Managment of ipsilateral interstitial pregnancy after tubal surgery: a retrospective study focusing on focal rupture

Managment of ipsilateral interstitial pregnancy after tubal surgery: a retrospective study focusing on focal rupture | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Managment of ipsilateral interstitial pregnancy after tubal surgery: a retrospective study focusing on focal rupture Miaomiao Jing, Wei Zhao This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4543075/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Study Objective ：To explore the high risk factors and clinical characteristics of interstitial pregnancy rupture by retrospectively studying the clinical characteristics, diagnosis, treatment and prognosis of patients with interstitial pregnancy, so as to provide a certain reference and basis for the clinical management of interstitial pregnancy. Design : A single-center, retrospective study. Setting : A university-based hospital. Patients : Patients diagnosed with interstitial pregnancy in the Women’s Hospital, Zhejiang University School of Medicine from January 2009 to May 2022 and treated in the hospital for the first time. Interventions : A retrospective statistical analysis was performed on the case data of patients with interstitial pregnancy who met the inclusion criteria and were treated in the Obstetrics and Gynecology Hospital Affiliated to Zhejiang University Medical College, and statistical software SPSS was used for data analysis. Measurement and Main Results : A total of 885 patients with interstitial pregnancy were included in the study, including 55 patients with heterotopic interstitial pregnancies. The gestational days of patients with interstitial rupture were shorter than those of intactness( p <0.01). The risk of interstitial pregnancy rupture was higher in women with a history of ipsilateral fallopian tube surgery p 42day rupture group, the gestation days were shorter in those with a history of ipsilateral surgery than those without, and the difference was statistically significant( p =0.005). The interval between ipsilateral tubal surgery and this interstitial pregnancy was 12 months as the cut-off point for analysis. The shorter the interval, the higher the risk of interstitial pregnancy rupture ( p =0.001). Conclusions : Patients with a history of ipsilateral tubal surgery have a higher risk of interstitial pregnancy rupture. The shorter the interval between ipsilateral tubal surgery and interstitial pregnancy, the higher the risk of rupture. For patients with intrauterine pregnancy and interstitial pregnancy, timely treatment can also obtain term live birth. Health sciences/Risk factors Health sciences/Diseases/Reproductive disorders/Urogenital reproductive disorders Interstitial pregnancy Salpingectomy Rupture Heterotopic interstitial pregnancy Introduction Interstitial pregnancy is a special site of ectopic pregnancy, which refers to the embryo implantation in the interstitial part of the fallopian tube pregnancy. Interstitial pregnancy has a low clinical incidence, generally accounting for 2-4% of all tubal pregnancies[1]. However, with the application of assisted reproductive technology, the incidence of interstitial ectopic pregnancy is up to 7.3%[2, 3]. The interstitial portion of the fallopian tube is the section of the tube surrounded by the myometrium in the cornual area, and about 1 cm long. This is accentuated by the rich vascular anastomosis of the uterine and the ovarian arteries in this region[4]. Once ruptured patients can fall into hemorrhagic shock in a short period, the disease is extremely dangerous, and the mortality rate is about 2.5%, seven times greater than that of ectopic pregnancies in general[5]. In tubal pregnancy, hydrosalpinx and other patients, salpingectomy is a routine treatment in current gynecologic practice. In addition, a recent Cochrane review showed that salpingectomy before assisted reproductive technology (ART) therapy may increase the clinical pregnancy rate for women with hydrosalpinx[6]. However, ipsilateral salpingectomy is a high risk factor for interstitial pregnancy. In a study of 32 cases of interstitial pregnancy, Togas Tulandi et al. pointed out that the risk factors for interstitial pregnancy were previous ectopic pregnancy (40.6%), previous salpingectomy (37.5%), in vitro fertilization (34.4%), sexually transmitted disease (25.0%), ovulation induction (3.1%)[7]. David Soriano et al. in another study identified risk factors for interstitial pregnancy as salpingectomy or tubal ligation(54.1%), previous extrauterine pregnancies(54.1%), IVF(29.7%), and previous pelvic inflammatory disease(12.5%)[8]. The risk factors for interstitial pregnancy are similar to those for other parts of the fallopian tube, but ipsilateral salpingectomy is a specific risk factor for interstitial pregnancy. The musculature around the tubal interstitium is thicker, and the rupture time is usually 12-16 weeks of gestation. However, it has been found in clinical practice that the time of interstitial pregnancy rupture in some patients after tubal surgery is much earlier than 12 weeks, and can even occur in about 5 weeks of pregnancy. To explore the risk factors of interstitial pregnancy rupture, timely diagnosis and treatment, so as to reduce the serious adverse outcomes caused by interstitial pregnancy rupture has become an urgent problem to be solved. This study reviewed the clinical characteristics, diagnosis, treatment, and prognosis of patients with interstitial pregnancy, and explored the risk factors and clinical characteristics of interstitial pregnancy rupture, so as to provide certain references and a basis for the clinical management of interstitial pregnancy. Materials and Methods The study was approved by the Ethics Committee of Women’s Hospital School of Medicine Zhejiang University. Informed consent was obtained from all subjects and/or their legal guardian(s). All methods in this study were performed in accordance with the relevant guidelines and regulations. Subjects Patients diagnosed with interstitial pregnancy who were eligible for inclusion and exclusion in the Women’s Hospital, Zhejiang University School of Medicine from January 2009 to May 2022 and treated in the hospital for the first time were enrolled in the study. Inclusion criteria: (1) patients with interstitial pregnancy diagnosed by imaging examination or intraoperative exploration; (2) patients who were first treated in our hospital after diagnosis of interstitial pregnancy; (3) natural pregnancy or assisted reproductive technology; (4) the same interstitial pregnancy of the same patient was only included in the first treatment data. Exclusion criteria: (1) combined with severe medical and surgical diseases; (2) incomplete data; (3) patients with uterine malformation; (4) patients with cornual-interstitial pregnancy. Medical records of the included patients, including in the analysis included age, height, weight, BIM, conception mode, pregnancy days, ipsilateral fallopian tube operation history, rupture or not, intrauterine and extrauterine complex pregnancy, treatment method, operation duration, intraoperative blood loss, postoperative hospital stay, and operative interval time, were retrospectively analyzed. A total of 885 interstitial pregnancies were included in the study. Diagnosis of interstitial pregnancy Ultrasound is the most important and practical diagnostic method for the diagnosis of interstitial pregnancy. Interstitial pregnancy has the following ultrasound imaging features: (1) The echo of the gestational sac was not detected in the uterine cavity, and the interstitial pregnancy mass was obviously prominent outside the contour of the bottom side of the uterus. (2) interstitial pregnancy mass around the muscle is thin, or incomplete (gestational sac or heterogeneous mass around the muscle thickness of less than 5mm). (3) interstitial pregnancy mass is not connected with the uterine cavity, there is ' interstitial line characteristics '. The interstitial pregnancies included in this study were consistent with the above ultrasound characteristics or surgical diagnosis. Statistical analysis The statistical software package SPSS22 was used for data analysis. Continuous variables were analyzed by T-test or Mann-Whitney test. The chi-square test or Fisher’s exact probability method was used for the comparison of the rates, and P < 0.05 was considered statistically significant. Results A total of 885 patients with interstitial pregnancy were included in the study, of which 171 were ruptured, 714 were unruptured, 249 had ipsilateral tubal operation, and 636 had no history of ipsilateral tubal operation(Table 