Diagnosis Of Interstitial Pregnancy Research Articles

Редкий случай гетеротопической беременности после переноса одного эмбриона

This article presents a clinical case of heterotopic pregnancy in a 42-year-old patient after a single embryo transfer. One gestational sac implanted in the uterus and the other in the interstitial portion of the fallopian tube. In the interstitial portion of the fallopian tube, pregnancy stopped developing at 3–4 weeks’ gestation, and in the uterus – at 7–8 weeks’ gestation. The diagnosis of interstitial pregnancy was made 3 months after instrumental removal of non-developing uterine pregnancy. Operative hysteroscopy, hydrodissection and curettage with a resectoscope “cold” loop electrode, and electrodestruction of the chorionic plate were performed. The duration of surgery was 16 minutes, blood loss was minimal. Key words: heterotopic pregnancy, interstitial pregnancy, operative hysteroscopy, 3D ultrasound, power Doppler

Early Diagnosis of Interstitial Pregnancy Associated to Assisted Reproductive Techniques Case Report

Background: 2.4% of ectopic pregnancies develop in the interstitial portion of the fallopian tube and is associated over to a 2.5% mortality rate, in contrast to other forms of tubal ectopic pregnancy with a lower mortality rate. Case Report: A patient with a 5 years history of primary infertility and severe endometriosis undergoes an in vitro fertilization (IVF) after pituitary suppression. Embryos were transferred and a month afterward, ultrasonography examination reported an 18 mm gestational sac, with an embryo in the left adnexal mass. However, an empty uterine cavity is reported in spite of an elevated human chorionic gonadotropin beta fraction. Because of this a diagnostic/ operative laparoscopy is performed. The histopathology result reports a left interstitial ectopic pregnancy. The patient progresses through an uneventful postoperative period, and is checked-out the next day in proper clinical status. Conclusion: Ectopic pregnancy is a complication of assisted reproduction techniques and interstitial pregnancy is a rare form of tubal pregnancy posing a diagnostic challenge and a life-threatening condition due to the risk of massive bleeding. Hence, clinical suspicion of an interstitial pregnancy requires a quick intervention to avoid a potentially life-threatening situation.

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.

INTERSTITIAL PREGNANCY AFTER IPSILATERAL SALPINGECTOMY - CASE REPORT

Interstitial pregnancy is ectopic pregnancy which occurs within the intramural (interstitial) part of the uterine tube. The frequency of its occurrence is 3-4% of all ectopic pregnancies. It is also significant because of a long asymptomatic period and common ending with the rupture of the uterine horn as a serious complication. Mortality after this type of ectopic pregnancy is about 2,5%. This paper presents a case of a 29year-old patient hospitalized for suspected ectopic interstitial pregnancy in the left uterine horn. Her anamnesis showed the left tube pregnancy ended with salpingectomy after the rupture of the uterine tube. The patient was examined both clinically and by ultrasound, her s-HCG level was being monitored, and after an adequate preoperative preparation, she underwent a surgery. Surgical intervention consisted of the incision of pregnancy-altered uterine horn, curettage and evacuation of ovulary tissue, which saved the uterine horn. Timely diagnosis of interstitial pregnancy can prevent its possible serious complications. Acta Medica Medianae 2015;54(2):52-55.

Acute Abdomen in Interstitial Ectopic Pregnancy, An Emergency Laparoscopic Treatment

The present case report demonstrates a laparoscopic approach to treat interstitial cornual pregnancy in emergency. Interstitial ectopic pregnancy develops in the uterine portion of the fallopian tube which accounts for 2–4% of all ectopic pregnancies and has the potential to cause life-threatening hemorrhage at rupture. The mortality rate for a woman diagnosed with such a pregnancy is 2–2.5%. Diagnosis of interstitial pregnancy is made by ultrasound. In this case a 32 year-old woman, Gravida 0 Parity 0 Living 0 Ectopic 1, presented to the emergency obstetrical room complaining acute abdominal pain. There was a history of 10 weeks of pregnancy but no pelvic ultrasound scan was performed before the access. A transvaginal ultrasound scan immediately performed demonstrated a gestational sac with viable fetus in the right interstitial region. Moreover there was an ultrasound evidence of hemoperitoneum. She was transferred to the operating room and an emergency laparoscopy surgery was performed. The postoperative course was uneventful and the patient was discharged two days after the surgery. Interstitial pregnancies present a difficult management problem with no absolute standard of care in literature. Laparoscopic technique is under study with favorable results. For our personal point of view a treatment via laparoscopy could be performed both in elective and in emergency cases.

