| Letter
to the Editor
Primary Care July 2003
To The Editor:
I read Dr Sloan's article, "Abdominal Pregnancy Revealed
Following Vaginal Hysterectomy" [Sloan D. The Female Patient.
Most interesting case: Abdominal pregnancy revealed following vaginal
hysterectomy. 2003;28(5):55-56]. Dr Sloan's case is the twenty-second
case of pregnancy after hysterectomy reported in the English literature.
Most
of the cases were found immediately after hysterectomy was performed,
but one case from Australia occurred more than 10 years
postoperatively.
I evaluated one case in New York City in which
the proximal end of one fallopian tube was visible in the vagina
at the vaginal
cuff. This conception occurred 3 months postoperatively.
All
of the reported cases had at least one tube remaining along with
ovarian function.
It was obvious that most of these cases occurred
with transuterine sperm migration, but it is also apparent that
conception
can occur without a uterus.
Certainly these cases are so rare
that there is no need to change our practices regarding either
abdominal or vaginal
hysterectomy,
but Dr. Sloan makes us clearly aware that pregnancy can,
and occasionally does, occur posthysterectomy.
Arnold
L. Sperling, MD, MPH, MBA,
Assistant Clinical Professor OB/GYN Tufts Medical School
Boston, Mass
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