1 ).. The main reason for ipsilateral fallopian tube surgery is ectopic pregnancy (74.3%). The main treatment is laparoscopic cornual resection (73.2%). Table 1 Basic parameters of interstitial pregnancy Parameter Number(n) Interstitial pregnancy 885 Interstitial pregnancy rupture 171(19.3%) Rupture with a history of ipsilateral tubal surgery 101 Rupture without a history of ipsilateral tubal surgery 70 Interstitial pregnancy unrupture 714(80.7%) Ipsilateral tubal surgery 249 Without ipsilateral tubal surgery 636 Reasons for ipsilateral fallopian tube surgery Ectopic pregnancy 185(74.3%) Fallopian tube inflammation/hydrops 56(22.5%) Other reasons 8(3.2%) Progestation method IVF-ET 198(22.4%) Nature pregnancy 685(77.4%) Artificial insemination pregnancy 2(0.2%) Treatment Transabdominal cornual resection 143(16.2%) Transabdominal cornuostomy 14(1.6%) Laparoscopic cornual resection 648(73.2%) Laparoscopic cornuostomy 61(6.9%) Transvaginal puncture + MTX injection 8(0.9%) Hysteroscopic surgery 4(0.5%) MTX 3(0.2%) Observation 4(0.5%) IVF-ET = In vitro fertilization- embryo transfer. MTX = Methotrexate In this study, there were no significant differences in age, height, weight, BMI and operation duration between patients with interstitial pregnancy rupture and intactness. However, the gestational days of patients with interstitial rupture were shorter than those of intactness(P < 0.01)(Table 2 ). The risk of interstitial pregnancy rupture was higher in women with a history of ipsilateral fallopian tube surgery (P < 0.01) (Table 2 ). Table 2 Baseline data of interstitial pregnancy rupture group and intactness group Parameter Rupture Intactness P value Age(y) 31.95 ± 5.27 31.55 ± 5.21 0.37 Height(cm) 159.71 ± 4.42 159.84 ± 4.59 0.74 Weight(kg) 55.54 ± 7.72 56.48 ± 9.31 0.27 BMI 21.84 ± 2.88 22.09 ± 3.52 0.44 Gestational days(d) 48.62 ± 10.89 52.28 ± 10.91 < 0.01 Operation duration(min) 70.91 ± 26.13 72.35 ± 29.22 0.56 Intraoperative blood loss(ml) 1014.56 ± 788.61 69.57 ± 112.83 < 0.01 Postoperative hospital stay(d) 5.29 ± 2.68 4.42 ± 2.49 < 0.01 Ipsilateral tubal surgery(n) 101 148 - No ipsilateral tubal surgery(n) 70 566 - 12 (months) 44 100 0.001 The interval between ipsilateral tubal surgery and this interstitial pregnancy ranged from 2 months to 264 months. The analysis was performed at an interval of 12 months. Chi-square test was performed in the rupture group and the intactness group with ipsilateral operation history(P = 0.001), indicating that the shorter the interval, the higher the risk of rupture(Table 2 ). According to the stratified analysis with the gestational days as 42 days, there was no significant difference in the gestational days with or without the history of ipsilateral surgery in the patients with ruptured ≤ 42 days (P = 0.17). In the > 42day rupture group, the gestation days were shorter in those with a history of ipsilateral surgery than those without, and the difference was statistically significant( p = 0.005)(Table 3 ). Table 3 Pregnancy days in ruptured interstitial pregnancy patients with or without a history of ipsilateral tubal surgery Gestational days(d) Ipsilateral tubal surgery No ipsilateral tubal surgery P value ≤ 42 39.34 ± 2.38 37.57 ± 5.43 0.17 > 42 50.86 ± 8.48 56.27 ± 11.16 0.005 There were 47 cases of heterotopic interstitial pregnancies. There were 10(43.47%) live births and 9༈39.13%༉ miscarriages in the ruptured group, compared with 13༈54.17%༉live births and 6༈25%༉ miscarriages in the intactness group(Table 4 ). Table 4 Comparison of heterotopic interstitial pregnancy rupture group and intactness group Parameter Rupture Intactness P value Number(n) 23 24 - Age(y) 31.43 ± 5.20 31.75 ± 4.38 0.435 Height(cm) 159.04 ± 4.48 160.04 ± 4.93 0.451 Weight(kg) 54.56 ± 8.41 58.04 ± 8.26 0.738 BMI 21.65 ± 3.14 22.41 ± 3.45 0.863 Gestational days(d) 47.04 ± 9.23 50.54 ± 8.10 0.806 Operation duration(min) 75.87 ± 40.64 75.45 ± 25.99 0.794 Intraoperative blood loss(ml) 1518.70 ± 1077.23 145.65 ± 222.87 < 0.01 Postoperative hospital stay(d) 8.52 ± 4.99 5.48 ± 3.70 0.172 Ipsilateral tubal surgery(n) 20 12 - No ipsilateral tubal surgery(n) 3 12 < 0.01 Intrauterine pregnancy outcome Live birth(n) 10(43.47%) 13(54.17%) Miscarry(n) 9(39.13%) 6(25%) Discussion Interstitial pregnancy is a rare pregnancy. With the application of assisted reproductive technology, the incidence of interstitial pregnancy is higher than before, especially after salpingectomy. Patients with a history of ipsilateral tubal surgery ruptured earlier when the number of days of pregnancy exceeded 42. The shorter the interval between the previous tubal surgery and the current interstitial pregnancy, the higher the risk of rupture. Embryo implantation is a magical process that involves a variety of molecular regulatory mechanisms. Blastocysts enter the uterus on day 5 after fertilization. The human embryo resides in the uterine cavity for approximately 72 h prior to implantation[ 9 ]. In the meantime, search for a suitable implant site. Salpingectomy is a high risk factor for interstitial pregnancy. Previous data suggest that women with a history of salpingectomy have an increased risk of developing an interstitial pregnancy after IVF [ 10 , 11 ]. Jieyu Wang [ 11 ] research shows 76.3% of interstitial pregnancy after IVF were associated with previous salpingectomy, including 71.1% of cases with bilateral salpingectomy. The specific mechanism of interstitial pregnancy in ipsilateral salpingectomy is unknown. Tsuyoshi Ota et al [ 12 ] propose two possible mechanisms. The first hypothesis is that fertilization occurs normally in the contralateral normal fallopian tube, and fertilized egg passes via intrauterine transmigration into the contralateral fallopian tube. The second hypothesis is that fertilization occurs in the contralateral oviduct, but the fertilized egg migrates transperitoneally from the serosa into the interstitial portion of the tube before local embryonic nidation took place. Implantation requires regulated local expression of pro- and anti-inflammatory cytokines, chemokines, adhesion molecules, and angiogenic factors[ 13 ]. In laparoscopic conventional salpingectomy, the uterine horn is electrocoagulated before removing the fallopian tube[ 14 ]. Aseptic inflammation associated with tubal stump or uterine horn electrocoagulation injury produces chemokines that may lead to embryo migration and implantation into the interstitial portion of the fallopian tube[ 15 ]. Jianmin Chen et al showed that cornual suture at the time of salpingectomy helps reduce the risk of interstitial pregnancy[ 16 ]. Therefore, corner suture may be considered during salpingectomy to reduce the occurrence of interstitial pregnancy. The interstitial portion of the fallopian tube is the section of the tube surrounded by the myometrium in the cornual area. The muscularity surrounding the tubal interstitium is thick, and this relatively thick segment has a greater capacity to expand than the distal segment before rupture[ 4 ]. For this reason, the clinical symptoms are usually later than ordinary tubal pregnancy, often in about 12 weeks of pregnancy sudden severe abdominal pain, vaginal bleeding can be accompanied. Due to the uterine artery and ovarian artery branch double blood supply and its surrounding muscle layer is thicker, once broken, prone to hemorrhagic shock, leading to higher mortality. The mortality rate of interstitial rupture is seven times higher than that of other ectopic pregnancies[ 17 ]. Togas Tulandi et al[ 7 ] found that rupture of interstitial ectopic pregnancies commonly occurs before 12 weeks. In this study, we found that the average number of days of gestation with interstitial rupture was 48.62 ± 10.89 and the risk of interstitial pregnancy rupture was higher in women with a history of ipsilateral fallopian tube surgery. Generally, at 42 days of gestation (6 weeks), ultrasound can see the germ and the original cardiac tube beats to determine clinical pregnancy. Therefore, this study conducted a stratified analysis on the 42nd day of gestation and found that the risk of interstitial rupture within the 42nd day of gestation was not related to whether there was a history of ipsilateral tubal surgery. After the 42nd day of gestation, interstitial pregnancy with a history of ipsilateral tubal surgery was more likely to rupture than that with no history of ipsilateral tubal surgery. Xihong Li[ 18 ] et al. pointed out that the sensitivity of transvaginal sonography in the diagnosis of interstitial pregnancy was 97.8%, and the positive predictive value was 99.4%. The average time to diagnosis after transplantation was 31 days. Therefore, for women with a history of fallopian tube