: CD011174. DOI: 10.1002/14651858.CD011174.pub2.
• Jurkovic D, Hacket E, Campbell S. Diagnosis and treatment of early cervical pregnancy: a review and a report of two cases treated conservatively. Ultrasound Obstet Gynecol. 1996;8(6):373–380.
• Kirk E, Bottomley C, Bourne T. Diagnosing ectopic pregnancy and current concepts in the management of pregnancy of unknown location. Hum Reprod Update. 2014;20(2):250–261.
• Arleo EK, DeFilippis EM. Cornual, interstitial, and angular pregnancies: clarifying the terms and a review of the literature. Clin Imaging. 2014;38:(6)763–770.
• Strobelt N, Locatelli A, Ratti M, Ghidini A. Cervico-isthmic pregnancy: a case report, critical reappraisal of the diagnostic criteria, and reassessment of the outcome. Acta Obstet Gynecol Scand. 2001;80(6):586–588.
• Timor-Tritsch IE, Monteagudo A. Unforeseen consequences of the increasing rate of cesarean deliveries: early placenta accreta and cesarean scar pregnancy. A review. Am J Obstet Gynecol 2012;207(1):14–29.
• Özcan HÇ, Uğur MG, Balat Ö, Sucu S, Mustafa A, Tepe NB, et al. Is ultrasound-guided suction curettage a reliable option for treatment of cesarean scar pregnancy? A cross-sectional retrospective study. J Matern Neonatal Med. 2018;31(22):2953–2958.
• F. Cunningham, Kenneth Leveno, Steven Bloom, John Hauth, Dwight Rouse CS. Williams Obstetrics. 23rd Edition. 2009.
• Parker RA, Yano M, Tai AW, Friedman M, Narra VR, Menias CO. MR imaging findings of ectopic pregnancy: A pictorial review. Radiographics. 2012;32(5):1445–1460.
• Moawad NS, Mahajan ST, Moniz MH, Taylor SE, Hurd WW. Current diagnosis and treatment of interstitial pregnancy. Am J Obstet Gynecol. 2010;202(1):15–29.
• Ackerman TE, Levi CS, Dashefsky SM, Holt SC, Lindsay DJ. Interstitial line: sonographic finding in interstitial (cornual) ectopic pregnancy. Radiology. 1993;189(1):83–87.
• Ng S, Hamontri S, Chua I, Chern B, Siow A. Laparoscopic management of 53 cases of cornual ectopic pregnancy. Fertil Steril. 2009;92(2):448–452.
• Pal B, Akinfenwa O, Harrington K. Hysteroscopic management of cornual ectopic pregnancy. BJOG An Int J Obstet Gynaecol. 2003;110(9):879–880.
• Lau S, Tulandi T. Conservative medical and surgical management of interstitial ectopic pregnancy. Fertil Steril. 1999;72(2):207–215.
• Bernstein H. Expectant management of intramural ectopic pregnancy. Obstet Gynecol. 2001;97(5 Pt 2):826–827.
• Shan N, Dong D, Deng W, Fu Y. Unusual ectopic pregnancies: A retrospective analysis of 65 cases. J Obstet Gynaecol Res. 2014;40(1):147–154.
• Marchiolé P, Gorlero F, De Caro G, Podesta M, Valenzano M. Intramural pregnancy embedded in a previous Cesarean section scar treated conservatively. Ultrasound Obstet Gynecol. 2004;23(3):307–309.
• Jurkovic D, Hillaby K, Woelfer B, Lawrence A, Salim R, Elson CJ. First-trimester diagnosis and management of pregnancies implanted into the lower uterine segment Cesarean section scar. Ultrasound Obstet Gynecol. 2003;21(3):220–227.
• Chetty M, Elson J. Treating non-tubal ectopic pregnancy. Best Pract Res Clin Obstet Gynaecol. 2009;23(4):529–538.
