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  • Review Article
  • Open Access

Elective uterine artery embolization prior to laparoscopic resection of interstitial pregnancy: two cases and literature review

Gynecological Surgery201815:18

https://doi.org/10.1186/s10397-018-1049-1

  • Received: 13 June 2018
  • Accepted: 26 September 2018
  • Published:

Abstract

Background

Interstitial pregnancies (IP) can be treated medically or surgically. The most common complication remains hemorrhage. The risk of that may be reduced by elective uterine artery embolization (UAE) prior to surgery, which we applied in two consecutive cases with high vascularization on ultrasound. We also reviewed larger series (n ≥ 10) on medical as well as surgical management of IP on success and complication rates and reviewed the entire literature on UAE.

Results

A gravida 5 (two ectopic pregnancies treated by salpingectomy) para 1 (cesarean section complicated by a niche, earlier repaired) presented with an asymptomatic IP. Primary treatment consisted of systemic methotrexate (MTX). Because of raising β-hCG and persisting heart activity 1 week later, she was referred for surgery (β-hCG = 59,000 IU/L; CRL = 10.5 mm). Another gravida 5 para 3 presented with an asymptomatic evolutive IP on dating ultrasound. Because of the size (CRL = 24.5 mm), thin overlaying myometrium, and high β-hCG (121,758 IU/L), we opted for primary surgery. Both IPs were highly vascularized with high flow rates. To prevent bleeding, a bilateral UAE was performed. The surgery was nearly bloodless.

In the literature, a wide range of treatment regimens for IP is reported. Larger series report a success rate of 76% for primary systemic MTX, 88% for primary local medical treatment, and 94% for primary surgery. It was not possible to determine reliable hemorrhage or rupture rates following MTX administration. As to laparoscopic surgery, the blood transfusion rate for bleeding was 9% while the conversion rate for hemorrhage was 2%. The use of UAE to reduce the risk for hemorrhage before (n = 2) or after (n = 19) MTX administration was reported in 21 cases. This failed in two cases (90% success rate), and one patient required transfusion (5%). Two cases treated with UAE and primary surgery were reported, yet the exact indication for embolization was not elaborated. Alternative hemostatic techniques during surgical management have been proposed to reduce blood loss and operating time, yet individual outcomes were not identifiable.

Conclusion

We report on the use of elective UAE prior to laparoscopic resection of IP, because of signs of strong vascularization on ultrasound. This strategy coincided with a nearly bloodless operation. Literature review suggests that this is one of the effective methods to reduce blood loss intra-operatively.

Keywords

  • Ectopic pregnancy
  • Interstitial pregnancy
  • Embolization
  • Laparoscopy
  • Cornual resection
  • Cornuostomy

Background

Ectopic pregnancy (EP) is any type of pregnancy in which the fertilized ovum implants outside the uterine cavity. The vast majority of EPs are situated in the fallopian tube, typically in the ampullary region (70%), less likely in the isthmic (12%), fimbrial (11%), or interstitial part (2–4%). Other uncommon locations include ovarian (1–3%), abdominal (< 1%), cervical (< 1%), rudimentary horn (< 0.5%), and cesarean scar pregnancies (1–3%) [14].

In 1989, EPs occurred at an estimated prevalence of 1–2% worldwide. This is two to three times higher than in 1970 [5]. The increase is presumably related to an increased prevalence of risk factors directly or indirectly leading to decreased tubal passage. The prevalence has since not significantly changed [6, 7].

Pregnancies that are situated in the interstitial portion of the fallopian tube are referred to as interstitial [8, 9]. The intramural or interstitial part of the tube is approximately 0.7 mm wide and 1–2 cm long, often with a tortuous course [8]. Interstitial pregnancies (IPs) are also referred to as “cornual,” though some reserve this entity to pregnancies located within a rudimentary horn of an abnormal uterine cavity [8, 9]. While the generic risk factors displayed in Table 1 may also apply, specific risk factors to this type of EP are previous ipsilateral or bilateral salpingectomy, previous EP, in vitro fertilization, and tubal damage from previous EP [8]. Historically, the mortality rate of this condition was around 2.5%, which is approximately seven times higher than that of EPs in general. It is assumed that this can be explained by the greater expansion capacity at this location, the richer vascularization of the area, eventually leading to life-threatening hemorrhage when rupture occurs [8].
Table 1

Risk factors of ectopic pregnancy [1923]

Highly increased risk (OR = 4–40)

Moderately increased risk (OR = 2–20)

 Previous tubal surgery

 Infertility

 Documented tubal pathology

 Previous genital infections

 History of EP

 Multiple sexual partners

 In-utero exposure to DES

 

 Use of IUD [22, 23]

 

Minimally increased risk (OR = 1-4)

Other risk factors

 Previous pelvic/abdominal surgery

 Age (> 35–40 years)

 Cigarette smoking

 Assisted reproductive technologies

 Vaginal douching

 Anatomical uterine abnormality

 Early age at first intercourse

 Non-Caucasian

 Prior spontaneous or medically induced abortion

OR odds ratio, EP ectopic pregnancy, DES diethylstilbestrol, IUD intra-uterine device

There is to our knowledge no consensus on the best treatment modality of IP. Herein, we provide a literature review which we did on the occasion of treating two patients with uterine artery embolization (UAE) immediately prior surgical treatment, because of an anticipated high risk for bleeding.

Two cases

A 28-year-old gravida 5 para 1 was referred for a second opinion on an evolutive IP. She had a history of a primary cesarean section for vasa previa, a spontaneous first trimester miscarriage, two EPs treated by salpingectomy, and a hysteroscopic cesarean scar niche repair. The latter niche repair was done because of ultrasound signs of fluid in the niche before starting in vitro fertilization (IVF) treatment. On hysteroscopy, blood and debris were confirmed and a repair was performed 4 months prior to the index event (IP). Control hysteroscopy 1 month after the procedure showed normal findings. The index pregnancy was by IVF. On early scan at 6 + 6 weeks, an IP was suspected. We confirmed this at 7 + 1 weeks to be a left IP with a gestational sac of 19 × 20 mm, CRL of 6.8 mm, β-hCG of 38,000 IU/L, and heart activity. There was no abdominal fluid. The referring center opted for a single-dose methotrexate (MTX) protocol (75 mg; 50 mg/m2). She presented on day one post-injection with stinging and cramping abdominal pain, yet without hemodynamic impact or peritoneal signs. On day six post-injection, she was referred because of raising β-hCG and persisting heart activity, spotting, along with intermittent abdominal pain. Figure 1 displays the ultrasound, β-hCG, and hemoglobin findings over the reporting period. We decided to proceed with surgical intervention yet opted for prior bilateral UAE during the same general anesthesia to reduce the risk for hemorrhage based on the apparent high vascularization around the pregnancy. Access was gained through the right femoral artery with catheterization of the left internal iliac artery followed by selective catheterization of the left uterine artery. Polyvinyl particles (Contour 250-350, Boston Scientific, Diegem, Belgium) were injected under 3D angiography control. The same procedure was followed on the contralateral side. Then, a laparoscopic cornual resection was performed and the uterine defect was closed in two layers using Vicryl 2-0 (Fig. 2). Blood loss was negligible, yet operating time was 140 min. Histopathology confirmed an IP. She was discharged on day two, and β-hCG became unmeasurable 4 weeks later. She had a withdrawal bleeding 3 weeks after the operation and had another period 5 weeks later. A waiting period of at least 6 months [10, 11] was advised to allow maximal healing of the uterus. She conceived 8 months after the IP in the first IVF cycle. She presented again with right fossa pain at 5 + 3 weeks, yet ultrasound confirmed an intracavitary position without any signs of IP.
Fig. 1
Fig. 1

Case 1: clinical, biochemical and ultrasound findings (day 0 = day of surgery)

Fig. 2
Fig. 2

Case 1: Left: left interstitial pregnancy, preventive coagulation around insertion line. Middle: status post cornual resection and closure of uterine defect with gestational sac in the pouch of Douglas. Right: gestational sac bulging out of resection piece

A 32-year-old gravida 5 para 3 spontaneously conceived. She was referred because on elective dating ultrasound at 9 + 2 weeks a right evolutive IP was found. She had a history of a spontaneous first trimester miscarriage and three uncomplicated term vaginal deliveries. On ultrasound, the surrounding myometrium was 2.2 mm which was strongly vascularized (Fig. 3). Because of the size (CRL = 24.5 mm), the thin myometrial layer, and a β-hCG of 121,758 IU/L, we advocated immediate surgery, yet because of the vascularization we first offered bilateral UAE. Polyvinyl particles (Contour 355-500, Boston Scientific; Embosphere 500-700 and 700-900, Merit Medical, Brussels, Belgium) and spongostan plugs (Ethicon, Diegem, Belgium) were used (Fig. 4). On laparoscopy, a 6-cm pregnancy in the right uterine horn was observed. The pregnancy was removed by cornuostomy, and the myometrial defect was sutured in three layers (first V-loc 2-0, second and third Vicryl 2-0). Blood loss was negligible, and operating time was 180 min. Two months later she still had some brown vaginal discharge. Ultrasound showed normal findings with a strong proliferative endometrium along with a corpus luteum on the left ovary and a normal looking scar at the resection site. β-hCG was 3.2 IU/L.
Fig. 3
Fig. 3

Case 2: interstitial pregnancy on ultrasound: Left: 2D image showing high flow in the thin surrounding myometrium. Right: 3D rendered image showing the interstitial localization

Fig. 4
Fig. 4

Case 2: Left: 3D CT angiography after contrast injection in the right iliac artery visualizing the right interstitial pregnancy (arrow). Middle: before embolization of the right uterine artery. Right: after embolization of the right uterine artery

Both patients explicitly consented to have their history being reported in the literature.