surgery, once pregnancy is found, it is easy to conduct ultrasound examination as soon as possible, find interstitial pregnancy as early as possible, and closely monitor to prevent interstitial pregnancy rupture, so as not to cause serious consequences. How long after salpingectomy is appropriate for a second pregnancy to reduce the risk of a ruptured interstitial pregnancy༟There is no standard answer to this question. In this study, a stratified analysis was conducted between the history of ipsilateral tubal surgery and the interstitial pregnancy interval of 12 months, the results showed that the shorter the interval between ipsilateral tubal surgery and interstitial pregnancy, the higher the risk of rupture. The reason may be related to hyperplasia of local fibrous connective tissue and poor dilatation after salpingectomy. Therefore, it is recommended to extend the next pregnancy time after salpingectomy. Heterotopic pregnancy is a multiple pregnancy, with one or more viable embryos implanting in the uterus and the other(s) implanting outside the uterine cavity[ 19 ]. The incidence of spontaneous ectopic pregnancy is very rare, approximately 1 in 30,000[ 20 ].However, the more frequent use of assisted reproductive technologies(ART) increases its incidence, the reported incidence of heterotopic pregnancy in IVF recipients is estimated to be 1 in 100[ 21 , 22 ]. Intrauterine pregnancy with interstitial pregnancy is rare and most cases are reported in case reports or case series. The incidence of heterotopic interstitial pregnancy after IVF is unknown, yet through calculation of combined incidences it can be estimated to be as high as 1 in 3600 IVF pregnancies[ 23 , 24 ]. Aryan Maleki[ 25 ] et al. summarized the risk factors for heterotopic pregnancy can be broadly grouped into two categories: (1) damage to the fallopian tubes and (2) ART. Tubal abnormalities include a history of pelvic inflammatory disease (PID), previous ectopic pregnancy, prior tubal surgery, and previous abdominopelvic surgery[ 26 , 27 ]. ART includes ovarian hyperstimulation syndrome (OHSS) and multiple embryo transfer[ 27 – 29 ]. Heterotopic pregnancy treatment experiences are limited and there is little consensus regarding the optimal treatment modality[ 30 ]. Of the 47 heterotopic interstitial pregnancies in this study, 46 were conceived by IVF and 1 was conceived naturally. The mean gestation days before treatment was 48.83 ± 8.76 d. There were 23 cases with interstitial pregnancy rupture and 24 cases with intactness. There were 10(43.47%) live births and 9༈39.13%༉ miscarriages in the ruptured group, compared with 13༈54.17%༉live births and 6༈25%༉ miscarriages in the intactness group. The prognosis of the intactness group was better than that of the ruptured group. Therefore, for heterotopic interstitial pregnancies, early intervention before interstitial pregnancy rupture can achieve a better outcome. The study also has some limitations. Firstly, this study is a retrospective study, and there may be recall bias and some missing data. Secondly, only patients with interstitial pregnancy in our hospital were studied, and it is uncertain whether similar problems exist in other hospitals. Thirdly, the time span is large, and there may be some differences in operation methods. In a word, large prospective studies are needed in patients with interstitial pregnancy after salpingectomy. Conclusion In the current study, patients with a history of ipsilateral tubal surgery have a higher risk of interstitial pregnancy rupture. For patients with interstitial rupture of pregnancy > 42 days of gestation, the gestation days of patients with ipsilateral surgery history were shorter than those without ipsilateral surgery history, and there was a statistical difference. The shorter the interval between ipsilateral tubal surgery and interstitial pregnancy, the higher the risk of rupture. For patients with intrauterine pregnancy and interstitial pregnancy, timely treatment can also obtain term live birth. Declarations Funding: None Conflict of Interest: No. Author Contribution Miaomiao Jing is responsible for data collection and analysis and writing the first draft.Wei Zhao is responsible for revising the paper. Acknowledgement We would like to thank Yonghong Tian of the Obstetrics and Gynecology Hospital Affiliated to Zhejiang University School of Medicine for their guidance in the writing process. References Alkatout, I., et al., Clinical diagnosis and treatment of ectopic pregnancy . Obstet Gynecol Surv, 2013. 68(8): p. 571–81. Pisarska, M.D. and S.A. Carson, Incidence and risk factors for ectopic pregnancy . Clin Obstet Gynecol, 1999. 42(1): p. 2–8; quiz 55 – 6. Khan, Z. and S.R. Lindheim, In pursuit of understanding interstitial pregnancies: a rare yet high-risk ectopic pregnancy . Fertil Steril, 2019. 112(2): p. 246–247. Moawad, N.S., et al., Current diagnosis and treatment of interstitial pregnancy . Am J Obstet Gynecol, 2010. 202(1): p. 15–29. Stabile, G., et al., Interstitial Ectopic Pregnancy: The Role of Mifepristone in the Medical Treatment . Int J Environ Res Public Health, 2021. 18(18). Melo, P., et al., Surgical treatment for tubal disease in women due to undergo in vitro fertilisation . Cochrane Database Syst Rev, 2020. 10(10): p. Cd002125. Tulandi, T. and D. Al-Jaroudi, Interstitial pregnancy: results generated from the Society of Reproductive Surgeons Registry . Obstet Gynecol, 2004. 103(1): p. 47–50. Soriano, D., et al., Laparoscopic treatment of cornual pregnancy: a series of 20 consecutive cases . Fertil Steril, 2008. 90(3): p. 839–43. Sharma, A. and P. Kumar, Understanding implantation window, a crucial phenomenon . J Hum Reprod Sci, 2012. 5(1): p. 2–6. Habana, A., et al., Cornual heterotopic pregnancy: contemporary management options . Am J Obstet Gynecol, 2000. 182(5): p. 1264–70. Wang, J., et al., Incidence of Interstitial Pregnancy After In Vitro Fertilization/Embryo Transfer and the Outcome of a Consecutive Series of 38 Cases Managed by Laparoscopic Cornuostomy or Cornual Repair . J Minim Invasive Gynecol, 2016. 23(5): p. 739–47. Ota, T., et al., Interstitial pregnancy after ipsilateral salpingectomy: Report of a case and discussion of the possible migration route . Gynecol Minim Invasive Ther, 2017. 6(1): p. 40–41. Hutchinson, J.L., et al., Molecular regulators of resolution of inflammation: potential therapeutic targets in the reproductive system . Reproduction, 2011. 142(1): p. 15–28. Venturella, R., et al., Wide excision of soft tissues adjacent to the ovary and fallopian tube does not impair the ovarian reserve in women undergoing prophylactic bilateral salpingectomy: results from a randomized, controlled trial . Fertil Steril, 2015. 104(5): p. 1332–9. Chen, J., et al., Prevention, diagnosis, and management of interstitial pregnancy:A review of the literature. Laparoscopic, Endoscopic and Robotic Surgery, 2019. 2: p. 12–17. Chen, J., et al., Cornual Suture at the Time of Laparoscopic Salpingectomy Reduces the Incidence of Interstitial Pregnancy after In Vitro Fertilization . J Minim Invasive Gynecol, 2018. 25(6): p. 1080–1087. Ahlschlager, L.M., D. Mysona, and A.J. Beckham, The elusive diagnosis and emergent management of a late-presenting ruptured interstitial pregnancy: a case report . BMC Pregnancy Childbirth, 2021. 21(1): p. 553. Li, X., et al., Heterotopic Interstitial Pregnancy: Early Ultrasound Diagnosis of 179 Cases after In Vitro Fertilization-Embryo Transfer . J Ultrasound Med, 2022. Talbot, K., et al., Heterotopic pregnancy . J Obstet Gynaecol, 2011. 31(1): p. 7–12. Barrenetxea, G., et al., Heterotopic pregnancy: two cases and a comparative review . Fertil Steril, 2007. 87(2): p. 417.e9-15. Wu, Z., et al., Clinical analysis of 50 patients with heterotopic pregnancy after ovulation induction or embryo transfer . Eur J Med Res, 2018. 23(1): p. 17. Abusheikha, N., O. Salha, and P. Brinsden, Extra-uterine pregnancy following assisted conception treatment . Hum Reprod Update, 2000. 6(1): p. 80–92. Chin, H.Y., et al., Heterotopic pregnancy after in vitro fertilization-embryo transfer . Int J Gynaecol Obstet, 2004. 86(3): p. 411–6. Dendas, W., et al., Management and outcome of heterotopic interstitial pregnancy: Case report and review of literature . Ultrasound, 2017. 25(3): p. 134–142. Maleki, A., et al., The rising incidence of heterotopic pregnancy: Current perspectives and associations with in-vitro fertilization . Eur J Obstet Gynecol Reprod Biol, 2021. 266: p. 138–144. Liu, M., et al., Risk Factors and Early Predictors for Heterotopic Pregnancy after In Vitro Fertilization . PLoS One, 2015. 10(10): p. e0139146. Jeon, J.H., et al., The Risk Factors and Pregnancy Outcomes of 48 Cases of Heterotopic Pregnancy from a Single Center . J Korean Med Sci, 2016. 