Challenges in the diagnosis and management of interstitial and cornual ectopic pregnancies

Rizk, Botros; Holliday, Candice P.; Abuzeid, Mostafa I.

doi:10.1016/j.mefs.2013.01.004

Cited by 31 publications

(21 citation statements)

References 26 publications

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“…The ultrasonographic diagnosis of interstitial ectopic pregnancies is challenging and needs expert hands because, as the images are similar to those of intrauterine pregnancies they are more likely to be mistaken for normal intrauterine pregnancies. Three sonographic criteria can be used to diagnose interstitial pregnancy: empty uterine cavity, the chorionic sac separated 1 cm from the most lateral edge of the uterine cavity and a thin myometrial layer surrounding the chorionic sac 2 5. The interstitial line sign (the echogenic line extending into the upper part of the uterine horn bordering the margins of the intrauterine gestational sac) is also helpful in diagnosing an interstitial pregnancy 5 6.…”

Section: Discussionmentioning

confidence: 99%

“…Three sonographic criteria can be used to diagnose interstitial pregnancy: empty uterine cavity, the chorionic sac separated 1 cm from the most lateral edge of the uterine cavity and a thin myometrial layer surrounding the chorionic sac 2 5. The interstitial line sign (the echogenic line extending into the upper part of the uterine horn bordering the margins of the intrauterine gestational sac) is also helpful in diagnosing an interstitial pregnancy 5 6. Transabdominal ultrasound has a low sensitivity and specificity in diagnosing ectopic pregnancies7 and two-dimensional sonographic examination is not able to define the exact anatomic position of the gestational sac.…”

Section: Discussionmentioning

confidence: 99%

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Interstitial pregnancy rupture at 15 weeks of pregnancy

Pedroso¹,

Lermann

Amaral

et al. 2014

BMJ Case Reports

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Ectopic pregnancy occurs when the developing blastocyst becomes implanted outside the uterine cavity. Interstitial pregnancy is a rare type, representing 2-3%, of all ectopic pregnancies. It is located outside the uterine cavity in the segment of the fallopian tube that penetrates the muscular layer of the uterus. Therefore, it is a difficult and challenging diagnosis. We report a case of a 19-year-old girl who was admitted to our emergency department because of a ruptured interstitial pregnancy at 15 weeks of gestation.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Interstitial pregnancy rupture at 15 weeks of pregnancy

Pedroso¹,

Lermann

Amaral

et al. 2014

BMJ Case Reports

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“…As the gestational sac enlarges, the myo metrial mantle may be incomplete, but the sac is seen as inseparable from the myometrium in all imaging planes (Fig 3c, 3d). The eccentric location of the gestational sac in the interstitial segment of the fallopian tube, at the level of the uterine fundus, is best seen on sagittal and transverse US images as a characteristic bulging in the contour of the uterus, a finding termed the bulging sign (Fig 3f) (10,11). The US signs of interstitial ectopic pregnancy are summarized in Table 2.…”

Section: Cervical Ectopic Pregnancymentioning

confidence: 99%

Uncommon Implantation Sites of Ectopic Pregnancy: Thinking beyond the Complex Adnexal Mass

Chukus¹,

Tirada²,

Restrepo³

et al. 2015

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Ectopic pregnancy occurs when implantation of the blastocyst takes place in a site other than the endometrium of the uterine cavity. Uncommon implantation sites of ectopic pregnancy include the cervix, interstitial segment of the fallopian tube, scar from a prior cesarean delivery, uterine myometrium, ovary, and peritoneal cavity. Heterotopic and twin ectopic pregnancies are other rare manifestations. Ultrasonography (US) plays a central role in diagnosis of uncommon ectopic pregnancies. US features of an interstitial ectopic pregnancy include an echogenic interstitial line and abnormal bulging of the myometrial contour. A gestational sac that is located below the internal os of the cervix and that contains an embryo with a fetal heartbeat is indicative of a cervical ectopic pregnancy. In a cesarean scar ectopic pregnancy, the gestational sac is implanted in the anterior lower uterine segment at the site of the cesarean scar, with thinning of the myometrium seen anterior to the gestational sac. An intramural gestational sac implants in the uterine myometrium, separate from the uterine cavity and fallopian tubes. In an ovarian ectopic pregnancy, a gestational sac with a thick hyperechoic circumferential rim is located in or on the ovarian parenchyma. An intraperitoneal gestational sac is present in an abdominal ectopic pregnancy. Intra- and extrauterine gestational sacs are seen in a heterotopic pregnancy. Two adnexal heartbeats suggest a live twin ectopic pregnancy. Recognition of the specific US features will help radiologists diagnose these uncommon types of ectopic pregnancy.

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“…However, over the last decade evidence now suggests that early rupture is not uncommon. 5 For patients who are medically unstable or experiencing life-threatening haemorrhage, a surgical approach is indicated. For others, management should be based on patient preference after discussion of the risks, benefits, and monitoring requirements of all approaches.…”

Section: Introductionmentioning

confidence: 99%

A case report on ruptured interstitial ectopic pregnancy: diagnostic dilemma

Sharma

Gokhale

Agrawal

2019

Int J Reprod Contracept Obstet Gynecol

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The ectopic pregnancy occurs when implantation of the blastocyst takes place in a site other than the endometrium of the uterine cavity. Interstitial ectopic pregnancies are gestations that implant within the proximal, intramural portion of the fallopian tubes with high vascularity. Ectopic pregnancy in the interstitial part of the fallopian tubes can be lifethreatening considering the thin myometrial tissue surrounding the gestational sac and high vascularization which may result in catastrophic haemorrhage when interstitium is ruptured. Being a hazardous type of ectopic pregnancy, it becomes extremely important to diagnose and manage it. This condition presents a challenge for clinical as well as radiological diagnosis. Generally, a case of interstitial ectopic pregnancy has typical radiological features distinguishing it from other ectopic. The ultrasonographic finding of interstitial line has better sensitivity (80%) and specificity (98%) than eccentric gestational sac location (sensitivity, 40%; specificity, 88%) and myometrial thinning (sensitivity, 40%; specificity, 93%) for the diagnosis of interstitial ectopic pregnancy. Ultrasound is the mainstay of diagnosis, but magnetic resonance imaging can be helpful in unusual or complicated cases. Interstitial ectopic pregnancy rupturing into the leaves of broad ligament and creating a tamponade effect to alter the clinical presentation is a rare event which presents as a diagnostic challenge. Here authors present a case of ruptured interstitial ectopic pregnancy confined to the leaves of broad ligament, with atypical presentation and radiological features which led to difficulty in diagnosing the interstitial ectopic pregnancy. After laparoscopic confirmation of ruptured interstitial ectopic pregnancy, the patient was managed successfully by laparoscopic cornual resection.

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Challenges in the diagnosis and management of interstitial and cornual ectopic pregnancies

Cited by 31 publications

References 26 publications

Interstitial pregnancy rupture at 15 weeks of pregnancy

Interstitial pregnancy rupture at 15 weeks of pregnancy

Uncommon Implantation Sites of Ectopic Pregnancy: Thinking beyond the Complex Adnexal Mass

A case report on ruptured interstitial ectopic pregnancy: diagnostic dilemma

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