Skip to main content

Ectopic pregnancies with unusual location and an angular pregnancy: Report of eight cases

Ektope Schwangerschaften mit untypischer Lokalisation und eine angulare Schwangerschaft: Bericht von acht Fällen

Wiener klinische Wochenschrift volume 124, pages 193–197 (2012)Cite this article

Zusammenfassung

ZWECK DER STUDIE: Durch die vermehrte Anwendung von assistierter Reproduktionstechnologie kommt es auch zu einer Zunahme von ektopen Schwangerschaften mit untypischen Lokalisationen und der damit vergesellschafteten erhöhten mütterlichen Morbidität und Mortalität. Sieben Fallberichte von ektopen Schwangerschaften mit seltenen Lokalisationen und eine anguläre Schwangerschaft werden vorgestellt, die diagnostischen und therapeutischen Optionen diskutiert sowie eine kurze Literaturübersicht inklusive genauer Nomenklatur wird präsentiert. UNTERSUCHUNGEN UND METHODEN: Fallberichtserie von sieben ektopen Schwangerschaften in untypischer Lokalisation, nach künstlicher Befruchtung oder spontan entstanden (Sectionarbenschwangerschaft, Bauchhöhlenschwangerschaft im Mesoappendix) sowie eine anguläre Schwangerschaft. Alle Patienten wurden in den letzen acht Jahren an unserer Klinik behandelt. Eine retrospektive Analyse. ERGEBNISSE: Interstitielle Schwangerschaft, cornuale Schwangerschaft, Sectionarbenschwangerschaft, Bauchhöhlenschwangerschaft im Omentum majus, heterotope-zervikale Schwangerschaft, Bauchhöhlenschwangerschaft im Mesoappendix, anguläre Schwangerschaft. Alle Patienten wurden operativ therapiert. SCHLUSSFOLGERUNG: Die Diagnose von ektopen Schwangerschaften, besonders derer in unüblichen Lokalisationen, ist schwierig und wird verkompliziert durch die embryonale Einnistung in unmittelbarer Nähe des Ostium uterinum tubae. Hier besonders hinsichtlich der genauen Beurteilung einer intra- oder extrauterinen Lokalisation. Hohe Komplikationsraten und verschiedene Behandlungsmöglichkeiten erschweren die Situation.

Summary

OBJECTIVE: The increased use of assisted reproduction techniques has been accompanied by an increase in ectopic pregnancies with unusual location being associated with significant maternal morbidity and mortality. This article reports on seven cases of ectopic pregnancies with unusual location and an angular pregnancy. Diagnostic and therapeutic strategies are discussed and a brief review of literature is presented. STUDY DESIGN: Case series of seven cases with ectopic pregnancy in unusual location, following assisted reproductive technique or conceived spontaneously (cesarean scar pregnancy and early abdominal pregnancy in mesoappendix) and an angular pregnancy, having presented at our hospital during the last eight years. Retrospective analyses. RESULTS: Interstitial pregnancy, cornual pregnancy, cesarean scar pregnancy, early abdominal pregnancy in omentum majus, heterotopic (cervical) pregnancy, early abdominal pregnancy in mesoappendix, angular pregnancy. All patients were surgically treated. CONCLUSION: Diagnosis of ectopic pregnancy with unusual location may be difficult, and differentiation of intact intrauterine or extrauterine pregnancy with adequate consideration of the area of uterine ostium of the fallopian tube may be delicate. Moreover, varying treatment strategies and high rates of complications aggravate the situation.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

References

  • Barnhart KT, Sammel MD, Gracia CR, Chittams J, Hummel AC, Shaunik A. Risk factors for ectopic pregnancy in women with symptomatic first-trimester pregnancies. Fertil Steril 2006;86:36–43

    PubMed  Article  Google Scholar 

  • Weström L, Bengtsson LPH, Mardh PA. Incidence, trends and risks of ectopic pregnancy in a population of women. Br Med J 1981;282:15–8

    Article  Google Scholar 

  • Clayton HB, Schieve LA, Peterson HB, Jamieson DJ, Reynolds MA, Wright VC. Ectopic pregnancy risk with assisted reproductive technology procedures. Obstet Gynecol 2006;107:595–604

    PubMed  Article  Google Scholar 

  • Dickey RP, Olar TT, Curole DN. Controlled ovarian hyperstimulation as a risk factor for ectopic pregnancy. Obstet Gynecol 1992;79(2):319–20

    PubMed  CAS  Google Scholar 

  • Shibahara H, Funabiki M, Shiotani T, Ikeda Y, Koyama K. A case of primary ovarian pregnancy after in vitro fertilization and embryo transfer. J Assist Reprod Genet 1997;14(1):63–4

    PubMed  Article  CAS  Google Scholar 

  • Cormio G, Santamato S, Putignano G, Bettocchi S, Pascazio F. Concomitant abdominal and intrauterine pregnancy after in vitro fertilization in a woman with bilateral salpingectomy. A case report. J Reprod Med 2003;48(9):747–9

    PubMed  Google Scholar 

  • Duff P. A simple checklist for preventing major complications associated with cesarean delivery. Obstet Gynecol 2010;116(6):1393–6

    PubMed  Article  Google Scholar 

  • Banhart KT. Clinical practice. Ectopic pregnancy. N Engl J Med 2009;361(4):379–87