Methods

For the literature review, we searched the PubMed on this matter, published until February 2018, using the following key terms “Pregnancy, Interstitial”[Mesh], “Therapeutics”[Mesh], “Interstitial Pregnancy,” and “Pregnancy Treatment” (953 papers). Sources of relevant articles in the references were screened as well (> 100 papers). All English-, French-, Dutch- and German-language articles were retrieved and screened on title and abstract for relevance (Appendix 1, 2, 3, 4, 5, and 6). Articles in which the location of the EP was unclear or in which the outcome was not clearly specified or objectively measured were excluded. We empirically decided to further discuss outcomes of series with 10 patients or more as to have reasonable denominators for calculating overall outcomes. The only exception to that was Table 4, which displays the entire published experience with UAE. There was not a single series with ≥ 10 patients treated with UAE.

Results

There is considerable experience with primary systemic medical therapy in asymptomatic hemodynamically stable patients with IP. Table 2 summarizes studies describing ten or more patients with IP treated by primary systemic MTX. Dosing and regimen of MTX are inconsistent, and success rates are typically over 70%, except in one series [12]. In case of failure (persisting β-hCG leading to additional treatment), surgery was offered, except in one series by Hiersch et al., where second-line local MTX was combined with UAE. Out of five patients, two still required surgery as a third step. Tanaka et al. described 33 cases treated with a very consistent scheme of slowly intravenously injected, yet a fixed dose MTX. The success rate was 94%; two patients required surgery. The opposite was true in the experience of Kim et al. (n = 30) administering intramuscular MTX, yet with an inconsistent dosing regimen. Sixteen (53%) required additional surgery.
Table 2

Primary systemic MTX treatment of interstitial pregnancy

Author

N

Initial β-hCG

Systemic MTX treatment

Hospital stay

Negative β-hCG

Success

Jermy et al. [24]

17

32–31,381

50 mg/m2 IM

0–40

3–13

16/17

Hiersch et al. [25]

14

15,764

1 mg/kg/d IM on day 1, 3, 5, 7

N/A

N/A

9/14

 

3

< 2500

50 mg/m2 IM

1

N/A

3/3

Tanaka et al. [26]

33

230–106,634

100 mg IV + 200 mg IV

1–4

3–19

31/33

Kim et al. [12]

5

375–102,970

1 mg/kg/d IM on day 1, 3, 5, 7

N/A

N/A

14/30

 

24

 

50 mg/m2 IM

N/A

N/A

 
 

1

 

100 mg IV in bolus followed by 200 mg IV

N/A

N/A

 

N number of cases, β-hCG mIU/ml, MTX methotrexate, IM intramuscular, IV intravenous, hospital stay days, negative β-hCG weeks

Local injection of MTX, potassium chloride (KCL), etoposide, and actinomycin D under laparoscopic, ultrasound, or hysteroscopic guidance have all been reported as effective (Table 3 and Appendix 2). These injections are usually given into the gestational sac, occasionally in the surrounding myometrium or locally intra-arterial. These are invasive procedures, compared to systemic MTX. Benifla et al. used MTX for IP locations and KCl for heterotopic presentations, out of concerns for teratogenicity. Of the three eutopic pregnancies associated to a heterotopic location, two were eventually lost. Further details on outcomes are missing. The calculated success rate was 88%. Treatment failures were not offered a second MTX injection, yet successfully managed by surgery.
Table 3

Primary local medical treatment of interstitial pregnancy

Author

N

Initial β-hCG

Local medical treatment

Hospital stay

Negative β-hCG

Complications

Success

Benifla et al. [27]

2

16,000–43,000

MTX 1 mg/kg + SMTX

3

6 (1/2)

Bleeding 1/2

1/2

 

6

360–10,000

MTX 1 mg/kg

3

1–3

6/6

 

3a

15,000–25,205

KCL 2 mEq in 2 ml volume

3

a

Miscarriage 2/3

3/3

Cassik et al. [28]

23

102–69,820

MTX 25 mg

N/A

3–14

21/23

Framarino et al. [29]

14

2800–3200

MTX 25 mg

N/A

Max. 8

14/14

N number of cases, β-hCG mIU/ml, (S)MTX (systemic) methotrexate, KCL potassium chloride, hospital stay days, negative β-hCG weeks

aHeterotopic pregnancy

Table 4 displays reports on patients managed with selective UAE combined with any administration regimen of MTX. The actual indication for secondary UAE was refusal of surgery (Ophir et al., Yang et al.; each n = 1) or not mentioned (Deruelle et al., Tamarit et al., Berretta et al., Hiersch et al.). Primary UAE combined with MTX was either part of a standard protocol (n = 9; Krissi et al.) or because of the suspicion of increased risk for hemorrhage (n = 1; Valsky et al.). The paper does however not mention how that increased risk was estimated. Table 4 also includes two cases managed by UAE followed immediately by planned surgery (either laparoscopic or hysteroscopic). The argument for UAE was made based on increased vascularization on 3D CT angiography. In one of those two cases, a subsequent spontaneous conception and cesarean delivery of a healthy baby at 37 weeks was reported. Overall success rate in all the series in this table is 91%.
Table 4

Primary and secondary treatment of interstitial pregnancy with elective UAE

Author

N

Initial

β-hCG

Initial treatment

β-hCG

pre- UAE

Treatment

Hospital stay

Negative β-hCG

Complications

Success

Valsky et al. [30]

1

11,695

MTX + UAE

N/A

5

1/1

Takeda et al. [31]

1

95,365

UAE + CR

8

6

1/1

Krissi et al. [32]

9

1667–46,923

UAE + S/LMTX

13

8

9/9

Takeda et al. [33]

1

44,917

UAE + TE + SMTX

N/A

13

1/1

Ophir et al. [34]

1

33,689

SMTX

51,098

UAE

7

8

1/1

Deruelle et al. [35]

1

17,785

SMTX

20,458

UAE

6

10

1/1

Yang et al. [17]

1

29,454

SMTX

35,654

UAE

6

4

1/1

Tamarit et al. [36]

2

4394–8970

SMTX

8689–10,164

UAE + LMTX

1

10

2/2

Berretta et al. [37]

1

49,997

SMTX

59,494

UAE

11

10

1/1

Hiersch et al. [25]

5

15,383

SMTX

N/A

UAE + LMTX

N/A

N/A

Transfusion 1/5

Rupture 2/5

3/5

N number of cases, β-hCG mIU/ml, S/LMTX systemic/local methotrexate, UAE uterine artery embolization, CR cornual resection (laparoscopic), TE transcervical evacuation (under laparoscopic guidance), hospital stay days, negative β-hCG weeks

Table 5 displays the experience with primary surgery, typically by minimally invasive access. Success rate was 94%; transfusion need was 9%. Primary laparotomy was performed for tubal rupture, in case of severe adhesions (Tulandi et al.) or because of surgeon’s preference (Hwang et al.). Conversions were because of significant hematoperitoneum or because of uncontrolled bleeding perioperatively (n = 7; 2%).
Table 5

Primary surgical treatment of interstitial pregnancy

Author

N

Initial β-hCG

Surgical treatment

Duration

Rupture

Hospital stay

Negative β-hCG

Complications

Success

Moon et al. [38]

3

1320–24,700

Laparoscopic CS°

52

No

N/A

N/A

3/3

 

18

28.5–305,100

Laparoscopic CS°°

U:28; R:82

3/18

N/A

N/A

17/18

 

3

4469–13,000

Laparoscopic CS°°°

35

No

N/A

N/A

3/3

Tulandi et al. [39]

13

11,471

Laparotomic CR

N/A

9/13

N/A

N/A

Transfusion 7/13

13/13

 

8

2087

Laparoscopic CR

N/A

5/11

N/A

N/A

Transfusion 2/11

7/8

 

3

2087

Laparoscopic CS

N/A

5/11

N/A

N/A

Transfusion 2/11

3/3

MacRae et al. [40]

3

3150–38,000

Laparoscopic CS

N/A

1/3

2

N/A

3/3

 

8

0–21,352

Laparoscopic CR

N/A

3/8

2

N/A

Conversion: 1/8

7/8

Ng et al. [41]

53

N/A

Laparoscopic CS if IP 1–2 cm° Laparoscopic CR if IP ≥ 3 cm°

67 (mean)

8/53

2

3

Conversion: 1/53

Transfusion: 8/53

44/53

Moon et al. [14]

20

177–39,508

Laparoscopic CS°

N/A

2/20

N/A

N/A

19/20

Hwang et al. [42]

54

12,741

Laparotomic CR

71

19/54

6

N/A

Transfusion 25/54

54/54

 

34

12,905

Laparoscopic CR

81

8/34

5

N/A

Transfusion 13/34

34/34

Cai et al. [43]

15

N/A

Laparoscopic CS°

30–80

N/A

2–5

2–5

15/15

 

7

3000–32,000

TE, LG and HG

45–90

No

N/A

2–5

Perforation: 2/7

5/7

Zuo et al. [44]

16

14,696

Laparoscopic CR

25–120

No

3–4

N/A

Rupture: 1/16

16/16

Ahn et al. [45]

6

17,797–69,303

TE, UG

N/A

N/A

2–8

N/A

5/6

 

9

20,319–50,271

Laparoscopic CR

N/A

N/A

4–7

N/A

Transfusion: 1/9

9/9

Douysset et al. [46]

13

369–45,780

Laparoscopic CR

N/A

9/18

5

N/A

Transfusion: 4/18

11/13

 

