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

Distinguishing between cornual, angular and interstitial ectopic pregnancy: A case report and a brief literature review

For all clinical purposes, cornual, angular, and interstitial pregnancies are considered ectopic pregnancies that can have grave consequences for the patient. In this article, we describe and distinguish 3 types of ectopic pregnancies in the cornual region of the uterus. The authors advocate using the "cornual pregnancy" term only for ectopic pregnancies in malformed uteruses. We describe an ectopic pregnancy in a 25-year-old G2P1 patient in the cornual region of the uterus that was missed twice sonographically in the second trimester and had almost fatal consequences in the patient. Radiologists and sonographers should be aware of the sonographic diagnosis of angular, cornual and interstitial pregnancies. Whenever possible, first-trimester transvaginal ultrasound scanning is crucial for diagnosing these 3 types of ectopic pregnancies in the cornual region. In the second and third trimesters, ultrasound tends to become equivocal; hence alternate imaging, such as MRI, might add additional value to the management of the patient. A case report assessment and a comprehensive literature review comprising 61 case reports of ectopic pregnancy in the second and third trimesters are diligently undertaken in the Medline, Embase and Web of Science databases. The major strength of our study is that it is one of the few studies that describe a literature review of ectopic pregnancy in the cornual region exclusively in the second and third trimesters.

Successful Management of a Ruptured Interstitial Pregnancy: A Case Report

Interstitial pregnancy is a rare entity that usually leads to the rupture of the uterus. The difficulty and delay in diagnosing this condition have been reported to cause high mortality rates. Here, we present the case of a 36-year-old woman who presented to the emergency department with severe epigastric pain and hemodynamic instability. Her current gestational age (GA) could not be accurately measured as she was unbooked and had irregular periods. However, by abdominal examination, the GA was estimated to be 38 weeks, whereas by ultrasound it was approximately 28 weeks. It was also noted that the uterus was empty, and the fetus was found in the abdominal cavity. Hence, a working diagnosis of uterine rupture was made and the patient was taken for emergency laparotomy. The patient delivered an alive 1.2 kg baby. Intraoperatively, the placenta was implanted in the interstitial part of the right fallopian tube. The placenta was then excised and right salpingectomy was performed, following which the abdomen was closed in layers. Postoperatively, the patient made an uneventful recovery and was discharged home in stable condition; however, the baby passed away due to complications related to extreme prematurity.

Interstitial ectopic pregnancy rupture at 17 weeks of gestation: A case report and literature review

Interstitial pregnancy is a rare type of ectopic pregnancy that commonly results in uterine rupture and life-threatening haemorrhage. Interstitial ectopic pregnancies are associated with a 2–5% mortality rate and a high risk of uterine rupture before 12 weeks of gestation when compared to tubal pregnancy. Due to the thickness and distensibility of the interstitial segment of the Fallopian tube, ectopic pregnancy in this location attains a considerable size before complications arise. Unfortunately, this clinical entity may prove to be a diagnostic challenge, leading to delays in treatment and significant morbidity and mortality in women of reproductive age. Herein, we report a case of a ruptured interstitial ectopic pregnancy occurring at 17 weeks of gestation that was successfully managed with surgical intervention, after proving to be a diagnostic challenge.

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Interstitial ectopic pregnancy is commonly associated with uterine rupture before 12 weeks of gestation.

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Ruptured interstitial ectopic pregnancy is best treated surgically.

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Follow-up should include serial B-hCG measurements to exclude the persistence of trophoblastic tissue.

Sonographic diagnosis of an interstitial pregnancy in an asymptomatic patient at 7 weeks' gestation

An interstitial pregnancy is an ectopic pregnancy located within the proximal intramural segment of the Fallopian tube traversing the myometrium. This type of ectopic pregnancy is relatively rare, occurring in approximately 1%-3% of all ectopic pregnancies. Given the myometrial mantle surrounding the gestational sac, which is considerably thicker than in other tubal pregnancies, patients with interstitial pregnancies classically manifest symptoms later in gestation. Thus, there is an increased risk of life-threatening intraperitoneal hemorrhage upon rupture of the myometrium encompassing the pregnancy. We present an unusual case of early sonographic diagnosis of an interstitial pregnancy in an asymptomatic patient at 7 and 3/7 weeks’ gestation, discuss predisposing factors, hallmarks of sonographic diagnosis, and review the literature regarding available clinical management modalities. With the increasing application of point of care ultrasound (POCUS) by emergency room physicians and other providers in outpatient facilities, our case emphasizes both the importance of correct sonographic identification of interstitial pregnancy and the clinical importance of uniform early first-trimester sonography, preferably no later than 7-8 weeks’ gestation.