31(7): p. 1094–9. Alqahtani, H.A., A case of heterotopic pregnancy after clomiphene-induced ovulation . SAGE Open Med Case Rep, 2019. 7: p. 2050313x19873794. Tummon, I.S., et al., Transferring more embryos increases risk of heterotopic pregnancy . Fertil Steril, 1994. 61(6): p. 1065–7. Li, J.B., et al., Management of Heterotopic Pregnancy: Experience From 1 Tertiary Medical Center . Medicine (Baltimore), 2016. 95(5): p. e2570. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4543075","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":321744930,"identity":"69d7f9ae-75ab-4659-a721-7bb40e130985","order_by":0,"name":"Miaomiao Jing","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA5ElEQVRIie3RsYoCMRCA4VkGss0c20bYe4c9FkRQ8FWyCNrI1RYWAUEbwXZ9mwmBrSLb+gTWeQK5PaurcrETzN8NzAcDA5BKvWAFFp49bakAUMOM/5PRAb5MW3blSMeSqofa0gxnFT/mCAIWlGnXguqebxI200bnFw6KbAfM3pU0Zl5KcKtG07cKEsRMm/NR0Njopcz2ttGSqiARiGA/7kj1DgZyjyCEAiwRUiV+iY4gEglMSx1JB4uJ6lb1ntZhMu8d+uGV8+LkmqvfTj9PuQuTvzeqxzNF7P5Qzk8sp1Kp1Dv1AxnhQVvzNWXyAAAAAElFTkSuQmCC","orcid":"","institution":"Women's Hospital, School of Medicine, Zhejiang University","correspondingAuthor":true,"prefix":"","firstName":"Miaomiao","middleName":"","lastName":"Jing","suffix":""},{"id":321744931,"identity":"40076676-56c2-4609-9971-ce0b98d9ae87","order_by":1,"name":"Wei Zhao","email":"","orcid":"","institution":"Women's Hospital, School of Medicine, Zhejiang University","correspondingAuthor":false,"prefix":"","firstName":"Wei","middleName":"","lastName":"Zhao","suffix":""}],"badges":[],"createdAt":"2024-06-07 02:59:13","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4543075/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4543075/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":64057338,"identity":"b15e1dcb-4a42-41b4-a7ea-939514fe0c74","added_by":"auto","created_at":"2024-09-05 20:02:49","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":539686,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4543075/v1/0f8bc3b3-230e-4674-babd-a8df6078384f.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Managment of ipsilateral interstitial pregnancy after tubal surgery: a retrospective study focusing on focal rupture","fulltext":[{"header":"Introduction","content":"\u003cp\u003eInterstitial pregnancy is a special site of ectopic pregnancy, which refers to the embryo implantation in the interstitial part of the fallopian tube pregnancy. Interstitial pregnancy has a low clinical incidence, generally accounting for 2-4% of all tubal pregnancies[1]. However, with the application of assisted reproductive technology, the incidence of interstitial ectopic pregnancy is up to 7.3%[2, 3]. The interstitial portion of the fallopian tube is the section of the tube surrounded by the myometrium in the cornual area, and about 1 cm long. This is accentuated by the rich vascular anastomosis of the uterine and the ovarian arteries in this region[4]. Once ruptured patients can fall into hemorrhagic shock in a short period, the disease is extremely dangerous, and the mortality rate is about 2.5%, seven times greater than that of ectopic pregnancies in general[5].\u003c/p\u003e\n\u003cp\u003eIn tubal pregnancy, hydrosalpinx and other patients, salpingectomy is a routine treatment in current gynecologic practice. In addition, a recent Cochrane review showed that salpingectomy before assisted reproductive technology (ART) therapy may increase the clinical pregnancy rate for women with hydrosalpinx[6]. However, ipsilateral salpingectomy is a high risk factor for interstitial pregnancy. In a study of 32 cases of interstitial pregnancy, Togas Tulandi et al. pointed out that the risk factors for interstitial pregnancy were previous ectopic pregnancy (40.6%), previous salpingectomy (37.5%), in vitro fertilization (34.4%), sexually transmitted disease (25.0%), ovulation induction (3.1%)[7]. David Soriano et al. in another study identified risk factors for interstitial pregnancy as salpingectomy or tubal ligation(54.1%), previous extrauterine pregnancies(54.1%), IVF(29.7%), and previous pelvic inflammatory disease(12.5%)[8]. The risk factors for interstitial pregnancy are similar to those for other parts of the fallopian tube, but ipsilateral salpingectomy is a specific risk factor for interstitial pregnancy.\u003c/p\u003e\n\u003cp\u003eThe musculature around the tubal interstitium is thicker, and the rupture time is usually 12-16 weeks of gestation. However, it has been found in clinical practice that the time of interstitial pregnancy rupture in some patients after tubal surgery is much earlier than 12 weeks, and can even occur in about 5 weeks of pregnancy. To explore the risk factors of interstitial pregnancy rupture, timely diagnosis and treatment, so as to reduce the serious adverse outcomes caused by interstitial pregnancy rupture has become an urgent problem to be solved.\u003c/p\u003e\n\u003cp\u003eThis study reviewed the clinical characteristics, diagnosis, treatment, and prognosis of patients with interstitial pregnancy, and explored the risk factors and clinical characteristics of interstitial pregnancy rupture, so as to provide certain references and a basis for the clinical management of interstitial pregnancy.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003e The study was approved by the Ethics Committee of Women\u0026rsquo;s Hospital School of Medicine Zhejiang University. Informed consent was obtained from all subjects and/or their legal guardian(s). All methods in this study were performed in accordance with the relevant guidelines and regulations.\u003c/p\u003e \u003cp\u003eSubjects\u003c/p\u003e \u003cp\u003ePatients diagnosed with interstitial pregnancy who were eligible for inclusion and exclusion in the Women\u0026rsquo;s Hospital, Zhejiang University School of Medicine from January 2009 to May 2022 and treated in the hospital for the first time were enrolled in the study. Inclusion criteria: (1) patients with interstitial pregnancy diagnosed by imaging examination or intraoperative exploration; (2) patients who were first treated in our hospital after diagnosis of interstitial pregnancy; (3) natural pregnancy or assisted reproductive technology; (4) the same interstitial pregnancy of the same patient was only included in the first treatment data. Exclusion criteria: (1) combined with severe medical and surgical diseases; (2) incomplete data; (3) patients with uterine malformation; (4) patients with cornual-interstitial pregnancy. Medical records of the included patients, including in the analysis included age, height, weight, BIM, conception mode, pregnancy days, ipsilateral fallopian tube operation history, rupture or not, intrauterine and extrauterine complex pregnancy, treatment method, operation duration, intraoperative blood loss, postoperative hospital stay, and operative interval time, were retrospectively analyzed. A total of 885 interstitial pregnancies were included in the study.\u003c/p\u003e \u003cp\u003eDiagnosis of interstitial pregnancy\u003c/p\u003e \u003cp\u003eUltrasound is the most important and practical diagnostic method for the diagnosis of interstitial pregnancy. Interstitial pregnancy has the following ultrasound imaging features: (1) The echo of the gestational sac was not detected in the uterine cavity, and the interstitial pregnancy mass was obviously prominent outside the contour of the bottom side of the uterus. (2) interstitial pregnancy mass around the muscle is thin, or incomplete (gestational sac or heterogeneous mass around the muscle thickness of less than 5mm). (3) interstitial pregnancy mass is not connected with the uterine cavity, there is ' interstitial line characteristics '. The interstitial pregnancies included in this study were consistent with the above ultrasound characteristics or surgical diagnosis.\u003c/p\u003e \u003cdiv id=\"Sec2\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eThe statistical software package SPSS22 was used for data analysis. Continuous variables were analyzed by T-test or Mann-Whitney test. The chi-square test or Fisher\u0026rsquo;s exact probability method was used for the comparison of the rates, and P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 885 patients with interstitial pregnancy were included in the study, of which 171 were ruptured, 714 were unruptured, 249 had ipsilateral tubal operation, and 636 had no history of ipsilateral tubal operation(Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).. The main reason for ipsilateral fallopian tube surgery is ectopic pregnancy (74.3%). The main treatment is laparoscopic cornual resection (73.2%).