5

369–45,780

Laparoscopic CS

N/A

9/18

5

N/A

Transfusion: 4/18

4/5

Watanabe et al. [47]

12

998–55,820

Laparoscopic CS°

61–160

2/12

N/A

N/A

12/12

 

1

69

Laparoscopic CS°

N/A

Yes

N/A

N/A

1/1

Kim et al. [11]

13*

N/A

Laparoscopic CR

40–145

2/13

2–7

N/A

Rupture 1/11

Transfusion: 2/13

Miscarriage: 1/13

13/13

Nikodijevic et al. [48]

13

16,687

Laparoscopic CR

N/A

N/A

N/A

4–8

Conversion: 5/13

Transfusion: 4/13

13/13

Nirgianakis et al. [49]

10

27,634

Laparoscopic CR~

115

N/A

3

N/A

Transfusion: 3/10

10/10

Wang et al. [50]

38

25,150

Laparoscopic CS°

71

11/38

3

N/A

35/38

Lee et al. [51]

53

575–64,831

Laparoscopic CR

77

N/A

N/A

N/A

49/53

 

22

1454–62,422

Laparoscopic CS, °

59

N/A

N/A

N/A

21/22

N number of cases, β-hCG mIU/ml, CR cornual resection, CS cornuostomy, IP interstitial pregnancy, TE transcervical evacuation, HG under hysteroscopic guidance, LG under laparoscopic guidance, R ruptured, UR unruptured, duration minutes, hospital stay days, negative β-hCG weeks

Hemostatic technique: °vasopressin, °°endoloop, °°°encircling suture, *heterotopic pregnancy

Discussion

Today the diagnosis of EP is usually made by ultrasound. In high-risk patients or countries where access to early ultrasound is easy, the diagnosis can be made prior to the development of symptoms. This allows careful planning of management. We surgically managed two cases of IP, which both were initially asymptomatic. One had typical risk factors and the other one did not. One had prior MTX therapy, and the second one had a very high β-hCG level. Both the ultrasound examination raised the suspicion of a highly vascularized lesion. Therefore, we decided to perform primarily bilateral UAE and surgery in the same anesthesia. This is different than the cases managed in Table 4. Though it is impossible to prove that UAE reduces the risk for hemorrhage, it seems that our surgery in both cases was nearly bloodless. Treatment was apparently also effective given that β-hCG levels fell as expected.

When systematically searching the literature, a gap of knowledge is identified on the use of UAE or in a broader perspective, the management of IP. This is probably because of the rarity of the condition. The data around do neither allow a proper meta-analysis, so that we limited ourselves to summarize the findings in somewhat larger series for each management option. There is quite some experience with primary medical therapy in asymptomatic hemodynamically stable patients. In analogy to other ectopic locations [13], the variability of MTX administration protocols is wide, including systemic single shot (either promptly or slowly infused), repetitive doses, and local administration [13]. Medical therapy has also been combined with UAE, mostly successful, yet Hiersch et al. reports on two cases where second line local MTX treatment combined with UAE failed. In those, we would guess the patient would have had more benefit of surgery.

Our literature review learns that the most frequent complication of surgery is hemorrhage, either with or without transfusion. The overall transfusion rate in IP is not judgeable since no reference to that outcome was made in any of the medically treated cases. However, 9% of laparoscopically managed IPs required blood transfusion. Therefore, it seems logical to take measures to reduce that risk. Surgically, one can use prophylactic coagulation by electrosurgery or ligation of the feeding artery, yet this may compromise viability of the tissue. Alternatively, vasoconstrictors have been described to reduce blood loss and operating time, yet they may have their own side effects and have only been reported to be effective for IPs with an average β-hCG of 10,000–25,000 IU/L [8, 14, 15]. Conversely, these are very cheap agents.

Modern invasive radiologic techniques are becoming increasingly popular, and those services become more widely accessible even in a semi-acute setting. Embolization techniques have found their place in modern obstetrics and gynecology. The experience with uterine myomas is meanwhile very large, and subsequent conception seems to be possible and relatively safe [16]. Torre et al. described an insignificant change in fertility rate and ovarian reserve after UAE for uterine fibroids in women with no other infertility factors [16]. Krissi et al. reported on the subsequent fertility after MTX administration with UAE in the treatment IP. Out of five women who tried to conceive, four did so, and three delivered successfully. Disadvantages of UAE are the higher cost in comparison to vasopressin, the longer duration of anesthesia, the more complicated logistics, and the additional local morbidity (e.g. ischemic pain, Asherman syndrome) [17, 18].

Conclusions

We report on the use of elective UAE prior to laparoscopic resection of IP, which coincided with a nearly bloodless operation. A literature search shows a wide variety of treatment options, yet most cases seem to be following the typical approach to EP. The overall success rate of surgical treatment of IP is higher than that of medical treatment. When performing laparoscopy, good hemostatic techniques are recommended since the operation takes place in a strongly vascularized region [8, 14, 15]. Our experience with two cases of UAE is yet another approach. It seems safe and reliable and does not preclude future conception.

Abbreviations

EP: 

Ectopic pregnancy

IP: 

Interstitial pregnancy

IVF: 

In vitro fertilization

KCL: 

Potassium chloride

MTX: 

Methotrexate

UAE: 

Uterine artery embolization

Declarations

Availability of data and materials

Search results and supplementary tables are available on line. The dataset is available with the primary author.

Authors’ contributions

IV, FD, PJB, DT, AVH, SAC, ASVR, LVDH, SG, CT, and JDP did the clinical management of the patients involved. IV and FD did the data collection. IV and JDP did the data analysis. All authors contributed to the manuscript writing and read and approved the final manuscript.

Authors’ information

JD was a fundamental clinical researcher for the Fonds Wetenschappelijk Onderzoek Vlaanderen (2001–2016). He is now funded by the Great Ormond Street Hospital Charity Fund, London, UK.

Ethics approval and consent to participate

Both patients explicitly consented to have their history being part of a case report. This study is approved by the Education-Support Committee of The University of Leuven (OBC MP001948). The Education-Support Committee (OBC) evaluates master’s thesis projects as mandated by the Research Ethics Committee of the KU/UZ Leuven.

Competing interests

The authors declare that they no competing interests.

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Authors’ Affiliations

(1)
Department Gynecology-Obstetrics, University Hospital Leuven, Herestraat 49, 3000 Leuven, Belgium
(2)
Department Radiology, University Hospital Leuven, Herestraat 49, 3000 Leuven, Belgium
(3)
Department Pathology, University Hospital Leuven, Herestraat 49, 3000 Leuven, Belgium
(4)
Department Reproductive medicine LIFE, General Hospital Heilig Hart Ziekenhuis, Naamsestraat 105, 3000 Leuven, Belgium
(5)
Department Gynecology-Obstetrics, General Hospital Onze-Lieve-Vrouwziekenhuis, Moorselbaan 164, 9300 Aalst, Belgium
(6)
Institute for Women’s Health and Wellcome/EPSRC Centre for Interventional & Surgical Sciences (WEISS), University College London, Charles Bell House, 43-45 Foley Street, London, W1W 7TS, UK

