[Ectopic pregnancy? Interstitial pregnancy].
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Female↗
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Three conservative approaches to treatment of interstitial pregnancy.
Interstitial pregnancy is among the most dangerous types of ectopic pregnancy. Four such pregnancies in three women were treated by three conservative modalities with favorable results. A 10-week interstitial pregnancy was successfully treated by laparoscopic-guided local methotrexate (MTX) injection into the gestational sac. Six years later the same woman had a repeat unruptured interstitial pregnancy at 9 weeks' gestation, with the gestational sac located in the same location as the previous one. Laparoscopic cornuostomy was performed. An asymptomatic woman in the eighth week of an interstitial pregnancy was treated with systemic MTX, but despite decreasing beta-human chorionic gonadotropin levels, cornual rupture occurred. The patient was successfully treated by laparoscopic cornuostomy. The final patient was admitted in hypovolemic shock and hemoperitoneum and was treated successfully for ruptured 8-week interstitial pregnancy by laparoscopic cornuostomy. (J Am Assoc Gynecol Laparosc 8(1):154-158, 2001)
Abortifacient Agents, Nonsteroidal↗
Sonographic detection of interstitial pregnancy.
Interstitial pregnancy is a rare form of ectopic pregnancy that carries a higher morbidity and mortality than other tubal pregnancies. The sonographic findings in 11 cases of proven interstitial pregnancy were reviewed and compared with 12 cases published thus far. An ectopic pregnancy was diagnosed in all cases, and an interstitial location was suspected in five cases preoperatively. An eccentrically located gestational sac surrounded by an asymmetric myometrial mantle and a separate empty uterine cavity with endometrial echoes were the most common findings in our cases. When an interstitial pregnancy is suspected by sonography, confirmation by laparoscopy is recommended.
Adolescent↗
Case report: laparoscopic treatment of a ruptured interstitial pregnancy.
Interstitial pregnancy is a rare but life-threatening condition. A case of a 28-year-old woman with a partially ruptured interstitial pregnancy treated with operative laparoscopy is presented. A laparoscopic cornual resection and a left salpingectomy were performed uneventfully. Serum beta-human chorionic gonadotrophin concentrations were measured serially at weekly intervals until resolved on day 20 postoperatively. It seems, therefore, that laparoscopic treatment is still an effective option for management even in ruptured interstitial pregnancy, preserving the anatomical integrity of the uterus and future fertility, and that rupture of interstitial ectopic pregnancy is not a contra-indication for laparoscopy.
Adult↗
Surgical management of interstitial pregnancy.
Interstitial pregnancy is a rare and potentially dangerous event. Standard treatment involves laparotomy with cornual resection or hysterectomy, with few reported cases of laparoscopic management. A 14-week, 6-cm interstitial pregnancy was treated laparoscopically, without cornual resection or hysterectomy. Gestational products were removed from the fetal side of the implantation site through a salpingotomy incision through myometrium. In selected patients, this procedure can be accomplished safely and efficaciously while preserving reproductive function and avoiding laparotomy.
Adult↗
Laparoscopic treatment of an interstitial pregnancy.
Interstitial (cornual) pregnancies occur rarely, estimated at 1 for every 2500 to 5000 live births. Since the morbidity and mortality are high, the correct diagnosis must be made and treatment begun promptly. A number of management options have been described, including conservative treatments such as expectant management, methotrexate injections (local or systemic), potassium chloride injections (local), and prostaglandin administration. Among conservative surgical treatments, hysteroscopy has been performed successfully to diagnose and treat the condition. To my knowledge, this is the first report of laparoscopic treatment of interstitial pregnancy.
Adult↗
Recurrent interstitial pregnancy.
As a rare form of ectopic pregnancy, interstitial pregnancy threatens the future fertility of the patient. Methods of management include observation only, medical treatment with methotrexate either systemically or locally, or surgery either with laparotomy or laparoscopy. We present the case of a woman with recurrent interstitial pregnancy. Treatment with methotrexate was successful in her first interstitial pregnancy, however the second necessitated laparotomy. Selection of patients for treatment with methotrexate and the importance of subsequent tubal investigation are emphasized.
Abortifacient Agents, Nonsteroidal↗
Tubal curettage: a new conservative treatment for haemorrhagic interstitial pregnancies.
Haemorrhagic interstitial pregnancies are commonly treated by cornual resection. This invasive procedure may increase the risk of uterine rupture in subsequent pregnancies. We report here a case of a haemorrhagic interstitial pregnancy, associated with a viable intrauterine pregnancy in a salpingectomized woman, which was treated successfully by curettage of the uterine cornu.
Adult↗
[Subsequent pregnancy following uterine artery embolization for interstitial pregnancy].
Subsequent pregnancy following an interstitial pregnancy is rare. The risk of uterine rupture may be increased in this situation. Uterine selective embolization has been proposed as an effective treatment. However, no further pregnancy has ever been described after this method of management. We are reporting a case of subsequent pregnancy following interstitial pregnancy managed by embolization. The pregnancy was uneventful. A healthy male infant was delivered by C-section. This case supports the hypothesis that selective embolization for interstitial pregnancy may respect fertility. However, as actual risk of uterine rupture in subsequent pregnancies remains unknown, a C-section is advised.
Adult↗
Diagnosis of interstitial pregnancy with sonography.