A conservative and fertility preserving treatment for interstitial ectopic pregnancy

This is a case series of women presenting to a tertiary care centre with a diagnosis of interstitial pregnancy. Dilatation and evacuation was performed under ultrasound control with systemic methotrexate post-operatively. All women had successful termination of their interstitial pregnancy. Although described in the international literature, this is the first time that this technique has been documented in Australia, and it may ultimately prove to be a relatively safe and simple fertility preserving method of treating women with unruptured interstitial pregnancies.

Clinician-performed ultrasound diagnosis of ruptured interstitial pregnancy

An interstitial pregnancy is a rare type of ectopic pregnancy located within the proximal portion of the fallopian tube in the muscular wall of the uterus. They are more likely to result in significant or fatal hemorrhage because of the increased vascularity. Diagnosis of interstitial pregnancy is challenging but critical to facilitate prompt and appropriate intervention. Ultrasound performed by an emergency physician is commonly used to assess early pregnancy, but little has been published in the emergency medicine literature regarding its use in assessing for presence of interstitial pregnancy. We describe a case of a ruptured interstitial pregnancy diagnosed by emergency ultrasonography in the emergency department and review the literature regarding the sonographic findings of interstitial pregnancies.

Pitfalls in diagnosis of interstitial pregnancy.

To determine the incidence and reasons for misdiagnosis in interstitial ectopic pregnancy. We conducted a retrospective study from 1990 to 2001. Women with interstitial pregnancy were identified and their case records retrieved and reviewed. Reasons for delay in diagnosis and associated morbidity were recorded. Thirty-six women were diagnosed as having interstitial pregnancy during the study period. Initial diagnosis was incorrect in 15 cases (41.7%). In 14 cases, the interstitial pregnancies were mistaken as intrauterine pregnancy. These misdiagnoses resulted in six inappropriate surgical procedures (evacuation of uterus) being performed and led to rupture of interstitial pregnancy in eight women. In two women, the interstitial pregnancy was mistaken as normal intrauterine pregnancy while the uterus itself was thought to be a cervical fibroid. In both cases, the interstitial pregnancies ruptured at 18-20 weeks of gestation. Despite advances in sonographic skills and equipment and the availability of beta-human chorionic gonadotropin (hCG) monitoring, misdiagnosis of interstitial pregnancy still occurs frequently. Clinicians should be aware of the limitations of various investigations and maintain a high index of suspicion.

Pitfalls in diagnosis of interstitial pregnancy

Background. To determine the incidence and reasons for misdiagnosis in interstitial ectopic pregnancy. Methods. We conducted a retrospective study from 1990 to 2001. Women with interstitial pregnancy were identified and their case records retrieved and reviewed. Reasons for delay in diagnosis and associated morbidity were recorded. Results. Thirty-six women were diagnosed as having interstitial pregnancy during the study period. Initial diagnosis was incorrect in 15 cases (41.7%). In 14 cases, the interstitial pregnancies were mistaken as intrauterine pregnancy. These misdiagnoses resulted in six inappropriate surgical procedures (evacuation of uterus) being performed and led to rupture of interstitial pregnancy in eight women. In two women, the interstitial pregnancy was mistaken as normal intrauterine pregnancy while the uterus itself was thought to be a cervical fibroid. In both cases, the interstitial pregnancies ruptured at 18–20 weeks of gestation. Conclusion. Despite advances in sonographic skills and equipment and the availability of β-human chorionic gonadotropin (hCG) monitoring, misdiagnosis of interstitial pregnancy still occurs frequently. Clinicians should be aware of the limitations of various investigations and maintain a high index of suspicion.

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.

Unruptured interstitial pregnancy: A pitfall of MR imaging

We report two cases with interstitial pregnancy, which showed completely different MR appearances. In case 1, a gestational sac was demonstrated and the diagnosis of ectopic pregnancy was straightforward. In case 2, a hypervascular mass was shown without demonstration of a gestational sac, the findings usually seen in gestational trophoblastic disease (GTD). MR imaging may play some role in the diagnosis of interstitial pregnancy when sonography is insufficient or equivocal. If GS is visualized, diagnosis is easy. However, if not, the appearance may have a spectrum and can be similar to GTD.

