Case Of Interstitial Pregnancy Research Articles

Successful hysteroscopic management of two cases of interstitial pregnancy

Introduction. Interstitial pregnancy (IP) is the rarest type of tubal pregnancy with a high rupture rate and often remains asymptomatic in the first 10?12 gestational weeks. Therefore, the timing of the diagnosis is crucial for successful management. Case report. Two patients, aged 28 and 22, were diagnosed with IP using transvaginal ultrasound. Both patients were asymptomatic, with initial serum ?hCG of 6,664 mIU/mL and 4,641 mIU/mL, respectively. Since they refused treatment with methotrexate and wanted to preserve their fertility, we performed operative hysteroscopy with resection and evacuation of the gestational tissue. The procedures were uneventful. The ?hCG levels dropped significantly, and the patients were discharged after three and four hospital days, respectively. Conclusion. Using hysteroscopic procedures, we successfully treated two asymptomatic patients with IP of gestational age < 10 weeks by ultrasonography and levels of serum ?hCG < 7,000 mIU/mL. With the occurrence of IP but also the numerous advantages of hysteroscopy, large, multicenter studies are necessary to further investigate the place of this approach as a single treatment method for IP. Trends and consequences observed during the COVID-19 pandemic correlate with the importance of timely diagnosis of ectopic pregnancies, the benefits of a minimally invasive approach in their treatment, and epidemiologically justified shorter hospital stays.

Two cases of interstitial pregnancy after ipsilateral salpingectomy

Two cases of interstitial pregnancy after ipsilateral salpingectomy

Operative hysteroscopy and interstitial pregnancy. Potential of minimally invasive intervention

This article presents a clinical case of interstitial pregnancy, in which operative hysteroscopy was the main treatment method. The original technique of intrauterine surgery, which consists of four stages, was introduced. Indications and conditions for operative hysteroscopy in interstitial pregnancy were developed. Key words: interstitial pregnancy, operative hysteroscopy, laparoscopy, ultrasonography

Selective medical treatment of heterotopic interstitial pregnancy

A new case of interstitial pregnancy after embryos transfer is reported. The interstitial pregnancy was one of twin pregnancy who was diagnosed sonographically and selectively interrupted at the 15th week. The residual pregnancy ended in an elective cesarean section early term.

The Ethics of Interstitial and Cesarean Scar Ectopic Pregnancies: Four Case Studies and a Review of the Literature.

Catholic bioethicists have extensively addressed extrauterine tubal pregnancies, which represent the great majority of ectopic pregnancies. However, additional management options have been developed for the other 7-10 percent of ectopic pregnancies. Using two cases of interstitial pregnancy and two cases of cesarean scar pregnancy (CSP) seen at a Catholic tertiary care center, this article discusses options including expectant management, systemic methotrexate, intragestational methotrexate, intragestational potassium chloride, uterine artery embolization, dilation and curettage (D&C), vasopressin use, cornuostomy, cornual wedge resection, CSP evacuation, CSP scar excision, CSP salvage, and hysterectomy. Cornual wedge resection, vasopressin use, and CSP scar excision are morally acceptable; less clearly licit are aspiration of gestational sac contents, cornuostomy, gestational excision for CSPs, and methotrexate. Certainly illicit are any techniques leading to direct abortion such as D&Cs on live embryos or fetuses, double-balloon catheter placement, and use of potassium chloride. Summary: An ectopic pregnancy is any pregnancy outside the uterus. These are dangerous because the pregnancy can burst out of its abnormal location and cause life-threatening internal bleeding. Most are in the part of the fallopian tube outside the uterus, but there are other types, including interstitial pregnancies (located in the part of the tube tunneling through the uterine wall) and cesarean scar pregnancies (buried in the uterine scar where the cut for a C-section was made). This article lists the ways that physicians prevent women from dying from interstitial and cesarean scar pregnancies and proposes which treatments are morally acceptable.

