Diagnosis pitfall of interstitial pregnancy: a case report of a term pregnancy with abnormal placentation

Fatemeh Sadat Najib,Homeira Vafaei,Amin Abolhasan Foroughi,Niloofar Namazi

doi:10.1186/s12884-021-04153-1

Fatemeh Sadat Najib, Homeira Vafaei + Show 2 more

Open Access

https://doi.org/10.1186/s12884-021-04153-1

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Abstract

BackgroundInterstitial Pregnancy (IP) is a lethal condition due to high risk of sudden onset massive hemorrhage. Such conditions are managed as soon as diagnosed almost in the first trimester. There are a few case reports of IP conditions terminated after the second trimester. Herein, we introduce a term interstitial pregnancy complicated by abnormal placentation.Case presentationIn this case report, we introduce a 32-year-old lady, primigravida, with an undiagnosed IP that was in her 38 weeks of gestational with placenta increta. She developed with perforated IP presenting with acute abdomen and internal bleeding at 26 weeks of gestational age. However, with a misdiagnosis impression, she got stable in operation room. Then, the pregnancy continued till 36 weeks of gestational age that was misdiagnosed with cervical cancer in prenatal work-ups. Finally, during elective cesarean section at 38 weeks, an IP with placenta increta (placenta evading from the serosa to the myometrium of the uterus) was observed. The baby was healthy with no obvious anomaly or morbidity.ConclusionsPhysicians should be aware to detect IP in all trimesters and pay attention to the coexisting complications such as placenta accreta to manage them more accurately.

Highlights

Interstitial Pregnancy (IP) is a lethal condition due to high risk of sudden onset massive hemorrhage
It is estimated that it accounts for less than 3% of ectopic pregnancies [1, 2]. It may remain asymptomatic in the first 14–16 weeks of pregnancy [3], it is mostly ruptured after the first trimester that leads to massive hemorrhage due to high vascularity [4]
High vascularity of abnormal placentation in MRI was another diagnosis pitfall that was labeled as cervical cancer

Summary

Introduction

Interstitial Pregnancy (IP) is a lethal condition due to high risk of sudden onset massive hemorrhage. The rarity of this case report is delivery a full term misdiagnosed interstitial pregnancy complicated by placenta increta. At gestational age of 36 weeks and 4 days, she was referred to our high-risk perinatology clinic affiliated to Shiraz University of Medical Sciences which is a referral center of perinatology in the south of Iran due to suspicion to cervical malignancy in a local sonography.

Results

Conclusion