Diagnosis pitfall of interstitial pregnancy: a case report of a term pregnancy with abnormal placentation

Background Interstitial Pregnancy (IP) is a lethal condition due to high risk of sudden onset massive hemorrhage. Such conditions are managed as soon as diagnosed almost in the first trimester. There are a few case reports of IP conditions terminated after the second trimester. Herein, we introduce a term interstitial pregnancy complicated by abnormal placentation. Case presentation In this case report, we introduce a 32-year-old lady, primigravida, with an undiagnosed IP that was in her 38 weeks of gestational with placenta increta. She developed with perforated IP presenting with acute abdomen and internal bleeding at 26 weeks of gestational age. However, with a misdiagnosis impression, she got stable in operation room. Then, the pregnancy continued till 36 weeks of gestational age that was misdiagnosed with cervical cancer in prenatal work-ups. Finally, during elective cesarean section at 38 weeks, an IP with placenta increta (placenta evading from the serosa to the myometrium of the uterus) was observed. The baby was healthy with no obvious anomaly or morbidity. Conclusions Physicians should be aware to detect IP in all trimesters and pay attention to the coexisting complications such as placenta accreta to manage them more accurately.

Analysis on the Outcome of Tubal Interstitial Pregnancy after Partial Cornual Resection

Objective: To investigate the safety of re-pregnancy after partial cornual resection for tubal interstitial pregnancy. Methods: The clinical data of 22 cases of re-pregnancy after partial cornual resection from November 20J 3 to June 20J 9 were retrospectively analyzed, the operation condition, re-pregnancy outcome and neonatal outcome were analyzed. Results: 18 of the 21 cases were tubal interstitial pregnancy, the re-pregnancy interval was 6-36 months, the median delivery time was 17.4 moths, the median delivery time was 36 weeks (28-41+2W), there was 2 cases of birth weight <2500 g. The remaining 4 cases were interstitial heterotopic pregnancy, the median delivery time was 36 weeks (32+4-38+2W), there was 1 case of birth weight <2500g. Of the 22 patients, 21 were delivered by cesarean section and 1 was vaginal delivery, all the newborns survived. There were no cases of rupture of uterus, adhesion or implantation of placenta at uterine horn. Conclusion: The patients with tubal interstitial pregnancy after standard partial cornual resection have a good outcome of re-pregnancy.

A rare case report of cornual pregnancy

Cornual pregnancy is a rare type of ectopic pregnancy in which embryo implants in the junction between the fallopian tube and uterus. Ectopic pregnancy is more common in the ampullary region of the fallopian tube. However, cornual (interstitial) pregnancy is seen in 2-4% of ectopic pregnancies. It is more dangerous than other ectopic as it may lead to catastrophic hemorrhage, shock with mortality rate of 2-2.5%. A cornual pregnancy is diagnosed at 7+3 week of amenorrhea in 27-year-old healthy woman. Ultrasound examination showed a right live cornual pregnancy with CRL corresponding to 6+4week of gestation with fetal heart pulsation. We performed right cornuostomy by laparotomy without any immediate or delayed postoperative complications. Cornual pregnancy poses significant diagnostic and therapeutic challenge; early diagnosis may help to select the proper management and treatment according to the clinical presentation, hemodynamic stability, serum b-hCG level and ultrasound findings. Early diagnosis and management remain the mainstay for tackling maternal mortality due to cornual pregnancy.

Interstitial Ectopic Pregnancy: The Role of Mifepristone in the Medical Treatment

Interstitial pregnancy is defined as the presence of a gestational sac in the most proximal section of the fallopian tube. Management of interstitial pregnancy remains a debated topic. Depending on hemodynamic stability, size of pregnancy, depth of surrounding myometrium, and desires for future fertility, interstitial pregnancy can be managed medically or surgically. We reviewed the literature in December 2020 using keywords “interstitial pregnancy”, “medical treatment”, “methotrexate”, and “mifepristone”. Articles published from January 1991 until 2020 were obtained from databases EMBASE, SCOPUS, and PUBMED. We describe the case of a patient with an interstitial pregnancy that was managed with a total medical approach in August 2020 at Burlo Garofolo Hospital. The patient was asymptomatic and hemodynamically stable, with a high level of serum β-hCG (22,272 mUi/mL). We used the combination of methotrexate (MTX) and mifepristone. Medical therapy was effective leading to interstitial pregnancy resolution in 51 days without collateral effects for the patient. We found seven previous cases reported in the literature. Our purpose is to underline the efficacy of medical therapy with systemic multidose MTX associated with a single oral dose of mifepristone and also folinic acid when is present a viable fetus and a high serum β-hCG level.

Interstitial Pregnancy Managed with Single-dose Systemic Methotrexate: A Case Report

Interstitial pregnancy is a rare type of ectopic pregnancy with a high risk of massive hemorrhage on rupture as compared to ectopic on other sites. The mortality rate for the ruptured interstitial pregnancy is high. Therefore, early diagnosis of such pregnancy before the rupture occurs facilitates appropriate management and avoids life-threatening complications. With the advancement in diagnostic imaging modalities, early diagnosis and more conservative management for interstitial pregnancy have become possible. Here, we report a case of primigravida diagnosed with interstitial pregnancy with ultrasonography and successfully managed with a single dose of methotrexate.

The elusive diagnosis and emergent management of a late-presenting ruptured interstitial pregnancy: a case report

Background Interstitial 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 presentation A 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. Conclusions 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.