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBasic parameters of interstitial pregnancy\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParameter\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNumber(n)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInterstitial pregnancy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e885\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInterstitial pregnancy rupture\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e171(19.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRupture with a history of ipsilateral tubal surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e101\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRupture without a history of ipsilateral tubal surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e70\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInterstitial pregnancy unrupture\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e714(80.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIpsilateral tubal surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e249\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWithout ipsilateral tubal surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e636\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReasons for ipsilateral fallopian tube surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEctopic pregnancy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e185(74.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFallopian tube inflammation/hydrops\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e56(22.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther reasons\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8(3.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProgestation method\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIVF-ET\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e198(22.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNature pregnancy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e685(77.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eArtificial insemination pregnancy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2(0.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTreatment\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTransabdominal cornual resection\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e143(16.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTransabdominal cornuostomy\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14(1.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLaparoscopic cornual resection\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e648(73.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLaparoscopic cornuostomy\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e61(6.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTransvaginal puncture\u0026thinsp;+\u0026thinsp;MTX injection\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8(0.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHysteroscopic surgery\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4(0.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMTX\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3(0.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eObservation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4(0.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"2\"\u003eIVF-ET\u0026thinsp;=\u0026thinsp;In vitro fertilization- embryo transfer.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"2\"\u003eMTX\u0026thinsp;=\u0026thinsp;Methotrexate\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eIn this study, there were no significant differences in age, height, weight, BMI and operation duration between patients with interstitial pregnancy rupture and intactness. However, the gestational days of patients with interstitial rupture were shorter than those of intactness(P\u0026thinsp;\u0026lt;\u0026thinsp;0.01)(Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The risk of interstitial pregnancy rupture was higher in women with a history of ipsilateral fallopian tube surgery (P\u0026thinsp;\u0026lt;\u0026thinsp;0.01) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline data of interstitial pregnancy rupture group and intactness group\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParameter\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRupture\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIntactness\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge(y)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31.95\u0026thinsp;\u0026plusmn;\u0026thinsp;5.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31.55\u0026thinsp;\u0026plusmn;\u0026thinsp;5.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.37\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHeight(cm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e159.71\u0026thinsp;\u0026plusmn;\u0026thinsp;4.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e159.84\u0026thinsp;\u0026plusmn;\u0026thinsp;4.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.74\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWeight(kg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e55.54\u0026thinsp;\u0026plusmn;\u0026thinsp;7.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e56.48\u0026thinsp;\u0026plusmn;\u0026thinsp;9.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.27\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21.84\u0026thinsp;\u0026plusmn;\u0026thinsp;2.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22.09\u0026thinsp;\u0026plusmn;\u0026thinsp;3.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.44\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGestational days(d)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e48.62\u0026thinsp;\u0026plusmn;\u0026thinsp;10.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e52.28\u0026thinsp;\u0026plusmn;\u0026thinsp;10.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOperation duration(min)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e70.91\u0026thinsp;\u0026plusmn;\u0026thinsp;26.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e72.35\u0026thinsp;\u0026plusmn;\u0026thinsp;29.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.56\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntraoperative blood loss(ml)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1014.56\u0026thinsp;\u0026plusmn;\u0026thinsp;788.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e69.57\u0026thinsp;\u0026plusmn;\u0026thinsp;112.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostoperative hospital stay(d)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.29\u0026thinsp;\u0026plusmn;\u0026thinsp;2.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.42\u0026thinsp;\u0026plusmn;\u0026thinsp;2.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIpsilateral tubal surgery(n)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e101\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e148\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo ipsilateral tubal surgery(n)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e566\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInterval between ipsilateral tubal surgery and this interstitial pregnancy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;12 (months)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;12 (months)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe interval between ipsilateral tubal surgery and this interstitial pregnancy ranged from 2 months to 264 months. The analysis was performed at an interval of 12 months. Chi-square test was performed in the rupture group and the intactness group with ipsilateral operation history(P\u0026thinsp;=\u0026thinsp;0.001), indicating that the shorter the interval, the higher the risk of rupture(Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAccording to the stratified analysis with the gestational days as 42 days, there was no significant difference in the gestational days with or without the history of ipsilateral surgery in the patients with ruptured\u0026thinsp;\u0026le;\u0026thinsp;42 days (P\u0026thinsp;=\u0026thinsp;0.17). In the \u0026gt;\u0026thinsp;42day rupture group, the gestation days were shorter in those with a history of ipsilateral surgery than those without, and the difference was statistically significant(\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.005)(Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePregnancy days in ruptured interstitial pregnancy patients with or without a history of ipsilateral tubal surgery\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGestational days(d)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIpsilateral tubal surgery\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo ipsilateral tubal surgery\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e39.34\u0026thinsp;\u0026plusmn;\u0026thinsp;2.