Interstitial pregnancy

Abstract

This case describes the use of ultrasound and Doppler imaging for the diagnosis of an interstitial ectopic pregnancy. Interstitial pregnancy is rare, occurring in 2%–4% of all extrauterine pregnancies; sudden rupture and profuse bleeding make it a potentially life-threatening condition (1Idama T.O Tuck C.S Ivory C Ellerington M.C Travis S Survival of cornual (interstitial) pregnancy.Eur J Obstet Gynecol Reprod Biol. 1999; 84: 103-105Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar). Management options depend upon the timing of the diagnosis and the patient’s desire for maintenance of fertility. Currently, medical treatment with methotrexate (either systemically or locally) or surgery (either by laparotomy or laparoscopy) are the two most widely accepted forms of treatment (2Lau S Tulandi T Conservative medical and surgical management of interstitial ectopic pregnancy.Fertil Steril. 1999; 72: 207-215Abstract Full Text Full Text PDF PubMed Scopus (273) Google Scholar). A 23-year-old (G5 P1121) woman at 11.5 weeks of amenorrhea came to the emergency department complaining of vaginal bleeding but was otherwise asymptomatic. A quantitative hCG level was reported as 15,127 IU/mL. Transvaginal ultrasound examination of the uterus revealed an extrauterine pregnancy in the interstitial region (Fig. 1, top left). A subsequent Doppler flow evaluation revealed an increased blood flow to that area, consistent with the diagnosis (Fig. 1, top right). Diagnostic laparoscopy examination confirmed the location of the gestation (Fig. 1, bottom). Because of the large size of the fetus, the patient underwent a laparotomy, during which a cornual resection was performed without complications. The patient was discharged home 48 hours later without incident.