Abstract
Objective:Ectopic pregnancy in the interstitial part of the Fallopian tubes can be life-threatining considering the thin myometrial tissue surrounding the gestational sac and highly vascularization which may result in catastrophic haemorrhage when interstitium is ruptured. The diagnosis and management is challenging. Conservative, medical, and surgical treatment options should be considered based on individual patient factors.Methods:Four women were diagnosed with interstitial pregnancy in last five years in our tertiary center. Four different treatment modalities, including single dose methotrexate, laparotomy, hysteroscopy followed by vacuum aspiration, and vacuum aspiration under laparoscopy were performed according to patients’ characteristics.Results:. Successful outcome was achieved in all patients.Conclusion:Interstitial pregnancy can be successfully treated with a single dose systemic methotrexate when all criteria are met. The classical cornual wedge resection remains lifesaving operation for cases of ruptured interstitial pregnancy. Less invasive procedures such as laparoscopic assisted transcervical vacuum aspiration and diagnostic hysteroscopy followed by vacuum aspiration can be performed in selected cases.
Highlights
Interstitial pregnancy is a rare type of ectopic pregnancy that accounts for 2-4% of all ectopic pregnancies, and almost 20% of all deaths caused by ectopic pregnancy.[1]
‘The interstitial line sign’ that extends from the upper region of the uterine horn to border the intramural portion of the fallopian tube has been used in the past for diagnosis of this rare type of ectopic pregnancy.[4]
The patient’s story of laparoscopic salpingectomy due to ectopic pregnancy prompted taking this diagnosis into consideration, as ipsilateral salpingectomy has been reported as a unique risk factor for this rare type of ectopic pregnancy.[3]
Summary
Ilker Kahramanoglu[1], Zahid Mammadov[2], Hasan Turan[3], Aslihan Urer[4], Abdullah Tuten[5]
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