Ruptured cornual ectopic of an advanced pregnancy: a case report

Authors

DOI:

https://doi.org/10.33448/rsd-v12i1.39848

Keywords:

Ectopic Pregnancy; Tubal Pregnancy; Cornish Pregnancy.

Abstract

Ectopic pregnancy is a pathology that presents a wide range of clinical manifestations, with numerous risk factors and a significant rate of complications. The pathophysiology refers to the implantation of the blastocyst. The most commonly reported clinical picture is related to vaginal bleeding with or without abdominal symptoms, but the characteristics can be variable because it is an embryonic implantation in the wrong place. There is a frequent association with pregnancies conceived through in vitro fertilization. Rarely, an ectopic pregnancy implants in the cornual region. Diagnosis is based on visualization of an extrauterine gestational sac with yolk sac or embryo, positive serum chorionic gonadotropin, and no products of conception on uterine aspiration or visualization on surgery. Treatment is related to the severity and symptoms presented by the individual. The objective of this study is to report a case of ruptured cornual ectopic pregnancy with advanced gestational age, showing the management and the form of treatment chosen for the patient.

References

Alataş, E., Yildirim, B., Oztekin, O., & Gezgin, T. (2008). Laparoscopic management of a primary ectopic ovarian pregnancy and vaginal douching as a possible cause. Archives of gynecology and obstetrics, 277(4), 363–365. https://doi.org/10.1007/s00404-007-0464-8

Alkatout, I., Honemeyer, U., Strauss, A., Tinelli, A., Malvasi, A., Jonat, W., Mettler, L., & Schollmeyer, T. (2013). Clinical diagnosis and treatment of ectopic pregnancy. Obstetrical & gynecological survey, 68(8), 571–581. https://doi.org/10.1097/OGX.0b013e31829cdbeb

Antell, K., Deshmukh, P., & Brown, E. J. (2017). Contraception Update: Intrauterine Devices. FP essentials, 462, 20–24.

Baggio, S., Garzon, S., Russo, A., Ianniciello, C. Q., Santi, L., Laganà, A. S., Raffaelli, R., & Franchi, M. (2021). Fertility and reproductive outcome after tubal ectopic pregnancy: comparison among methotrexate, surgery and expectant management. Archives of gynecology and obstetrics, 303(1), 259–268. https://doi.org/10.1007/s00404-020-05749-2

Barnhart, K. T., Gosman, G., Ashby, R., & Sammel, M. (2003). The medical management of ectopic pregnancy: a meta-analysis comparing "single dose" and "multidose" regimens. Obstetrics and gynecology, 101(4), 778–784. https://doi.org/10.1016/s0029-7844(02)03158-7

Barnhart, K. T., Sammel, M. D., Rinaudo, P. F., Zhou, L., Hummel, A. C., & Guo, W. (2004). Symptomatic patients with an early viable intrauterine pregnancy: HCG curves redefined. Obstetrics and gynecology, 104(1), 50–55. https://doi.org/10.1097/01.AOG.0000128174.48843.12

Barnhart K. T. (2009). Clinical practice. Ectopic pregnancy. The New England journal of medicine, 361(4), 379–387. https://doi.org/10.1056/NEJMcp0810384

Barnhart, K. T., Guo, W., Cary, M. S., Morse, C. B., Chung, K., Takacs, P., Senapati, S., & Sammel, M. D. (2016). Differences in Serum Human Chorionic Gonadotropin Rise in Early Pregnancy by Race and Value at Presentation. Obstetrics and gynecology, 128(3), 504–511. https://doi.org/10.1097/AOG.0000000000001568

Berg, C. J., Callaghan, W. M., Syverson, C., & Henderson, Z. (2010). Pregnancy-related mortality in the United States, 1998 to 2005. Obstetrics and gynecology, 116(6), 1302–1309. https://doi.org/10.1097/AOG.0b013e3181fdfb11

Bouyer, J., Coste, J., Fernandez, H., Pouly, J. L., & Job-Spira, N. (2002). Sites of ectopic pregnancy: a 10 year population-based study of 1800 cases. Human reproduction (Oxford, England), 17(12), 3224–3230. https://doi.org/10.1093/humrep/17.12.3224

Bouyer, J., Coste, J., Shojaei, T., Pouly, J. L., Fernandez, H., Gerbaud, L., & Job-Spira, N. (2003). Risk factors for ectopic pregnancy: a comprehensive analysis based on a large case-control, population-based study in France. American journal of epidemiology, 157(3), 185–194. https://doi.org/10.1093/aje/kwf190

