Diagnosis and treatment of complicated interstitial pregnancy

Abstract

To review the diagnosis and treatment of interstitial pregnancy. Four cases with complicated interstitial pregnancy were diagnosed and treated from January, 2004 to June, 2007 at the Affiliated Obstetrics and Gynecology Hospital, College of Medicine, Zhejiang University. The clinical data and follow-up records were analyzed retrospectively. All 4 nulliparous patients were misdiagnosed before operation. The median age was 30 years (25-34 years), and the median duration of amenorrhea was 48 days (37-58 days). The median concentrations of serum beta-hCG were 3245.5 IU/L (282-30729 IU/L). Two patients with interstitial pregnancy had high levels of beta-hCG, and were diagnosed and treated under laparoscopy. Among them one patient was underwent transcervical curettage under laparoscopic guidance,and another underwent laparoscopic salpingotomy. The remained two patients had low levels of beta-hCG, and were diagnosed and treated under hysteroscopy, 50 mg methorexate(MTX)was injected into the implanted sites under hysteroscopic guidance. The levels of serum beta-hCG in 4 patients dropped down quickly, reaching undetected levels at a mean duration of 13 days after operation. Three months postoperatively, ultrasonic examination revealed the normal contour of uterus. Endoscopic examination is helpful to make a correct diagnosis, and transcervical curettage (or transcatheter chemotherapy) under laparoscopic guidance (or under hysteroscopic guidance) may be a promising approach for young or nulliparous women with interstitial pregnancy who want to maintain future fertility.