Measure content performance. Develop and improve products. List of Partners vendors. It is not possible to carry a pregnancy after a hysterectomy , which is the surgical removal of a female's uterus. The uterus, also described as the womb, is where a baby grows during pregnancy. Hysterectomies are common procedures. In fact, one in three females in the U.
The decision is not taken lightly—it has many effects, including permanently eliminating the ability to carry a pregnancy. Sometimes during a hysterectomy procedure, the cervix , ovaries , and fallopian tubes are also removed. In this case, the surgery is called and hysterectomy and bilateral salpingo-oophorectomy. When the cervix is not removed during a hysterectomy, the procedure is called a supracervical or subtotal hysterectomy.
In very rare cases, someone who has had a hysterectomy will experience ovulation release of an egg that can become fertilized and subsequent fertilization conception , resulting in an abnormal and dangerous situation known as an ectopic pregnancy. Also known as a tubal pregnancy, an ectopic pregnancy occurs when a fertilized egg implants outside the uterus, most often in a fallopian tube. An ectopic pregnancy can occur after hysterectomy only if at least one fallopian tube and one ovary have been left intact.
Risk factors for ectopic pregnancy after hysterectomy:. With an ectopic pregnancy, ovulation and fertilization may occur, but there is no chance of a fetus surviving to term without a uterus. Ectopic pregnancy can become life-threatening as the fetus continues to grow, eventually causing a major rupture and internal hemorrhage. The first sign is usually excruciating abdominal pain. After diagnosis, a doctor will typically prescribe medication methotrexate to eliminate the fetal cells.
If that is ineffective, surgical removal of the pregnancy and repair of the fallopian tube may be done via laparoscopy. If there is an active rupture, emergency surgery laparotomy may be needed. If you want to have children but you need a hysterectomy for medical reasons, it is possible for you to start a family.
While you might be able to use your own eggs, you can't carry the pregnancy yourself. One option is to have your eggs harvested for future fertilization and surrogate implantation. Harvesting can be done before the surgery if your ovaries will be removed, or after surgery if your ovaries are to remain intact. While a surrogate will carry the child, it will be your biological child. Only one case has been previously reported [ 2 ]. We report the ocurrence of one case after more than two thousands LSH in our Hospital in the last 10 years, which is a really low incidence.
We do not know why the ectopic pregnancy appeared in this patient, but probably her fallopian tubes remained very close to the cervical stump due to fibrosis and adhesions paradoxically caused by previous intra-cesarean sterilization. At present when fallopian tubes remain very close to the cervical stump after supracervical hysterectomy, we electrocoagulate a large portion of both tubes including proximal and distal ends, to prevent eggs from being fertilize.
Ectopic pregnancy must be suspected in hysterectomized patients presenting with abdominal pain or genital bleeding, since a rapid diagnosis is of vital importance [ 12 ]. This possibility must be kept in mind when establishing a differential diagnosis, even though the prevalence is very low.
Surgery is the required treatment in all cases. Conservative management with methotrexate is possible, but does not avoid future recurrences; as a result, it cannot be regarded as the treatment of choice [ 15 ]. Regarding the type of surgery, removal of the ectopic pregnancy with bilateral salpingectomy is indicated.
There have been reports of pregnancies to term, though this is truly life-threatening for the patient [ 16 ]. In cases presenting a fistular tract, it should be corrected, and isolation of the remaining cervical stump should be increased in cases of supracervical hysterectomy [ 17 ]. The surgical approach can be laparoscopic or using a laparotomy, depending on the urgency of the case and the skill of the surgeon.
The vaginal route has also been described, not as a first choice but only in hemodynamically stable cases with a firmly established diagnosis.
In these cases, the absence of the uterus facilitates rapid access to the adnexal regions via the vaginal route [ 18 ]. We describe the case of a year-old white caucasian woman seen in the emergency room due to abdominal pain for the last two days.
The pain had appeared suddenly and intensely. Her personal history revealed arterial hypertension and chronic venous insufficiency. The gynecological-obstetric antecedents comprised two pregnancies with cesarean section , with bilateral tubal block performed on occasion of the last pregnancy. In the patient underwent LSH due to the presence of a polymyomatous uterus.
Surgery was uncomplicated and cervical canal was coagulated to avoid any kind of periodical bleeding. Upon admission, the patient was hemodynamically stable, though the pain was described as being very intense. The gynecological exploration proved particularly painful.
No masses were palpable in the adnexal regions. The abdomen proved tender, with localized peritoneal irritation in the hypogastric region. Abdominal and transvaginal ultrasound was performed due to the lack of specificity of the symptoms.
An echographic heterogeneous, cystic image with hyperechogenic reinforcement was observed in the left adnexal region, suggesting tubal ectopic pregnancy Figure 1. Embryonic structures were visualized Figure 2.
Emergency laparoscopy revealed an ectopic pregnancy in the left tubal region, together with hemoperitoneum ml. In view of this finding, which confirmed the diagnosis of ectopic pregnancy, we performed bilateral salpingectomy, with the preservation of both ovaries and sutured the cervical stump to seal the fistula tract.
The postoperative course proved normal, with discharge on the fourth day, followed by outpatient controls. The pathology report confirmed the presence of chorionic villi, trophoblastic tubal implantation and hematosalpinx.
Ectopic pregnancy after any type of hysterectomy is very infrequent, yet possible. It must be kept in mind when establishing a differential diagnosis in all reproductive-aged women with intact ovaries presenting with abdominal pain, since a delay in diagnosis could prove life-threatening for the patient. A rapid diagnosis and correct surgical management reduce mortality and contribute to prevent recurrences. On the other hand, closing the remaining cervical stump with peritonisation in supracervical hysterectomy or vaginal cuff in vaginal hysterectomy and removal of Fallopian tubes at the time of hysterectomy might reduce the risk of post-hysterectomy ectopic pregnancy.
Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor of this journal. All authors read and approved the final manuscript. We thank the Malaga University Hospital nursing staff for their contribution to the final resolution of this clinical case. National Center for Biotechnology Information , U. BMC Womens Health. Published online May Author information Article notes Copyright and License information Disclaimer.
Corresponding author. Emilia Villegas: se. Received Feb 9; Accepted May This article has been cited by other articles in PMC. Abstract Background Ectopic pregnancy after hysterectomy is a very rare condition, but it must be kept in mind in women with history of hysterectomy who present with abdominal pain and ecographic adnexal heterogeneous images. To our knowledge, only 24 cases have been reported to date, with two thirds of these appearing in the last 14 years.
Several factors are involved in this curious entity, namely, the role of the general surgeon in its definitive treatment, the increasing frequency of hysterectomy in women of childbearing age, and the vagueness of exact differential diagnosis before laparotomy.
Two different pathophysiologic mechanisms have been postulated in its occurrence. In addition, two subgroups of patients have been identified with regard to timing of the clinical presentation. We will review the known factors, describe the clinical course, and add our own case report of this condition. Zolli A, Rocko JM. Arch Surg. Coronavirus Resource Center.
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