pituitrin and Pregnancy--Ectopic

Although cornual pregnancy is a rare form of ectopic pregnancy, the associated mortality rate is considerably higher than that of ectopic pregnancy overall. Historically, cornual ectopic pregnancy has been treated via laparotomy. With advancements in technology, equipment, and technique, laparoscopy offers a safer approach for the management of cornual pregnancy. However, laparoscopy of this nature requires excellent technique. The Vasopressin Injection Purse-String Ectopic Resection technique serves as an effective strategy for the laparoscopic management of cornual ectopic pregnancy. First, dilute vasopressin is administered into the myometrium surrounding the pregnancy. Next, a purse-string stitch is placed in the myometrium circumferential to the pregnancy. Finally, the pregnancy is excised by cornual wedge resection, and the defect is repaired using the attached remaining suture from the purse-string stitch. The Figure shows the graphical depiction of the Vasopressin Injection Purse-String Ectopic Resection technique, and the Video shows a laparoscopic recording of the Vasopressin Injection Purse-String Ectopic Resection technique. Between 2012 and 2022, 17 patients underwent a laparoscopic cornual ectopic pregnancy resection at a high-volume academic hospital and its affiliated community hospital. This case series revealed a mean operative time of 107 minutes, with a mean estimated blood loss of 41 mL for nonruptured ectopic pregnancies and 412 mL for ruptured ectopic pregnancies. No case was converted to laparotomy. Our findings suggest that the integration of the vasopressin administration and the pursue-string stitch placement minimizes blood loss and mitigates the risk of conversion to laparotomy for both nonruptured and ruptured cornual ectopic pregnancies.

Topics: Female; Humans; Laparoscopy; Laparotomy; Pregnancy; Pregnancy, Cornual; Pregnancy, Ectopic; Vasopressins

To report the results of local injection of diluted vasopressin followed by suction curettage as a conservative treatment for women with cervical ectopic pregnancy, who wish to preserve their future fertility.. This was a retrospective chart review in a university hospital and a municipal hospital. We injected diluted vasopressin (Pitressin R, total amount of 4-10 units) transvaginally into the cervix surrounding the gestational sac, but not directly into the gestational sac, and/or the lower segment of the uterine body under transvaginal ultrasonographic guidance. After cessation of fetal heartbeats, we aspirated the conceptus by performing suction curettage. We injected additional vasopressin into the gestational sac in cases with a viable fetus after the initial injection. Forced contraction of the cervical smooth muscle facilitated removal of the conceptus with minimal blood loss during curettage. We measured operative time, total blood loss, complications, and the need for additional treatment.. We included 11 women. Mean patient age, gestational age, and serum human chorionic gonadotrophin (hCG) at the intervention were 31.2±6.4years, 6.0±0.6 weeks, and 18,370±21,570 IU/L, respectively. Mean size of the gestational sac was 19.6±9.5mm. The uterus was successfully preserved without any complications in all patients. All procedures were completed within 15min except for the first case (range: 5-33min). In 4 cases, the conceptus containing a gestational sac was spontaneously extruded en bloc from the external os after the injection. Additional systematic methotrexate administration was required in one case because of remaining villi at the implantation site with persistence of serum hCG levels after the procedure.. Local injection of diluted vasopressin and subsequent suction curettage is a feasible conservative treatment for cervical ectopic pregnancy.

Topics: Adult; Blood Loss, Surgical; Cervix Uteri; Chorionic Gonadotropin; Combined Modality Therapy; Feasibility Studies; Female; Hospitals, Municipal; Hospitals, University; Humans; Injections, Intramuscular; Japan; Operative Time; Postoperative Complications; Pregnancy; Pregnancy, Ectopic; Retrospective Studies; Ultrasonography, Doppler, Color; Vacuum Curettage; Vasoconstrictor Agents; Vasopressins

