Management of interstitial pregnancy – a case managed with ultrasound guidance and a review of literature

Abstract

Interstitial pregnancy is a rare form of ectopic pregnancy. Interstitial pregnancy refers to an ectopic pregnancy implanted in the interstitial portion of the tube. This is the segment of Fallopian tube traversing the muscular wall of the uterus, beginning at the tubal ostium and proceeding superiorly and laterally away from the uterine cavity to join the isthmic portion of the tube arising from the fundus. The interstitial portion, being a relatively thicker portion of the tube, has a greater capacity to expand before rupture takes place. Therefore, such pregnancies may present late and rupture can result in life-threatening haemorrhage, particularly because of the high vascularity of this region. Diagnosis is difficult and treatment has not been standardized. A high index of suspicion is required to diagnose this type of pregnancy. Access to high-resolution transvaginal ultrasonography and highly sensitive quantitative b-hCG assays has increased early detection and appropriate management. A wide array of treatment methods have been tried for the management of this condition. The optimum therapeutic option depends on variables related to each individual case.