Diagnosis Of Interstitial Ectopic Pregnancy Research Articles

Commentary: Three-dimensional transvaginal ultrasound diagnosis of interstitial ectopic pregnancy in a unicornuate uterus: A case report

A rare case of unicornuate uterus with interstitial ectopic pregnancy (IEP) was diagnosed using three-dimensional transvaginal ultrasound (3D-TVUS). The ultrasound revealed a "lancet-shaped" endometrial corona, a gestational sac near the uterus base extending towards the uterine serosa, and visible interstitial lines. The patient underwent laparoscopic surgery for a lesion in the right fallopian tube. 3D-TVUS was crucial in precisely locating the gestational sac, aiding in effective treatment. Interstitial ectopic pregnancies risk severe hemorrhaging upon rupture. Rapid, accurate diagnosis is vital for lifesaving treatment and preventing critical complications.

An interstitial ectopic pregnancy managed with laparoscopic cornual resection

Introduction: Interstitial ectopic pregnancy is a rare type of tubal ectopic pregnancy associated with increased case fatality rate due to profuse haemorrhage. It is initially asymptomatic and ruptured later than other tubal ectopic pregnancies. Case report: A 31 years old primigravida presented with per vaginal bleeding at period of amenorrhoea of six weeks. Her examination findings were unremarkable and transvaginal scan revealed left sided interstitial pregnancy. Her initial serum beta human Chorionic Gonadotropin (β-hCG) level was 7300 mIU/ml. As she was haemodynamically stable, there were no signs of rupture and serum β-hCG was dropping, she was initially managed expectantly. As she developed abdominal pain with per vaginal bleeding and drop in serum β-hCG was slow, expectant management was abandoned and surgical management was planned. Laparoscopy was performed and revealed a left sided interstitial pregnancy with thinned out myometrium. As laparoscopy guided transcervical suction evacuation has failed, laparoscopic corneal resection was performed after vasopressin infiltration into myometrium. She had uneventful recovery and was followed up until her serum β-hCG became less than 30 IU/L. Discussion: An Interstitial ectopic pregnancy must be differentiated from cornual and angular pregnancies with clearly defined ultrasound diagnostic criteria. Three dimensional (3D) ultrasound and magnetic resonance imaging (MRI) will further help in diagnosis of interstitial ectopic pregnancy. It can be managed expectantly, medically or surgically depending on the patient’s clinical condition, preference and serum β-hCG level.

Methotrexate injection for interstitial pregnancy: Hysteroscopic conservative mini-invasive approach.

Interstitial localisation of ectopic pregnancy is associated with high rates of maternal morbidity and mortality. Considering the rarity of interstitial pregnancy, the optimal treatment regimen remains unclear. We propose the management of interstitial pregnancy with local methotrexate injection using a combined hysteroscopic and ultrasonographic approach. Hysteroscopy was performed under local anaesthesia in the operating room, using a 2.9-mm Hopkins II Forward-Oblique Telescope 30° endoscope with a 4.3-mm inner sheath and 5 FR instruments. A needle was pushed into the cornual region injecting methotrexate solution directly into the gestational sac and into the myometrial tissue tangentially at the four cardinal points. A contemporary transabdominal ultrasound (US) was performed in order to reduce risks of complications. Five patients with an US diagnosis of interstitial ectopic pregnancy admitted to our department between January 2016 and September 2019 were managed with a local hysteroscopic injection of methotrexate. The technique was effective in all patients and no surgical complications occurred during or after the procedure. Three patients were evaluated for tubal patency with contrast ultrasonography confirming bilateral tubal patency 9 months from treatment, while one patient had a spontaneous birth 22 months from their initial surgery. The hysteroscopic ultrasound-guided approach combined with the local injection of methotrexate is a minimally invasive conservative approach that seems to be promising in the management of interstitial ectopic pregnancy.

