Interstitial Pregnancy After Assisted Reproductive Technology:a Series Of38Cases And Cornua Uteri Anatomy Study

OBJECTIVE:To validate the characteristics and clinical efficacy of interstitial pregnancy after assisted reproductive technology by laparoscopic conservative surgery, and to study the anatomy of cornua uteri for guiding the treatment and prevention of interstitial pregnancy.Materials and Methods:(1).Conclude the characteristics of thirty-eight women with interstitial pregnancy after embryos transfer, treated at our department from April2011to April2014. All thirty-eight patients of interstitial pregnancy were accurately established by transvaginal sonography (TVS) and done with laparoscopic conservative surgery. Thirty-six of the women(97.4%) were treated with spoon forceps via cornual linear incision to remove cornual gestational sacs, followed by hemostasis and cornual repair. The other one was treated with local injection of methotrexate into the gestational sac.(2). HE staining and immunohistochemistry of postmenopausal patients with hysterectomy, to know the tubal interstitial lumen and the surrounding muscle layer. Immunohistochemical (IHC) for epithelial marker——keratin, mesenchymal cells marker——vimentin and smooth muscle cell marker——alpha smooth muscle actin staining.RESULT(S):(1). Thirty-seven of the women underwent in vitro fertilization treatment with the main reason of tubal infertility. One was pelvic endometriosis. Twenty-nine had the lesion side salpingectomy, Two had proximal tubal block.(2). The average day to ET was34.2±11.1d, and the median day was33d. The average day to ET of symptomatic cases was30.5±12.4d, and the median day was26d. The average day to ET of rupture cases was26.2±5.3d, and the median day was26d.(3). The average internal hemorrhage was945.5±645.9ml in the eleven ruptured patients(29.0%). Seven of them was>1000ml, which considered in hypovolemic shock. versus16.1±53.2ml in intact cases16.1±53.2ml (p<0.01). The average estimated intra-operative blood loss was37.7±55.7ml in ruptured patients, versus43.5±42.4ml in intact cases, with no significant difference.(4). Thirty-five of the women had no complication during and after laparoscopic conservative surgery. Two had persistent abdominal pregnancy after surgery, followed by systemic methotrexate injection and resection of abdominal pregnancy by laparoscopic surgery. One was done with the same surgery twice because still considered interstitial pregnancy after the first surgery.(5). There is a transitional belt between the uterus and fallopian tube.CONCLUSION(S):(1). Salpingectomy or tubal block is the high risk of interstitial pregnancy after assisted reproductive technology.(2). We found an early onset of cornual rupture for interstitial pregnancies after in-utero transfer, which is different from the traditional belief. Patients with high risk of interstitial pregnancy should be followed up early and closely after successful embryo transfer.(3). Cornual linear incision to remove cornual gestational sacs and cornual repair by laparoscopic surgery is a most safe and effective treatment for interstitial pregnancy. But be care of persistent ectopic pregnancy.(4). For patients with fertility requirements, we need to improve the operation method to reduce interstitial pregnancy.(5). Fallopian tube and uterine endometrium and submucosa are ancient uterus. Both are suitable for embryo implantation.