A new laparoscopic technique for interstitial pregnancy resection. A case report.
BACKGROUND
The interstitial gestation prevalence ranges from 1 in 2,500-5,000 live births, with a mortality rate of 2-2.5%. Total abdominal hysterectomy is usually offered to clinically stable patients over 35 years old. For younger women who desire to preserve their child-bearing capacity, interstitial pregnancy excision with a salpingo-oopherectomy is offered. The case presented here differed from the classic approach in that the adnexal structures were preserved, the products of conception were excised laparoscopically, and myometrium reconstruction was performed by suturing and tying with a laparoscopic technique.


METHODS
A 34-year-old multipara presented with genital tract bleeding and gradual-onset, diffuse pelvic cramps progressively worsening and associated with nausea and vomiting. As expected, the regular, last menstrual period was 8 weeks prior to the patient's hospital admission. The serum beta-human chorionic gonadotropin level was 20,159 mIU/mL and the progesterone level 12.6 ng/mL. High-resolution transvaginal ultrasound revealed no intrauterine gestational sac. A 1.2-cm fluid collection was observed in the right uterine cornual area, and posterior cul-de-sac fluid was present. A hysteroscopic evaluation was inconclusive, and the endometrium frozen section histologic study failed to confirm the presence of chorionic villi. The patient underwent diagnostic and operative laparoscopic excision of the interstitial pregnancy with adnexa preservation.


CONCLUSIONS
Laparoscopic resection of interstitial pregnancy with the preservation of the adnexal structures was a safe alternative to laparotomy in this case.
Ostrzenski
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Department of Gynecology and Obstetrics, Howard University College of Medicine, Washington, D.C. 20060, USA.
D000328:Adult; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D009215:Myometrium / Q000601:surgery; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000601:surgery*