A systematic review of ectopic pregnancy after hysterectomy.

ABSTRACT

BACKGROUND: An ectopic pregnancy after hysterectomy is a rare but potentially life-threatening event. Women with this condition might not be appropriately investigated, resulting in delays in diagnosis and treatment. OBJECTIVES: To characterize cases of ectopic pregnancy occurring after hysterectomy. SEARCH STRATEGY PubMed, Embase, Scopus, and Web of Science were searched using the terms "pregnancy, abdominal" or "pregnancy, tubal" or "pregnancy, ectopic" and "hysterectomy" or "post-hysterectomy" or "post hysterectomy." SELECTION CRITERIA Case reports or case series published in English up to October 10, 2016, were included. Patients were included if the diagnosis was confirmed by definitive tests such as serum or urine ß-human chorionic gonadotropin (ß-hCG) testing, ultrasonography evidence of pregnancy, or histology. DATA COLLECTION AND ANALYSIS: Patient characteristics were extracted via a standard spreadsheet. MAIN RESULTS: A total of 57 patients were included in the analysis. Abdominal pain was the predominant symptom. Implantation in a remaining fallopian tube was common. Most patients were managed surgically. CONCLUSIONS: A high index of suspicion and a low threshold for performing a ß-hCG pregnancy test is recommended in all women presenting with clinical symptoms of ectopic pregnancy, regardless of the hysterectomy status. This could lead to earlier diagnosis and fewer complications.