Abstract
BackgroundInterstitial pregnancies are rare and often difficult to diagnose given their proximal position to the uterine cavity, however most are identified by 12 weeks gestation. Delayed or missed diagnosis contributes to heightened incidence of poor outcomes including hemorrhage and death.Case presentationA 35-year-old woman at 15 weeks gestation with confirmed intrauterine pregnancy on first trimester ultrasound and prior negative MRI presented in hemorrhagic shock and was found to have a ruptured interstitial pregnancy. Exploratory laparotomy revealed the fetus to be in the abdomen as well as a large cornual defect and abnormal placentation that resulted in supracervical hysterectomy.ConclusionsInterstitial pregnancy should be considered in a patient presenting with symptoms consistent with ectopic rupture, especially in the setting of equivocal or suboptimal prior imaging. Earlier diagnosis may allow for fertility-sparing intervention and decreased risk of morbidity and mortality.
Highlights
ConclusionsInterstitial pregnancy should be considered in a patient presenting with symptoms consistent with ectopic rupture, especially in the setting of equivocal or suboptimal prior imaging
Interstitial pregnancies are rare and often difficult to diagnose given their proximal position to the uterine cavity, most are identified by 12 weeks gestation
2) Clinical suspicion for an interstitial ectopic pregnancy should remain high if a patient has persistent symptoms consistent with an ectopic pregnancy despite prior imaging indicating an intrauterine pregnancy
Summary
Interstitial pregnancy should be considered in a patient presenting with symptoms consistent with ectopic rupture, especially in the setting of equivocal or suboptimal prior imaging. Earlier diagnosis may allow for fertility-sparing intervention and decreased risk of morbidity and mortality. 1) First trimester dating ultrasounds and even advanced imaging such as MRI have difficulty visualizing and definitively diagnosing interstitial ectopic pregnancies. 2) Clinical suspicion for an interstitial ectopic pregnancy should remain high if a patient has persistent symptoms consistent with an ectopic pregnancy despite prior imaging indicating an intrauterine pregnancy. 3) While fertility-preserving and conservative surgical approaches are the ideal management for an interstitial ectopic pregnancy, in certain cases hysterectomy may be necessary
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