Preface

The idea of this book came about due to the increasing number of case reports in the medical literature on non-tubal ectopic pregnancies, which is mainly due to the increased number of cesarean sections and assisted reproduction. There is no consensus in the literature about the best treatment, therefore non-tubal ectopic pregnancy is still a challenge for obstetricians. Innumerous innovations in the diagnosis and management of non-tubal ectopic pregnancies have occurred in the recent years and this book offers an immersion on the subject. Throughout the book the reader is invited to visit the most important issues related to non-tubal ectopic pregnancies.

Non-tubal ectopic pregnancies presents serious complications, which are greater than in tubal pregnancies. Therefore, the maternal morbidity and mortality are higher. Due to this, an early diagnosis is crucial for the best result of the treatment. In this book we present the challenges and pitfalls for diagnosis.

In the various chapters, the authors contemplate the management of different types of non-tubal ectopic pregnancies such as cervical, interstitial, cesarean scar, ovarian, and abdominal pregnancy to which several modalities of treatment are presented: surgery, local treatment with methotrexate, systemic treatment with MTX, embolization, and specific treatments for the different sites of non-tubal pregnancy.

The book presents the most relevant aspects of the non-tubal ectopic pregnancy scenario. Authors from all over the world who have contributed to this book are experts in their areas and offer readers the best from their research.

Our intention is for the reader to be presented with the latest updates on non-tubal ectopic pregnancies.

I would like to thank my wife, Camila, and our children, João and Pedro, for their support, understanding, and love during the journey to complete this mission that will help women with non-tubal ectopic pregnancy all over the world.

**II**

**Chapter 7 95**

*by Stelios Fiorentzis, Theodoros Margetousakis, Chrysostomos Georgellis, Pantelis Kotridis, Dimitra Oikonomopoulou, Alexandros Karamperis,* 

*Georgia Karamperi-Sotiropoulou and Dionysios Karavyrakis*

Broad Ligament Pregnancy

**Julio Elito Jr.** Associate Professor of the Department of Obstetrics at Federal University of São Paulo, São Paulo, Brazil

**1**

Section 1

Introduction

Section 1 Introduction

**3**

**Chapter 1**

Pregnancy

*Julio Elito Jr*

**1. Introduction**

broad ligament (**Figure 1**).

ectopic pregnancy are asymptomatic.

are higher than in tubal ectopic pregnancies.

usually confirmed only during the surgery.

will be presented in this introductory chapter.

similar non-surgical protocol.

Introductory Chapter: An

Overview of the Diagnosis and

Treatment of Non-tubal Ectopic

Non-tubal ectopic pregnancies represent 7–10% of all ectopic pregnancies [1]. The incidence is increasing in the past years especially because of assisted reproduc-

Non-tubal locations of ectopic pregnancies are cervix, cesarean section scar, interstitial portion of the fallopian tube, cornual, ovary, abdominal cavity, and

There is a broad spectrum of clinical presentation according to the location of the pregnancy. The first symptoms are pelvic pain and vaginal bleeding. In ruptured ectopic pregnancies, the patients present with severe abdominal pain, shoulder tip pain, nausea, vomiting and dizziness and collapse. However, some women with

The diagnosis is usually late, because these pregnancies present themselves later than tubal pregnancies. Therefore, the risks of maternal morbidity and mortality

The management of non-tubal ectopic pregnancy depends on their location. The cases of abdominal pregnancy must be individualized and the treatment is different from the other sites of ectopic pregnancy. The diagnosis of ovarian pregnancy is

The other sites (cesarean scar, cervical and intersticial pregnancy) follow a

The classic treatment is surgery; however, it is very aggressive, because in the majority of the cases it is necessary to perform a hysterectomy. Several minimally invasive techniques have been proposed to avoid the mutilation of the uterus. Some of the alternative treatments to avoid surgery are local injection of MTX guided by transvaginal ultrasound, systemic medical treatment with methotrexate (MTX), and embolization of uterine arteries. There are several case reports in this subject but very few original articles. And in the few articles, there is no consensus on the best treatment. This book aims to provide the reader with a concise, comprehensive, and updated review of the epidemiology, diagnosis, and treatment of non-tubal ectopic pregnancy. As there is a lack of consensus on the guideline for the treatment of non-tubal ectopic pregnancy, this book intends to fill this gap in the literature, compiling the best evidences in the medical literature guiding the reader on choosing the adequate treatment. An overview of each non-tubal ectopic pregnancy site

tion treatment, particularly IVF, and the high rates of cesarean sections [2].

#### **Chapter 1**