Interstitial and Cornual Ectopic Pregnancy: Conservative Surgical and Medical Management

Interstitial and cornual ectopic pregnancy is rare, accounting for 2-4% of ectopic pregnancies and remains the most difficult type of ectopic pregnancy to diagnose due to low sensitivity and specificity of symptoms and imaging. The classic triad of ectopic pregnancy-abdominal pain, amenorrhea and vaginal bleeding-occurs in less than 40% of patients. The site of implantation in the intrauterine portion of fallopian tube and invasion through the uterine wall make this pregnancy difficult to differentiate from an intrauterine pregnancy on ultrasound. The high mortality in this type of pregnancy is partially due to delay in diagnosis as well as the speed of hemorrhage. Three cases of interstitial pregnancy were retrospectively analyzed. Successful laparoscopic cornuostomy and removal of products of conception were performed in two cases, while one case was successfully managed by local injection with KCL and methotrexate followed by systemic methotrexate. Early diagnosis and timely management are key to the management of interstitial and cornual ectopic pregnancy. With expertise in ultrasound imaging and advances in laparoscopic skills progressively, conservative medical and surgical measures are being used to treat interstitial and cornual ectopic pregnancy successfully.

正常子宮内妊娠と判断されたが卵管間質部妊娠であった一例

正常子宮内妊娠と判断されたが卵管間質部妊娠であった一例

Laparoscopic temporary clipping of uterine and ovarian arteries for the treatment of interstitial ectopic pregnancy

Purpose of investigation: To assess the effect of laparoscopic temporary clipping of uterine and ovarian arteries for the treatment of interstitial ectopic pregnancy. Materials and Methods: A 29-year-old woman with vaginal bleeding and pelvic pain was admitted to thecurrent clinic. She had secondary amenorrhea for nine weeks. Transvaginal ultrasonography revealed normal empty uterus and right interstitial ectopic pregnancy with viable embryo. Laparoscopic temporary clipping of uterine and ovarian arteries, interstitial pregnancy resection, and primary myometrial suturing was performed. Results: Following dissection Latzko pararectal space for the visualization of both uterine arteries, four vascular clips were placed (two to uterine arteries, two to infundibulopelvic ligaments). Excision of interstitial pregnancy and primary myometrial suturing was performed with minimal blood loss. The patient was discharged from the hospital after one day without any remarkable complications. Conclusions: To the best of the authors’ knowledge, this is the first case of interstitial pregnancy that was successfully treated by temporary laparoscopic clipping of uterine and ovarian vessels prior to interstitial ectopic pregnancy resection.

Successful Treatment of Interstitial Ectopic Pregnancy Using Courses of Methotrexate and Folinic Acid Rescue: A Case Report

The diagnosis of interstitial pregnancy (IP) is a challenge to the healthcare provider and has been documented to be the most difficult ectopic pregnancy (EP) to be diagnosed or managed. Unlike the diagnosis of other forms of EP that has now become precise and reliable, the diagnosis of IP has remained a challenge. Here, we report a case of IP that was suspected intraoperatively during evacuation of retained product of conception. It was successfully managed medically using methotrexate and folinic acid rescue.

Pivotal points in interstitial pregnancy: New insights in conservative medical treatment of non-ruptured interstitial pregnancy

We report the efficacy of a minimally invasive approach of the multidose protocol with methotrexate (MTX) in the management of three cases of interstitial pregnancy (IP), with elevated serum β-hCG in two cases. New considerations and management strategies are discussed. Successful termination of IP and in one case, a subsequent successful pregnancy, was achieved. The process led to the development of an enhanced understanding of diagnostic modalities and their limitations, with regard to the particular entities under discussion. We also focused attention on pivotal points and anatomical features in the management of this dangerous occurrence. Long-term results with careful follow-up were analysed by instrumental procedure. This hazardous type of ectopic pregnancy can be managed with systemic administration of MTX, also in patients with elevated β-hCG values. The present report underlines that an integrated approach in early diagnosis, multidose treatment and close follow-up, are essential forms of medical management.

Laparoscopic management of interstitial pregnancy: the “purse‐string” technique

We report five cases of interstitial pregnancy, treated between 2004 and 2010, to evaluate surgical and obstetric outcome of laparoscopic cornual resection with a "purse-string" technique. A hemostatic suture was passed at the base of the mass in a purse-string fashion prior to resection, to minimize intraoperative blood loss. Subsequent pregnancies were analysed, with a mean follow-up time of 48 months. The mean operating time was 39 min and mean blood loss 47 mL. Three of four patients who desired children delivered at term uneventfully. Laparoscopic cornual resection with a "purse-string" technique appears to be useful for treatment of early interstitial pregnancy. The technique ensures effective and safe treatment, with satisfactory obstetric outcome.