• Alkatout I, Honemeyer U, Strauss A, Tinelli A, Malvasi A, Jonat W, et al. Clinical Diagnosis and Treatment of Ectopic Pregnancy. Obstet Gynecol Surv. 2013;68(8):571–581.
• Litwicka K, Greco E. Caesarean scar pregnancy. Curr Opin Obstet Gynecol. 2011;23(6):415–421.
• Parker VL, Srinivas M. Non-tubal ectopic pregnancy. Arch Gynecol Obstet. 2016;294(1):19–27.
• Fylstra DL. Cervical pregnancy: 13 cases treated with suction curettage and balloon tamponade. Am J Obstet Gynecol. 2014;210(6):581.e1-5.
• Leeman LM, Wendland CL. Cervical Ectopic Pregnancy: Diagnosis With Endovaginal Ultrasound Examination and Successful Treatment With Methotrexate. Arch Fam Med. 2000;9(1):72–77.
• Oyelese Y, Elliott TB, Asomani N, Hamm R, Napoli L, Lewis KM. Sonography and Magnetic Resonance Imaging in the Diagnosis of Cervico-Isthmic Pregnancy. J Ultrasound Med. 2003;22(9):981–983.
• Honda T, Hasegawa M, Nakahori T, Maeda A, Sai R, Takata H, et al. Perinatal management of cervicoisthmic pregnancy. J Obstet Gynaecol Res. 2005;31(4):332–336.
• Uzuncakmak C, Guldas A, Aydin S, Var A, Özçam H. Investigation of cesarean sections at Istanbul Training and Research Hospital Obstetrics and Gynecology Department between 2005 and 2012. Istanbul Med J. 2013;14(2):112–117.
• Polat I, Ekiz A, Acar DK, Kaya B, Ozkose B, Ozdemir C, et al. Suction curettage as first-line treatment in cases with cesarean scar pregnancy: feasibility and effectiveness in early pregnancy. J Matern Neonatal Med. 2016;29(7):1066–1071.
• Birch Petersen K, Hoffmann E, Rifbjerg Larsen C, Nielsen HS. Cesarean scar pregnancy: a systematic review of treatment studies. Fertil Steril. 2016;105(4):958–967.
• Seow K-M, Huang L-W, Lin Y-H, Lin M Y-S, Tsai Y-L, Hwang J-L. Cesarean scar pregnancy: issues in management. Ultrasound Obstet Gynecol. 2004;23(3):247–253.
• Wang Y-L, Su T-H, Chen H-S. Operative laparoscopy for unruptured ectopic pregnancy in a caesarean scar. BJOG An Int J Obstet Gynaecol. 2006;113(9):1035–1038.
• Osborn DA, Williams TR, Craig BM. Cesarean Scar Pregnancy. J Ultrasound Med. 2012;31(9):1449–1456.
• Jurkovic D, Knez J, Appiah A, Farahani L, Mavrelos D, Ross JA. Surgical treatment of Cesarean scar ectopic pregnancy: efficacy and safety of ultrasound-guided suction curettage. Ultrasound Obstet Gynecol. 2016;47(4):511–517.
• Bignardi T, Condous G. Transrectal ultrasound-guided surgical evacuation of Cesarean scar ectopic pregnancy. Ultrasound Obstet Gynecol. 2010;35(4):481–485.
• Tinelli A, Tinelli R, Malvasi A. Laparoscopic management of cervical–isthmic pregnancy: a proposal method. Fertil Steril. 2009;92(2):829.e3-829.e6.
• Bayoglu Tekin Y, Mete Ural U, Balık G, Ustuner I, Kır Şahin F, Güvendağ Güven ES. Management of cesarean scar pregnancy with suction curettage: a report of four cases and review of the literature. Arch Gynecol Obstet. 2014;289(6):1171–1175.
• Fylstra DL, Pound-Chang T, Miller MG, Cooper A, Miller KM. Ectopic pregnancy within a cesarean delivery scar: A case report. Am J Obstet Gynecol. 2002;187(2):302–304.