Download PDF
Geburtshilfe Frauenheilkd 2003; 63(3): 263-266
DOI: 10.1055/s-2003-38429
Fallbericht

Georg Thieme Verlag Stuttgart · New York

Operatives Management der cornualen Gravidität - Fallbericht und Übersicht

Surgical Management of Interstitial Ectopic PregnancyC. Jäger 1 , A. Reich 1 , R. Kreienberg 1 , F. Flock 1
  • 1Universitätsfrauenklinik Ulm (Direktor: Prof. Dr. med. R. Kreienberg)
Further Information

Publication History

Eingang Manuskript: 20. Januar 2003

Akzeptiert: 5. Februar 2003

Publication Date:
02 April 2003 (online)

Also available at
    Permissions and Reprints

Zusammenfassung

Die cornuale Gravidität ist eine seltene und potenziell lebensbedrohliche Form der extrauterinen Schwangerschaft, die den interstitiellen Anteil der Tuba uterina betrifft. Das Hauptrisiko besteht in schweren intraabdominalen Blutungen. Allgemein gültige Therapieempfehlungen zum Management dieser Sonderform existieren nicht. Im beschriebenen Fall wurde durch eine spezielle laparoskopische Nahttechnik ein exzellenter Tourniquet-Effekt durch lokale Ischämie ausgenutzt und eine suffiziente Hämostase gesichert. Das therapeutisch-operative Vorgehen sowie weitere mögliche Therapiemodalitäten, beispielsweise die primäre Methotrexatapplikation, werden erörtert.

Abstract

Interstitial or cornual pregnancies represent a small fraction of ectopic gestations. They are especially feared due to their life-threatening intraabdominal hemorrhage. General guide-lines for the medical management are missing. In this case report, a special endoscopic conservative procedure using encircling suture and endoloop-technique was performed. This method provided an excellent tourniquet effect and resulted in effective hemostasis. In addition to our endoscopic treatment, other therapeutic procedures, such as primary methotrexate application will be discussed.

