Management options for interstitial ectopic pregnancies: A case series

Abstract

Objective:Ectopic pregnancy in the interstitial part of the Fallopian tubes can be life-threatining considering the thin myometrial tissue surrounding the gestational sac and highly vascularization which may result in catastrophic haemorrhage when interstitium is ruptured. The diagnosis and management is challenging. Conservative, medical, and surgical treatment options should be considered based on individual patient factors.Methods:Four women were diagnosed with interstitial pregnancy in last five years in our tertiary center. Four different treatment modalities, including single dose methotrexate, laparotomy, hysteroscopy followed by vacuum aspiration, and vacuum aspiration under laparoscopy were performed according to patients’ characteristics.Results:. Successful outcome was achieved in all patients.Conclusion:Interstitial pregnancy can be successfully treated with a single dose systemic methotrexate when all criteria are met. The classical cornual wedge resection remains lifesaving operation for cases of ruptured interstitial pregnancy. Less invasive procedures such as laparoscopic assisted transcervical vacuum aspiration and diagnostic hysteroscopy followed by vacuum aspiration can be performed in selected cases.

Twelve Week Ruptured Interstitial Ectopic Pregnancy

“…In conclusion, there's practically any unanimity on the strongest health-associated procedure for interstitial pregnancy (6). Minimal invasive surgeries, for example, laparoscopic excision, hysteroscopic excision, curettage, or suction dilation under the support of laparoscopy, transabdominal ultrasound, or hysteroscopy had been used a field more regular (6).…”

“…Minimal invasive surgeries, for example, laparoscopic excision, hysteroscopic excision, curettage, or suction dilation under the support of laparoscopy, transabdominal ultrasound, or hysteroscopy had been used a field more regular (6). From our target of viewpoint, trained surgeons may conclude these approaches in hemodynamically stable people without proof of uterine rupture (6). We should counsel individuals about the chances of uterine rupture, severe demand and hemorrhage for hysterectomy and laparotomy.…”

“…To diagnose interstitial ectopic pregnancy ultra-sonographically; "(i) a clear endometrial cavity, (ii) separate from the uterine cavity and at least 1 centimeter away and close to the lateral outer edge of the uterus, and (iii) It should be a thin myometrial tissue below 5 millimeters surrounding the gestational sac" (5). Interstitial line sign; In the uterine horn, the image of the fallopian tube surrounding the gestational sac above the intramural component (6,7). As a result of all these, early diagnosis of interstitial pregnancy becomes difficult if it goes unnoticed (3).…”

Embarazo ectópico cornual, diagnóstico y tratamiento: reporte de dos casos y revisión de la literatura

“…Considerando que el embarazo cornual tiene una tasa de mortalidad de 2.5%, su detección precoz es crucial (19). Para ello, se cuenta con el cuadro clínico, exámenes de laboratorio, y como examen imagenológico es esencial la ecografía transvaginal.…”

“…Otro manejo es la cuernectomía (resección de la región cornual afectada), sin embargo esta se ha asociado a menores tasas de fertilidad y mayor incidencia de ruptura en embarazos futuros (32). Se ha descrito también la eliminación histeroscópica del embarazo ectópico intersticial (3, 19).…”