摘要
OBJECTIVE:To summarize management of interstitial pregnancy and its outcome among 32re ported cases in the world METHODS:From 1999to 2002,32c ases of inter-stitial pregnancy were reported to t he registry of the Society of Reproductive Surgeons.The participants completed a five -page questionnaire regarding when and how diagnosis was made,the characteristics of the pregnancy,treatment modalities,and subsequent reprodu ctive outcome.RE-SULTS:History of ipsilateral salpi ngectomy was encoun-tered in 37.5%of patients,and the di agnosis was made by ultrasound in 71.4%of the patients.Eight women were treated with methotrexate either sy stemically(n =4),lo-cally under ultrasound guidance(n =2),or under la-paroscopic guidance(n =2).Eleven patients were treated by laparoscopy and 13by laparotomy.Three patients failed systemic methotrexate treatment an d subsequently required surgery.Persistently elevated serumβhuman chorionic gonadotropin levels were found in on e patient after laparo-scopic cornual excision,and she was successfully treated with methotrexate.Fourteen cases(43.7%)of rupture of interstitial pregnancy were found.This included five cases(15.6%)of heterotopic pregnancy;all were t he results of in vitro fertilization,and all rupt ured at the time of diag-nosis.Subsequent pregnancywas ach ieved in ten patients.No uterine rupture was encountered d uring pregnancy or labor.CONCLUSION:Ipsilateral salpingectomy,previous ectopic pregnancy,and in vitro fertilization are predispos-ing factors for interstitial pregnancy.Contrary to previous belief,rupture of interstitial pre gnancy occurs relatively early in pregnancy.In selected patients,laparoscopiccornual excision is a viable treatme nt option.
OBJECTIVE:To summarize management of interstitial pregnancy and its outcome among 32re ported cases in the world METHODS:From 1999to 2002,32c ases of inter-stitial pregnancy were reported to t he registry of the Society of Reproductive Surgeons.The participants completed a five -page questionnaire regarding when and how diagnosis was made,the characteristics of the pregnancy,treatment modalities,and subsequent reprodu ctive outcome.RE-SULTS:History of ipsilateral salpi ngectomy was encoun-tered in 37.5%of patients,and the di agnosis was made by ultrasound in 71.4%of the patients.Eight women were treated with methotrexate either sy stemically(n =4),lo-cally under ultrasound guidance(n =2),or under la-paroscopic guidance(n =2).Eleven patients were treated by laparoscopy and 13by laparotomy.Three patients failed systemic methotrexate treatment an d subsequently required surgery.Persistently elevated serumβhuman chorionic gonadotropin levels were found in on e patient after laparo-scopic cornual excision,and she was successfully treated with methotrexate.Fourteen cases(43.7%)of rupture of interstitial pregnancy were found.This included five cases(15.6%)of heterotopic pregnancy;all were t he results of in vitro fertilization,and all rupt ured at the time of diag-nosis.Subsequent pregnancywas ach ieved in ten patients.No uterine rupture was encountered d uring pregnancy or labor.CONCLUSION:Ipsilateral salpingectomy,previous ectopic pregnancy,and in vitro fertilization are predispos-ing factors for interstitial pregnancy.Contrary to previous belief,rupture of interstitial pre gnancy occurs relatively early in pregnancy.In selected patients,laparoscopiccornual excision is a viable treatme nt option.