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e37.57\u0026thinsp;\u0026plusmn;\u0026thinsp;5.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.17\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e50.86\u0026thinsp;\u0026plusmn;\u0026thinsp;8.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e56.27\u0026thinsp;\u0026plusmn;\u0026thinsp;11.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThere were 47 cases of heterotopic interstitial pregnancies. There were 10(43.47%) live births and 9༈39.13%༉ miscarriages in the ruptured group, compared with 13༈54.17%༉live births and 6༈25%༉ miscarriages in the intactness group(Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of heterotopic interstitial pregnancy rupture group and intactness group\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParameter\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRupture\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIntactness\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNumber(n)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge(y)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31.43\u0026thinsp;\u0026plusmn;\u0026thinsp;5.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31.75\u0026thinsp;\u0026plusmn;\u0026thinsp;4.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.435\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHeight(cm)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e159.04\u0026thinsp;\u0026plusmn;\u0026thinsp;4.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e160.04\u0026thinsp;\u0026plusmn;\u0026thinsp;4.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.451\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWeight(kg)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e54.56\u0026thinsp;\u0026plusmn;\u0026thinsp;8.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e58.04\u0026thinsp;\u0026plusmn;\u0026thinsp;8.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.738\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBMI\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21.65\u0026thinsp;\u0026plusmn;\u0026thinsp;3.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22.41\u0026thinsp;\u0026plusmn;\u0026thinsp;3.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.863\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGestational days(d)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e47.04\u0026thinsp;\u0026plusmn;\u0026thinsp;9.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50.54\u0026thinsp;\u0026plusmn;\u0026thinsp;8.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.806\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOperation duration(min)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e75.87\u0026thinsp;\u0026plusmn;\u0026thinsp;40.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e75.45\u0026thinsp;\u0026plusmn;\u0026thinsp;25.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.794\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIntraoperative blood loss(ml)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1518.70\u0026thinsp;\u0026plusmn;\u0026thinsp;1077.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e145.65\u0026thinsp;\u0026plusmn;\u0026thinsp;222.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePostoperative hospital stay(d)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8.52\u0026thinsp;\u0026plusmn;\u0026thinsp;4.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.48\u0026thinsp;\u0026plusmn;\u0026thinsp;3.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.172\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIpsilateral tubal surgery(n)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNo ipsilateral tubal surgery(n)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIntrauterine pregnancy outcome\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLive birth(n)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10(43.47%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13(54.17%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMiscarry(n)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9(39.13%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6(25%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eInterstitial pregnancy is a rare pregnancy. With the application of assisted reproductive technology, the incidence of interstitial pregnancy is higher than before, especially after salpingectomy. Patients with a history of ipsilateral tubal surgery ruptured earlier when the number of days of pregnancy exceeded 42. The shorter the interval between the previous tubal surgery and the current interstitial pregnancy, the higher the risk of rupture.\u003c/p\u003e \u003cp\u003eEmbryo implantation is a magical process that involves a variety of molecular regulatory mechanisms. Blastocysts enter the uterus on day 5 after fertilization. The human embryo resides in the uterine cavity for approximately 72 h prior to implantation[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. In the meantime, search for a suitable implant site. Salpingectomy is a high risk factor for interstitial pregnancy. Previous data suggest that women with a history of salpingectomy have an increased risk of developing an interstitial pregnancy after IVF [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Jieyu Wang [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] research shows 76.3% of interstitial pregnancy after IVF were associated with previous salpingectomy, including 71.1% of cases with bilateral salpingectomy. The specific mechanism of interstitial pregnancy in ipsilateral salpingectomy is unknown. Tsuyoshi Ota et al [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] propose two possible mechanisms. The first hypothesis is that fertilization occurs normally in the contralateral normal fallopian tube, and fertilized egg passes via intrauterine transmigration into the contralateral fallopian tube. The second hypothesis is that fertilization occurs in the contralateral oviduct, but the fertilized egg migrates transperitoneally from the serosa into the interstitial portion of the tube before local embryonic nidation took place. Implantation requires regulated local expression of pro- and anti-inflammatory cytokines, chemokines, adhesion molecules, and angiogenic factors[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. In laparoscopic conventional salpingectomy, the uterine horn is electrocoagulated before removing the fallopian tube[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Aseptic inflammation associated with tubal stump or uterine horn electrocoagulation injury produces chemokines that may lead to embryo migration and implantation into the interstitial portion of the fallopian tube[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Jianmin Chen et al showed that cornual suture at the time of salpingectomy helps reduce the risk of interstitial pregnancy[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Therefore, corner suture may be considered during salpingectomy to reduce the occurrence of interstitial pregnancy.\u003c/p\u003e \u003cp\u003eThe interstitial portion of the fallopian tube is the section of the tube surrounded by the myometrium in the cornual area. The muscularity surrounding the tubal interstitium is thick, and this relatively thick segment has a greater capacity to expand than the distal segment before rupture[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. For this reason, the clinical symptoms are usually later than ordinary tubal pregnancy, often in about 12 weeks of pregnancy sudden severe abdominal pain, vaginal bleeding can be accompanied. Due to the uterine artery and ovarian artery branch double blood supply and its surrounding muscle layer is thicker, once broken, prone to hemorrhagic shock, leading to higher mortality. The mortality rate of interstitial rupture is seven times higher than that of other ectopic pregnancies[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Togas Tulandi et al[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] found that rupture of interstitial ectopic pregnancies commonly occurs before 12 weeks.