Current diagnosis and treatment of interstitial pregnancy

Interstitial pregnancy is rare and dangerous variation of ectopic pregnancy. We describe a case of unilateral interstitial viable twin pregnancy treated by selective uterine artery embolization. A 23-year-old women with clinical and ultrasonic diagnosis of viable twin interstitial pregnancy was treated by selective uterine artery embolization after failure of systemic methotrexate treatment. Her serum beta-HCG was undetectable 2 months after the procedure and the ultrasound scan 70 days after embolization showed only multiple echogenic spots in the right uterine cornua. This therapeutic modality seems to be effective for conservative management of interstitial ectopic pregnancy, and as a prophylactic measure before surgical intervention to prevent major bleeding.

Uterine artery embolization for management of interstitial twin ectopic pregnancy: Case report

Cornual gestation: A systematic literature review and two case reports of a novel treatment regimen

The objective of this article is to review the published literature on the diagnosis and management of interstitial pregnancies (IPs). IPs account for 2–6% of all ectopic pregnancies and have the potential to cause life-threatening haemorrhage resulting in a 2–5% mortality rate. There is little consensus on the best practice for diagnosing and managing interstitial pregnancies. By reviewing the published data, we set out to determine what the best evidence-based practice for the management of interstitial ectopic pregnancies is, what protocols can be used and whether this improves post-operative outcomes and future fertility rates.

/pdf/the-diagnosis-and-management-of-interstitial-ectopic-45ehqju3s1.pdf

The diagnosis and management of interstitial ectopic pregnancies: a review

Background
Interstitial and cornual ectopic pregnancy is rare, accounting for 2–4% of ectopic pregnancies and remains the most difficult type of ectopic pregnancy to diagnose due to low sensitivity and specificity of symptoms and imaging. The classic triad of ectopic pregnancy—abdominal pain, amenorrhea and vaginal bleeding—occurs in less than 40% of patients. The site of implantation in the intrauterine portion of fallopian tube and invasion through the uterine wall make this pregnancy difficult to differentiate from an intrauterine pregnancy on ultrasound. The high mortality in this type of pregnancy is partially due to delay in diagnosis as well as the speed of hemorrhage.

/pdf/interstitial-and-cornual-ectopic-pregnancy-conservative-4ovmw8q04e.pdf

Interstitial and Cornual Ectopic Pregnancy: Conservative Surgical and Medical Management

Objective

To assess the effectiveness of non-surgical management of interstitial pregnancy.



Design

A prospective interventional study.



Subjects

Eleven women with the ultrasound diagnosis of interstitial ectopic pregnancy.



Methods

Women with suspected early pregnancy complications were examined by transvaginal ultrasound. Those with the diagnosis of interstitial pregnancy were offered non-surgical treatment with methotrexate, which was administered systemically or by local injection. Follow-up with regular measurements of s-human chorionic gonadoropin and ultrasound scans continued until the pregnancy had resolved completely.



Results

Ten women were managed non-surgically, and one woman opted for surgery. Five women received systemic and five local methotrexate. Local therapy was successful in all five cases (100%), whereas four out of five (80%) women receiving systemic methotrexate were cured. Significant side-effects were noted in two women following systemic therapy. In comparison, there were no side-effects in the group of women who received local therapy. There were no significant differences between the two treatment groups in the length of time taken for the pregnancy to resolve.



Conclusions

Non-surgical treatment of interstitial pregnancy with methotrexate appears to be safe and effective. Local administration appears to be more successful and better tolerated by patients and may be used as the first-line therapy. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology

The effectiveness of non-surgical management of early interstitial pregnancy: a report of ten cases and review of the literature.

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The effectiveness of non-surgical management of early interstitial pregnancy: a report of ten cases and review of the literature.