Interstitial pregnancy is a rare and extremely dangerous form of ectopic pregnancy. Preoperative diagnosis of this condition prior to rupture is difficult, and early detection is essential to avoid a fatal outcome. Six cases in our series were diagnosed as interstitial pregnancy. Their clinical features were missed period, positive pregnancy test, and sudden onset of lower abdominal pain with or without vaginal spotting. The sonographic images showed an endometrial echo in uterine cavity, eccentric sac, protruding mass over the cornual area, and/or the presence of free fluid in the cul-de-sac. Five of 6 patients had sacs found in the cornual area or a protruding cornual mass. We termed the sonographic findings of interstitial pregnancy as "pregnancy in cornus." High resolution transvaginal sonography permits determination of the exact location of the gestational sac and increases the diagnosis rate of interstitial pregnancy.
Adult↗
Combined hysteroscopy and laparoscopy in the treatment of interstitial pregnancy.
Traditional management of interstitial pregnancy involves laparotomy with cornual resection. Increasingly sensitive human chorionic gonadotropin assays and ultrasonography has led to earlier diagnosis of interstitial pregnancy. We report two cases of interstitial pregnancy treated with a combined hysteroscopic and laparoscopic approach. Early diagnosis of interstitial pregnancy can lead to conservative treatment options.
Adult↗
Triplet heterotopic pregnancy with an intrauterine monochorionic diamniotic twin pregnancy and an interstitial pregnancy following in vitro fertilisation and transfer of two embryos.
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Adult↗
[Coexistence of intrauterine pregnancy with ectopic interstitial pregnancy].
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Adult↗
Ruptured interstitial pregnancy presenting as an intrauterine pregnancy by ultrasound.
Interstitial pregnancy is an uncommon subset of ectopic pregnancy in which the conceptum implants in the intrauterine portion of the fallopian tube. These pregnancies tend to progress further before rupture than do other tubal pregnancies and subsequently have greater propensity for massive intra-abdominal bleeding and maternal demise. Abdominal ultrasound can be deceptive in evaluating interstitial ectopic pregnancies. Transvaginal ultrasonography is more sensitive in the diagnosis of early ectopic pregnancy. Knowledge of the application and limitations of both transabdominal and transvaginal ultrasound will assist the emergency physician in the timely evaluation of this potentially lethal condition.
Abortion, Threatened↗
Interstitial pregnancy: a potential for misdiagnosis of ectopic pregnancy with emergency department ultrasonography.
Interstitial pregnancy is a rare and dangerous form of ectopic pregnancy that can be mistaken for a normal intrauterine pregnancy on ultrasonography, leading to catastrophic results. Increasingly, emergency physicians are using ultrasonography to diagnose intrauterine pregnancy. Emergency physicians should be aware of the potential for mistaking an interstitial pregnancy for an intrauterine pregnancy. We present a case report of an interstitial pregnancy misdiagnosed as an intrauterine pregnancy and discuss ultrasonographic and physical examination findings to help differentiate interstitial pregnancy from an intrauterine pregnancy.
Adult↗
Successful conservative treatment for advanced interstitial pregnancy. A case report.
BACKGROUND: Interstitial pregnancy is a relatively rare and life-threatening disease, occurring in 2-4% of all extrauterine pregnancies, and the maternal mortality rate is 2-2.5%. Laparoscopic surgery and, less commonly, methotrexate are the treatments of choice for interstitial pregnancy. However, there is another treatment, ultrasound-guided direct injection of etoposide, the effect and safety of which are unclear. CASE REPORT: In a 32-year-old woman with interstitial pregnancy at 12 weeks of gestation, ultrasound-guided direct injection of etoposide (100 mg) was used successfully after intravenous high-dose methotrexate, 300 mg (200 mg/m2), therapy failed to produce a response. The patient's posttherapeutic course was smooth. Twelve months after treatment, she conceived and later delivered a healthy infant vaginally without adverse events. CONCLUSION: Ultrasound-guided direct injection of etoposide offers another choice for treating advanced interstitial pregnancy, but further study is needed to define its efficacy and safety.
Abortifacient Agents, Nonsteroidal↗
Acute abdomen in ruptured interstitial pregnancy following unilateral salpingectomy.
Interstitial pregnancy is an infrequent type of ectopic pregnancy. Two cases of acute abdomen due to ruptured interstitial pregnancy following salpingectomy, a rare event, are presented. Both patients were young women who had had a previous salpingo-oophorectomy due to ovarian cyst. The presenting symptoms were in the first case abdominal pain followed by hemorrhagic shock, and in the second a right iliac fossa syndrome simulating acute appendicitis. Surgical intervention consisted of wedge resection of the uterine segment involved. A review of the literature and practical considerations are presented.
Abdomen, Acute↗
Interstitial pregnancy and transcervical curettage.
BACKGROUND: Interstitial pregnancies too large to be treated with methotrexate are usually managed surgically, and that may adversely affect future fertility and pregnancies. Transcervical curettage under laparoscopic guidance may be possible in some cases if the pregnancy is accessible vaginally. CASE: Three women with interstitial pregnancy were treated by transcervical suction curettage under laparoscopic guidance. In all cases, the procedure was quick, bleeding was minimal, and there were no complications. Removal was complete, and the serum beta-hCG quickly became undetectable. CONCLUSION: Transcervical curettage under laparoscopic guidance provides an alternative conservative treatment for interstitial pregnancy.
Adult↗