An Ectopic Pregnancy in the Tubal Interstitium: Beware!

Abstract

An interstitial ectopic pregnancy is a rare and a dangerous form of an ectopic pregnancy. It presents late clinically and it is difficult to be imaged radiographically. We are presenting a case of an interstitial pregnancy which was a surprise intra operative finding.As Assisted Reproductive Technology (ART) procedures are becoming popular, the incidence of ectopic pregnancies is likely to increase. The clinicians should be well equipped to diagnose and to treat this unusual form of ectopic pregnancies at the earliest.

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.…”

“…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. However, in this case, because of the hCG-β levels and presence of cardiac activity, a surgical approach was preferred.…”

“…However, diagnostic suspicion should be made in patients with known risk factors and those who undergo assisted reproductive techniques with serial biochemical and ultrasonography controls, since early treatment allows more conservative treatments that reduce the morbidity and mortality rate. Diagnosis is accomplished by quantifying the beta fraction of the human chorionic gonadotropin, vaginal ultrasonography and sometimes even laparoscopy [9][10][11]. The "interstitial line" sign, part of the Trish criteria for ultrasound diagnosis was originally described by Ackerman (Table 2) [9,[11][12][13].…”

“…Diagnosis is accomplished by quantifying the beta fraction of the human chorionic gonadotropin, vaginal ultrasonography and sometimes even laparoscopy [9][10][11]. The "interstitial line" sign, part of the Trish criteria for ultrasound diagnosis was originally described by Ackerman (Table 2) [9,[11][12][13]. Original treatment for interstitial ectopic pregnancy is laparotomy, hysterectomy and cornual resection, all three procedures associated to frequent complications and an increased morbidity rate [11].…”

A Case of a Ruptured Cornual In vitro Fertilization Pregnancy

“…Transfer of multiple embryos, a transfer near the uterine horn, high pressure applied while transferring; contribute the cornual risk [2]. Bilateral salpingectomy is thought to be another risk factor [2].…”