Current diagnosis and treatment of interstitial pregnancy

The incidence of interstitial pregnancy is rising. Traditional treatment with laparotomy, hysterectomy, or cornual wedge resection is associated with high morbidity and detrimental effects on future fertility. A diverse array of alternate treatments has been introduced over the last 3 decades, with the common goal of achieving a minimally invasive, standardized management strategy. This has been facilitated by impressive strides towards prompt diagnosis, both radiologically and chemically. In this review, we explore the current state of the art diagnostic criteria and the clinically significant diverse therapeutic options with supporting literature. Finally, we propose a structured, best-practice management plan for the once-lethal interstitial pregnancy, based on the current literature.

Interstitial Pregnancy and Transcervical Curettage

BACKGROUND

Interstitial pregnancies too large to be treated with methotrexate are usually managed surgically, and that may adversely affect future fertility and pregnancies. Transcervical curettage under laparoscopic guidance may be possible in some cases if the pregnancy is accessible vaginally.

CASE

Three women with interstitial pregnancy were treated by transcervical suction curettage under laparoscopic guidance. In all cases, the procedure was quick, bleeding was minimal, and there were no complications. Removal was complete, and the serum beta-hCG quickly became undetectable.

CONCLUSION

Transcervical curettage under laparoscopic guidance provides an alternative conservative treatment for interstitial pregnancy.

Case report: Laparoscopic treatment of a ruptured interstitial pregnancy

Interstitial pregnancy is a rare but life-threatening condition. A case of a 28-year-old woman with a partially ruptured interstitial pregnancy treated with operative laparoscopy is presented. A laparoscopic cornual resection and a left salpingectomy were performed uneventfully. Serum beta-human chorionic gonadotrophin concentrations were measured serially at weekly intervals until resolved on day 20 postoperatively. It seems, therefore, that laparoscopic treatment is still an effective option for management even in ruptured interstitial pregnancy, preserving the anatomical integrity of the uterus and future fertility, and that rupture of interstitial ectopic pregnancy is not a contra-indication for laparoscopy.