An interstitial ectopic pregnancy managed with laparoscopic cornual resection

Abstract

Introduction: Interstitial ectopic pregnancy is a rare type of tubal ectopic pregnancy associated with increased case fatality rate due to profuse haemorrhage. It is initially asymptomatic and ruptured later than other tubal ectopic pregnancies. Case report: A 31 years old primigravida presented with per vaginal bleeding at period of amenorrhoea of six weeks. Her examination findings were unremarkable and transvaginal scan revealed left sided interstitial pregnancy. Her initial serum beta human Chorionic Gonadotropin (β-hCG) level was 7300 mIU/ml. As she was haemodynamically stable, there were no signs of rupture and serum β-hCG was dropping, she was initially managed expectantly. As she developed abdominal pain with per vaginal bleeding and drop in serum β-hCG was slow, expectant management was abandoned and surgical management was planned. Laparoscopy was performed and revealed a left sided interstitial pregnancy with thinned out myometrium. As laparoscopy guided transcervical suction evacuation has failed, laparoscopic corneal resection was performed after vasopressin infiltration into myometrium. She had uneventful recovery and was followed up until her serum β-hCG became less than 30 IU/L. Discussion: An Interstitial ectopic pregnancy must be differentiated from cornual and angular pregnancies with clearly defined ultrasound diagnostic criteria. Three dimensional (3D) ultrasound and magnetic resonance imaging (MRI) will further help in diagnosis of interstitial ectopic pregnancy. It can be managed expectantly, medically or surgically depending on the patient’s clinical condition, preference and serum β-hCG level.