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Archives of Gynecology and Obstetrics

, Volume 300, Issue 3, pp 651–660 | Cite as

Chronic ectopic pregnancy: case report and systematic review of the literature

  • Clemens B. TempferEmail author
  • Askin Dogan
  • Iris Tischoff
  • Ziad Hilal
  • Günther A. RezniczekEmail author
General Gynecology
  • 57 Downloads

Abstract

Background

Chronic ectopic pregnancy (CEP) is a variant of ectopic pregnancy (EP) characterized by low or absent serum human chorionic gonadotropin (hCG) levels, resistance to methotrexate (MTX), and an adnexal mass with fibrosis, necrosis, and blood clots due to repeated and gradual fallopian tube wall disintegration. CEP may complicate the course of patients with EP and is difficult to diagnose.

Case presentation

The case of a 36-year-old woman with EP, low serum hCG levels, a small echogenic adnexal mass, and resistance to MTX is presented. Salpingectomy was performed and histology demonstrated CEP with fibrosis, necrosis, and a hematocele within degenerated chorionic villi.

Systematic literature review

In a database search, 19 case reports, 3 case–control studies, and 3 case series describing 399 patients with CEP were identified. Serum hCG was negative in 40/124 cases (32%) with reported levels of serum hCG. The most common presenting symptom was abdominal pain (284/399 [71%]), followed by irregular vaginal bleeding (219/399 [55%]), and fever (20/399 [5%]). 73/399 (18%) women were asymptomatic. An adnexal mass was seen in 144/298 (48%) cases with perioperative ultrasound examination and with a mean largest diameter of 6.8 cm. Data on treatment modalities and outcomes were available for 297 women. Of these, 89% underwent surgery as first-line therapy. Laparoscopy was performed in most cases. MTX was the first-line therapy in a minority of cases. Complete resolution was achieved by first-line therapy in 287/297 (97%) cases. Adverse events were reported in 218 patients with CEP. Among those, adverse events ≥ grade 3 were seen in 186/218 (85%) cases. There was no case of treatment-related mortality.

Conclusion

CEP is a variant of EP with low or absent trophoblast activity. A prolonged clinical course is typical and surgery is the mainstay of treatment.

Keywords

Chronic ectopic pregnancy Pregnancy Methotrexate Pregnancy complication Trophoblast 

Abbreviations

CCSL

Case–control study

CEP

Chronic ectopic pregnancy

CR

Case report

CRP

C-reactive protein

CS

Case series

CTCAE

Common toxicity criteria for adverse events

EP

Ectopic pregnancy

hCG

Human chorionic gonadotropin

LAP

Laparotomy

LSC

Laparoscopy

MTX

Methotrexate

WBC

White blood cell count

Notes

Author contributions

CBT, AD, and IT collected data. CBT, AD, IT, ZH, and GAR wrote the manuscript. GAR analyzed the data. All the authors participated in discussion and revision of the manuscript.

Funding

None.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.

Consent for publication

Available.

Availability of data and material

Available.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Obstetrics and GynecologyRuhr-Universität BochumBochumGermany
  2. 2.Department of PathologyRuhr-Universität BochumBochumGermany
  3. 3.Department of Obstetrics and GynecologyRuhr-Universität Bochum, Marien Hospital HerneHerneGermany

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