Interstitial ectopic pregnancy (Clinical case)

Abstract

Ectopic pregnancy is the leading cause of I trimester maternal morbidity and mortality worldwide. Ectopic pregnancy is diagnosed in 1.5–2% of the general population and in 1.4–5.4% of patients after assisted reproductive technologies. In up to 98% of cases, an ectopic pregnancy develops in the fallopian tubes. Signs and symptoms of a ruptured fallopian tube in an ectopic pregnancy can occur between the 6th and 8th weeks of gestation.Interstitial ectopic pregnancy is a type of non-tubal ectopic pregnancy, when the attachment of a fertilized egg occurs at the junction of the interstitial part of the fallopian tube with the uterine myometrium. Localization of ectopic pregnancy not in the fallopian tube is detected infrequently – in 7-10% of all ectopic pregnancies, but this type of pregnancy is associated with a greater number of complications due to late manifestation and diagnostic difficulties.The interstitial part of the fallopian tube is approximately 1–2 cm long and 0.7 mm wide. The gestational sac, implanted in the interstitial part of the fallopian tube, is surrounded by a layer of myometrium, that is, the middle layer of the uterine wall, consisting mainly of smooth muscle cells, as well as supporting interstitial and vascular tissue. The surrounding tissue of the myometrium allows pregnancy to progress up to 12 weeks, and in the presence of its changes at this time, the uterus actually ruptures, which leads to significant bleeding or even death.The article describes a clinical case of an ectopic pregnancy in a 30-year-old woman who was hospitalized at the Perinatal Center of Kyiv after a routine examination for in vitro fertilization. The patient did not have any complaints. During a transvaginal ultrasound examination a progressive interstitial ectopic pregnancy was diagnosed, and the level of β-human chorionic gonadotropin in the blood serum corresponded to 5–6 weeks of gestation. The patient was hospitalized for surgical intervention, as a result of which the ectopic interstitial pregnancy was interrupted by excision of the uterine angle without penetration into its cavity, which was accompanied by minimal blood loss.