To describe resectoscopic treatment with vasopressin injection as an effective surgical intervention for ectopic pregnancy in previous cesarean delivery scar (PCDS) defect.. Case report.. University hospital.. Two women with ectopic pregnancy in PCDS defect.. The patients underwent transvaginal ultrasound examination, followed by operative hysteroscopy with vasopressin injection for evacuating the ectopic pregnancy in PCDS defect.. Conservation of the uterus.. Successful resectoscopic treatment of ectopic pregnancy in PCDS defect.. Resectoscopic treatment of ectopic pregnancy in PCDS defect is a safe and efficient technique that has the advantage of a rapid return to normal levels of β-hCG. Intracervical vasopressin administration could decrease intraoperative bleeding and provide a clear view during the operation.

Topics: Adult; Biomarkers; Blood Loss, Surgical; Cesarean Section; Chorionic Gonadotropin; Cicatrix; Female; Gestational Age; Hemostatics; Humans; Hysteroscopy; Injections; Pregnancy; Pregnancy, Ectopic; Treatment Outcome; Ultrasonography, Prenatal; Vasopressins

We sought to report the safety and effectiveness of bleeding control using a large amount of highly diluted vasopressin in laparoscopic management of interstitial pregnancy.. This was an uncontrolled retrospective review of 20 patients who were laparoscopically treated for interstitial pregnancy using a large amount of highly diluted vasopressin. For hemostasis, 1 ampule of vasopressin was diluted in 1000 mL of normal saline (1000-fold) and 150-250 mL of diluted vasopressin was injected in the uterus below interstitial pregnancy.. Mean patient age and gestational age was 33.5 years and 6.7 weeks, respectively. Mean blood loss was 24 mL. The mean serum human chorionic gonadotropin level was 10,950, 4065, and 959 mIU/mL on the day of operation and postoperative days 1 and 4, respectively.. Laparoscopic management of interstitial pregnancy using a large amount of highly diluted vasopressin is safe and effective in hemostasis with minimal blood loss and no complications.

Topics: Adult; Female; Hemostasis, Surgical; Humans; Laparoscopy; Pregnancy; Pregnancy, Ectopic; Retrospective Studies; Vasoconstrictor Agents; Vasopressins

Topics: Chorionic Gonadotropin, beta Subunit, Human; Female; Humans; Injections; Laparoscopy; Pregnancy; Pregnancy Outcome; Pregnancy, Ectopic; Retrospective Studies; Sutures; Tourniquets; Vasopressins

To evaluate the efficiency of laparoscopic cornuotomy.. Retrospective case review.. An urban medical center.. Eight patients with interstitial pregnancy who have undergone laparoscopic cornuotomy.. Laparoscopic cornuotomy was performed using a temporary tourniquet suture and the injection of diluted vasopressin around the cornual mass. The tourniquet suture was removed completely after repairing the cornu.. Operating time, hemorrhage, beta-hCG levels.. The estimated blood loss was 50 +/- 22 mL (mean +/- SD), and the operating time was 58 +/- 16 minutes. The serum beta-hCG level returned to within the normal range approximately 4 weeks postoperatively in all patients. There were no major postoperative complications, such as hemorrhage, and no postoperative adjuvant therapy was required.. Laparoscopic cornuotomy is a safe and effective method in interstitial pregnancy, and we believe that it has the advantage of preserving reproductive capacity over cornual resection.

Topics: Chorionic Gonadotropin, beta Subunit, Human; Female; Humans; Injections; Laparoscopy; Pregnancy; Pregnancy, Ectopic; Retrospective Studies; Sutures; Tourniquets; Vasopressins

Hemorrhage from a cervical pregnancy is a time-sensitive matter. Effective temporization measures for the initial management of this hemorrhage have not previously been reported in the literature.. A 43-year-old woman, gravida 0, underwent in vitro fertilization and embryo transfer. She subsequently presented to the office with sudden onset of vaginal hemorrhage due to a cervical pregnancy. Cervical artery sutures were placed, and a cervical vasoconstricting agent was injected, at which point the patient's bleeding stopped. She then underwent successful treatment with dilation and curettage.. Conservative measures to manage hemorrhage due to cervical pregnancy can be initiated, with possible rapid establishment of hemostasis until definitive treatment can be achieved.

