Non-surgical management and obstetric outcomes of heterotopic interstitial pregnancies

Kwon, Boram; Kang, Suk Ho; Lee, Hyun Jung; Kim, Migang; Lee, Yoon Hee; Im, Jisun; Moon, Miri; Ahn, Eun Hee; Kim, Young Ran

doi:10.1080/13645706.2019.1653924

Cited by 9 publications

(6 citation statements)

References 20 publications

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“…However, there is also a risk of persistent EP [ 39 ] and intrauterine growth retardation [ 40 ]. In addition, the operative time tends to be longer, with an average of 55.5 ± 21.3 min, and the average intraoperative blood loss is 76.0 ± 73.2 mL [ 41 ]. Surgery also increases the risk of uterine rupture in another pregnancy by about 33% [ 42 ].…”

Section: Discussionmentioning

confidence: 99%

Successful Ultrasound-Guided Methotrexate Intervention in the Treatment of Heterotopic Interstitial Pregnancy: A Case Report and Literature Review

Tan

Chen

et al. 2023

JPM

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Purpose: This study aims to share the experience of minimally invasive ultrasound-guided methotrexate intervention in the treatment of heterotopic interstitial pregnancy (HIP) with good pregnancy outcomes, and to review the treatment, pregnancy outcomes, and impact on the future fertility of HIP patients. Methods: The paper describes the medical history, clinical manifestations, treatment history, and clinical prognosis of a 31-year-old woman with HIP, and reviews cases of HIP from 1992 to 2021 published in the PubMed database. Results: The patient was diagnosed with HIP by transvaginal ultrasound (TVUS) at 8 weeks after assisted reproductive technology. The interstitial gestational sac was inactivated by ultrasound-guided methotrexate injection. The intrauterine pregnancy was successfully delivered at 38 weeks of gestation. Twenty-five HIP cases in 24 studies published on PubMed from 1992 to 2021 were reviewed. Combined with our case, there were 26 cases in total. According to these studies, 84.6% (22/26) of these cases were conceived by in vitro fertilization embryo transfer, 57.7% (15/26) had tubal disorders, and 23.1% (6/26) had a history of ectopic pregnancy; 53.8% (14/26) of the patients presented with abdominal pain and 19.2% (5/26) had vaginal bleeding. All cases were confirmed by TVUS. In total, 76.9% (20/26) of intrauterine pregnancies had a good prognosis (surgery vs. ultrasound interventional therapy 1:1). All fetuses were born without abnormalities. Conclusions: The diagnosis and treatment of HIP remain challenging. Diagnosis mainly relies on TVUS. Interventional ultrasound therapy and surgery are equally safe and effective. Early treatment of concomitant heterotopic pregnancy is associated with high survival of the intrauterine pregnancy.

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Section: Discussionmentioning

confidence: 99%

Successful Ultrasound-Guided Methotrexate Intervention in the Treatment of Heterotopic Interstitial Pregnancy: A Case Report and Literature Review

Tan

Chen

et al. 2023

JPM

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“…In this study, the average diagnostic time was 6.9 weeks, and most cases (74.9%) were diagnosed between 4 and 6 weeks, which was much earlier than previously reported. 19,22 Live embryos were seen in 48.9% (85/174) of cases, which may be because cardiac activity appeared from 6 weeks in normal embryos, and most patients received their routine first TVS scan at that time. However, 40 cases were diagnosed after 6 weeks; among them, 14 cases postponed their first TVS scan after 6 weeks, while IPs were missed in 26 cases when ≤6 weeks.…”

Section: Discussionmentioning

confidence: 99%

Heterotopic Interstitial Pregnancy: Early Ultrasound Diagnosis of 179 Cases After In Vitro Fertilization‐Embryo Transfer

