The effectiveness of non‐surgical management of early interstitial pregnancy: a report of ten cases and review of the literature

Abstract

Non-surgical treatment of interstitial pregnancy with methotrexate appears to be safe and effective. Local administration appears to be more successful and better tolerated by patients and may be used as the first-line therapy.

Laparoscopic cornuotomy using a temporary tourniquet suture and diluted vasopressin injection in interstitial pregnancy

“…As shown in Figure 1, transvaginal ultrasound reveals an empty endometrial cavity, an extremely eccentrically located gestational sac or hyperechoic mass surrounded by a layer of thin myometrium, and peritrophoblastic blood flow seen as a ''solid ring of fire'' pattern on color flow Doppler ultrasound, which implies a highly vascular peritrophoblastic implantation (11,12). Figure 2A, the diagnosis was confirmed by a laparoscopic finding of an extremely lateralized, highly vascular protruding cornual mass and confirmed on histopathologic examination.…”

“…In the last two decades, conservative management has been advocated with laparoscopy, hysteroscopy, or medical treatment (3)(4)(5)(6)(7)(8)(9)(10)(11).…”

“…Medical treatment, such as with methotrexate, is noninvasive, but some patients require secondary treatment, and it has some adverse effects (2,10,11).…”

How feasible is expectant management of interstitial ectopic pregnancy?

“…Ultrasound scans were performed by gynecologists with an interest in transvaginal ultrasound and the diagnosis was confirmed by the consultant supervising the clinic. An interstitial pregnancy was diagnosed sonographically when the uterine cavity was empty (except in the case of heterotopic pregnancy), a gestational sac was located eccentrically near the superolateral aspect of the uterus, lateral to the endometrial cavity, and when there was a thin layer (< 5 mm) of myometrium surrounding the gestational sac ( Figure 1) 6,10 .…”

Grossesse interstitielle. Diagnostic échographique et apport de l'IRM. À propos d'un cas

“…Il est retrouvé une activité cardiaque dans 18 % des cas, un embryon sans activité cardiaque dans 28 % des cas, un sac vide dans 36 % des cas, ou une tumeur solide dans 18 % des cas [5]. Le sac est cerné d'un « anneau de feu » au doppler signant le flux vasculaire trophoblastique ; • l'absence de caduque autour de la GEI explique l'absence de la double couronne échogène (double decidual sac sign dans la littérature anglo-saxonne) retrouvée dans le cas des grossesses intra-utérines ; • la GEI est entièrement bordée par un feuillet de myomètre de moins de 5 mm [6,7] ; • le signe échographique le plus pertinent est celui de la ligne interstitielle, qui est la partie interstitielle de la trompe qui joint l'endomètre au trophoblaste [6].…”