Ectopic Pregnancy

Togas TulandiEditor

Ectopic Pregnancy

A Clinical Casebook

EditorTogas TulandiDepartment of Obstetrics andGynecologyMcGill UniversityMontrealQuébecCanada

ISBN 978-3-319-11139-1 ISBN 978-3-319-11140-7 (eBook)DOI 10.1007/978-3-319-11140-7

Library of Congress Control Number: 2014959416

Springer Cham Heidelberg New York Dordrecht London© Springer International Publishing Switzerland 2015This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on micro-films or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar meth-odology now known or hereafter developed.The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use.The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publica-tion. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made.

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v

Preface

There have been many reviews and books on ectopic pregnancy. So, why produce another book? In fact, a casebook on ectopic preg-nancy is unique and has never been published. More importantly, due to advances in the management of ectopic pregnancy, clini-cians, and researchers are not always current with their knowledge.

In this book, we presented real cases that were treated by our expert contributors. Each chapter contains a case report, a discus-sion about diagnosis and assessment, and management of the case followed by images. At the end of the chapter, we provide clinical pearls and pitfalls about the topic.

The book starts with risk factors related to ectopic pregnancy, and human chorionic gonadotropin (hCG) discriminatory zone. It is followed by “Pregnancy of unknown location” and “Ecto-pic pregnancy after in-vitro fertilization.” Chapters 5–7 deal with medical and surgical treatments of ectopic pregnancy. For medical treatment, patient compliance is crucial and discussed in Chap. 8. Inadvertent methotrexate administration to a woman with an intra-uterine pregnancy and its implication is discussed in Chaps. 9 and 10. Different types of ectopic pregnancy including the rare types and their management are discussed in Chaps. 10–20. The last chapter discusses fertility after an ectopic pregnancy.

This concise casebook on ectopic pregnancy is for practicing physicians, obstetricians and gynecologists, residents and fellows

in Obstetrics and Gynecology, and allied health care professionals. Readers will gain an understanding of many aspects of different types of ectopic pregnancy and their management. We also hope that this book will be helpful in preparing students for examina-tion, and directing new investigations and the clinical management of patients.

vi Preface

Professor of Obstetrics and Gynecology, andMilton Leong Chair in Reproductive Medicine McGill University

EditorTogas Tulandi MD, MHCM

vii

Contents

1 Identification of Risk Factors of Ectopic Pregnancy ...... 1Ali Ardehali, Ishwari Casikar and George Condous

2 Discriminatory Serum hCG Level for Ectopic Pregnancy ........................................................................... 11Ishai Levin and Shiri Shinar

3 Pregnancy of Unknown Location ..................................... 19Shabnam Bobdiwala and Tom Bourne

4 Ectopic Pregnancy After In Vitro Fertilization ............... 27Lisa Caronia, Rebecca Flyckt and Tommaso Falcone

5 Surgical Treatment of Ectopic Pregnancy ....................... 33Jillian Main and Camran Nezhat

6 Bleeding Ectopic Pregnancy .............................................. 41M. Jean Uy-Kroh

7 Medical Treatment of Ectopic Pregnancy ........................ 49Togas Tulandi

8 Compliance with Methotrexate Treatment for Ectopic Pregnancy ....................................................... 55Ishai Levin and Benny Almog

9 Inadvertent Methotrexate Administration .................... 61Togas Tulandi and Senem Ates

10 Effect of Methotrexate Treatment for Ectopic Pregnancy on Current and Subsequent Pregnancy ...... 69Shirin Namouz-Haddad and Gideon Koren

11 Interstitial Pregnancy ...................................................... 77Margaret Dziadosz, Ana Monteagudo and Ilan E. Timor-Tritsch

12 Cervical Pregnancy .......................................................... 85Abdulrahman Alserri and Togas Tulandi

13 Ovarian Ectopic Pregnancy ............................................ 93Warren J. Huber and Gary N. Frishman

14 Cesarean Scar Pregnancy ................................................ 101Marcos Cordoba, Ana Monteagudo and Ilan E. Timor-Tritsch

15 Abdominal Pregnancy ..................................................... 109Amanda Ecker MD and Richard Guido MD

16 Intramural Pregnancy ..................................................... 115Maria Memtsa and Davor Jurkovic

17 Heterotopic Pregnancy .................................................... 123Mallory Stuparich and Kimberly A. Kho

18 Retroperitoneal Ectopic Pregnancy ............................... 131Ana Monzo-Miralles, Alicia Martinez-Varea and Antonio Pellicer

19 Ectopic Molar Pregnancy ................................................ 139Atif Zeadna and Togas Tulandi

viii Contents

ix

20 Rudimentary Uterine Horn Pregnancy.......................... 145Mette Petri Lauritsen and Marianne Johansen

21 Fertility After Tubal Ectopic Pregnancy ........................ 153Perrine Capmas, Jean Bouyer and Hervé Fernandez

Index ........................................................................................ 163

ixContents

xi

Contributors

Benny Almog MD Lis Maternity Hospital, Tel Aviv Sourasky Medical Center Affiliated to Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel

Abdulrahman Alserri MD McGill University Health Center, Montreal, QC, Canada

Ali Ardehali MD Acute Gynaecology, Early Pregnancy and Advanced Endosurgery Unit, Nepean Centre for Perinatal Care, Nepean Clinical School, Nepean Hospital, University of Sydney, Penrith, Sydney, Australia

Senem Ates MD McGill University Health Center, Montreal, QC, Canada

Shabnam Bobdiwala MD Queen Charlotte and Chelsea Hospital, Imperial College London, London, UK

Tom Bourne MD, PhD Queen Charlotte and Chelsea Hospital, Imperial College London, London, UK

Jean Bouyer MD Centre of research in Epidemiology and population health (CESP), Inserm, Le Kremlin Bicêtre, France

Perrine Capmas MD Service de Gynécologie Obstétrique, Hôpital Bicêtre, GHU Sud, AP-HP, Le Kremlin Bicêtre Cedex, France

Centre of research in Epidemiology and population health (CESP), Inserm, Le Kremlin Bicêtre, France

Univ Paris Sud, Le Kremlin Bicêtre, France

Lisa Caronia MD Cleveland Clinic, Cleveland, OH, USA

Ishwari Casikar MD Acute Gynaecology, Early Pregnancy and Advanced Endosurgery Unit, Nepean Centre for Perinatal Care, Nepean Clinical School, Nepean Hospital, University of Sydney, Penrith, Sydney, Australia

George Condous MBBS, MD Acute Gynaecology, Early Pregnancy and Advanced Endosurgery Unit, Nepean Centre for Perinatal Care, Nepean Clinical School, Nepean Hospital, University of Sydney, Penrith, Sydney, Australia

Marcos Cordoba MD Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, New York University School of Medicine, New York, NY, USA

Margaret Dziadosz MD Department of Obstetrics and Gynecology, New York University School of Medicine, New York, NY, USA

Amanda Ecker MD Magee-Womens Hospital of UPMC, Pittsburgh, PA, USA

Tommaso Falcone MD Cleveland Clinic, Cleveland, OH, USA

Hervé Fernandez MD, PhD. Service de Gynécologie Obstétrique, Hôpital Bicêtre, GHU Sud, AP-HP, Le Kremlin Bicêtre Cedex, France

Centre of research in Epidemiology and population health (CESP), Inserm, Le Kremlin Bicêtre, France

Univ Paris Sud, Le Kremlin Bicêtre, France

BICETRE, Le Kremlin Bicetre, France

Rebecca Flyckt MD Cleveland Clinic, Cleveland, OH, USA

Gary N. Frishman MD Women and Infants Hospital, Providence, RI, USA

Richard Guido MD Magee-Womens Hospital of UPMC, Pittsburgh, PA, USA

Warren J. Huber III, MD, PhD Women and Infants Hospital, Providence, RI, USA

xii Contributors

Marianne Johansen MD Department of Obstetrics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark

Davor Jurkovic MD Department of Obstetrics and Gynecology, University College Hospital, London, UK

Gynaecology Diagnostic and Outpatient Treatment Unit,, University College Hospital, London, UK

Kimberly A. Kho MD, MPH Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX, USA

Gideon Koren MD The Hospital for Sick Children, Toronto, ON, Canada

Mette Petri Lauritsen MD The Fertility Clinic, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark

Ishai Levin MD Lis Maternity Hospital, Tel Aviv Sourasky Medical Center Affiliated to Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel

Jillian Main MD Stanford University Medical Center, OBGYN, Palo Alto, CA, USA

Alicia Martinez-Varea MD Obstetrics & Gynecology, La Fe University Hospital, Valencia, Spain

Maria Memtsa MD Department of Obstetrics and Gynecology, University College Hospital, London, UK

Ana Monteagudo MD Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, New York University School of Medicine, New York, NY, USA

Department of Obstetrics and Gynecology, New York University School of Medicine, New York, NY, USA

Ana Monzo-Miralles MD Obstetrics & Gynecology, La Fe University Hospital, Valencia, Spain

Shirin Namouz-Haddad MD The Hospital for Sick Children, Toronto, ON, Canada

xiiiContributors

Camran Nezhat MD Stanford University Medical Center, OBGYN, Palo Alto, CA, USA

Antonio Pellicer MD Obstetrics & Gynecology, La Fe University Hospital, Valencia, Spain

Shiri Shinar MD Lis Maternity Hospital, Tel Aviv Sourasky Medical Center Affiliated to Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel

Mallory Stuparich MD Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX, USA

Ilan E. Timor-Tritsch MD Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, New York University School of Medicine, New York, NY, USA

Department of Obstetrics and Gynecology, New York University School of Medicine, New York, NY, USA

Togas Tulandi MD, MHCM McGill University Montreal, QC, Canada

M. Jean Uy-Kroh MD Department of Obstetrics and Gynecology, Women’s Health Institute, Cleveland Clinic, Cleveland, OH, USA

Atif Zeadna MD McGill University Health Center, Montreal, QC, Canada

Soroka University Medical Center, Beersheba, Israel

xiv Contributors