Diagnosis of an interstitial pregnancy with 4-dimensional volume contrast imaging

The purpose of this study was to investigate the use of a new ultrasound technique, termed 4-dimensional volume contrast imaging in coronal-plane to facilitate the early detection of interstitial pregnancy. A case of interstitial pregnancy was diagnosed accurately at 6 weeks of gestation with 4-dimensional transvaginal volume contrast imaging in coronal plane technology. A scan of the uterus revealed that the eccentric gestational sac was located in the right uterotubal junctional area, lying 1 cm outside the most upper lateral edge of the uterine cavity with thick endometrial echoes. After the appropriate counseling, the patient was treated with an ultrasonographically guided intracardiac injection of 2.5 mEq of potassium chloride followed by aspiration of the gestational sac. A transvaginal scan immediately after the procedure demonstrated a collapsed empty gestational sac. Three months after the conservative treatment, the serum beta-human chorionic gonadotropin level fell to 1.17 mIU/mL, and normal echotexture of the uterus was noted. Four-dimensional volume contrast imaging in coronal-plane technology provides scan planes that are not accessible by conventional 2-dimensional scanning, with enhanced tissue contrast resolution in region of interest. This new ultrasound technique has the potential to provide more accurate, inexpensive and less variable virtual reality image-guided interventional options through more realistic interaction with the virtualized in utero condition, particularly when 2-dimensional transvaginal scan fails to differentiate between interstitial, angular, and cornual pregnancies.

Interstitial pregnancy: role of MRI

We report the MRI features of two cases of interstitial pregnancy. In both cases, MRI was able to localize the ectopic pregnancy by showing a gestational structure surrounded by a thick wall in the upper part of the uterine wall separated from the endometrium by an uninterrupted junctional zone. Because US may confuse angular and interstitial pregnancies and because interstitial pregnancy has a particular evolutive course, MR imaging may play a key role in the diagnosis and management of women with interstitial pregnancy.

A case of interstitial pregnancy which could be performed laparoscopic operation after methotrexate intramuscular injection

A case of interstitial pregnancy which could be performed laparoscopic operation after methotrexate intramuscular injection

Usefulness of Long-Jaw Forceps in Laparoscopic Cornual Resection of Interstitial Pregnancies

Although laparoscopic surgery could be an option for treating interstitial pregnancies, it has not gained wide acceptance largely because of difficulty achieving hemostasis. To overcome this, we employed long-jaw forceps in three cases of interstitial pregnancy that were successfully treated by laparoscopic cornual resection. The forceps grasped a relatively large portion of pregnant myometrium without slipping, thus securing hemostasis and facilitating suturing.

Expectant management of interstitial pregnancy.

A case of interstitial pregnancy is described. Transvaginal ultrasound examination, performed at 8 weeks' gestation, revealed an empty endometrial cavity with an eccentric gestational sac in the left uterine corner, with a clear separation between the uterine cavity (endometrium) and the gestational sac. Expectant management, consisting of repeated sonographic examinations and assessment of serum beta-human chorionic gonadotropin, resulted in a favorable outcome.

Local medical treatment of interstitial pregnancy after in-vitro fertilization and embryo transfer (IVF—ET): two case reports

Two cases of interstitial pregnancy (one singleton, one heterotopic twins) were confirmed 31 and 34 days after in-vitro fertilization. Serum human chorionic gonadotrophin concentrations were 35,000 and 86,000 mlU/ml, respectively. They were treated conservatively with transvaginal ultrasonically guided intra-ovular injection of either methotrexate in the singleton pregnancy, or potassium chloride into the ectopic sac of the heterotopic twins. No complications were observed. The intra-uterine pregnancy continued and the patient delivered a 3350 g healthy baby at 39 weeks.

Ultrasound diagnosis of interstitial pregnancy

A case of interstitial pregnancy is reported. The diagnosis was made by ultrasound examination in an asymptomatic patient at risk for ectopic pregnancy following cornual anastomosis. Characteristic sonographic signs are discussed, with a review of the literature.

A Case of Interstitial Pregnancy (Unruptured)

A Case of Interstitial Pregnancy (Unruptured)

Interstitial tubal pregnancy.

SummaryThe diagnosis and management of 4 cases of interstitial pregnancy (1 in 2,600 deliveries) is presented.