    Article  Google Scholar 

  • Shaw JLV, Dey SK, Critchly HOD, Horne AW. Current knowledge of the aetiology of human tubal ectopic pregnancy. Hum Reprod Update 2010;16(4):432–44

    PubMed  Article  CAS  Google Scholar 

  • Fernandez H, Gervaise A. Ectopic pregnancies after infertility treatment: modern diagnosis and therapeutic strategy. Hum Reprod Update 2004;10(6):503–13

    PubMed  Article  Google Scholar 

  • Hsu CC, Yang TT, Hsu CT. Ovarian pregnancy resulting from corneal fistulae in a woman who had undergone bilateral salpingectomy. Fert Stert 2005;83:205–7

    Article  Google Scholar 

  • Ackerman TE, Levi CS, Dashefsky SM, Holt SC, Lindsay DJ. Interstitial line: sonographic finding in interstitial (cornual) ectopic pregnancy. Radiology 1993;189(1):83–7

    PubMed  CAS  Google Scholar 

  • Malinowsky A, Bates S.K. Semantics and pitfalls in the diagnosis of cornual/interstitial pregnancy. Fertil Steril 2006;86 (6):1764

    Google Scholar 

  • Jansen RP, Elliott PM. Angular intrauterine pregnancy. Obstet Gynecol 1981;58(2):167–75

    PubMed  CAS  Google Scholar 

  • Kirk E, Papageorghiou AT, Condous G, Tan L, Bora S, Bourne T. The diagnostic effectiveness of an initial transvaginal scan in detecting ectopic pregnancy. Hum Reprod 2007;22(11):2824–8

    PubMed  Article  Google Scholar 

  • Mol BW, van der Veen F, Bossuyt PM. Symptom-free women at increased risk of ectopic pregnancy: should we screen? Acta Obstet Gynecol Scand 2002;81(7):661–72

    PubMed  Article  Google Scholar 

  • Izquierdo LA, Nicholas MC. Three-dimensional transvaginal sonography of interstitial pregnancy. J Clin Ultrasound 2003;31(9):484–7

    PubMed  Article  Google Scholar 

  • Timor-Tritsch IE, Monteagudo A, Matera C, Veit CR. Sonographic evolution of cornual pregnancies treated without sugery. Obstet Gynecol 1992;79:1044–49

    PubMed  CAS  Google Scholar 

  • Olofsson JI, Poromaa IS, Ottander U, Kjellberg L, Damber MG. Clinical and pregnancy outcome following ectopic pregnancy; a prospective study comparing expectancy, surgery and systemic methotrexate treatment. Acta Obstet Gynecol Scand 2001;80(8):744–9

    PubMed  Article  CAS  Google Scholar 

  • Maymon R, Halperin R, Mendlovic S, Schneider D, Vaknin Z, Herman A, Pansky M. Ectopic pregnancies in Caesarean section scars: the 8 year experience of one medical centre. Hum Reprod 2004;19(2):278–84

    PubMed  Article  CAS  Google Scholar 

  • Api M, Api O. Laparoscopic cornuotomy in the management of an advanced interstitial ectopic pregnancy: a case report. Gynecol Endocrinol 2009;26:1–5

    Article  Google Scholar 

  • Eray Çalışkan, Yiğit Çakıroğlu, Aydın Çorakçı. Expectant management of an intramural ectopic pregnancy in a primigravid woman. JTGGA 2008;9(4):234–6

    Google Scholar 

  • Lam PM, Lo KW, Lau TK. Unsuccessful medical treatment of cesarean scar ectopic pregnancy with systemic methotrexate: a report of two cases. Acta Obstet Gynecol Scand 2004;83(1):108–11

    PubMed  Google Scholar 

  • Reissmann C, Goecke TW, Beckmann WM, Schild, RL, Oppelt P. Low-dose methotrexate administration in the management of cervical pregnancy. JTGGA 2009;10(2):99–103

    Google Scholar 

  • Yang SB, Lee SJ, Joe HS, Goo DE, Chang YW, Kim DH. Selective uterine artery embolization for management of interstitial ectopic pregnancy. Korean J Radiol 2007;8(2):176–9

    PubMed  Article  Google Scholar 

  • Muehlparzer L, Arzt W, Ebner T, Tews G. Secondary abdominal pregnancy with live birth. Acta Obstet Gynecol Scand 2011;90(3):288

    Google Scholar 

Download references

Author information

Affiliations

  1. Landes-Frauen- und Kinderklinik, Kinderwunschzentrum, Linz, Austria

    Richard B. Mayer, Thomas Ebner, Omar Shebl, Johannes Hartl & Gernot Tews

  2. General Hospital Linz, Linz, Austria

    Cemil Yaman

  3. Landeskrankenhaus Gmunden, Gmunden, Austria

    Michael Sommergruber

Authors
  1. Richard B. Mayer
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Cemil Yaman
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Thomas Ebner
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Omar Shebl
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Michael Sommergruber
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Johannes Hartl
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Gernot Tews
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Richard B. Mayer.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Mayer, R., Yaman, C., Ebner, T. et al. Ectopic pregnancies with unusual location and an angular pregnancy: Report of eight cases. Wien Klin Wochenschr 124, 193–197 (2012). https://doi.org/10.1007/s00508-011-0115-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00508-011-0115-8

Keywords

  • Ectopic pregnancy
  • Unusual location
  • Angular pregnancy
  • Treatment
  • Assisted reproduction technique