Kazuaki Imai1, Yoshiyuki Fukushi2, Mai Nishimura3, Yasuhiro Ohara4, Yukio Suzuki5, Hajime Ota6, Ayako Nakajima7, Shinichiro Wada8, Takafumi Fujino9. 1. Department of Obstetrics and Gynecology, Teine Keijinkai Hospital, 1-12-1-40, Maeda, Teine-ku, Sapporo 006-8555, Japan. Electronic address: wing.of.kazu.kun@gmail.com. 2. Department of Obstetrics and Gynecology, Teine Keijinkai Hospital, 1-12-1-40, Maeda, Teine-ku, Sapporo 006-8555, Japan. Electronic address: kohta294@yahoo.co.jp. 3. Department of Obstetrics and Gynecology, Teine Keijinkai Hospital, 1-12-1-40, Maeda, Teine-ku, Sapporo 006-8555, Japan. Electronic address: mainqq119@gmail.com. 4. Department of Obstetrics and Gynecology, Teine Keijinkai Hospital, 1-12-1-40, Maeda, Teine-ku, Sapporo 006-8555, Japan. Electronic address: yasumots@yahoo.co.jp. 5. Department of Obstetrics and Gynecology, Yokohama City University Hospital, Fukuura, Kanazawa, Yokohama, Kanagawa Prefecture 236-0004, Japan. Electronic address: yetii18@yahoo.co.jp. 6. Department of Obstetrics and Gynecology, Teine Keijinkai Hospital, 1-12-1-40, Maeda, Teine-ku, Sapporo 006-8555, Japan. Electronic address: hjm.ohta@gmail.com. 7. Department of Obstetrics and Gynecology, Teine Keijinkai Hospital, 1-12-1-40, Maeda, Teine-ku, Sapporo 006-8555, Japan. Electronic address: ayaya-n@tkeijinkai.gr.jp. 8. Department of Obstetrics and Gynecology, Teine Keijinkai Hospital, 1-12-1-40, Maeda, Teine-ku, Sapporo 006-8555, Japan. Electronic address: wa_shin_2002@yahoo.co.jp. 9. Department of Obstetrics and Gynecology, Teine Keijinkai Hospital, 1-12-1-40, Maeda, Teine-ku, Sapporo 006-8555, Japan. Electronic address: bxr06623@nifty.com.
Abstract
INTRODUCTION: We investigated whether temporary bilateral laparoscopic uterine artery clipping with hysteroscopic transcervical resection (LUA clipping-TCR) is an effective minimally invasive treatment for the management of cervical pregnancy. MATERIALS AND METHODS: This study is a retrospective clinical case series conducted at Teine Keijinkai Hospital from January 2014 to June 2019. Nine cervical pregnancies among 164 ectopic pregnancies were retrospectively examined. The intervention involved performing LUA clipping-TCR on villous tissue. Information on patient characteristics, clinical data, and surgical details was collected from medical records and surgical videos. RESULTS: The mean (range) age of the patients was 33 years (29-41 years); and mean gestational sac diameter, 12.8 mm (5-24 mm). Five patients had a history of intrauterine procedures. Three patients had a positive fetal heartbeat. The mean (range) preoperative serum hCG level (mIU/mL), surgical time (min), uterine artery blocking time (min), and amount of surgical blood loss (ml) were 14,040 (2880-41,367), 82 (62-120), 42 (21-68), and 57 (10-200), respectively. The mean decrease in serum hCG level (second postoperative day) and duration until resumption of menstruation were 79.7 % (70-86.7 %) and 46 days (35-80 days), respectively. The hospitalization period was 2-3 days, with no evidence of persistent ectopic pregnancy. Live birth was achieved in four cases. DISCUSSION: Our results confirm previous findings and provide new evidence that LUA clipping-TCR is effective for cervical pregnancy management and fertility preservation, respectively. Future large-scale prospective studies to compare different cervical pregnancy management methods are required.
INTRODUCTION: We investigated whether temporary bilateral laparoscopic uterine artery clipping with hysteroscopic transcervical resection (LUA clipping-TCR) is an effective minimally invasive treatment for the management of cervical pregnancy. MATERIALS AND METHODS: This study is a retrospective clinical case series conducted at Teine Keijinkai Hospital from January 2014 to June 2019. Nine cervical pregnancies among 164 ectopic pregnancies were retrospectively examined. The intervention involved performing LUA clipping-TCR on villous tissue. Information on patient characteristics, clinical data, and surgical details was collected from medical records and surgical videos. RESULTS: The mean (range) age of the patients was 33 years (29-41 years); and mean gestational sac diameter, 12.8 mm (5-24 mm). Five patients had a history of intrauterine procedures. Three patients had a positive fetal heartbeat. The mean (range) preoperative serum hCG level (mIU/mL), surgical time (min), uterine artery blocking time (min), and amount of surgical blood loss (ml) were 14,040 (2880-41,367), 82 (62-120), 42 (21-68), and 57 (10-200), respectively. The mean decrease in serum hCG level (second postoperative day) and duration until resumption of menstruation were 79.7 % (70-86.7 %) and 46 days (35-80 days), respectively. The hospitalization period was 2-3 days, with no evidence of persistent ectopic pregnancy. Live birth was achieved in four cases. DISCUSSION: Our results confirm previous findings and provide new evidence that LUA clipping-TCR is effective for cervical pregnancy management and fertility preservation, respectively. Future large-scale prospective studies to compare different cervical pregnancy management methods are required.