Early Diagnosis of Interstitial Pregnancy Associated to Assisted Reproductive Techniques Case Report

Mercedes Del Pilar Alvarez Goris,Abraham Zavala Garcia

doi:10.21767/2476-1974.100031

Abstract

Background: 2.4% of ectopic pregnancies develop in the interstitial portion of the fallopian tube and is associated over to a 2.5% mortality rate, in contrast to other forms of tubal ectopic pregnancy with a lower mortality rate. Case Report: A patient with a 5 years history of primary infertility and severe endometriosis undergoes an in vitro fertilization (IVF) after pituitary suppression. Embryos were transferred and a month afterward, ultrasonography examination reported an 18 mm gestational sac, with an embryo in the left adnexal mass. However, an empty uterine cavity is reported in spite of an elevated human chorionic gonadotropin beta fraction. Because of this a diagnostic/ operative laparoscopy is performed. The histopathology result reports a left interstitial ectopic pregnancy. The patient progresses through an uneventful postoperative period, and is checked-out the next day in proper clinical status. Conclusion: Ectopic pregnancy is a complication of assisted reproduction techniques and interstitial pregnancy is a rare form of tubal pregnancy posing a diagnostic challenge and a life-threatening condition due to the risk of massive bleeding. Hence, clinical suspicion of an interstitial pregnancy requires a quick intervention to avoid a potentially life-threatening situation.

Highlights

The incidence of tubal sterilization failure is estimated to be between 0.13 and 1.3%; of these cases, 15-33% present as ectopic pregnancies
Literature sometimes differentiates between the terms by stating that a cornual pregnancy is found in the endometrium of the cornus of a bicornual/unicornual uterus, or even outside the endometrial cavity, while an interstitial pregnancy is found within the union of the uterus and the proximal portion of the Fallopian tube [6,7,8]
Risk factors for interstitial pregnancy are similar to those of other types of ectopic pregnancy: Pelvic inflammatory disease, previous tubal surgery, previous ectopic pregnancy, and factors associated to assisted reproduction techniques, such as multiple embryo transfers, or embryos transferred in close proximity to the uterine cornua, and excessive pressure of the syringe during embryo transfer

Summary

Introduction

The incidence of tubal sterilization failure is estimated to be between 0.13 and 1.3%; of these cases, 15-33% present as ectopic pregnancies. The incidence of ectopic pregnancy is 1-2% in all pregnancies [2], and interstitial pregnancy is a rare form of tubal The patient checks-in to our fertility clinic for the first time, and a gynecologic hormonal assay is performed, along with Ca-125 levels as an indirect marker for endometriosis (Table 1).

Results

Conclusion