Successful hysteroscopic management of two cases of interstitial pregnancy

Abstract

Introduction. Interstitial pregnancy (IP) is the rarest type of tubal pregnancy which has a high rupture rate and often remains asymptomatic in the first 10-12 gestational weeks. Therefore, the timing of the diagnosis is crucial for successful management. Case reports. Two patients, aged 24 and 22, were diagnosed with IP using transvaginal ultrasound. Both patients were asymptomatic, with initial serum bhCG of 6 664 and 4641 mIU/mL, respectively. Since they refused treatment with methotrexate and wanted to preserve their fertility, we have performed operative hysteroscopy with resection and evacuation of the gestational tissue. The procedures were uneventful. bhCG levels dropped significantly, and the patients were discharged after three and four hospital days, respectively. Conclusion. We have successfully treated two asymptomatic patients with IP of gestational age < 10 weeks by ultrasonography and levels of serum bhCG < 7000 mIU/mL. With the occurrence of IP but also numerous advantages of hysteroscopy, we aim for larger, multicenter studies to further investigate the place of this approach as a single treatment method for IP. Consequences and trends observed during the COVID 19 pandemics correlate with the importance of timely diagnosis of ectopic pregnancies, benefits of a minimally invasive approach in their treatment, and epidemiologically justified shorter hospital stay.