Cai

Ouyang

2022

J of Ultrasound Medicine

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Objectives-What is the role of transvaginal sonography (TVS) in the early diagnosis of hectopic interstitial pregnancy (HIP) after in vitro fertilization-embryo transfer (IVF-ET)?Methods-A retrospective observational study was conducted from January 2005 to December 2018. Routine two-dimensional and three-dimensional TVS were used to confirm clinical pregnancy. Women were diagnosed with HIP when an intrauterine gestational sac was combined with an extrauterine chorionic sac, which was at least 1 cm away from the uterine cavity and surrounded by a thin myometrial layer (<5 mm). Surgery and pathology results were the gold standard for diagnosing interstitial pregnancy. Non-surgical patients were excluded from the study. The performance of TVS and the pregnancy outcomes of intrauterine pregnancies (IUPs) were evaluated.Results-A total of 97,161 women underwent IVF treatment and TVS examinations in our hospital during this study. Of these, 194 patients were diagnosed with HIP, with an incidence of 0.2% (194/97,161). Surgical and pathological findings confirmed 179 interstitial pregnancies, of which 174 were diagnosed by TVS, 4 were missed, and 1 was misdiagnosed. The sensitivity of TVS diagnosis was 97.8% and the positive predictive value was 99.4%. The mean time to diagnosis was 31 days after transplantation. One hundred and thirty-nine cases of HIP (77.7%) were diagnosed at the time of initial TVS examination. In 132 patients (73.7%), IUPs resulted in live births.Conclusions-In our practice, most HIPs following IVF-ET can be accurately diagnosed by TVS, which facilitates early management of interstitial pregnancies and enables high live birth rates for IUPs.

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“…Kwon et al [10] have recently argued that in those hemodynamically stable women who present a heterotopic interstitial pregnancy with cardiac activity in the extrauterine embryo, the best therapeutic option is sacular aspiration with KCl injection since it is a less invasive technique, with less blood loss, with less surgical morbidity and that preserves the fertility of the patient. We hypothesize that this technique would also be of choice in cases in which the HP is in locations of difficult surgical access such as the cervix, as in the case presented here, a previous caesarean section scar or at the cornual level [5,11].…”

Section: Discussionmentioning

confidence: 99%

A case of heterotopic pregnancy with intrauterine and cervical pregnancy coexisting: intrasacular KCl injection, intrauterine pregnancy being preserved, and then massive bleeding at 32 weeks

Sierra¹,

Romera²,

Luján³

et al. 2022

Clin. Exp. Obstet. Gynecol.

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Background: Heterotopic pregnancy is the condition in which intrauterine and ectopic pregnancy coexist. The conservative management of the ectopic pregnancy, with the intrauterine pregnancy preserved, has been reported. Case(s): Here, we report a very rare case: intrauterine and cervical pregnancy coexist: intrasacular Potassium chloride (KCL) injection successfully terminated cervical pregnancy with intrauterine pregnancy preserved, but later massive bleeding occurred from the cervix. A 39-year-old woman at 7 +1 weeks was diagnosed with a heterotopic cervical gestation, with intrauterine and cervical sac, both with live embryos. The ectopic pregnancy was successfully terminated with intrasacular injection of KCl, preserving the intrauterine pregnancy. At 32 +4 weeks of gestation the patient started with a profuse bleeding from the cervical sac, causing maternal hypotension (80/45 mmHg) and tachycardia (160 bpm) and a decelerative pattern in the cardiotocographic fetal monitoring, prompting us to perform caesarean section. The cessation of bleeding was achieved using a double balloon intracervical catheter, which was withdrawn 24 hours after its insertion without observing a new bleeding episode. The patient was discharged after 8 days and the newborn after 35 days of life, both in good health. Conclusions: Conservative treatment of a heterotopic gestation is possible, managing to preserve the viability of the intrauterine pregnancy.

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Non-surgical management and obstetric outcomes of heterotopic interstitial pregnancies

Cited by 9 publications

References 20 publications

Successful Ultrasound-Guided Methotrexate Intervention in the Treatment of Heterotopic Interstitial Pregnancy: A Case Report and Literature Review

Successful Ultrasound-Guided Methotrexate Intervention in the Treatment of Heterotopic Interstitial Pregnancy: A Case Report and Literature Review

Heterotopic Interstitial Pregnancy: Early Ultrasound Diagnosis of 179 Cases After In Vitro Fertilization‐Embryo Transfer

A case of heterotopic pregnancy with intrauterine and cervical pregnancy coexisting: intrasacular KCl injection, intrauterine pregnancy being preserved, and then massive bleeding at 32 weeks

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