Highlights
- •An interstitial pregnancy can be removed using hysteroscopic morcellation.
- •Laparoscopic guidance is recommended.
- •It is a promising technique regarding safety, efficacy and maintaining fertility.
Abstract
Objective
An interstitial pregnancy is a rare form of ectopic pregnancy. Diagnosis and management
can be challenging. Treatment often involves invasive uterine surgery. Conservative
options such as methotrexate are important alternatives nowadays.
The aim of this review is to investigate the role of operative hysteroscopy in the
organ and fertility preserving management of interstitial pregnancy and interstitially
retained products of conception (RPOC).
Methods
A case is presented in which interstitially RPOC were removed using hysteroscopic
morcellation under laparoscopic guidance. Consequently, a systematic literature review
was performed. Medline, Embase and The Cochrane Library were used as literature resources.
Results
In the literature review, 14 case reports in which operative hysteroscopy was part
of the minimally invasive treatment of interstitial pregnancy and interstitially RPOC
of which 11 were studied. Of these 14 cases, 11 were reported as being successful.
Different techniques such as laparoscopy and suction curettage were associated. Various
hysteroscopic instruments were used, hysteroscopic graspers most commonly. Reported
complications were uterine perforation during suction curettage and incomplete hysteroscopic
resection. Analysis of the cases did not demonstrate a clear difference between different
approaches concerning safety, efficacy or subsequent fertility and pregnancy outcomes.
Conclusion
With the growing experience in hysteroscopy and the development of novel techniques
and devices, such as hysteroscopic morcellation, operative hysteroscopy has a promising
role in the minimally invasive management of interstitial pregnancy and interstitially
RPOC. (Laparoscopically guided) operative hysteroscopy might be a convenient approach
to avoid blind curettage and related complications such as uterine perforation.
Keywords
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Article info
Publication history
Published online: July 14, 2021
Accepted:
July 12,
2021
Received in revised form:
July 7,
2021
Received:
January 19,
2021
Identification
Copyright
© 2021 Elsevier B.V. All rights reserved.
