VOLUME 116, ISSUE 4, P1200-1201
Authors:
Kathryn Coyne, M.D., Rebecca Flyckt, M.D., Joseph Findley, M.D.
Abstract:
Reflections on ""Nerve-sparing" laparoscopic treatment of parametrial ectopic pregnancy" by Di Lorenzo et al.
A management algorithm and proposed pathogenesis for retroperitoneal ectopic pregnancies
Reflections
Published
Fertility and Sterility
Editorial Office, American Society for Reproductive Medicine
Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders.
Comments
We really want to thank you for your appreciation of our work.
The skills required for this type of surgery are borrowed from oncologic and endometriotic surgery, as mentioned, and difficult to reproduce by centers without adequate training.
Therefore, we especially agree on the need to develop diagnostic and therapeutic algorithms not only for abdominal/retroperitoneal ectopic pregnancies, but also for intrauterine ectopic pregnancies (scar pregnancy, cervical pregnancy, and so on).
Both are characterized by high complexity, due to the numerous noble anatomical structures on the one hand and the small but highly vascularized spaces on the other. These pathologies have heterogeneous but often related causes such as endometriosis on the one hand and cesarean delivery or D&C on the other. We fully agree that although rare, these ectopic pregnancies can occur in uncommon locations such as the retroperitoneum or CS scar for example. Both require high diagnostic expertise (for early detection) and surgical skill.
The medical world needs a serious reflection on the competences of the single centers and on how and how much a diagnostic and therapeutic algorithm can help in this path even in the most complicated and less frequent cases.