A novel approach with concomitant laparoscopic uterine artery ligation and D&C as initial treatment for complicated gestational trophoblast disease in cesarean scar and cervical ectopic pregnancies

Objective: Gestational trophoblast disease (GTD) in low-lying implantation ectopic pregnancy (LLIEP) is extremely rare. Surgical removal of GTD lesions which is the initial treatment of choice carries a high risk of intraoperative massive bleeding. Adequate management is challenging and inconclusive...

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Autores principales:	Yu-Han Lin, Yu-Che Ou, Fu-Tsai Kung
Formato:	article
Lenguaje:	EN
Publicado:	Elsevier 2021
Materias:	Cervical pregnancy Cesarean scar pregnancy Choriocarcinoma Gestational trophoblast disease Laparoscopy Gynecology and obstetrics RG1-991
Acceso en línea:	https://doaj.org/article/aa6aee0a459c4f7fbc81ef2c8939d684
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spelling	oai:doaj.org-article:aa6aee0a459c4f7fbc81ef2c8939d6842021-11-18T04:44:47ZA novel approach with concomitant laparoscopic uterine artery ligation and D&C as initial treatment for complicated gestational trophoblast disease in cesarean scar and cervical ectopic pregnancies1028-455910.1016/j.tjog.2021.09.022https://doaj.org/article/aa6aee0a459c4f7fbc81ef2c8939d6842021-11-01T00:00:00Zhttp://www.sciencedirect.com/science/article/pii/S102845592100262Xhttps://doaj.org/toc/1028-4559Objective: Gestational trophoblast disease (GTD) in low-lying implantation ectopic pregnancy (LLIEP) is extremely rare. Surgical removal of GTD lesions which is the initial treatment of choice carries a high risk of intraoperative massive bleeding. Adequate management is challenging and inconclusive. Case report: We present two unusual cases with a diagnosis of GTD in advanced LLIEP. The first case had choriocarcinoma in cesarean scar and the second case had mole pregnancy in cervix. Both cases were managed with laparoscopy uterine artery ligations followed by transvaginal intrauterine curettage and vacuum aspiration with a small amount of surgical blood loss and then resumed regular menstruation. To understand the different surgical approaches and their potential advantages in managing such rare diseases, relevant cases in the literature were reviewed. Conclusion: Much attention should be paid to avoid massive bleeding at initial surgical intervention in patients with GTD in advanced LLIEP. This novel approach with combination of laparoscopic uterine artery ligations and evacuating curettage in selected patients is highly recommended to minimize surgical blood loss. The obvious advantages include technical feasibility, less surgery-related bleeding and potential fertility preservation.Yu-Han LinYu-Che OuFu-Tsai KungElsevierarticleCervical pregnancyCesarean scar pregnancyChoriocarcinomaGestational trophoblast diseaseLaparoscopyGynecology and obstetricsRG1-991ENTaiwanese Journal of Obstetrics & Gynecology, Vol 60, Iss 6, Pp 1090-1093 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Cervical pregnancy Cesarean scar pregnancy Choriocarcinoma Gestational trophoblast disease Laparoscopy Gynecology and obstetrics RG1-991
spellingShingle	Cervical pregnancy Cesarean scar pregnancy Choriocarcinoma Gestational trophoblast disease Laparoscopy Gynecology and obstetrics RG1-991 Yu-Han Lin Yu-Che Ou Fu-Tsai Kung A novel approach with concomitant laparoscopic uterine artery ligation and D&C as initial treatment for complicated gestational trophoblast disease in cesarean scar and cervical ectopic pregnancies
description	Objective: Gestational trophoblast disease (GTD) in low-lying implantation ectopic pregnancy (LLIEP) is extremely rare. Surgical removal of GTD lesions which is the initial treatment of choice carries a high risk of intraoperative massive bleeding. Adequate management is challenging and inconclusive. Case report: We present two unusual cases with a diagnosis of GTD in advanced LLIEP. The first case had choriocarcinoma in cesarean scar and the second case had mole pregnancy in cervix. Both cases were managed with laparoscopy uterine artery ligations followed by transvaginal intrauterine curettage and vacuum aspiration with a small amount of surgical blood loss and then resumed regular menstruation. To understand the different surgical approaches and their potential advantages in managing such rare diseases, relevant cases in the literature were reviewed. Conclusion: Much attention should be paid to avoid massive bleeding at initial surgical intervention in patients with GTD in advanced LLIEP. This novel approach with combination of laparoscopic uterine artery ligations and evacuating curettage in selected patients is highly recommended to minimize surgical blood loss. The obvious advantages include technical feasibility, less surgery-related bleeding and potential fertility preservation.
format	article
author	Yu-Han Lin Yu-Che Ou Fu-Tsai Kung
author_facet	Yu-Han Lin Yu-Che Ou Fu-Tsai Kung
author_sort	Yu-Han Lin
title	A novel approach with concomitant laparoscopic uterine artery ligation and D&C as initial treatment for complicated gestational trophoblast disease in cesarean scar and cervical ectopic pregnancies
title_short	A novel approach with concomitant laparoscopic uterine artery ligation and D&C as initial treatment for complicated gestational trophoblast disease in cesarean scar and cervical ectopic pregnancies
title_full	A novel approach with concomitant laparoscopic uterine artery ligation and D&C as initial treatment for complicated gestational trophoblast disease in cesarean scar and cervical ectopic pregnancies
title_fullStr	A novel approach with concomitant laparoscopic uterine artery ligation and D&C as initial treatment for complicated gestational trophoblast disease in cesarean scar and cervical ectopic pregnancies
title_full_unstemmed	A novel approach with concomitant laparoscopic uterine artery ligation and D&C as initial treatment for complicated gestational trophoblast disease in cesarean scar and cervical ectopic pregnancies
title_sort	novel approach with concomitant laparoscopic uterine artery ligation and d&c as initial treatment for complicated gestational trophoblast disease in cesarean scar and cervical ectopic pregnancies
publisher	Elsevier
publishDate	2021
url	https://doaj.org/article/aa6aee0a459c4f7fbc81ef2c8939d684
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A novel approach with concomitant laparoscopic uterine artery ligation and D&C as initial treatment for complicated gestational trophoblast disease in cesarean scar and cervical ectopic pregnancies

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