Detection of Interstitial Pregnancy with Rupture by Point-of-Care Ultrasound at Emergency Department: A Case Report

Abstract

The interstitial portion of the fallopian tube is the proximal segment that is embedded within the muscular wall of the uterus. A pregnancy implanted at this site is called an interstitial pregnancy. Interstitial pregnancies are more dangerous than other types of ectopic pregnancies, as they tend to rupture later because of greater dispensability of the covering myometrium and lead to devastating hemorrhages. In this obstetric emergency, detection of hemoperitoneum by using point-of-care ultrasound (POC-US) may be life-saving. Case report and literature review. A 25-year-old woman, gravid 2, para 1, was pregnancy at 9 3/7 weeks of gestation, visited our Emergency Department (ED) due to progressive lower abdominal pain for one day. Point-of-care Ultrasound (POC-US) was performed by ED physician with free fluid in cavity and no gestation sac in uterine cavity seen (Figure 1). Right interstitial pregnancy was suspected and was proved by emergent laparotomy. Right cornual resection was performed. She was discharged days later and improvement was documented on the medical record at Outpatient Department. Interstitial pregnancy compromises about 2-3% of all ectopic pregnancies and may be misdiagnosed as intrauterine because it is partially implanted in the endometrium. Undiagnosed interstitial pregnancies usually rupture following 8 to 16 weeks of amenorrhea and are associated with mortality rate as high as 2.5% due to risk of severe hemorrhage. It is vital for ED physician to detect the acute abdomen in pregnant patients. Utilizing POC-US, ED physicians could rapidly identify hemoperitoneum and expedite the operative management in this patient. POC-US is a useful tool at ED because it provides real-time images for lesions detection and demonstrates the dynamic changes if is being performed repeatedly. Its non-invasive and radiation-free properties make it safer for pregnant woman and may be used as the primary tool to screen obstetric emergency.