Interstitial pregnancy
| Interstitial pregnancy | |
|---|---|
| Other names | Cornual pregnancy |
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| Specialty | Obstetrics |
An interstitial pregnancy is a uterine but
Anatomy
The part of the Fallopian tube that is located in the uterine wall and connects the remainder of the tube to the endometrial cavity is called its "interstitial" part, hence the term "interstitial pregnancy"; it has a length of 1–2 cm and a width of 0.7 cm.
Interstitial pregnancies can be confused with angular pregnancies; the latter, however, are located within the endometrial cavity in the corner where the tube connects; typically those pregnancies are viable although a high rate of miscarriage has been reported.[1] A pregnancy located next to the interstitial section laterally is an isthmic tubal pregnancy.
The definition of an ectopic pregnancy is a pregnancy outside the uterine cavity, not outside the uterus, as the interstitial pregnancy is still a uterine pregnancy.[4]
Diagnosis
Early diagnosis is important and today facilitated by the use of
In pregnant patients, sonography is the primary method to make the diagnosis, even when patients have no symptoms. The paucity of myometrium around the gestational sac is diagnostic, while, in contrast, the angular pregnancy has at least 5 mm of myometrium on all of its sides.
On average, the gestational age at presentation is about 7–8 weeks.[1] In a 2007 series, 22% of patients presented with rupture and hemorrhagic shock, while a third of the patients were asymptomatic; the remainder had abdominal pain and/or vaginal bleeding.[2] Cases that are not diagnosed until surgery show an asymmetrical bulge in the upper corner of the uterus.[1]
Treatment
Choice of treatment is largely dictated by the clinical situation. A ruptured interstitial pregnancy is a medical emergency that requires an immediate surgical intervention either by laparoscopy or laparotomy to stop the bleeding and remove the pregnancy.[1]
Surgical methods to remove the pregnancy include cornual evacuation, incision of the cornua with removal of the pregnancy (cornuostomy), resection of the cornual area or a cornual wedge resection, typically combined with an ipsilateral
In patients with an asymptomatic interstitial pregnancy methotrexate has been successfully used, however, this approach may fail and result in cornual rupture of the pregnancy.[7] Selective uterine artery embolization has been successfully performed to treat interstitial pregnancies.[8]
Subsequent pregnancies
Patients with an ectopic pregnancy are generally at higher risk for a recurrence, however, there are no specific data for patients with an interstitial pregnancy. When a new pregnancy is diagnosed it is important to monitor the pregnancy by transvaginal sonography to assure that is it properly located, and that the surgically repaired area remains intact.
Epidemiology
Interstitial pregnancies account for 2–4% of all tubal pregnancies, or for 1 in 2,500 to 5,000 live births.
References
- ^ PIIS0002-9378(09)00840-0.
- ^ PMID 17936282.
- ^ PMID 8372223.
- ISBN 0-7216-7042-3.
- S2CID 25708025.
- ISBN 0-7817-3633-1.
- PMID 15521876.
- PMID 16449137.
- ^ PMID 7473461.
- ^ ISBN 0-7817-2859-2.
- PMID 10438980.
External links
- The Ectopic Pregnancy Trust - Information and support for those who have had the condition by a medically overseen and moderated UK based charity, recognised by the National Health Service (UK) Department of Health (UK) and Royal College of Obstetricians and Gynaecologists
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