Ruptured Interstitial Ectopic Pregnancy at 18 Weeks: How Failure of Early Detection Resulted in a Maternal Near-miss

Interstitial ectopic pregnancy occurs when a gestational sac implants within the interstitial portion of the Fallopian tube. It is an uncommon and dangerous type of ectopic pregnancy with high morbidity and mortality. Rupture of interstitial ectopic pregnancy usually leads to life-threatening hemorrhage. This case report illustrates how failure of early detection of interstitial ectopic pregnancy resulted in a maternal near-miss and calls for the need for increased awareness and high index of suspicion among sonographers and clinicians. A case of a 24-year-old gravida two para zero, one previous ectopic pregnancy (G2P01EP) was brought into our facility with generalized abdominal pain and hemorrhagic shock. She had a previous history of left salpingectomy for a ruptured tubal ectopic pregnancy four years earlier at a secondary health care facility. Emergency laparotomy after aggressive resuscitation revealed ruptured interstitial ectopic pregnancy with massive hemoperitoneum and a dead fetus. Wedge resection of the right cornua along with the Fallopian tube was done. Diagnosis of interstitial ectopic pregnancy is challenging due to its rarity and location in the intrauterine portion of the Fallopian tube. Ultrasonographic diagnosis in early pregnancy is key. Awareness creation and a high index of suspicion is required among sonographers and clinicians to prevent needless morbidity and mortality.

A Purse-String Approach to Laparoscopic Cornuostomy for Interstitial Ectopic Pregnancy

Study Objective To review surgical techniques for tissue dissection in interstitial ectopic pregnancies, and demonstrate a novel approach to resection using a purse-string suture for improved hemostasis and minimized surgical morbidity. Design Brief literature review, clinical history, and video documentation. Setting The patients were both placed in a dorsal lithotomy position for laparoscopy in a tertiary care centre. Patients or Participants The two patients selected for inclusion in the video were chosen based upon confirmation of diagnosis of interstitial ectopic pregnancy, and primary surgeon at time of OR for operative consistency. Patient 1 was a 36-year old G5P1 woman who presented with bleeding at 8 weeks 5 days gestational age. Patient 2 was a 35 year-old G2P1 woman who presented with abdominal pain at 11 weeks gestational age, with additional risk factors for surgical complications. Interventions Laparoscopic cornuostomy for interstitial ectopic pregnancy Measurements and Main Results Pre-operatively, both diagnoses were confirmed with serial ultrasound. Findings at time of laparoscopy supported the above, with clear distension at the uterine cornea without normal endometrial implantation Our video demonstrates a four-step approach to resection of such pregnancies through laparoscopic cornuostomy. This includes isolating the pregnancy by salpingectomy and ligation of the utero-ovarian ligament, ensuring hemostasis with a novel purse string suture around the pregnancy at its equatorial line and injection of vasopressin, resection using a linear incision, and a layered repair of the uterine defect. Conclusion Although rare, interstitial ectopic pregnancies present a distinct surgical challenge, as they often present with rupture and carry a significant risk of hemorrhage at time of resection. The purse string suture is a useful tool in minimizing bleeding, and allows for interstitial ectopic pregnancies to be excised with a minimally invasive cornuostomy, even in cases of significant anatomical distortion.

Cornuostomy and Cornuectomy: Laparoscopic Management of Interstitial Ectopic Pregnancies

To demonstrate and contrast 2 techniques of laparoscopic management of interstitial ectopic pregnancies. Stepwise demonstration of the technique with narrated video footage. Tertiary referral center in Manchester, United Kingdom. Nontubal ectopic pregnancies typically involve the cervix, ovary, myometrium, cesarean scar, and the interstitial portion of the fallopian tube. Interstitial ectopic pregnancies account for 2% of all ectopic pregnancies [1] and are caused by implantation of a fertilized embryo within the proximal and intramural portion of the fallopian tube [2]. They represent specific challenges in diagnosis and management and are associated with increased morbidity and mortality when compared with tubal ectopic pregnancies [3]. The techniques for minimal access surgical management includes laparoscopic cornuectomy and cornuostomy. We present 2 cases of interstitial ectopic pregnancies managed laparoscopically using the 2 different techniques. Case 1: A 33-year-old women, para 2+1, presented at 8 weeks' gestation with lower abdominal pain, vaginal bleeding, and an episode of loss of consciousness. An ultrasound scan showed a gestational sac lateral and posterior to the endometrial cavity with the interstitial line sign present. A yolk sac and a 2-mm fetal pole were noted with fetal heart action present. At laparoscopy, an 800 mL hemoperitoneum was noted, and a laparoscopic cornuectomy was performed (Fig. S1). Operating time was 80 minutes, and she was discharged on day 1 postoperation. Case 2: A 34-year-old women, para 1, presented at 6 weeks' gestation to her local hospital with symptoms of vaginal bleeding and intermittent abdominal pain. A diagnosis of an interstitial ectopic pregnancy was suspected on the ultrasound scan, and conservative management was started because the diagnosis was uncertain. A follow-up scan 7 days later confirmed the diagnosis of a live interstitial ectopic pregnancy, and after consultation, she presented herself to a tertiary referral unit. Serum human chorionic gonadotropin was greater than 11 000 IU/L and 2-dimensional ultrasound scan confirmed the presence of a gestational sac with a yolk sac and fetal pole within the left interstitial space. A slow fetal heart action was seen. A diagnosis of a left interstitial ectopic pregnancy was further confirmed on 3-dimensional ultrasound scan. A laparoscopic cornuostomy was performed as demonstrated in the attached video (Figs. S2-S3). Operating time was 38 minutes with minimal blood loss. At day 7, serum human chorionic gonadotropin level was 364 IU/L. Although more research is needed to determine the optimal surgical technique for the management of interstitial ectopic pregnancies, the potential risks and benefits of different techniques should be discussed with the patient, and an individual decision should be made. This decision often depends on the desire for future fertility and previous gynecologic history.