Diagnosis of interstitial pregnancy with sonography.

Interstitial pregnancy is a rare and extremely dangerous form of ectopic pregnancy. Preoperative diagnosis of this condition prior to rupture is difficult, and early detection is essential to avoid a fatal outcome. Six cases in our series were diagnosed as interstitial pregnancy. Their clinical features were missed period, positive pregnancy test, and sudden onset of lower abdominal pain with or without vaginal spotting. The sonographic images showed an endometrial echo in uterine cavity, eccentric sac, protruding mass over the cornual area, and/or the presence of free fluid in the cul-de-sac. Five of 6 patients had sacs found in the cornual area or a protruding cornual mass. We termed the sonographic findings of interstitial pregnancy as "pregnancy in cornus." High resolution transvaginal sonography permits determination of the exact location of the gestational sac and increases the diagnosis rate of interstitial pregnancy.

The place of methotrexate in the management of interstitial pregnancy

Six patients with interstitial pregnancies were treated with systemic or local injections of methotrexate, 15 mg i.m. daily for 5 days, or 1 mg/kg for 1 day. One dose of folinic acid rescue (50 mg) was administered on the first day of the treatment course. Diagnosis of interstitial pregnancy was established either by laparoscopy or transvaginal ultrasound. Out of six patients, five had serial measurements of serum human chorionic gonadotrophin (HCG), progesterone (P) and 17 beta-oestradiol (E2) until either the ectopic pregnancy resolved or surgery was performed. For one patient operated on day 1 after medical treatment, no serial serum measurements were performed. Serum HCG became undetectable under medical treatment in only four of the six patients. Out of these four patients, three had an initial level of HCG less than 1000 mIU/ml. Two patients underwent surgery (salpingectomy) because either the level of serum HCG did not decrease after the course of methotrexate therapy or it was required the next day to stop haemorrhage. In these patients, the initial level of HCG at the time of diagnosis, was 5300 and 43,000 mIU/ml, respectively. In the four patients who received conservative medical treatment only, the next menstrual period occurred 20-46 days after the onset of methotrexate and was preceded by luteal activity. A control hysterosalpingography performed 2 months later showed that in the four patients who received medical treatment only, the Fallopian tube was patent, and three became pregnant within 1 year of the methotrexate therapy. One of two patients who failed to respond to medical treatment and required surgical treatment, became pregnant 6 months later.(ABSTRACT TRUNCATED AT 250 WORDS)

Interstitial pregnancy: a diagnostic challenge

A case report which illustrates the clinical problems and sonographic difficulties that accompany the diagnosis of interstitial pregnancy are reported. Non-specific clinical symptoms and normal sonographic findings do not always preclude interstitial pregnancy.

Interstitial pregnancy: A survey of 45 cases

1.1. An analysis of 45 cases of interstitial pregnancy has been presented. These were obtained from a total group of 944 ectopic pregnancies of all varieties, an incidence of 4.7 per cent.2.2. There was one death, a mortality rate for interstitial pregnancy of 2.2 per cent.3.3. Perforation occurred most frequently between the fifth and twelfth weeks of gestation, contrary to the general impression of late rupture.4.4. Transmigration of the ovum was noted in 26.7 per cent of the cases.5.5. The most frequent complaint was abdominal pain. Amenorrhea, anomalous vaginal bleeding, and shock were other important signs and symptoms.6.6. Profound shock appeared in 71.2 per cent of the patients with cornual perforation. This was the result of massive intraperitoneal hemorrhage.7.7. The diagnosis of interstitial pregnancy is seldom made prior to rupture. Tender cystic enlargement at one horn of the uterus is suggestive of this type of ectopic gestation.8.8. During laparotomy an interstitial pregnancy may be recognized by asymmetric enlargement of the uterus superior to the insertion of the round ligament, without a corresponding enlargement of the rest of the organ.9.9. Treatment is immediate surgery and blood transfusion. Because of the greater speed with which it usually can be accomplished, and because control of hemorrhage is almost immediate, hysterectomy is preferable to cornual resection of an extensive laceration.