\u003c/p\u003e \u003cp\u003eIn this study, we found that the average number of days of gestation with interstitial rupture was 48.62\u0026thinsp;\u0026plusmn;\u0026thinsp;10.89 and the risk of interstitial pregnancy rupture was higher in women with a history of ipsilateral fallopian tube surgery. Generally, at 42 days of gestation (6 weeks), ultrasound can see the germ and the original cardiac tube beats to determine clinical pregnancy. Therefore, this study conducted a stratified analysis on the 42nd day of gestation and found that the risk of interstitial rupture within the 42nd day of gestation was not related to whether there was a history of ipsilateral tubal surgery. After the 42nd day of gestation, interstitial pregnancy with a history of ipsilateral tubal surgery was more likely to rupture than that with no history of ipsilateral tubal surgery. Xihong Li[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] et al. pointed out that the sensitivity of transvaginal sonography in the diagnosis of interstitial pregnancy was 97.8%, and the positive predictive value was 99.4%. The average time to diagnosis after transplantation was 31 days. Therefore, for women with a history of fallopian tube surgery, once pregnancy is found, it is easy to conduct ultrasound examination as soon as possible, find interstitial pregnancy as early as possible, and closely monitor to prevent interstitial pregnancy rupture, so as not to cause serious consequences.\u003c/p\u003e \u003cp\u003eHow long after salpingectomy is appropriate for a second pregnancy to reduce the risk of a ruptured interstitial pregnancy༟There is no standard answer to this question. In this study, a stratified analysis was conducted between the history of ipsilateral tubal surgery and the interstitial pregnancy interval of 12 months, the results showed that the shorter the interval between ipsilateral tubal surgery and interstitial pregnancy, the higher the risk of rupture. The reason may be related to hyperplasia of local fibrous connective tissue and poor dilatation after salpingectomy. Therefore, it is recommended to extend the next pregnancy time after salpingectomy.\u003c/p\u003e \u003cp\u003eHeterotopic pregnancy is a multiple pregnancy, with one or more viable embryos implanting in the uterus and the other(s) implanting outside the uterine cavity[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. The incidence of spontaneous ectopic pregnancy is very rare, approximately 1 in 30,000[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].However, the more frequent use of assisted reproductive technologies(ART) increases its incidence, the reported incidence of heterotopic pregnancy in IVF recipients is estimated to be 1 in 100[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Intrauterine pregnancy with interstitial pregnancy is rare and most cases are reported in case reports or case series. The incidence of heterotopic interstitial pregnancy after IVF is unknown, yet through calculation of combined incidences it can be estimated to be as high as 1 in 3600 IVF pregnancies[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Aryan Maleki[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e] et al. summarized the risk factors for heterotopic pregnancy can be broadly grouped into two categories: (1) damage to the fallopian tubes and (2) ART. Tubal abnormalities include a history of pelvic inflammatory disease (PID), previous ectopic pregnancy, prior tubal surgery, and previous abdominopelvic surgery[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. ART includes ovarian hyperstimulation syndrome (OHSS) and multiple embryo transfer[\u003cspan additionalcitationids=\"CR28\" citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Heterotopic pregnancy treatment experiences are limited and there is little consensus regarding the optimal treatment modality[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Of the 47 heterotopic interstitial pregnancies in this study, 46 were conceived by IVF and 1 was conceived naturally. The mean gestation days before treatment was 48.83\u0026thinsp;\u0026plusmn;\u0026thinsp;8.76 d. There were 23 cases with interstitial pregnancy rupture and 24 cases with intactness. There were 10(43.47%) live births and 9༈39.13%༉ miscarriages in the ruptured group, compared with 13༈54.17%༉live births and 6༈25%༉ miscarriages in the intactness group. The prognosis of the intactness group was better than that of the ruptured group. Therefore, for heterotopic interstitial pregnancies, early intervention before interstitial pregnancy rupture can achieve a better outcome.\u003c/p\u003e \u003cp\u003eThe study also has some limitations. Firstly, this study is a retrospective study, and there may be recall bias and some missing data. Secondly, only patients with interstitial pregnancy in our hospital were studied, and it is uncertain whether similar problems exist in other hospitals. Thirdly, the time span is large, and there may be some differences in operation methods. In a word, large prospective studies are needed in patients with interstitial pregnancy after salpingectomy.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn the current study, patients with a history of ipsilateral tubal surgery have a higher risk of interstitial pregnancy rupture. For patients with interstitial rupture of pregnancy\u0026thinsp;\u0026gt;\u0026thinsp;42 days of gestation, the gestation days of patients with ipsilateral surgery history were shorter than those without ipsilateral surgery history, and there was a statistical difference. The shorter the interval between ipsilateral tubal surgery and interstitial pregnancy, the higher the risk of rupture. For patients with intrauterine pregnancy and interstitial pregnancy, timely treatment can also obtain term live birth.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eFunding:\u003c/h2\u003e \u003cp\u003eNone\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConflict of Interest:\u003c/strong\u003e \u003cp\u003eNo.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eMiaomiao Jing is responsible for data collection and analysis and writing the first draft.Wei Zhao is responsible for revising the paper.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eWe would like to thank Yonghong Tian of the Obstetrics and Gynecology Hospital Affiliated to Zhejiang University School of Medicine for their guidance in the writing process.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAlkatout, I., et al., \u003cem\u003eClinical diagnosis and treatment of ectopic pregnancy\u003c/em\u003e. Obstet Gynecol Surv, 2013. 68(8): p. 571\u0026ndash;81.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePisarska, M.D. and S.A. Carson, \u003cem\u003eIncidence and risk factors for ectopic pregnancy\u003c/em\u003e. Clin Obstet Gynecol, 1999. 42(1): p. 2\u0026ndash;8; quiz 55\u0026thinsp;\u0026ndash;\u0026thinsp;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKhan, Z. and S.R. Lindheim, \u003cem\u003eIn pursuit of understanding interstitial pregnancies: a rare yet high-risk ectopic pregnancy\u003c/em\u003e. Fertil Steril, 2019. 112(2): p. 246\u0026ndash;247.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMoawad, N.S., et al., \u003cem\u003eCurrent diagnosis and treatment of interstitial pregnancy\u003c/em\u003e. Am J Obstet Gynecol, 2010. 202(1): p. 15\u0026ndash;29.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStabile, G., et al., \u003cem\u003eInterstitial Ectopic Pregnancy: The Role of Mifepristone in the Medical Treatment\u003c/em\u003e. Int J Environ Res Public Health, 2021. 18(18).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMelo, P., et al., \u003cem\u003eSurgical treatment for tubal disease in women due to undergo in vitro fertilisation\u003c/em\u003e. Cochrane Database Syst Rev, 2020. 10(10): p. Cd002125.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTulandi, T. and D. Al-Jaroudi, \u003cem\u003eInterstitial pregnancy: results generated from the Society of Reproductive Surgeons Registry\u003c/em\u003e. Obstet Gynecol, 2004. 103(1): p. 47\u0026ndash;50.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSoriano, D., et al., \u003cem\u003eLaparoscopic treatment of cornual pregnancy: a series of 20 consecutive cases\u003c/em\u003e. Fertil Steril, 2008. 90(3): p. 839\u0026ndash;43.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSharma, A. and P. Kumar, \u003cem\u003eUnderstanding implantation window, a crucial phenomenon\u003c/em\u003e. J Hum Reprod Sci, 2012. 5(1): p. 2\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHabana, A., et al., \u003cem\u003eCornual heterotopic pregnancy: contemporary management options\u003c/em\u003e. Am J Obstet Gynecol, 2000. 182(5): p. 1264\u0026ndash;70.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang, J., et al., \u003cem\u003eIncidence of Interstitial Pregnancy After In Vitro Fertilization/Embryo Transfer and the Outcome of a Consecutive Series of 38 Cases Managed by Laparoscopic Cornuostomy or Cornual Repair\u003c/em\u003e. J Minim Invasive Gynecol, 2016. 