Schlüsselwörter

Cornuale/interstitielle Schwangerschaft - Laparoskopie - Methotrexat

Key words

Interstitial/cornual pregnancy - endoscopic treatment - methotrexate

Literatur

  • 1 Ratschläge für die Praxis A COG. Medikamentöses Management der tubaren Gravidität.  Geburtsh Frauenheilk. 1999;  59 343-347
    PubMedGoogle Scholar
  • 2 Benifla J L, Fernandez H, Sebban E. et al . Alternative to surgery of treatment of unruptured interstitial pregnancy: 15 cases of medical treatment.  Eur J Obstet Reprod Biol. 1996;  70 151-156
    PubMedGoogle Scholar
  • 3 Centers for Disease Control and Prevention . Ectopic pregnancy - United States, 1990 - 1992.  MMWR Morb Mortal Wkly Rep. 1995;  44 46-48 (Level II-3)
    PubMedGoogle Scholar
  • 4 Confino E, Gleicher N. Conservative surgical management of interstitial pregnancy.  Fertil Steril. 1989;  52 600-603
    PubMedGoogle Scholar
  • 5 Doffman S F, Grimes D A, Cares W, Binkin N J, Kafrissen M E, O'Reilly K R. Ectopic pregnancy mortality, United States, 1979 to 1980: clinical aspects.  Obstet Gynecol. 1984;  64 386-389
    PubMedGoogle Scholar
  • 6 Downey G P, Tuck S M. Spontaneous uterine rupture during subsequent pregnancy following non-excision of interstitial ectopic gestation.  Br J Obstet Gynaecol. 1994;  101 162-163
    PubMedGoogle Scholar
  • 7 Fernandez H, De Ziegler D, Bourget P. et al . The place of methotrexate in the management of interstitial pregnancy.  Hum Reprod. 1991;  6 302-306
    PubMedGoogle Scholar
  • 8 Fernandez H, Lelaidier C, Thouvenez V, Frydman R. The use of a pretherapeutic, predictive score to determine inclusion criteria for the non-surgical treatment of ectopic pregnancy.  Hum Reprod. 1991;  6 995-998
    PubMedGoogle Scholar
  • 9 Fisch J D, Ortiz B H, Tazuke S I, Chitkara U, Giudice L C. Medical management of interstitial ectopic pregnancy: a case report and literature review.  Hum Reprod. 1998;  13 1981-1986
    CrossrefPubMedGoogle Scholar
  • 10 Hajenius P J, Voigt R R, Engelsbel S. et al . Serum human chorionic gonadotropin clearance curves in patients with interstitial pregnancy treated with systemic methotrexate.  Fertil Steril. 1996;  66 723-728
    PubMedGoogle Scholar
  • 11 Hucke J. Extrauterine Schwangerschaft: Ätiologie - Klinik - Diagnostik.  Gynäkologe. 1997;  30 875-887
    PubMedGoogle Scholar
  • 12 Lipscomb G H, Stovall T G, Ling F W. Nonsurgical treatment of ectopic pregnancy.  NEJM. 2000;  343 1325-1329
    CrossrefPubMedGoogle Scholar
  • 13 Mishell D R. . Herbst AL, Mishell DR, Stenchever MA, Droegemueller W (eds) Comprehensive Gynecology. 2nd ed. St. Louis, MI; Mosby-Year Book Inc. 1997: 457-490
    Google Scholar
  • 14 Moon H S, Choi Y J, Park Y H, Kim S G. New simple endoscopic operations for interstitial pregnancies.  Am J Obstet Gynecol. 2000;  182 114-121
    PubMedGoogle Scholar
  • 15 Pasic R, Wolfe W M. Laparoscopic diagnosis and treatment of interstitial ectopic pregnancy: a case report.  Am J Obstet Gynecol. 1990;  163 587-589
    PubMedGoogle Scholar
  • 16 Rock J A, Damario M A. Ectopic pregnancy. Rock JA, Thompson JD TeLinde's Operative Gynecology. 8th ed. Philadelphia; Lippincott-Raven 1997: 505-520
    Google Scholar
  • 17 Sasso R A. Laparoscopic diagnosis and treatment of cornual pregnancy: a case report.  J Reprod Med. 1995;  40 68-70
    PubMedGoogle Scholar
  • 18 Stovall T G, Ling F W. Single-dose methotrexate: an expanded clinical trial.  Am J Obstet Gynecol. 1993;  168 1759-1765
    PubMedGoogle Scholar
  • 19 Talmon R, Filmar S, Itskovitz Eldor J. Successful treatment of cornual pregnancy with 1 day high dose methotrexate regimen and folinic acid rescue.  Gynecol Obstet Invest. 1993;  35 243-244
    PubMedGoogle Scholar
  • 20 Tanaka T, Hayashi H, Kutsuzawa T. Treatment of interstitial ectopic pregnancy with methotrexate: report of a successful case.  Fertil Steril. 1982;  37 831-832
    PubMedGoogle Scholar
  • 21 Tulandi T, Hemmings R, Khaife F. Rupture of ectopic pregnancy in woman with low and declining serum β-human chorionic gonadotropin concentration.  Fertil Steril. 1991;  56 786-787
    PubMedGoogle Scholar
  • 22 Tulandi T, Vilos G, Gomel V. Laparoscopic treatment of interstitial pregnancy.  Obstet Gynecol. 1995;  85 465-467
    CrossrefPubMedGoogle Scholar
  • 23 Voigt R R, Van der Veen F, Karsdorp V HM. et al . Treatment of interstitial pregnancy with methotrexate: report of an unsuccessful case.  Hum Reprod. 1994;  9 1567-1579
    PubMedGoogle Scholar
  • 24 Woodland M B, Depasquale S E, Molinari J A, Sagullo C C. Laparoscopic approach to interstitial pregnancy.  J Am Assoc Gynecol Laparosc. 1996;  3 439-441
    PubMedGoogle Scholar

Dr. med. Christoph Jäger

Universitätsfrauenklinik

Prittwitzstraße 43

89075 Ulm

Email: christoph.jaeger@medizin.uni-ulm.de

      >