References

  1. Bouyer J, Coste J, Fernandez H, Pouly JL, Job-Spira N (2002) Sites of ectopic pregnancy: a 10 year population-based study of 1800 cases. Hum Reprod 17(12):3224–3230.PubMedView ArticlePubMed CentralGoogle Scholar
  2. Ramkrishna J, Kan GR, Reidy KL, Ang WC, Palma-Dias R (2017) Comparison of management regimens following ultrasound diagnosis of nontubal ectopic pregnancies: a retrospective cohort study. BJOG 125(5):567–575.View ArticleGoogle Scholar
  3. Chetty M, Elson J (2009) Treating non-tubal ectopic pregnancy. Best Pract Res Clin Obstet Gynaecol 23(4):529–538.PubMedView ArticlePubMed CentralGoogle Scholar
  4. Alalade AO, Smith FJE, Kendall CE, Odejinmi F (2017) Evidence-based management of non-tubal ectopic pregnancies. J Obstet Gynaecol 37(8):982–991.PubMedView ArticlePubMed CentralGoogle Scholar
  5. Goldner TE, Lawson HW, Xia Z, Atrash HK (1993) Surveillance for ectopic pregnancy - United States 1970-1989. Morbidity and Mortality Weekly Report: Surveillance Summaries 42:73–85.Google Scholar
  6. Jurkovic D, Wilkinson H (2011) Diagnosis and management of ectopic pregnancy. BMJ 342:d3397.PubMedView ArticlePubMed CentralGoogle Scholar
  7. Alkatout I, Honemeyer U, Strauss A, Tinelli A, Malvasi A, Jonat W et al (2013) Clinical diagnosis and treatment of ectopic pregnancy. Obstet Gynecol Surv 68(8):571–581.PubMedView ArticlePubMed CentralGoogle Scholar
  8. Moawad NS, Mahajan ST, Moniz MH, Taylor SE, Hurd WW (2010) Current diagnosis and treatment of interstitial pregnancy. Am J Obstet Gynecol 202(1):15–29.PubMedView ArticlePubMed CentralGoogle Scholar
  9. Lau S, Tulandi T (1999) Conservative medical and surgical management of interstitial ectopic pregnancy. Fertil Steril 72(2):207–215.PubMedView ArticlePubMed CentralGoogle Scholar
  10. Faioli R, Berretta R, Dall’Asta A, Di Serio M, Galli L, Monica M et al (2016) Endoloop technique for laparoscopic cornuectomy: a safe and effective approach for the treatment of interstitial pregnancy. J Obstet Gynaecol Res 42(8):1034–1037.PubMedView ArticlePubMed CentralGoogle Scholar
  11. Manea C, Pavlidou E, Urias AA, Bouquet de la Joliniere J, Dubuisson JB, Feki A (2014) Laparoscopic management of interstitial pregnancy and fertility outcomes after ipsilateral salpingectomy - three case reports. Front Surg 1:34.PubMedPubMed CentralView ArticleGoogle Scholar
  12. Kim MJ, Cha JH, Bae HS, Kim MK, Kim ML, Yun BS et al (2017) Therapeutic outcomes of methotrexate injection in unruptured interstitial pregnancy. Obstet Gynecol Sci 60(6):571–578.PubMedPubMed CentralView ArticleGoogle Scholar
  13. Panelli DM, Phillips CH, Brady PC (2015) Incidence, diagnosis and management of tubal and nontubal ectopic pregnancies: a review. Fertil Res Pract 1:15.PubMedPubMed CentralView ArticleGoogle Scholar
  14. Moon HS, Kim SG, Park GS, Choi JK, Koo JS, Joo BS. Efficacy of bleeding control using a large amount of highly diluted vasopressin in laparoscopic treatment for interstitial pregnancy. Am J Obstet Gynecol 2010;203(1):30 e1–6.View ArticleGoogle Scholar
  15. Cucinella G, Calagna G, Rotolo S, Granese R, Saitta S, Tonni G et al (2014) Interstitial pregnancy: a ‘road map’ of surgical treatment based on a systematic review of the literature. Gynecol Obstet Investig 78(3):141–149.View ArticleGoogle Scholar
  16. Torre A, Fauconnier A, Kahn V, Limot O, Bussierres L, Pelage JP (2017) Fertility after uterine artery embolization for symptomatic multiple fibroids with no other infertility factors. Eur Radiol 27(7):2850–2859.PubMedView ArticlePubMed CentralGoogle Scholar
  17. Yang SB, Lee SJ, Joe HS, Goo DE, Chang YW, Kim DH (2007) Selective uterine artery embolization for management of interstitial ectopic pregnancy. Korean J Radiol 8(2):176–179.PubMedPubMed CentralView ArticleGoogle Scholar
  18. Song D, Liu Y, Xiao Y, Li TC, Zhou F, Xia E (2014) A matched cohort study comparing the outcome of intrauterine adhesiolysis for Asherman’s syndrome after uterine artery embolization or surgical trauma. J Minim Invasive Gynecol 21(6):1022–1028.PubMedView ArticlePubMed CentralGoogle Scholar
  19. Li C, Zhao WH, Zhu Q, Cao SJ, Ping H, Xi X et al (2015) Risk factors for ectopic pregnancy: a multi-center case-control study. BMC Pregnancy Childbirth 15:187.PubMedPubMed CentralView ArticleGoogle Scholar
  20. Bouyer J, Coste J, Shojaei T, Pouly J-L, Fernandez H, Gerbaud L et al (2003) Risk factors for ectopic pregnancy: a comprehensive analysis based on a large case-control, population-based study in France. Am J Epidemiol 157(3):185–194.PubMedView ArticleGoogle Scholar
  21. Ankum WM, Mol BWJ, Van der Veen F, Bossuyt PMM (1996) Risk factors for ectopic pregnancy: a meta-analysis**supported in part by grant OG 93/007 from the Ziekenfonds-Raad, Amstelveen, the Netherlands. Fertil Steril 65(6):1093–1099.PubMedView ArticleGoogle Scholar
  22. Backman T, Rauramo I, Huhtala S, Koskenvuo M (2004) Pregnancy during the use of levonorgestrel intrauterine system. Am J Obstet Gynecol 190(1):50–54.PubMedView ArticleGoogle Scholar
  23. Xiong X, Buekens P, Wollast E (1995) IUD use and the risk of ectopic pregnancy: a meta-analysis of case-control studies. Contraception 52(1):23–34.PubMedView ArticleGoogle Scholar
  24. Jermy K, Thomas J, Doo A, Bourne T (2004) The conservative management of interstitial pregnancy. BJOG 111(11):1283–1288.PubMedView ArticlePubMed CentralGoogle Scholar
  25. Hiersch L, Krissi H, Ashwal E, From A, Wiznitzer A, Peled Y (2014) Effectiveness of medical treatment with methotrexate for interstitial pregnancy. Aust N Z J Obstet Gynaecol 54(6):576–580.PubMedView ArticlePubMed CentralGoogle Scholar
  26. Tanaka K, Baartz D, Khoo SK (2015) Management of interstitial ectopic pregnancy with intravenous methotrexate: an extended study of a standardised regimen. Aust N Z J Obstet Gynaecol 55(2):176–180.PubMedView ArticlePubMed CentralGoogle Scholar
  27. Benifla JL, Fernandez H, Sebban E, Darai E, Frydman R, Madelenat P (1996) Alternative to surgery of treatment of unruptured interstitial pregnancy: 15 cases of medical treatment. Eur J Obstet Gynecol Reprod Biol 70(2):151–156.PubMedView ArticlePubMed CentralGoogle Scholar
  28. Cassik P, Ofili-Yebovi D, Yazbek J, Lee C, Elson J, Jurkovic D (2005) Factors influencing the success of conservative treatment of interstitial pregnancy. Ultrasound Obstet Gynecol 26(3):279–282.PubMedView ArticlePubMed CentralGoogle Scholar
  29. Framarino-dei-Malatesta M, Piccioni MG, Derme M, Polidori NF, Tibaldi V, Iannini I et al (2014) Transabdominal ultrasound-guided injection of methotrexate in the treatment of ectopic interstitial pregnancies. J Clin Ultrasound 42(9):522–526.PubMedView ArticlePubMed CentralGoogle Scholar
  30. Valsky DV, Hamani Y, Verstandig A, Yagel S (2007) The use of 3D rendering, VCI-C, 3D power Doppler and B-flow in the evaluation of interstitial pregnancy with arteriovenous malformation treated by selective uterine artery embolization. Ultrasound Obstet Gynecol 29(3):352–355.PubMedView ArticlePubMed CentralGoogle Scholar
  31. Takeda A, Koyama K, Imoto S, Mori M, Sakai K, Nakamura H (2009) Successful management of interstitial pregnancy with fetal cardiac activity by laparoscopic-assisted cornual resection with preoperative transcatheter uterine artery embolization. Arch Gynecol Obstet 280(2):305–308.PubMedView ArticlePubMed CentralGoogle Scholar
  32. Krissi H, Hiersch L, Stolovitch N, Nitke S, Wiznitzer A, Peled Y (2014) Outcome, complications and future fertility in women treated with uterine artery embolization and methotrexate for non-tubal ectopic pregnancy. Eur J Obstet Gynecol Reprod Biol 182:172–176.PubMedView ArticlePubMed CentralGoogle Scholar
  33. Takeda A, Koike W, Hayashi S, Imoto S, Nakamura H (2015) Magnetic resonance imaging and 3-dimensional computed tomographic angiography for conservative management of proximal interstitial pregnancy by hysteroscopic resection after transcatheter arterial chemoembolization. J Minim Invasive Gynecol 22(4):658–662.PubMedView ArticlePubMed CentralGoogle Scholar
  34. Ophir E, Singer-Jordan J, Oettinger M, Odeh M, Tendler R, Feldman Y et al (2004) Uterine artery embolization for management of interstitial twin ectopic pregnancy: case report. Hum Reprod 19(8):1774–1777.PubMedView ArticleGoogle Scholar