Cantwell, R., Clutton-Brock, T., Cooper, G., Dawson, A., Drife, J., Garrod, D., Harper, A., Hulbert, D., Lucas, S., McClure, J., Millward-Sadler, H., Neilson, J., Nelson-Piercy, C., Norman, J., O'Herlihy, C., Oates, M., Shakespeare, J., de Swiet, M., Williamson, C., Beale, V., … Springett, A. (2011). Saving Mothers' Lives: Reviewing maternal deaths to make motherhood safer: 2006-2008. The Eighth Report of the Confidential Enquiries into Maternal Deaths in the United Kingdom. BJOG : an international journal of obstetrics and gynaecology, 118 Suppl 1, 1–203. https://doi.org/10.1111/j.1471-0528.2010.02847.x

Capmas, P., Bouyer, J., & Fernandez, H. (2014). Treatment of ectopic pregnancies in 2014: new answers to some old questions. Fertility and sterility, 101(3), 615–620. https://doi.org/10.1016/j.fertnstert.2014.01.029

Creanga, A. A., Shapiro-Mendoza, C. K., Bish, C. L., Zane, S., Berg, C. J., & Callaghan, W. M. (2011). Trends in ectopic pregnancy mortality in the United States: 1980-2007. Obstetrics and gynecology, 117(4), 837–843. https://doi.org/10.1097/AOG.0b013e3182113c10

Du, T., Chen, H., Fu, R., Chen, Q., Wang, Y., Mol, B. W., Kuang, Y., & Lyu, Q. (2017). Comparison of ectopic pregnancy risk among transfers of embryos vitrified on day 3, day 5, and day 6. Fertility and sterility, 108(1), 108–116.e1. https://doi.org/10.1016/j.fertnstert.2017.05.027

Farquhar C. M. (2005). Ectopic pregnancy. Lancet (London, England), 366(9485), 583–591. https://doi.org/10.1016/S0140-6736(05)67103-6

Feng, C., Chen, Z. Y., Zhang, J., Xu, H., Zhang, X. M., & Huang, X. F. (2013). Clinical utility of serum reproductive hormones for the early diagnosis of ectopic pregnancy in the first trimester. The journal of obstetrics and gynaecology research, 39(2), 528–535. https://doi.org/10.1111/j.1447-0756.2012.02001.x

Hajenius, P. J., Mol, F., Mol, B. W., Bossuyt, P. M., Ankum, W. M., & van der Veen, F. (2007). Interventions for tubal ectopic pregnancy. The Cochrane database of systematic reviews, 2007(1), CD000324. https://doi.org/10.1002/14651858.CD000324.pub2

Hoover, R. N., Hyer, M., Pfeiffer, R. M., Adam, E., Bond, B., Cheville, A. L., Colton, T., Hartge, P., Hatch, E. E., Herbst, A. L., Karlan, B. Y., Kaufman, R., Noller, K. L., Palmer, J. R., Robboy, S. J., Saal, R. C., Strohsnitter, W., Titus-Ernstoff, L., & Troisi, R. (2011). Adverse health outcomes in women exposed in utero to diethylstilbestrol. The New England journal of medicine, 365(14), 1304–1314. https://doi.org/10.1056/NEJMoa1013961

Larraín, D., Marengo, F., Bourdel, N., Jaffeux, P., Aublet-Cuvelier, B., Pouly, J. L., Mage, G., & Rabischong, B. (2011). Proximal ectopic pregnancy: a descriptive general population-based study and results of different management options in 86 cases. Fertility and sterility, 95(3), 867–871. https://doi.org/10.1016/j.fertnstert.2010.10.025

Lau, S., & Tulandi, T. (1999). Conservative medical and surgical management of interstitial ectopic pregnancy. Fertility and sterility, 72(2), 207–215. https://doi.org/10.1016/s0015-0282(99)00242-3

Li, C., Zhao, W. H., Zhu, Q., Cao, S. J., Ping, H., Xi, X., Qin, G. J., Yan, M. X., Zhang, D., Qiu, J., & Zhang, J. (2015). Risk factors for ectopic pregnancy: a multi-center case-control study. BMC pregnancy and childbirth, 15, 187. https://doi.org/10.1186/s12884-015-0613-1

Liao, C. Y., Tse, J., Sung, S. Y., Chen, S. H., & Tsui, W. H. (2017). Cornual wedge resection for interstitial pregnancy and postoperative outcome. The Australian & New Zealand journal of obstetrics & gynaecology, 57(3), 342–345. https://doi.org/10.1111/ajo.12497

Lipscomb G. H. (2007). Medical therapy for ectopic pregnancy. Seminars in reproductive medicine, 25(2), 93–98. https://doi.org/10.1055/s-2007-970048

Liu, M., Jiang, Y., Wedow, R., Li, Y., Brazel, D. M., Chen, F., Datta, G., Davila-Velderrain, J., McGuire, D., Tian, C., Zhan, X., 23andMe Research Team, HUNT All-In Psychiatry, Choquet, H., Docherty, A. R., Faul, J. D., Foerster, J. R., Fritsche, L. G., Gabrielsen, M. E., Gordon, S. D., … Vrieze, S. (2019). Association studies of up to 1.2 million individuals yield new insights into the genetic etiology of tobacco and alcohol use. Nature genetics, 51(2), 237–244. https://doi.org/10.1038/s41588-018-0307-5

