ArticleThe American journal of case reports2022
Interstitial Ectopic Pregnancy in a 34-Year-Old Woman After Removal of Essure Microinserts and Reversal of Hysteroscopic Sterilization.
Article in The American journal of case reports, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
BACKGROUND Interstitial ectopic pregnancy, a pregnancy occurring in the part of the fallopian tube that is within the body of the uterus, poses a significant risk to patients, with a mortality rate of up to 2.5%, which is 7 times higher than for tubal ectopic pregnancies. Hysteroscopic sterilization reversal carries a potential risk of interstitial ectopic pregnancy; therefore, it is important to counsel patients appropriate and review the alternative option for in vitro fertilization. In vitro fertilization has been shown to have a superior pregnancy and live birth rate in comparison to sterilization reversal. Women who have undergone sterilization via hysteroscopic placement of the Essure device may complete in vitro fertilization with sterilization devices left in situ without significantly reducing the pregnancy rate. CASE REPORT A 34-year-old woman, G6P3023, presented to the Emergency Department after incidental detection of left interstitial ectopic pregnancy measuring 9 weeks of gestation. She had previously undergone a right salpingectomy for ectopic pregnancy soon after reversal of Essure sterilization via bilateral tubouterine reimplantation; this is a procedure that is infrequently performed due to limited evidence to suggest that this is a safe and efficacious method to achieve future pregnancies. This patient underwent an uncomplicated left cornuostomy and salpingectomy, rendering the need for in vitro fertilization to conceive in the future. CONCLUSIONS Patients seeking fertility treatment after hysteroscopic sterilization should be counseled that tubouterine reimplantation poses significant morbidity risk based on the nature of the surgery. Instead, patients who have undergone hysteroscopic sterilization who desire future pregnancy should be advised that in vitro fertilization, with or without salpingectomy, may be a safer and more efficacious option to achieve live birth.
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