Large Interstitial Ectopic Pregnancy: Management by Laparoscopic Cornuostomy Following Initial Misdiagnosis.

Shweta Mittal,Bhawani Shekhar

doi:10.7759/cureus.19280

Abstract

The purpose of the present report is to highlight the challenges in diagnosing interstitial ectopic pregnancy and to describe its management by laparoscopic cornuostomy. A 28-year-old gravida 3, para 1 woman was referred to us at 12 weeks period of gestation after failed medical termination following a diagnosis of missed abortion. On presenting to us, a large interstitial ectopic pregnancy was diagnosed by ultrasonography and managed by laparoscopic cornuostomy. Intra myometrial vasopressin and purse string sutures at the base of ectopic pregnancy bulge were used to reduce intra-operative bleeding. Intra-operative blood loss was 50 ml. Patient was discharged after two days of surgery. Interstitial pregnancy may be misdiagnosed as an intrauterine pregnancy, due to lack of suspicion and expertise. Large interstitial ectopic pregnancies can be successfully managed by a conservative surgical approach such as laparoscopic cornuostomy instead of cornual resection or hysterectomy.

Highlights

Interstitial ectopic pregnancy is defined as a gestation which implants within the proximal tubal segment that lies within the muscular uterine wall [1]
A more conservative surgical approach such as cornuostomy is being preferred over cornual resection or hysterectomy and laparoscopy is being preferred over laparotomy [1]
We describe a case of interstitial pregnancy initially misdiagnosed as missed abortion and eventually managed successfully by laparoscopic cornuostomy

Summary

Introduction

Interstitial ectopic pregnancy is defined as a gestation which implants within the proximal tubal segment that lies within the muscular uterine wall [1]. Interstitial pregnancies are rare, accounting for 2-4% of all ectopic pregnancies [2]. They are associated with high risk of uncontrolled hemorrhage and may be life threatening. Maternal mortality rate in interstitial pregnancies is 2-2.5%, which is seven times higher than ectopic pregnancies overall [3]. Interstitial pregnancy requires early diagnosis and prompt management. Surgical treatment of interstitial pregnancy included cornual resection or hysterectomy. A more conservative surgical approach such as cornuostomy is being preferred over cornual resection or hysterectomy and laparoscopy is being preferred over laparotomy [1]. We describe a case of interstitial pregnancy initially misdiagnosed as missed abortion and eventually managed successfully by laparoscopic cornuostomy

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Discussion

Conclusion