Mol, F., Mol, B. W., Ankum, W. M., van der Veen, F., & Hajenius, P. J. (2008). Current evidence on surgery, systemic methotrexate and expectant management in the treatment of tubal ectopic pregnancy: a systematic review and meta-analysis. Human reproduction update, 14(4), 309–319. https://doi.org/10.1093/humupd/dmn012

Morlock, R. J., Lafata, J. E., & Eisenstein, D. (2000). Cost-effectiveness of single-dose methotrexate compared with laparoscopic treatment of ectopic pregnancy. Obstetrics and gynecology, 95(3), 407–412. https://doi.org/10.1016/s0029-7844(99)00548-7

Murray, H., Baakdah, H., Bardell, T., & Tulandi, T. (2005). Diagnosis and treatment of ectopic pregnancy. CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 173(8), 905–912. https://doi.org/10.1503/cmaj.050222

Pereira A.S. et al. (2018). Metodologia da pesquisa científica. [free e-book]. Santa Maria/RS. Ed. UAB/NTE/UFSM

Refaat, B., Dalton, E., & Ledger, W. L. (2015). Ectopic pregnancy secondary to in vitro fertilisation-embryo transfer: pathogenic mechanisms and management strategies. Reproductive biology and endocrinology : RB&E, 13, 30. https://doi.org/10.1186/s12958-015-0025-0

Rogne, T., Liew, Z., Hernáez, Á., Brumpton, B. M., & Magnus, M. C. (2022). Modifiable risk factors for ectopic pregnancy: a Mendelian randomization study. American journal of obstetrics and gynecology, 227(2), 339–341.e4. https://doi.org/10.1016/j.ajog.2022.03.063

Shaw, J. L., Wills, G. S., Lee, K. F., Horner, P. J., McClure, M. O., Abrahams, V. M., Wheelhouse, N., Jabbour, H. N., Critchley, H. O., Entrican, G., & Horne, A. W. (2011). Chlamydia trachomatis infection increases fallopian tube PROKR2 via TLR2 and NFκB activation resulting in a microenvironment predisposed to ectopic pregnancy. The American journal of pathology, 178(1), 253–260. https://doi.org/10.1016/j.ajpath.2010.11.019

Tulandi, T., & Al-Jaroudi, D. (2004). Interstitial pregnancy: results generated from the Society of Reproductive Surgeons Registry. Obstetrics and gynecology, 103(1), 47–50. https://doi.org/10.1097/01.AOG.0000109218.24211.79

Van Den Eeden, S. K., Shan, J., Bruce, C., & Glasser, M. (2005). Ectopic pregnancy rate and treatment utilization in a large managed care organization. Obstetrics and gynecology, 105(5 Pt 1), 1052–1057. https://doi.org/10.1097/01.AOG.0000158860.26939.2d

Wu, G., Yang, J., Xu, W., Yin, T., Zou, Y., & Wang, Y. (2014). Serum beta human chorionic gonadotropin levels on day 12 after in vitro fertilization in predicting final type of clinical pregnancy. The Journal of reproductive medicine, 59(3-4), 161–166.

Yong, P. J., Matwani, S., Brace, C., Quaiattini, A., Bedaiwy, M. A., Albert, A., & Allaire, C. (2020). Endometriosis and Ectopic Pregnancy: A Meta-analysis. Journal of minimally invasive gynecology, 27(2), 352–361.e2. https://doi.org/10.1016/j.jmig.2019.09.778

Zane, S. B., Kieke, B. A., Jr, Kendrick, J. S., & Bruce, C. (2002). Surveillance in a time of changing health care practices: estimating ectopic pregnancy incidence in the United States. Maternal and child health journal, 6(4), 227–236. https://doi.org/10.1023/a:1021106032198

Zhang, D., Shi, W., Li, C., Yuan, J. J., Xia, W., Xue, R. H., Sun, J., & Zhang, J. (2016). Risk factors for recurrent ectopic pregnancy: a case-control study. BJOG : an international journal of obstetrics and gynaecology, 123 Suppl 3, 82–89. https://doi.org/10.1111/1471-0528.14011

Published

11/01/2023

How to Cite

GRANIERO, A. I.; MELO, L. M. C. B. de . Ruptured cornual ectopic of an advanced pregnancy: a case report . Research, Society and Development, [S. l.], v. 12, n. 1, p. e27112139848, 2023. DOI: 10.33448/rsd-v12i1.39848. Disponível em: https://rsdjournal.org/index.php/rsd/article/view/39848. Acesso em: 22 nov. 2024.

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Section

Health Sciences