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Updated: Jun 30, 2026
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Laparoscopic Non-Mesh Cerclage Pectopexy with Uterine Preservation for Pelvic Organ Prolapse
Published on: October 25, 2024
[Persistent ectopic pregnancy. Peritoneal-uterine late implantation. Case report]
Alfonso Gutiérrez Nájar1, Radamés Rivas López
1Hospital Angeles del Pedregal, México, DF. gutierrezan@prodigy.net.mx
Ginecologia Y Obstetricia De Mexico
|September 19, 2008
Summary
Persistent high hCG levels after ectopic pregnancy treatment necessitated repeat laparoscopy, revealing multiple active trophoblastic implants. Successful management involved bipolar fulguration and methotrexate, highlighting its role in complex cases.
Area of Science:
- Reproductive Medicine
- Gynecologic Surgery
- Medical Therapeutics
Background:
- Ectopic pregnancy, particularly persistent or recurrent forms after initial treatment, poses significant clinical challenges.
- Laparoscopic salpingectomy is a common treatment for fimbrial ectopic pregnancy, but requires careful follow-up for residual trophoblastic activity.
Observation:
- A 31-year-old female presented with persistent elevated human chorionic gonadotropin (hCG) levels and abdominal pain 33 days post-laparoscopic salpingectomy for fimbrial ectopic pregnancy.
- Repeat laparoscopy identified three distinct ectopic implantation sites (one uterine, two peritoneal) exhibiting active trophoblastic cells and intermittent bleeding.
Findings:
- Surgical intervention included fulguration of the implants with bipolar current.
- Intramuscular methotrexate was administered as supplementary therapy, leading to a decline in hCG levels to negative within ten days.
Implications:
- This case underscores that active trophoblastic cells can persist despite thorough surgical review, potentially necessitating urgent intervention.
- Supplementary methotrexate therapy, even a single dose, appears to be a safe and effective option for managing residual trophoblastic disease after surgical treatment of ectopic pregnancy.
