Vojnosanitetski pregled 2023 Volume 80, Issue 2, Pages: 173-177
https://doi.org/10.2298/VSP211227020J
Full text ( 332 KB)
Successful hysteroscopic management of two cases of interstitial pregnancy
Jokanović Predrag (Clinic for Gynecology and Obstetrics “Narodni front”, Belgrade, Serbia), drpredragjokanovic@gmail.com
Rakić Aleksandar (Clinic for Gynecology and Obstetrics “Narodni front”, Belgrade, Serbia)
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 βhCG 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 βhCG 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 βhCG < 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.
Keywords: gynecologic surgical procedures, minimally invasive surgical procedures, pregnancy, ectopic
Show references
Finlinson AR, Bollig KJ, Schust DJ. Differentiating pregnancies near the uterotubal junction (angular, cornual, and interstitial): a review and recommendations. Fertil Res Pract 2020; 6: 8.
Tang A, Baartz D, Khoo SK. A medical management of interstitial ectopic pregnancy: A 5-year clinical study. Aust N Z J Obstet Gynaecol 2006; 46(2): 107-11.
Lin TY, Chueh HY, Chang SD, Yang CY. Interstitial ectopic pregnancy: A more confident diagnosis with three-dimensional sonography. Taiwan J Obstet Gynecol 2021; 60(1): 173-6.
Wang YL, Weng SS, Huang WC, Su TH. Laparoscopic management of ectopic pregnancies in unusual locations. Taiwan J Obstet Gynecol 2014; 53(4): 466-70.
Jansen RP, Elliott PM. Angular intrauterine pregnancy. Obstet Gynecol 1981; 58(2): 167-75.
Timor-Tritsch IE, Monteagudo A, Matera C, Veit CR. Sonographic evolution of cornual pregnancies treated without surgery. Obstet Gynecol 1992; 79(6): 1044-9.
Ackerman TE, Levi CS, Dashefsky SM, Holt SC, Lindsay DJ. Interstitial line: sonographic finding in interstitial (cornual) ectopic pregnancy. Radiology 1993; 189(1): 83-7.
Dagar M, Srivastava M, Ganguli I, Bhardwaj P, Sharma N, Chawla D. Interstitial and Cornual Ectopic Pregnancy: Conservative Surgical and Medical Management. J Obstet Gynaecol India 2018; 68(6): 471-6.
Shetty V, Shivananda RP, Vasudeva A, Shetty J. Successful management of three cases of interstitial pregnancies with local instillation of potassium chloride: avoiding a potential cornuostomy. BMJ Case Rep 2021; 14(3): e239918.
Stabile G, Mangino FP, Romano F, Zinicola G, Ricci G. Ectopic Cervical Pregnancy: Treatment Route. Medicina (Kaunas) 2020; 56(6): 293.
Meyer WR, Mitchell DE. Hysteroscopic removal of an interstitial ectopic gestation. A case report. J Reprod Med 1989; 34(11): 928-9.
D'hoore E, D'hoore L, Van den Berghe S, Roets E, van Wessel S, Hamerlynck T. Operative hysteroscopy in the minimally invasive management of interstitial pregnancy and interstitially retained products of conception: A case report and systematic literature review. Eur J Obstet Gynecol Reprod Biol 2021; 265: 54-9.
Niu X, Tang Y, Li S, Ni S, Zheng W, Huang L. The feasibility of laparoscopically assisted, hysteroscopic removal of interstitial pregnancies: A case series. J Obstet Gynaecol Res 2021; 47(10): 3447-55.
Casadio P, Arena A, Verrelli L, Ambrosio M, Fabbri M, Giovannico K, et al. Methotrexate injection for interstitial pregnancy: Hysteroscopic conservative miniinvasive approach. Facts Views Vis Obgyn 2021; 13(1): 73-6.
Leggieri C, Guasina F, Casadio P, Arena A, Pilu G, Seracchioli R. Hysteroscopic Methotrexate Injection Under Ultrasonographic Guidance for Interstitial Pregnancy. J Minim Invasive Gynecol 2016; 23(7): 1195-9.
Casadio P, Youssef A, Arena A, Gamal N, Pilu G, Seracchioli R. Increased rate of ruptured ectopic pregnancy in COVID-19 pandemic: analysis from the North of Italy. Ultrasound Obstet Gynecol 2020; 56(2): 289.
Werner S, Katz A. Change in ectopic pregnancy presentations during the covid-19 pandemic. Int J Clin Pract 2021; 75(5): e13925.
Chmielewska B, Barratt I, Townsend R, Kalafat E, van der Meulen J, Gurol-Urganci I, et al. Effects of the COVID-19 pandemic on maternal and perinatal outcomes: a systematic review and meta-analysis. Lancet Glob Health 2021; 9(6): e759-e772.
Dvash S, Cuckle H, Smorgick N, Vaknin Z, Padoa A, Maymon R. Increase rate of ruptured tubal ectopic pregnancy during the COVID-19 pandemic. Eur J Obstet Gynecol Reprod Biol 2021; 259: 95-9.
Barg M, Rotem R, Mor P, Rottenstreich M, Khatib F, Grisaru-Granovsky S, et al. Delayed presentation of ectopic pregnancy during the COVID-19 pandemic: A retrospective study of a collateral effect. Int J Gynaecol Obstet 2021; 153(3): 457-61.
Elito Júnior J, Araujo Júnior E. Medical Treatment for Ectopic Pregnancy during the COVID-19 Pandemic. Rev Bras Ginecol Obstet 2020; 42(12): 849-50.
Maglic R, Rakic A, Nikolic B, Maglic D, Jokanovic P, Mihajlovic S. Management of Cervical Ectopic Pregnancy with Small-Caliber Hysteroscopy. JSLS 2021; 25(2): e2021.00016.