23(5): p. 739\u0026ndash;47.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOta, T., et al., \u003cem\u003eInterstitial pregnancy after ipsilateral salpingectomy: Report of a case and discussion of the possible migration route\u003c/em\u003e. Gynecol Minim Invasive Ther, 2017. 6(1): p. 40\u0026ndash;41.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHutchinson, J.L., et al., \u003cem\u003eMolecular regulators of resolution of inflammation: potential therapeutic targets in the reproductive system\u003c/em\u003e. Reproduction, 2011. 142(1): p. 15\u0026ndash;28.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVenturella, R., et al., \u003cem\u003eWide excision of soft tissues adjacent to the ovary and fallopian tube does not impair the ovarian reserve in women undergoing prophylactic bilateral salpingectomy: results from a randomized, controlled trial\u003c/em\u003e. Fertil Steril, 2015. 104(5): p. 1332\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChen, J., et al., \u003cem\u003ePrevention, diagnosis, and management of interstitial pregnancy:A review of the literature.\u003c/em\u003e Laparoscopic, Endoscopic and Robotic Surgery, 2019. 2: p. 12\u0026ndash;17.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChen, J., et al., \u003cem\u003eCornual Suture at the Time of Laparoscopic Salpingectomy Reduces the Incidence of Interstitial Pregnancy after In Vitro Fertilization\u003c/em\u003e. J Minim Invasive Gynecol, 2018. 25(6): p. 1080\u0026ndash;1087.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAhlschlager, L.M., D. Mysona, and A.J. Beckham, \u003cem\u003eThe elusive diagnosis and emergent management of a late-presenting ruptured interstitial pregnancy: a case report\u003c/em\u003e. BMC Pregnancy Childbirth, 2021. 21(1): p. 553.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLi, X., et al., \u003cem\u003eHeterotopic Interstitial Pregnancy: Early Ultrasound Diagnosis of 179 Cases after In Vitro Fertilization-Embryo Transfer\u003c/em\u003e. J Ultrasound Med, 2022.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTalbot, K., et al., \u003cem\u003eHeterotopic pregnancy\u003c/em\u003e. J Obstet Gynaecol, 2011. 31(1): p. 7\u0026ndash;12.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBarrenetxea, G., et al., \u003cem\u003eHeterotopic pregnancy: two cases and a comparative review\u003c/em\u003e. Fertil Steril, 2007. 87(2): p. 417.e9-15.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWu, Z., et al., \u003cem\u003eClinical analysis of 50 patients with heterotopic pregnancy after ovulation induction or embryo transfer\u003c/em\u003e. Eur J Med Res, 2018. 23(1): p. 17.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAbusheikha, N., O. Salha, and P. Brinsden, \u003cem\u003eExtra-uterine pregnancy following assisted conception treatment\u003c/em\u003e. Hum Reprod Update, 2000. 6(1): p. 80\u0026ndash;92.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChin, H.Y., et al., \u003cem\u003eHeterotopic pregnancy after in vitro fertilization-embryo transfer\u003c/em\u003e. Int J Gynaecol Obstet, 2004. 86(3): p. 411\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDendas, W., et al., \u003cem\u003eManagement and outcome of heterotopic interstitial pregnancy: Case report and review of literature\u003c/em\u003e. Ultrasound, 2017. 25(3): p. 134\u0026ndash;142.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMaleki, A., et al., \u003cem\u003eThe rising incidence of heterotopic pregnancy: Current perspectives and associations with in-vitro fertilization\u003c/em\u003e. Eur J Obstet Gynecol Reprod Biol, 2021. 266: p. 138\u0026ndash;144.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiu, M., et al., \u003cem\u003eRisk Factors and Early Predictors for Heterotopic Pregnancy after In Vitro Fertilization\u003c/em\u003e. PLoS One, 2015. 10(10): p. e0139146.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJeon, J.H., et al., \u003cem\u003eThe Risk Factors and Pregnancy Outcomes of 48 Cases of Heterotopic Pregnancy from a Single Center\u003c/em\u003e. J Korean Med Sci, 2016. 31(7): p. 1094\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlqahtani, H.A., \u003cem\u003eA case of heterotopic pregnancy after clomiphene-induced ovulation\u003c/em\u003e. SAGE Open Med Case Rep, 2019. 7: p. 2050313x19873794.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTummon, I.S., et al., \u003cem\u003eTransferring more embryos increases risk of heterotopic pregnancy\u003c/em\u003e. Fertil Steril, 1994. 61(6): p. 1065\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLi, J.B., et al., \u003cem\u003eManagement of Heterotopic Pregnancy: Experience From 1 Tertiary Medical Center\u003c/em\u003e. Medicine (Baltimore), 2016. 95(5): p. e2570.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Interstitial pregnancy, Salpingectomy, Rupture, Heterotopic interstitial pregnancy","lastPublishedDoi":"10.21203/rs.3.rs-4543075/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4543075/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eStudy Objective\u003c/strong\u003e：To explore the high risk factors and clinical characteristics of interstitial pregnancy rupture by retrospectively studying the clinical characteristics, diagnosis, treatment and prognosis of patients with interstitial pregnancy, so as to provide a certain reference and basis for the clinical management of interstitial pregnancy.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDesign\u003c/strong\u003e: A single-center, retrospective study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSetting\u003c/strong\u003e: A university-based hospital.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePatients\u003c/strong\u003e: Patients diagnosed with interstitial pregnancy in the Women’s Hospital, Zhejiang University School of Medicine from January 2009 to May 2022 and treated in the hospital for the first time.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInterventions\u003c/strong\u003e: A retrospective statistical analysis was performed on the case data of patients with interstitial pregnancy who met the inclusion criteria and were treated in the Obstetrics and Gynecology Hospital Affiliated to Zhejiang University Medical College, and statistical software SPSS was used for data analysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMeasurement and Main Results\u003c/strong\u003e: A total of 885 patients with interstitial pregnancy were included in the study, including 55 patients with heterotopic interstitial pregnancies. The gestational days of patients with interstitial rupture were shorter than those of intactness(\u003cem\u003ep\u003c/em\u003e\u0026lt;0.01). The risk of interstitial pregnancy rupture was higher in women with a history of ipsilateral fallopian tube surgery \u003cem\u003ep\u003c/em\u003e\u0026lt;0.01). In the \u0026gt;42day rupture group, the gestation days were shorter in those with a history of ipsilateral surgery than those without, and the difference was statistically significant(\u003cem\u003ep\u003c/em\u003e=0.005). The interval between ipsilateral tubal surgery and this interstitial pregnancy was 12 months as the cut-off point for analysis. The shorter the interval, the higher the risk of interstitial pregnancy rupture (\u003cem\u003ep\u003c/em\u003e=0.001).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e: Patients with a history of ipsilateral tubal surgery have a higher risk of interstitial pregnancy rupture. The shorter the interval between ipsilateral tubal surgery and interstitial pregnancy, the higher the risk of rupture. For patients with intrauterine pregnancy and interstitial pregnancy, timely treatment can also obtain term live birth.\u003c/p\u003e","manuscriptTitle":"Managment of ipsilateral interstitial pregnancy after tubal surgery: a retrospective study focusing on focal rupture","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-03 09:29:22","doi":"10.21203/rs.3.rs-4543075/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"bc060234-14e4-4929-b04e-25c602b2212d","owner":[],"postedDate":"July 3rd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":34016342,"name":"Health sciences/Risk factors"},{"id":34016343,"name":"Health sciences/Diseases/Reproductive disorders/Urogenital reproductive disorders"}],"tags":[],"updatedAt":"2024-10-04T19:04:41+00:00","versionOfRecord":[],"versionCreatedAt":"2024-07-03 09:29:22","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4543075","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4543075","identity":"rs-4543075","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}