  35. Deruelle P, Lucot J-P, Lions C, Robert Y (2005) Management of interstitial pregnancy using selective uterine artery embolization. Obstet Gynecol 106(5):1165–1167.PubMedView ArticleGoogle Scholar
  36. Tamarit G, Lonjedo E, Gonzalez M, Tamarit S, Domingo S, Pellicer A. Combined use of uterine artery embolization and local methotrexate injection in interstitial ectopic pregnancies with poor prognosis. Fertil Steril 2010;93(4):1348 e1–4.View ArticleGoogle Scholar
  37. Berretta R, Merisio C, Dall'Asta A, Verrotti C, Rolla M, Bruni S et al (2014) Conservative treatment for interstitial monochorionic twin pregnancy: case report and review of the published work. J Obstet Gynaecol Res 40(3):829–832.PubMedView ArticleGoogle Scholar
  38. Moon HS, Choi YJ, Park YH, Kim SG (2000) New simple endoscopic operations for interstitial pregnancies. Am J Obstet Gynecol 182(1).PubMedView ArticlePubMed CentralGoogle Scholar
  39. Tulandi T, Al-Jaroudi D (2004) Interstitial pregnancy: results generated from the Society of Reproductive Surgeons Registry. Obstet Gynecol 103(1):47–50.PubMedView ArticleGoogle Scholar
  40. MacRae R, Olowu O, Rizzuto MI, Odejinmi F (2009) Diagnosis and laparoscopic management of 11 consecutive cases of cornual ectopic pregnancy. Arch Gynecol Obstet 280(1):59–64.PubMedView ArticlePubMed CentralGoogle Scholar
  41. Ng S, Hamontri S, Chua I, Chern B, Siow A (2009) Laparoscopic management of 53 cases of cornual ectopic pregnancy. Fertil Steril 92(2):448–452.PubMedView ArticlePubMed CentralGoogle Scholar
  42. Hwang JH, Lee JK, Lee NW, Lee KW (2011) Open cornual resection versus laparoscopic cornual resection in patients with interstitial ectopic pregnancies. Eur J Obstet Gynecol Reprod Biol 156(1):78–82.PubMedView ArticlePubMed CentralGoogle Scholar
  43. Cai Z, Wang F, Cao H, Xia Q, Chen X, Cai Y (2012) The value of laparoscopy alone or combined with hysteroscopy in the treatment of interstitial pregnancy: analysis of 22 cases. Arch Gynecol Obstet 285(3):727–732.PubMedView ArticlePubMed CentralGoogle Scholar
  44. Zuo X, Shen A, Chen M (2012) Successful management of unruptured interstitial pregnancy in 17 consecutive cases by using laparoscopic surgery. Aust N Z J Obstet Gynaecol 52(4):387–390.PubMedView ArticlePubMed CentralGoogle Scholar
  45. Ahn JW, Lee SJ, Lee SH, Kang SP, Won HS (2013) Ultrasound-guided transcervical forceps extraction of unruptured interstitial pregnancy. BJOG 120(10):1285–1288.PubMedView ArticlePubMed CentralGoogle Scholar
  46. Douysset X, Verspyck E, Diguet A, Marpeau L, Chanavaz-Lacheray I, Rondeau S et al (2014) Interstitial pregnancy: experience at Rouen’s hospital. Gynecol Obstet Fertil. 42(4):216–221.PubMedView ArticlePubMed CentralGoogle Scholar
  47. Watanabe T, Watanabe Z, Watanabe T, Fujimoto K, Sasaki E (2014) Laparoscopic cornuotomy for interstitial pregnancy and postoperative course. J Obstet Gynaecol Res 40(8):1983–1988.PubMedView ArticlePubMed CentralGoogle Scholar
  48. Nikodijevic K, Bricou A, Benbara A, Moreaux G, Nguyen C, Carbillon L et al (2016) Cornual pregnancy: management and subsequent fertility. Gynecol Obstet Fertil 44(1):11–16.PubMedView ArticlePubMed CentralGoogle Scholar
  49. Nirgianakis K, Papadia A, Grandi G, McKinnon B, Bolla D, Mueller MD (2017) Laparoscopic management of ectopic pregnancies: a comparison between interstitial and “more distal” tubal pregnancies. Arch Gynecol Obstet 295(1):95–101.PubMedView ArticlePubMed CentralGoogle Scholar
  50. Wang J, Huang D, Lin X, Saravelos SH, Chen J, Zhang X et al (2016) Incidence of interstitial pregnancy after in vitro fertilization/embryo transfer and the outcome of a consecutive series of 38 cases managed by laparoscopic cornuostomy or cornual repair. J Minim Invasive Gynecol 23(5):739–747.PubMedView ArticlePubMed CentralGoogle Scholar
  51. Lee MH, Im SY, Kim MK, Shin SY, Park WI (2017) Comparison of laparoscopic cornual resection and cornuotomy for interstitial pregnancy. J Minim Invasive Gynecol 24(3):397–401.PubMedView ArticlePubMed CentralGoogle Scholar
  52. Tanaka T, Hayashi H, Kutsuzawa T, Fujimoto S, Ichinoe K (1982) Treatment of interstitial ectopic pregnancy with methotrexate: report of a successful case. Fertil Steril 37(6):851–852.PubMedView ArticlePubMed CentralGoogle Scholar
  53. Hajenius PJ, Voigt RR, Engelsbel S, Mol BWJ, Hemrika DJ, Van der Veen F (1996) Serum human chorionic gonadotropin clearance curves in patients with interstitial pregnancy treated with systemic methotrexate**supported in part by grant OG 93/007 from the Health Insurance Funds Council, Amstelveen, the Netherlands. Fertil Steril 66(5):723–728.PubMedView ArticlePubMed CentralGoogle Scholar
  54. Galimberti A, Jones MR (1997) Failure of conservative treatment with methotrexate for interstitial pregnancy despite progressive decrease of serial serum betaHCG. J Obstet Gynaecol 17(4):407–408.PubMedView ArticlePubMed CentralGoogle Scholar
  55. Bernardini L, Valenzano M, Foglia G (1998) Spontaneous interstitial pregnancy on a tubal stump after unilateral adenectomy followed by transvaginal colour Doppler ultrasound. Hum Reprod 13(6):1723–1726.PubMedView ArticlePubMed CentralGoogle Scholar
  56. Fisch JD, Ortiz BH, Tazuke SI, Chitkara U, Giudice LC. Medical management of interstitial ectopic pregnancy: a case report and literature review. 1998;13(7):1981–1986.Google Scholar
  57. Sagiv R, Golan A, Arbel-Alon S, Glezerman M (2001) Three conservative approaches to treatment of interstitial pregnancy. J Am Assoc Gynecol Laparosc. 8(1):154–158.PubMedView ArticlePubMed CentralGoogle Scholar
  58. Lalchandani S, Geary M, O’Herlihy C, Sheil O (2003) Conservative management of placenta accreta and unruptured interstitial cornual pregnancy using methotrexate. Eur J Obstet Gynecol Reprod Biol 107(1):96–97.PubMedView ArticlePubMed CentralGoogle Scholar
  59. Verity L, Ludlow J, Dickinson JE (2003) Interstitial ectopic pregnancy: a contemporary case series. Aust NZ J Obstet Gynecol 43:232–235.View ArticleGoogle Scholar
  60. Advincula AP, Senapati S (2004) Interstitial pregnancy. Fertil Steril 82(6):1660–1661.PubMedView ArticlePubMed CentralGoogle Scholar
  61. Reid P, Buddha L (2004) Hysteroscopic diagnosis of interstitial ectopic pregnancy. BJOG 111:89–90.PubMedView ArticlePubMed CentralGoogle Scholar
  62. Rodriguez L, Takacs P, Kang J (2004) Single-dose methotrexate for the management of interstitial ectopic pregnancy. Int J Gynaecol Obstet 84(3):271–272.PubMedView ArticlePubMed CentralGoogle Scholar
  63. Klemm P, Koehler C, Eichhorn KH, Hillemanns P, Schneider A (2006) Sonographic monitoring of systemic and local methotrexate (MTX) therapy in patients with intact interstitial pregnancies. J Perinat Med 34(2):149–157.PubMedView ArticlePubMed CentralGoogle Scholar
  64. Araujo Junior E, Zanforlin Filho SM, Pires CR, Guimaraes Filho HA, Massaguer AA, Nardozza LM et al (2007) Three-dimensional transvaginal sonographic diagnosis of early and asymptomatic interstitial pregnancy. Arch Gynecol Obstet 275(3):207–210.PubMedView ArticlePubMed CentralGoogle Scholar
  65. Fujioka S, Yamashita Y, Kawabe S, Kamegai H, Terai Y, Ohmichi M (2009) A case of a methotrexate-resistant ectopic pregnancy in which dactinomycin was effective as a second-line chemotherapy. Fertil Steril 91(3):929 e13–929 e15.View ArticleGoogle Scholar
  66. Api M, Api O (2010) Laparoscopic cornuotomy in the management of an advanced interstitial ectopic pregnancy: a case report. Gynecol Endocrinol 26(3):208–212.PubMedView ArticlePubMed CentralGoogle Scholar
  67. Gunenc Z, Bingol B, Celik A, Bozkurt S, Ozekici U (2010) Laparoscopic surgery of interstitial (cornual) pregnancy, a case report. J Turk Ger Gynecol Assoc 11(2):102–104.PubMedPubMed CentralView ArticleGoogle Scholar
  68. Kato S, Tanaka T, Terai Y, Yamashita Y, Ohmichi M (2011) Interstitial pregnancy treated by transcervical aspiration of the gestational sac combined with systemic and local administration of methotrexate. J Obstet Gynaecol Res 37(9):1250–1254.PubMedView ArticlePubMed CentralGoogle Scholar
  69. Lee ES, Hahn HS, Park BJ, Ro DY, Kim JH, Kim YW (2011) Single-port laparoscopic cornual resection for a spontaneous cornual ectopic pregnancy following ipsilateral salpingectomy. Fertil Steril 96(2):e106–e110.PubMedView ArticlePubMed CentralGoogle Scholar
