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Case Reports
. 2012;130(3):202-7.
doi: 10.1590/s1516-31802012000300011.

Video laparoscopic intervention for an interstitial pregnancy after failure of clinical treatment

Nilson Abrão Szylit  1 , Sérgio Podgaec, Evelyn Traina, Rita de Cassia Sanches Oliveira
Affiliations
Case Reports

Video laparoscopic intervention for an interstitial pregnancy after failure of clinical treatment

Nilson Abrão Szylit et al. Sao Paulo Med J. 2012.

Abstract
in English, Portuguese

Context: Interstitial pregnancy is a rare form of ectopic pregnancy for which the best therapeutic course of action has yet to be determined. Surgical intervention entails a high risk of hemorrhage due to the great vascularization of the cornual region of the uterus. Case descriptions facilitate the analysis of results and aid clinicians in determining the most appropriate course of action in these situations.

Case report: In a patient with an ultrasound diagnosis of interstitial pregnancy, clinical treatment using methotrexate was chosen. However, after one week, there was a marked decline in the serum level of the β subunit of chorionic gonadotropin hormone, although an ultrasound examination revealed embryonic cardiac activity. A second dose of the chemotherapy was administered. Embryonic cardiac activity persisted 48 hours later. Video laparoscopy was performed to achieve right-side cornual resection, which resulted in satisfactory resolution of the case.

CONTEXTO:: A gestação intersticial é uma forma rara de gestação ectópica. A melhor opção terapêutica ainda não está definida, havendo risco de hemorragia com o tratamento cirúrgico, em decorrência da grande vascularização na região cornual uterina. A descrição de casos facilitam a análise dos resultados e ajuda os clínicos a determinarem a melhor conduta nessas situações.

RELATO DE CASO:: Em paciente com diagnóstico ultrassonográfico de gestação intersticial, optou-se por tratamento clínico com administração de metotrexate. Após uma semana, houve declínio acentuado do nível sérico da sub-unidade b do hormônio gonadotrófico coriônico, porém, na ultrassonografia, foi detectada a presença de atividade cardíaca embrionária. Foi administrada uma segunda dose do quimioterápico. Após 48 horas, a atividade cardíaca persistia. Realizou-se vídeo-laparoscopia para ressecção cornual direita, com resolução satisfatória do caso.

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Conflict of interest statement

Conflict of interest: None

Figures

Figure 1.
Figure 1.. Gestational sac at time of diagnosis of interstitial pregnancy.
Figure 2.
Figure 2.. Embryonic cardiac activity in a case of interstitial pregnancy.
Figure 3.
Figure 3.. Gestational sac next to endometrium in a case of interstitial pregnancy. White arrow shows the empty uterine cavity.
Figure 4.
Figure 4.. Gestational sac growing into the fallopian tube (white arrow).
Figure 5.
Figure 5.. Laparoscopic image. White arrow shows gestational sac.
See this image and copyright information in PMC

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