Antenatal diagnosis of a third trimester interstitial pregnancy: A case report

Abstract

Interstitial pregnancy cases that advance to term, or near term, are occasionally reported. We present an unusual case of a third trimester interstitial pregnancy with antenatal diagnosis and expectant management. She presented at 20 weeks of pregnancy with an early preterm premature rupture of membranes, and expectant management was initiated. The ultrasound suggested an interstitial location and a posterior magnetic resonance image, obtained at 26 weeks, confirmed the diagnosis. Because of the risk of uterine rupture, an elective cesarean section was performed at 28 weeks. During the laparotomy, the uterine fundus appeared intact with an asymmetric bulge that provided evidence of placenta increta. The baby was delivered, and an obstetric hysterectomy was performed. The newborn was admitted to the neonatal intensive care unit with a severe respiratory distress syndrome. No response to mechanical ventilation was observed, and neonatal death was reported. A uterine pathological examination confirmed the diagnosis.

Interstitial Pregnancy Resulting in a Viable Infant Coexistent with Massive Perivillous Fibrin Deposition: A Case Report and Literature Review

“…FGR was observed in 3 of the 10 cases (30%). 8,13,14 We hypothesize that the placental abnormalities in patients with interstitial pregnancy may be associated with FGR, and propose a possible explanation for the relationship between interstitial pregnancy and FGR. The eccentric position of the gestational sac and abnormal placentation may cause uteroplacental insufficiency, potentially leading to FGR.…”

“…The placenta was markedly adherent to the uterus in 5 of the 10 cases (50%), 5,7,9,11,13 which clinically suggests the presence of placenta accreta. Four of the five cases 6,7,9,13 were treated with hysterectomy and one was treated with intramuscular methotrexate injection. 11 In our case, we chose expectant management, because there was no evidence of ongoing bleeding during cesarean section.…”

“…Only 10 cases of interstitial pregnancy with a viable infant have been reported previously. [5][6][7][8][9][10][11][12][13][14] We were able to obtain detailed information for these patients, as shown in ►Table 1. All patients underwent cesarean section for obstetrical indications, including uterine rupture in 4 of the 10 patients (40%), 5,7,8,10 malpresentation in 3, 6,11,12 and previous cesarean section in 2 patients.…”

“…All patients underwent cesarean section for obstetrical indications, including uterine rupture in 4 of the 10 patients (40%), 5,7,8,10 malpresentation in 3, 6,11,12 and previous cesarean section in 2 patients. 9,14 A prenatal diagnosis was established in one patient, 13 and an elective cesarean section was performed. There has been no case of vaginal delivery in a patient with interstitial pregnancy diagnosed in the antenatal period.…”

Diagnosis pitfall of interstitial pregnancy: a case report of a term pregnancy with abnormal placentation

“…Also, there are reports of abnormal placentation in this condition. To explain more, one premature third trimester pregnancy presented with myometrial infiltrating placenta [ 6 ]. Kakigano et al presented another case report of asymmetrical appearance of the uterus with final diagnosis of interstitial pregnancy with placenta accreta [ 4 ].…”