  70. Gomez Garcia MT, Aguaron Benitez G, Barbera Belda B, Callejon Rodriguez C, Gonzalez Merlo G (2012) Medical therapy (methotrexate and mifepristone) alone or in combination with another type of therapy for the management of cervical or interstitial ectopic pregnancy. Eur J Obstet Gynecol Reprod Biol 165(1):77–81.PubMedView ArticlePubMed CentralGoogle Scholar
  71. Monia M, Atef Y, Manel M, Fethi B, Khaled N, Hedi R (2012) Traitement médicale des grossesses interstitielles non rompues. Tunis Méd 90(5):421–423.Google Scholar
  72. SzylitI N, Podgaec S, Traina E, Oliveira R (2012) Video laparoscopic intervention for an interstitial pregnancy after failure of clinical treatment. Sao Paulo Med J 130(3):202–207.View ArticleGoogle Scholar
  73. Sagiv R, Debby A, Keidar R, Kerner R, Golan A (2013) Interstitial pregnancy management and subsequent pregnancy outcome. Acta Obstet Gynecol Scand 92(11):1327–1330.PubMedView ArticlePubMed CentralGoogle Scholar
  74. Surbone A, Cottier O, Vial Y, Francini K, Hohlfeld P, Achtari C (2013) Interstitial pregnancies’ diagnosis and management: an eleven cases series. Swiss Med Wkly 143:w13736.PubMedPubMed CentralGoogle Scholar
  75. Fritz RB, Rosenblum N, Gaither K, Sherman A, McCalla A (2014) Successful laparoscopically assisted transcervical suction evacuation of interstitial pregnancy following failed methotrexate injection in a community hospital setting. Case Rep Obstet Gynecol 2014:695293.PubMedPubMed CentralGoogle Scholar
  76. Horne AW, Skubisz MM, Tong S, Duncan WC, Neil P, Wallace EM et al (2014) Combination gefitinib and methotrexate treatment for non-tubal ectopic pregnancies: a case series. Hum Reprod 29(7):1375–1379.PubMedPubMed CentralView ArticleGoogle Scholar
  77. Meddeb S, Rhim MS, Zarrouk W, Bibi M, Yacoubi MT, Khairi H (2014) Unusual gestational choriocarcinoma arising in an interstitial pregnancy. Int J Surg Case Rep 5(11):787–788.PubMedPubMed CentralView ArticleGoogle Scholar
  78. Corioni S, Perelli F, Bianchi C, Cozzolino M, Maggio L, Masini G et al (2015) Interstitial pregnancy treated with a single-dose of systemic methotrexate: a successful management. J Res Med Sci 20(3):312–316.PubMedPubMed CentralGoogle Scholar
  79. Kim TH, Lee HH (2015) Pseudocyst development after treatment for interstitial ectopic pregnancy. Taiwan J Obstet Gynecol 54(1):107–108.PubMedView ArticlePubMed CentralGoogle Scholar
  80. Singh N, Tripathi R, Mala Y, Batra A (2015) Diagnostic dilemma in cornual pregnancy- 3D ultrasonography may aid!! J Clin Diagn Res 9(1):QD12–QD13.PubMedPubMed CentralGoogle Scholar
  81. Kahramanoglu I, Mammadov Z, Turan H, Urer A, Tuten A (2017) Management options for interstitial ectopic pregnancies: a case series. Pak J Med Sci 33(2):476–482.PubMedPubMed CentralView ArticleGoogle Scholar
  82. Timor-Tritsch IE, Monteagudo A, Matera C, Veit C (1992) Sonographic evolution of cornual pregnancies treated without surgery. Obstet Gynecol 79(6):1044–1049.PubMedPubMed CentralGoogle Scholar
  83. Baker VL, Givens CR, Martin Cadieux MC (1997) Transvaginal reduction of an interstitial heterotopic pregnancy with preservation of the intrauterine gestation. Am J Obstet Gynecol 176:1384–1385.PubMedView ArticlePubMed CentralGoogle Scholar
  84. Wilkinson C, Petrucco O, Pachulicz M, Furness M (1998) Interstitial ectopic pregnancy - management with laparoscopically-guided local methotrexate infiltration. Aust NZ J Obstet Gynaecol 38(4):434–437.View ArticleGoogle Scholar
  85. Lin Y, Hwang J, Huang L, Chou C (2002) Conservative treatment for a ruptured interstitial pregnancy. Acta Obstet Gynecol Scand 81:179.PubMedView ArticlePubMed CentralGoogle Scholar
  86. Oyawoye S, Chander B, Pavlovic B, Hunter J, Gadir AA (2003) Heterotopic pregnancy: successful management with aspiration of cornual/interstitial gestational sac and instillation of small dose of methotrexate. Fetal Diagn Ther 18(1):1–4.PubMedView ArticlePubMed CentralGoogle Scholar
  87. Chou MM, Tseng JJ, Yi YC, Chen WC, Ho ES (2005) Diagnosis of an interstitial pregnancy with 4-dimensional volume contrast imaging. Am J Obstet Gynecol 193(4):1551–1553.PubMedView ArticlePubMed CentralGoogle Scholar
  88. Narang L, Kalu G (2009) Laparoscopic salpingocentesis using methotrexate in combination with oral mifepristone for successful treatment of interstitial pregnancy: a case report. Fertil Steril 92(6):2038 e5–2038 e7.View ArticleGoogle Scholar
  89. Andres MP, Campillos JM, Lapresta M, Lahoz I, Crespo R, Tobajas J (2012) Management of ectopic pregnancies with poor prognosis through ultrasound guided intrasacular injection of methotrexate, series of 14 cases. Arch Gynecol Obstet 285(2):529–533.PubMedView ArticlePubMed CentralGoogle Scholar
  90. Swank ML, Harken TR, Porto M (2013) Management of interstitial ectopic pregnancies with a combined intra-amniotic and systemic approach. Obstet Gynecol 122(2 Pt 2):461–464.PubMedView ArticlePubMed CentralGoogle Scholar
  91. Yu Y, Xu W, Xie Z, Huang Q, Li S (2014) Management and outcome of 25 heterotopic pregnancies in Zhejiang, China. Eur J Obstet Gynecol Reprod Biol 180:157–161.PubMedView ArticlePubMed CentralGoogle Scholar
  92. Macaes A, Fernandes S, Rodrigues C, Branco M (2015) Interstitial ectopic pregnancy managed with local methotrexate. BMJ Case Rep. 2015. https://doi.org/10.1136/bcr-2015-212563.
  93. Leggieri C, Guasina F, Casadio P, Arena A, Pilu G, Seracchioli R (2016) Hysteroscopic methotrexate injection under ultrasonographic guidance for interstitial pregnancy. J Minim Invasive Gynecol 23(7):1195–1199.PubMedView ArticlePubMed CentralGoogle Scholar
  94. Takeda A, Manabe S, Mitsui T, Nakamura H (2006) Management of patients with ectopic pregnancy with massive hemoperitoneum by laparoscopic surgery with intraoperative autologous blood transfusion. J Minim Invasive Gynecol 13(1):43–48.PubMedView ArticlePubMed CentralGoogle Scholar
  95. Sahoo S, Jose J, Shah N, Opemuyi I (2008) Recurrent cornual ectopic pregnancies. Gynecol Surg 6(4):389–391.View ArticleGoogle Scholar
  96. Poon LC, Emmanuel E, Ross JA, Johns J (2014) How feasible is expectant management of interstitial ectopic pregnancy? Ultrasound Obstet Gynecol 43(3):317–321.PubMedView ArticlePubMed CentralGoogle Scholar
  97. Steadman H (1956) Ruptured interstitial pregnancy following homolateral salpingectomy. Obstet Gynecol 7(5):572–575.PubMedPubMed CentralGoogle Scholar
  98. Bickerstaff H (1957) Homolateral interstitial pregnancy following salpingectomy. Obstet Gynecol 10(4):422–424.PubMedPubMed CentralGoogle Scholar
  99. Farabow W, Cater C, Brame R (1969) Interstitial pregnancy: presentation of two cases and review of salient clinical features. South Med J 62:859–862.PubMedView ArticlePubMed CentralGoogle Scholar
  100. Iuchtman M, Grunstein S (1987) Acute abdomen in ruptured interstitial pregnancy following unilateral salpingectomy. Eur J Obstet Gynecol Reprod Biol 26:165–168.PubMedView ArticleGoogle Scholar
  101. Hill GA, Segars JH, Herbert CM (1989) Laparoscopic management of interstitial pregnancy. J Gynecol Surg 5:209–212.View ArticleGoogle Scholar
  102. Reich H, McGlynn F, Budin R, Tsoutsoplides G, DeCaprio J (1990) Laparoscopic treatment of ruptured interstitial pregnancy. J Gynecol Surg 6(2):135–138.View ArticleGoogle Scholar
  103. de Boer C, van Dongen P, Willemsen W, Klapwijk C (1992) Ultrasound diagnosis of interstitial pregnancy. Eur J Obstet Gynecol Reprod Biol 47:164–166.PubMedView ArticleGoogle Scholar
  104. Pelosi M (1994) Successful taparoscopic removal of an interstitial ectopic pregnancy. J Am Assoc Gynecol Laparosc. 1(4):S28.PubMedView ArticleGoogle Scholar
  105. Laury D (1995) Laparoscopic treatment of an interstitial pregnancy. J Am Assoc Gynecol Laparosc. 2:219–212.PubMedView ArticleGoogle Scholar
  106. Sherer DM, Scibetta JJ, Sanko SR (1995) Heterotopic quadruplet gestation with laparoscopic resection of ruptured interstitial pregnancy and subsequent successful outcome of triplets. Am J Obstet Gynecol 172:216–217.PubMedView ArticleGoogle Scholar
  107. Tulandi T, Vilos G, Gomel V (1995) Laparoscopic treatment of interstitial pregnancy. Obstet Gynecol 85(3):465–467.PubMedView ArticleGoogle Scholar
  108. Woodland M, DePasquale S, Molinari J, Sagullo C (1996) Laparoscopic approach to interstitial pregnancy. J Am Assoc Gynecol Laparosc. 3(3):439–441.PubMedView ArticleGoogle Scholar
