The aim of this chapter is to describe non tubal ectopic pregnancies with particular emphasis on evolving strategies towards improving the diagnosis and management of these rare pregnancies. The chief concern is that these rare pregnancies are misdiagnosed and if unattended in a timely fashion they are associated with high morbidity often requiring major surgical intervention with loss of future reproductive function. Non tubal ectopic pregnancies comprise of pregnancies at unusual locations. These ectopic pregnancies may be implanted in the cervix, cesarean section scar, cornua of the uterus, ovary or in the abdominal cavity. Ectopic pregnancies at these sites are rare. The etiology of non tubal ectopic pregnancies in most cases is unknown. Several risk factors have been described in the literature. In vitro fertilization and cesarean section constitute the major risk factors for pregnancy implantation at unusual locations. The incidence of these pregnancies is increasing world wide due to increase in assisted reproductive technology in achieving pregnancy and increasing cesarean section rate. Early diagnosis of non tubal ectopic pregnancies is difficult and it requires expertise. However, with the advances in ultrasound technology and availability of quantitative p-hCG, early diagnosis of these rare ectopic pregnancies is feasible. In the past, surgical treatment such as hysterectomy or extensive resection of the cornua was the only option. These surgical treatments were associated with significant morbidity and potential mortality and loss of reproductive function. Conservative management with preservation of reproductive function is now the preferred treatment. There is no universally agreed methodology regarding the conservative treatment of these ectopic pregnancies. All published information regarding management of non tubal ectopic pregnancies is in the form of case reports or small case series. Different conservative or minimally invasive treatments have been attempted in the past. Medical treatment includes use of methotrexate (MTX), mifepristone, and misoprostol in termination of these pregnancies. Other minimally invasive approaches mentioned in the literature are ultrasound guided local injection of methotrexate or potassium chloride combined with systemic MTX, dilatation and curettage, and laparoscopic or hysteroscopic excision of these pregnancies. All these conservative management modalities have been reported with high degree of success and with minimal morbidities. In all non tubal ectopic pregnancies, early diagnosis is the key as the conservative treatment in early ectopic pregnancy is highly successful and the morbidity is minimal. Conservative treatment is possible in advanced non tubal ectopic pregnancies; however, the treatment is associated with increased morbidity. Advanced pregnancies often require multiple combination treatments over a prolonged period of time with the attendant high morbidity. Hemorrhage is one of the significant complications associated with non tubal ectopic pregnancies and it may require interventions such as tamponade with Foley's catheter in cases with cervical or cesarean section scar ectopic pregnancies. Other interventions to control acute hemorrhage in non tubal ectopic pregnancy include placement of cerclage suture in cervical ectopic pregnancy, and embolization of the uterine arteries. These highly successful interventions to control acute hemorrhage in non tubal ectopic pregnancies have drastically reduced the need for hysterectomy. Modern conservative treatment of these rare ectopic pregnancies has brought highly successful outcomes with minimal morbidity and preservation of reproductive function.
|Original language||English (US)|
|Title of host publication||Ectopic Pregnancy: Diagnosis, Management and Complications|
|Publisher||Nova Science Publishers, Inc.|
|Number of pages||28|
|ISBN (Print)||9781634632867, 9781634632607|
|State||Published - Oct 1 2014|
ASJC Scopus subject areas