Topics: Adult; Cervix Uteri; Female; Hemostatics; Humans; Injections; Ligation; Pregnancy; Pregnancy, Ectopic; Suture Techniques; Uterine Hemorrhage; Vasopressins

Topics: Cesarean Section; Cicatrix; Female; Hemostatics; Humans; Pregnancy; Pregnancy, Ectopic; Vasopressins

Topics: Abortifacient Agents, Nonsteroidal; Adult; Cervix Uteri; Diagnosis, Differential; Embryo Transfer; Female; Fertilization in Vitro; Humans; Injections; Methotrexate; Pregnancy; Pregnancy, Ectopic; Ultrasonography, Prenatal; Vasoconstrictor Agents; Vasopressins

Topics: Adult; Chorionic Gonadotropin; Embryo Transfer; Female; Humans; Pregnancy; Pregnancy, Ectopic; Treatment Outcome; Ultrasonography; Vasopressins

Our aim was to report a new approach of endoscopic management (endoloop and encircling suture methods) for interstitial or cornual pregnancy and to determine the safety and effectiveness of these procedures and their effects on subsequent pregnancies.. This is an uncontrolled retrospective review of 24 patients treated for interstitial pregnancies through endoscopic operations with 14 to 72 months of follow-up at a large urban medical center. Blood loss, operation time, changes of serum human chorionic gonadotropin levels, the resumption of menstruation, and subsequent pregnancy after operation were analyzed.. Among 24 interstitial pregnancies, 3 had ruptured at the time of operation and 21 had not ruptured. Treatment consisted of either the vasopressin and electric cauterization method, the endoloop before evacuation of the conceptus method, or the encircling suture before evacuation of the conceptus method. The blood loss and operation time (mean +/- SD) for unruptured cases were 133 +/- 134 mL and 51.6 +/- 7.6 minutes in the vasopressin and electric cauterization group (n = 3), 32 +/- 22 mL and 28.5 +/- 6.4 minutes in the endoloop group (n = 15), and 40 +/- 17 mL and 35.0 +/- 5.0 minutes in the encircling suture group (n = 3). In 3 patients with ruptured pregnancy treated with the endoloop method, the blood loss and operation time (mean +/- SD) were 1100 +/- 854 mL and 82.5 +/- 51.6 minutes. Any of these operative methods resulted in rapid decline of serum human chorionic gonadotropin levels within 1 week with the exception of 1 case, in which the endoloop method was used; this patient needed additional treatment with methotrexate. Seventeen patients desired pregnancy in the future, and 15 eventually became pregnant. One of these 15 pregnancies ended in an ectopic pregnancy on the opposite side 6 months after the interstitial pregnancy. Three ended in a spontaneous abortion, and 11 were delivered by elective cesarean section at term before labor started. Operative records of cesarean section in 8 patients delivered at our institution showed little or no adhesions or defect in the cornual area of the previous operation.. The endoloop method and the encircling suture method are simple, safe, effective, and nearly bloodless. There were no uterine ruptures in the pregnancies subsequent to these methods of endoscopic management.

Topics: Adult; Blood Loss, Surgical; Cesarean Section; Chorionic Gonadotropin; Electrocoagulation; Endoscopy; Female; Humans; Menstruation; Pregnancy; Pregnancy Outcome; Pregnancy, Ectopic; Retrospective Studies; Rupture, Spontaneous; Time Factors; Treatment Outcome; Vasopressins

Topics: Adult; Chorionic Gonadotropin; Female; Humans; Pregnancy; Pregnancy, Ectopic; Ultrasonography; Vasopressins

Topics: Cervix Uteri; Drug Therapy; Felypressin; Female; Hemostasis; Hemostatics; Humans; Pregnancy; Pregnancy, Ectopic; Surgical Procedures, Operative; Vasopressins