  109. Katz Z, Lurie S (1997) Laparoscopic cornuostomy in the treatment of interstitial pregnancy with subsequent hysterosalpingography. BJOG 104:955–956.View ArticleGoogle Scholar
  110. Grobman WA, Milad MP (1998) Conservative laparoscopic management of a large cornual ectopic pregnancy. Hum Reprod 13(7):2002–2004.PubMedView ArticlePubMed CentralGoogle Scholar
  111. Kasum M, Grizelj V, Simunic V (1998) Combined interstitial and intrauterine pregnancies after in-vitro fertilization and embryo transfer. Hum Reprod 13(6):1547–1549.PubMedView ArticlePubMed CentralGoogle Scholar
  112. Crvenkoviæ G, Barišiæ D, Æorušiæ A, Nola M (1999) Laparoscopic management of the cornual pregnancy. Croatian Med J 40(1).Google Scholar
  113. Rahimi M (1999) A new laparoscopic approach for the treatment of interstitial ectopic pregnancy. J Am Assoc Gynecol Laparosc 6(2):205–207.PubMedView ArticlePubMed CentralGoogle Scholar
  114. Vicino M, Loverro G, Resta L, Bettocchi S, Vimercati A, Selvaggi L (2000) Laparoscopic cornual excision in a viable large interstitial pregnancy without blood flow detected by color Doppler ultrasonography. Fertil Steril 74(2):407–409.PubMedView ArticlePubMed CentralGoogle Scholar
  115. Ayoubi J-M, Fanchin R, Fo O, Fernandez H, Pons J-C (2001) Tubal curettage: a new conservative treatment for haemorrhagic interstitial pregnancies: case report. Hum Reprod 16(4):780–781.PubMedView ArticlePubMed CentralGoogle Scholar
  116. Dumesic DA, Damario MA, Session DR (2001) Interstitial heterotopic pregnancy in a woman conceiving by in vitro fertilization after bilateral salpingectomy. Mayo Clin Proc 76(1):90–92.PubMedView ArticlePubMed CentralGoogle Scholar
  117. Kun W, Tung W (2001) On the look out for a rarity: interstitial/cornual pregnancy. Eur J Emerg Med 8:147–150.PubMedView ArticlePubMed CentralGoogle Scholar
  118. Osuga Y, Tsutsumi O, Fujiwara T, Kugu K, Fujimoto A, Taketani Y (2001) Usefulness of long-jaw forceps in laparoscopic cornual resection of interstitial pregnancies. J Am Assoc Gynecol Laparosc. 8(3):429–432.PubMedView ArticlePubMed CentralGoogle Scholar
  119. DeWitt C, Abbott J (2002) Interstitial pregnancy: a potential for misdiagnosis of ectopic pregnancy with emergency department ultrasonography. Ann Emerg Med 40(1):106–109.PubMedView ArticlePubMed CentralGoogle Scholar
  120. Sills ES, Perloe M, Kaplan CR, Sweitzer CL, Morton PC, Tucker MJ (2002) Uncomplicated pregnancy and normal singleton delivery after surgical excision of heterotopic (cornual) pregnancy following in vitro fertilization/embryo transfer. Arch Gynecol Obstet 266:181–184.PubMedView ArticlePubMed CentralGoogle Scholar
  121. Chang Y, Lee JN, Yang CH, Hsu SC, Tsai EM (2003) An unexpected quadruplet heterotopic pregnancy after bilateral salpingectomy and replacement of three embryos. Fertil Steril 80(1):218–220.PubMedView ArticlePubMed CentralGoogle Scholar
  122. Habek D, Mrcela M, Rubin M, Hrgovic Z (2003) Ruptured interstitial pregnancy. Arch Gynecol Obstet 267:170–172.PubMedView ArticlePubMed CentralGoogle Scholar
  123. Izquierdo LA, Nicholas MC (2003) Three-dimensional transvaginal sonography of interstitial pregnancy. J Clin Ultrasound 31(9):484–487.PubMedView ArticlePubMed CentralGoogle Scholar
  124. Katz DL, Barrett JP, Sanfilippo JS, Badway DM (2003) Combined hysteroscopy and laparoscopy in the treatment of interstitial pregnancy. Am J Obstet Gynecol 188(4):1113–1114.PubMedView ArticlePubMed CentralGoogle Scholar
  125. Yoo E-H, Chun S-H, Kim J-I (2003) Endoscopic treatment of interstitial pregnancy. Acta Obstet Gynecol Scand 82:189–191.PubMedView ArticlePubMed CentralGoogle Scholar
  126. Gezer A, Mutlu H (2004) Laparoscopic management of cornual pregnancy without sutures. Arch Gynecol Obstet 270(3):194–196.PubMedView ArticlePubMed CentralGoogle Scholar
  127. Grimbizis G (2004) Case report: laparoscopic treatment of a ruptured interstitial pregnancy. Reprod BioMed Online 9(4):447–451.PubMedView ArticlePubMed CentralGoogle Scholar
  128. Lee GS, Hur SY, Kown I, Shin JC, Kim SP, Kim SJ (2005) Diagnosis of early intramural ectopic pregnancy. J Clin Ultrasound 33(4):190–192.PubMedView ArticlePubMed CentralGoogle Scholar
  129. Savvidou MD, Setchell TE, Sieunarine K, Smith JR (2006) Conservative surgical management of ruptured interstitial pregnancy. Acta Obstet Gynecol Scand 85(5):629–631.PubMedView ArticlePubMed CentralGoogle Scholar
  130. Thakur Y, Coker A, Morris J, Oliver R (2004) Laparoscopic and ultrasound-guided transcervical evacuation of cornual ectopic pregnancy: an alternative approach. J Obstet Gynaecol 24(7):809–810.PubMedView ArticlePubMed CentralGoogle Scholar
  131. Zhang X, Liu X, Fan H (2004) Interstitial pregnancy and transcervical curettage. Obstet Gynecol 104(5 Pt 2):1193–1195.PubMedView ArticlePubMed CentralGoogle Scholar
  132. Huang MC, Su TH, Lee MY (2005) Laparoscopic management of interstitial pregnancy. Int J Gynaecol Obstet 88(1):51–52.PubMedView ArticlePubMed CentralGoogle Scholar
  133. Kumakiri J, Takeuchi H, Kitade M, Kikuchi I, Shimanuki H, Kubo M et al (2005) Interstitial pregnancy with huge adenomyosis uteri managed laparoscopically by using pre-operative and intra-operative imaging: case report. BJOG 112(11):1578–1580.PubMedView ArticlePubMed CentralGoogle Scholar
  134. Ross R, Lindheim SR, Olive DL, Pritts EA (2006) Cornual gestation: a systematic literature review and two case reports of a novel treatment regimen. J Minim Invasive Gynecol 13(1):74–78.PubMedView ArticlePubMed CentralGoogle Scholar
  135. Ko ML, Jeng CJ, Chou CS, She BC, Chen SC, Tzeng CR (2007) Laparoscopic electrodessication of an interstitial pregnancy. Fertil Steril 88(3):705 e19–705 e20.View ArticleGoogle Scholar
  136. Lee W, Chen C, Chang T, Chen R, Chow S. Interstitial pregnancy with a retained intrauterine device. Taiwan J Obstet Gynecol 2007;46(4):442–4.PubMedView ArticlePubMed CentralGoogle Scholar
  137. Oliver R, Malik M, Coker A, Morris J (2007) Management of extra-tubal and rare ectopic pregnancies: case series and review of current literature. Arch Gynecol Obstet 276(2):125–131.PubMedView ArticlePubMed CentralGoogle Scholar
  138. Lialios GA, Kallitsaris A, Kabisios T, Messinis IE (2008) Ruptured heterotopic interstitial pregnancy: rare case of acute abdomen in a Jehovah's Witness patient. Fertil Steril 90(4):1200 e15–1200 e17.View ArticleGoogle Scholar
  139. Qin L, Li S, Tan S (2008) Laparoscopic loop ligature for selective therapy in heterotopic interstitial and intrauterine pregnancy following in-vitro fertilization and embryo transfer. Int J Gynaecol Obstet 101(1):80–81.PubMedView ArticlePubMed CentralGoogle Scholar
  140. Sherer DM, Dalloul M, Sokolovski M, Borawski D, Granderson F, Abulafia O (2009) Interstitial pregnancy undetected during earlier first-trimester screening for fetal aneuploidy at 13 weeks’ gestation. J Clin Ultrasound 37(3):168–170.PubMedView ArticlePubMed CentralGoogle Scholar
  141. Casadio P, Formelli G, Spagnolo E, De Angelis D, Marra E, Armillotta F et al (2009) Laparoscopic treatment of interstitial twin pregnancy. Fertil Steril 92(1):390 e13–390 e17.View ArticleGoogle Scholar
  142. Cheng Z, Xu L, Zhu Y, Dai H, Qu X, Gong J (2009) Laparoscopic uterine vessels occlusion for the treatment of interstitial pregnancy. J Laparoendosc Adv Surg Tech A 19(4):509–512.PubMedView ArticlePubMed CentralGoogle Scholar
  143. Choi YS, Eun DS, Choi J, Shin KS, Choi JH, Park HD (2009) Laparoscopic cornuotomy using a temporary tourniquet suture and diluted vasopressin injection in interstitial pregnancy. Fertil Steril 91(5):1933–1937.PubMedView ArticlePubMed CentralGoogle Scholar
  144. Duong D, Baker WE, Adedipe A (2009) Clinician-performed ultrasound diagnosis of ruptured interstitial pregnancy. Am J Emerg Med 27(9):1170 e1–1170 e2.View ArticleGoogle Scholar
  145. Pluchino N, Ninni F, Angioni S, Carmignani A, Genazzani AR, Cela V (2009) Spontaneous cornual pregnancy after homolateral salpingectomy for an earlier tubal pregnancy: a case report and literature review. J Minim Invasive Gynecol 16(2):208–211.PubMedView ArticlePubMed CentralGoogle Scholar
  146. Pan J, Qian Y, Wang J (2010) Bilateral interstitial pregnancy after in vitro fertilization and embryo transfer with bilateral fallopian tube resection detected by transvaginal sonography. J Ultrasound Med 29:1829–1832.PubMedView ArticlePubMed CentralGoogle Scholar
