A pregnancy at the utero-tubal junction is a rare type of ectopic pregnancy and is associated with high maternal morbidity if it remains undetected. In the present study we discuss four cases of ...ectopic pregnancies at the utero-tubal junction which caused diagnostic and management dilemmas.
Four cases of early pregnancies with the gestational sac (G-sac) implanted near the utero-tubal junction are described. In case 1 this was suspected after a failed attempt at dilatation and curettage at our hospital, cases 2 and 3 presented with amenorrhea and pain abdomen and case 4 was diagnosed on first pregnancy documentation scan after frozen embryo transfer.
As initial two-dimensional (2D) transvaginal scan (TVS) failed to diagnose the exact location of the G-sac, three-dimensional (3D) TVS helped to localize the exact location of pregnancy and subsequent individualized management. Case 1 had a partial intramural ectopic pregnancy managed by laparotomy and removal of the ectopic sac. The second and third cases were eccentric uterine pregnancies. The fourth was an interstitial ectopic pregnancy managed by a laparoscopic loop and stitch technique.
This case series describes the role of 3D TVS for the evaluation of pregnancies implanted at the utero-tubal junction and individual management of eccentric intrauterine, interstitial ectopic and intramural ectopic pregnancies. A diagnostic algorithm for such types of cases and management options is discussed.
A RARE CASE OF AN INTERSTITIAL PREGNANCY Gincheva, Dobrinka; Hinkova, Nadezhda; Gincheva, Veronika ...
Journal of IMAB,
07/2024, Letnik:
30, Številka:
3
Journal Article
Odprti dostop
In ectopic pregnancy, implantation of the zygote occurs outside of the endometrial cavity. Interstitial pregnancy has an incidence of 2-4% of all ectopic pregnancies. We present a clinical case of ...interstitial pregnancy. On 20.10.2023, a woman visited the University Hospital "St. Marina" - Pleven, Bulgaria, because of a positive morning pregnancy test. The patient was a 30-year-old woman. The last menstrual period was on 12.09.2023. Two consecutive vaginal ultrasonography were made every 10 days. No fetal sac was visualized in the uterine cavity. The second ultrasonography visualized a hyperplastic endometrium, 21 mm thick. A fetal sac located interstitially was found high in the right uterine horn. The ß-hCG values were 412 mIU/ml and 12490 mIU/ml, respectively. The patient was referred for a pelvic MRI, which confirmed the diagnosis. After discussion and informed consent signed by the patient, on 30.10.2023 at University Hospital "St. Marina" - Pleven, Bulgaria, under general anesthesia on 30.11.2023, a Laparotomia a modo Pfannenstiel. Resectio cornualis dextra. Extirpatio graviditas interstitialis dextra. Salpingectomia dextra. Sutura uteri. Lavage. Drainage. Abrasio probatoria was performed. The patient tolerated the surgical intervention well. The histological result proved interstitially located ectopic pregnancy. In cases of interstitial pregnancy, early diagnosis is crucial for successful treatment and health of the patient.
The incidence of ‘Caesarean scar ectopic pregnancy’ has been increasing in recent times. Probably the rising caesarean rate around the world responsible for it. We are reporting three cases of ...Caesarean scar ectopic pregnancies, suspected clinically and confirmed by sonography of the uterus. Each of the three cases was managed with different modalities of treatment. Case one was operated by open laparotomy, case two underwent laparoscopy and case three was managed with medical treatment without surgery. Uterus could be saved in all three cases.
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