Interstitial Ectopic Pregnancy: Conservative Surgical Management

Abstract

Introduction:Interstitial pregnancy is a rare and life-threatening condition. Diagnosis and appropriate management are critical in preventing morbidity and death.Case Description:Four cases of interstitial pregnancy are presented. Diagnostic laparoscopy followed by laparotomy and cornuostomy with removal of products of conception was performed in 1 case. Laparoscopic cornuostomy and removal of products of conception were performed in the subsequent 3 cases with some modifications of the technique. Subsequent successful reproductive outcomes are also presented.Discussion:Progressively conservative surgical measures are being used to treat interstitial pregnancy successfully, with no negative impact on subsequent pregnancies.

Early Diagnosis of Interstitial Pregnancy Associated to Assisted Reproductive Techniques Case Report

“…However, bilateral tubal occlusion is the only risk factor exclusively associated to interstitial pregnancy. Moreover, in patients without bilateral tubal occlusion (BTO), peritubal or intratubal adhesions associated to endometriosis can also be a risk factor [6][7][8][9]. In the present case, the patient suffered from severe endometriosis, history of a previous tubal surgery and underwent assisted reproductive technique.…”

“…The incidence of interstitial pregnancy is greater after IVF, especially in women with a history of salpingectomy due to a tubal factor [7,8]. Risk factors for interstitial pregnancy are similar to those of other types of ectopic pregnancy: Pelvic inflammatory disease, previous tubal surgery, previous ectopic pregnancy, and factors associated to assisted reproduction techniques, such as multiple embryo transfers, or embryos transferred in close proximity to the uterine cornua, and excessive pressure of the syringe during embryo transfer.…”

“…However, literature sometimes differentiates between the terms by stating that a cornual pregnancy is found in the endometrium of the cornus of a bicornual/unicornual uterus, or even outside the endometrial cavity, while an interstitial pregnancy is found within the union of the uterus and the proximal portion of the Fallopian tube [6][7][8].…”

“…This highlights the importance of a rigorous follow-up during the post-operative period and in future pregnancies. Furthermore, patients who are submitted to any of these treatments should undergo caesarean section because of the risk of uterine rupture [7,8,13,14]. As first line of treatment, the Royal College of Obstetricians and Gynaecologists (RCOG) recommends methotrexate in patients with hCG-β <5000 UI/mL and ectopic pregancy smaller than 3.5 cm to 4 cm [9,10] and minimal symptoms.…”

About a Case of Failure of Medical Treatment of an Interstitial Pregnancy

“…By the past, the treatment of interstitial pregnancy consisted of salpingectomy and corneal resection by laparotomy, probably as a result of delayed diagnosis (Moawad et al, 2010) currently interstitial pregnancy is typically diagnosed at an early gestational age and prior to rupture, leaving the opportunity for conservative medical or surgical treatment (Hussein et al, 2014). However, in the presence of signs of severity (hemodynamic failure and presence of abundant hemoperitoneum), the treatment should be surgical by laparoscopic route if possible, but most often by laparotomy.…”