  147. Pistofidis G, Bardis NS, Koukoura OG, Balinakos P (2010) Spontaneous intraoperative rupture of interstitial pregnancy. Laparoscopic management. J Minim Invasive Gynecol 17(6):191.View ArticleGoogle Scholar
  148. Tinelli A, Malvasi A, Pellegrino M, Pontrelli G, Martulli B, Tsin DA (2010) Laparoscopical management of cornual pregnancies: a report of three cases. Eur J Obstet Gynecol Reprod Biol 151(2):199–202.PubMedView ArticlePubMed CentralGoogle Scholar
  149. Vignali M, Bertazzoli E, Natale A, Alabiso G, Barbisetti De Prun A, Ciocca E (2010) Three cases of interstitial tubal pregnancy after ipsilateral salpingectomy for a previous ectopic pregnancy. J Minim Invasive Gynecol 17(6):158.View ArticleGoogle Scholar
  150. Walid MS, Heaton RL (2010) Diagnosis and laparoscopic treatment of cornual ectopic pregnancy. Arch Gynecol Obstet 8. https://doi.org/10.3205/000105.
  151. Yan CM (2010) Laparoscopic management of three rare types of ectopic pregnancy. Hong Kong Med J 16(2):132–136.PubMedPubMed CentralGoogle Scholar
  152. Aust T, O'Neill A, Cario G (2011) Purse-string suture technique to enable laparoscopic management of the interstitial gestation of a heterotopic pregnancy. Fertil Steril 95(1):261–263.PubMedView ArticlePubMed CentralGoogle Scholar
  153. Cervino E, Ramon YCCL, Perez P, Couceiro E (2011) Ultrasound-guided transcervical evacuation of interstitial twin pregnancy. Fertil Steril 96(4):927–930.PubMedView ArticlePubMed CentralGoogle Scholar
  154. Chachan S, Waters N, Kent A (2011) Laparoscopic management of cornual heterotopic pregnancy with the use of Harmonic ACE®—a case report. Gynecol Surg 8(2):243–246.View ArticleGoogle Scholar
  155. Lazard A, Poizac S, Courbiere B, Cravello L, Gamerre M, Agostini A. Cornual resection for interstitial pregnancy by laparoendoscopic single-site surgery. Fertil Steril 2011;95(7):2432 e5–8.View ArticleGoogle Scholar
  156. Lodhi W, Andersen K, Yoong W (2011) Laparoscopic cornuectomy revisited: a case series of 3 patients using the Multifire Endo GIA Stapler. Eur J Obstet Gynecol Reprod Biol 159(2):477–478.PubMedView ArticlePubMed CentralGoogle Scholar
  157. Yamamoto MP, Zaritsky EF (2011) Total laparoscopic management of a 13 week cornual ectopic pregnancy. J Minim Invasive Gynecol 18(6).View ArticleGoogle Scholar
  158. Ahsan Akhtar M, Izzat F, Keay SD (2012) Laparoscopic management of interstitial pregnancy with automatic stapler. BMJ Case Rep 2012. https://doi.org/10.1136/bcr-2012-006851.Google Scholar
  159. Cucinella G, Rotolo S, Calagna G, Granese R, Agrusa A, Perino A (2012) Laparoscopic management of interstitial pregnancy: the “purse-string” technique. Acta Obstet Gynecol Scand 91(8):996–999.PubMedView ArticleGoogle Scholar
  160. Garavaglia E, Quaranta L, Pasi F, Redaelli A, Colombo G, Candiani M (2012) Interstitial pregnancy after in vitro fertilization and embryo transfer following bilateral salpingectomy: report of two cases and literature review. Int J Fertil Steril 6(2):131–134.PubMedPubMed CentralGoogle Scholar
  161. Muglu J, Uchil D, Sau A, Zamblera D, Jolaoso A (2012) Recurrent uterine rupture after laparoscopic surgery for interstitial ectopic pregnancy. J Gynecol Surg 28(2):169–171.View ArticleGoogle Scholar
  162. Rheinboldt M, Ibrahim S (2013) Atypical presentation of a large interstitial pregnancy. Emerg Radiol 20(3):251–254.PubMedView ArticlePubMed CentralGoogle Scholar
  163. Mackenna A, Fernandez E, Fernandez C (2013) Treatment of interstitial pregnancy by laparoscopic cornual resection. J Minim Invasive Gynecol 20(4):406–407.PubMedView ArticleGoogle Scholar
  164. Mooij R, van Dillen J (2013) Een jonge vrouw met acute buikpijn. Ned Tijdschr Geneesk 157:A5496.Google Scholar
  165. Warda H, Mamik MM, Ashraf M, Abuzeid MI (2013) Laparoscopic cornuostomy for a large interstitial ectopic pregnancy. J Minim Invasive Gynecol 20(6):742–743.PubMedView ArticlePubMed CentralGoogle Scholar
  166. Wright SD, Busbridge RC, Gard GB (2013) A conservative and fertility preserving treatment for interstitial ectopic pregnancy. Aust N Z J Obstet Gynaecol 53(2):211–213.PubMedView ArticlePubMed CentralGoogle Scholar
  167. Zhang K, Yuan P (2013) Laparoscopy-assisted vaginal cornual resection for the treatment of large interstitial pregnancy. J Laparoendosc Adv Surg Tech A. 23(9):783–786.PubMedView ArticlePubMed CentralGoogle Scholar
  168. Chandran JR (2014) Cornual pregnancy and its management: a case report. IJSS Case Reports & Reviews 1(6):1–3.Google Scholar
  169. Garretto D, Lee LN, Budorick NE, Figueroa R (2015) Interstitial twin pregnancy: a unique case presentation. J Clin Ultrasound 43(7):447–450.PubMedView ArticlePubMed CentralGoogle Scholar
  170. Nezhat CH, Dun EC (2014) Laparoscopically-assisted, hysteroscopic removal of an interstitial pregnancy with a fertility-preserving technique. J Minim Invasive Gynecol 21(6):1091–1094.PubMedView ArticlePubMed CentralGoogle Scholar
  171. Wang YL, Weng SS, Huang WC, Su TH (2014) Laparoscopic management of ectopic pregnancies in unusual locations. Taiwan J Obstet Gynecol. 53(4):466–470.PubMedView ArticlePubMed CentralGoogle Scholar
  172. Warda H, Mamik MM, Ashraf M, Abuzeid MI (2014) Interstitial ectopic pregnancy: conservative surgical management. JSLS 18(2):197–203.PubMedPubMed CentralView ArticleGoogle Scholar
  173. Ansari A, Ahmad S, James J, Jeppson C, Holloway R (2015) Robotic-assisted laparoscopic resection of cornual ectopic pregnancy a case report. J Reprod Med 60(1):58–64.PubMedPubMed CentralGoogle Scholar
  174. Afifi Y, Mahmud A, Fatma A (2016) Hemostatic techniques for laparoscopic management of cornual pregnancy: double-impact devascularization technique. J Minim Invasive Gynecol 23(2):274–280.PubMedView ArticlePubMed CentralGoogle Scholar
  175. Grindler NM, Ng J, Tocce K, Alvero R (2016) Considerations for management of interstitial ectopic pregnancies: two case reports. J Med Case Rep 10(1):106.PubMedPubMed CentralView ArticleGoogle Scholar
  176. Jeon JH, Hwang YI, Shin IH, Park CW, Yang KM, Kim HO (2016) The risk factors and pregnancy outcomes of 48 cases of heterotopic pregnancy from a single center. J Korean Med Sci 31(7):1094–1099.PubMedPubMed CentralView ArticleGoogle Scholar
  177. Kim MJ, Jung YW, Cha JH, Seok HH, Han JE, Seong SJ et al (2016) Successful management of heterotopic cornual pregnancy with laparoscopic cornual resection. Eur J Obstet Gynecol Reprod Biol 203:199–203.PubMedView ArticlePubMed CentralGoogle Scholar
  178. Mallick R, Ajala T (2016) A new technique in the laparoscopic resection of cornual ectopic pregnancies: a case series. Gynecol Surg 13(3):147–151.View ArticleGoogle Scholar
  179. Said TH (2016) Laparoscopic management of interstitial ectopic using simple and safe technique: case series and review of literature. J Obstet Gynaecol India 66(Suppl 1):482–487.PubMedPubMed CentralView ArticleGoogle Scholar
  180. Xu Y, Lu Y, Chen H, Li D, Zhang J, Zheng L (2016) Heterotopic pregnancy after in vitro fertilization and embryo transfer after bilateral total salpingectomy/tubal ligation: case report and literature review. J Minim Invasive Gynecol 23(3):338–345.PubMedView ArticlePubMed CentralGoogle Scholar
  181. Hamada S, Nakah O, Morideh N, Higuchih K, Takahashih H (1997) Ultrasonography and magnetic resonance imaging findings in a patient with an unruptured interstitial pregnancy. Eur J Obstet Gynecol Reprod Biol 73:107–201.View ArticleGoogle Scholar
  182. Sungurtekin U, Uyar Y (1998) Recurrent interstitial pregnancy. Aust NZ J Obstet Gynecol. 38(4):438–440.View ArticleGoogle Scholar
  183. Bremner T, Cela V, Luciano AA (2000) Surgical management of interstitial pregnancy. J Am Assoc Gynecol Laparosc. 7(3):387–389.PubMedView ArticlePubMed CentralGoogle Scholar
  184. Coric M, Barisic D, Strelec M (2004) Laparoscopic approach to interstitial pregnancy. Arch Gynecol Obstet 270(4):287–289.PubMedView ArticlePubMed CentralGoogle Scholar
  185. Vilos GA (2001) Laparoscopic ligation and resection of two ipsilateral interstitial pregnancies in the same patient. J Am Assoc Gynecol Laparosc. 8(2):299–302.PubMedView ArticlePubMed CentralGoogle Scholar
  186. Siow A, Ng S (2011) Laparoscopic management of 4 cases of recurrent cornual ectopic pregnancy and review of literature. J Minim Invasive Gynecol 18(3):296–302.PubMedView ArticleGoogle Scholar

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