Interstitial pregnancy management and subsequent pregnancy outcome

Abstract

We report on management and subsequent fertility outcome of interstitial pregnancy in a retrospective cohort study (Canadian Task Force classification II-3) at a university affiliated teaching hospital. Of 706 women with extrauterine pregnancy, 14 consecutive women with interstitial pregnancy were treated by methotrexate, laparotomy or laparoscopy between 1997 and 2007. The first four women, with significant hemoperitoneum, were treated by laparotomy. Of the next 10 women, four were selected for medical treatment with methotrexate. Only one case was treated successfully. The other six women had laparoscopic treatment. Of nine laparoscopies, one was converted to laparotomy due to excessive blood loss during the procedure. Of nine women desiring a child, three were infertile, whereas six conceived with an intrauterine pregnancy. A change from diagnosis later in pregnancy and laparotomy to more conservative treatment, mainly by laparoscopy, suggests a possibly better subsequent pregnancy rate.

Author's reply: Ultrasound‐guided transcervical forceps extraction of unruptured interstitial pregnancy

“…The interpretation depends on the reader's personal perspective. Additionally, except for the first procedure, the other five consecutive procedures in the UTCE series were all successful, and the success rates of medical or surgical methods of other previous studies were not 100%, which differs from our study …”

Laparoscopic Management of Tubal Ectopic Pregnancy: Single-Port Versus Conventional Multi-Port Laparoscopy.

“…Two patients required conversion to laparotomy for a total conversion rate of 3.8%; such figure is superior to that reported previously (21,22) . No case in SPL group required conversion to laparotomy for management of hemoperitoneum, while one case in CMPL required that; thus indicating effectiveness of SPL for management of TEP, irrespective of patients' conditions or intraoperative findings.…”

Magnetic resonance imaging for diagnosis and management of unruptured interstitial pregnancy

“…With the development of surgical instruments and the advent of surgical procedures, abdominal hysterectomy, which is the traditional method of management of interstitial pregnancy with loss of fertility, has been replaced by more conservative strategies enabling uterine preservation . However, the most appropriate technique to treat interstitial pregnancy remains undetermined and a variety of therapeutic options, including laparoscopic surgery, medical methotrexate treatment, uterine artery embolization, transcervical aspiration and resection, or forceps extraction, have been individually implemented without a clear management consensus to date.…”

“…Although this increased distensibility allows for painless growth of interstitial pregnancy (Fig. b, arrow) for a longer period of time than ectopic pregnancy in other tubal portions, interstitial pregnancy may eventually cause sudden life‐threatening hemorrhage once rupture occurs in this highly vascularized area without early diagnosis and prompt management …”

“…Until recently, imaging studies for the diagnosis of interstitial pregnancy have mostly been performed by ultrasonography . However, as some interstitial pregnancies can be misdiagnosed as intrauterine pregnancy solely by ultrasonography due to its inherently limited resolution and field of view, correct diagnosis of interstitial pregnancy remains a challenging issue for gynecologists, especially in an emergency setting .…”