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Ultrasound Diagnosis and Laparoscopic Excision of an Interstitial Ectopic Pregnancy
Author(s) -
Wood Carl,
Hurley Victor
Publication year - 1992
Publication title -
australian and new zealand journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.734
H-Index - 65
eISSN - 1479-828X
pISSN - 0004-8666
DOI - 10.1111/j.1479-828x.1992.tb02855.x
Subject(s) - ectopic pregnancy , medicine , interstitial pregnancy , laparotomy , pregnancy , laparoscopy , surgery , fallopian tube , obstetrics , genetics , biology
EDITORIAL COMMENT: We accepted this case report as readers may well marvel at the elegant details of careful removal of an interstitial pregnancy at laparoscopy. The procedure seems brave since the editor can recall being called by the junior author of this paper to lend a hand in a case of ruptured interstitial pregnancy with frightening haemorrhage at laparotomy ‐ in this case ergometrine lessened the bleeding that was then controlled by a mattress suture in the uterine wall. Dr Eric Bieber from Chicago delivered an interesting account of laparoscopic management of ectopic pregnancy in Melbourne in May, 1992, and strongly emphasized a point about the pathology of tubal ectopic pregnancy which seems important and was new to his audience ‐ namely that the pregnancy usually lies outside the tubal lumen having distended not the tube but the outer layer of the tubal wall beneath the peritoneum. This apparently explains how an ectopic pregnancy can be incised and evacuated without affecting tubal patency in a high proportion of cases. Our editorial committee would welcome a contribution giving details of this concept and its relevance to the success of conservative treatment of unruptured ectopic pregnancy. Summary: Interstitial tubal pregnancy occurs in about 5% of ectopic tubal pregnancies and is associated with an increased risk of severe haemorrhage (1). Diagnosis prior to rupture of the pregnancy into the peritoneal cavity is very important to avoid haemorrhage. Its presence has been considered to be a contraindication to laparoscopic surgery (2), although most ectopic pregnancies can be managed laparoscopically by an experienced endoscopist. We report the diagnosis of an interstitial pregnancy by ultrasound before rupture and treatment by laparoscopic excision of the pregnancy.