Diagnosis of interstitial ectopic pregnancy using a three-dimensional high-definition live rendering image

Diagnosis of interstitial ectopic pregnancy using a three-dimensional high-definition live rendering image

Factors influencing the success of conservative treatment of interstitial pregnancy

To identify demographic, morphological and biochemical characteristics of interstitial pregnancies that are associated with a successful outcome of conservative treatment (expectant management or medical treatment with methotrexate). Over a period of 6 years all clinically stable women with a certain ultrasound diagnosis of interstitial ectopic pregnancy were managed either expectantly (no interventions) or medically (systemic or local methotrexate injection). The outcome of conservative treatment was compared to a number of diagnostic parameters, which were recorded at the initial visit. The treatment was classified as successful if serum human chorionic gonadotropin (hCG) level declined below 20 IU/L without the need for any additional interventions, such as the administration of methotrexate or surgery. A total of 42 interstitial pregnancies were diagnosed during the study period. Out of 35 women included in the final analysis 7 (20%) were managed expectantly and 28 (80%) received either local (n = 23) or systemic methotrexate (n = 5). There were no significant differences in the success rates of expectant treatment and treatment with either systemic or local methotrexate. The initial median serum hCG was significantly lower in women with successful conservative management (3216 IU/L vs. 15 900 IU/L; P < 0.05) but there were no other significant differences between cases with successful and failed treatment. The measurement of serum hCG at the initial visit may be used to predict the likelihood of successful conservative treatment of interstitial pregnancy.

Expectant management of a cornual pregnancy followed up by serial transvaginal color power Doppler angiography and serum beta human chorionic gonadotropin levels

Expectant management of a cornual pregnancy followed up by serial transvaginal color power Doppler angiography and serum beta human chorionic gonadotropin levels

The effectiveness of non-surgical management of early interstitial pregnancy: a report of ten cases and review of the literature.

To assess the effectiveness of non-surgical management of interstitial pregnancy. A prospective interventional study. Eleven women with the ultrasound diagnosis of interstitial ectopic pregnancy. Women with suspected early pregnancy complications were examined by transvaginal ultrasound. Those with the diagnosis of interstitial pregnancy were offered non-surgical treatment with methotrexate, which was administered systemically or by local injection. Follow-up with regular measurements of beta-human chorionic gonadotropin and ultrasound scans continued until the pregnancy had resolved completely. Ten women were managed non-surgically, and one woman opted for surgery. Five women received systemic and five local methotrexate. Local therapy was successful in all five cases (100%), whereas four out of five (80%) women receiving systemic methotrexate were cured. Significant side-effects were noted in two women following systemic therapy. In comparison, there were no side-effects in the group of women who received local therapy. There were no significant differences between the two treatment groups in the length of time taken for the pregnancy to resolve. Non-surgical treatment of interstitial pregnancy with methotrexate appears to be safe and effective. Local administration appears to be more successful and better tolerated by patients and may be used as the first-line therapy.