ABSTRACT
Introduction: Interstitial (cornual) gestation is the mosthazardous type of ectopic, where pregnancy gets implantedin the proximal portion of tube that traverses myometrium . Itconstitutes 2-4% of all ectopic pregnancies.It poses a significantdiagnostic and therapeutic challenge and carries a greatermaternal mortality. It usually presents at a later gestation morethan 7-12 weeks .The usual clinical presentation is profuseintraabdominal bleeding and shock. Transvaginal sonographycan be helpful, but often is not conclusive.Case report: 21 year old nulliparous lady post laparascopicleft salpingo-oopherectomy, diagnosed to have a liveinterstitial ectopic pregnancy in left lateral wall of uterus withvery high levels of βhCG . She was treated with 2 cycles offolinic acid rescue regime and βhCG monitored accordingly.βhCG showed a decline of 15% initially (2365.9mIU/ml) andweekly βhCG monitored thereafter and reduced to 3.39mIU/ml within 4 months.Conclusion: Cornual resection/hysterectomy used to be thetraditional treatment for these cases. However conservativemanagement has been increasingly practiced successfullyincluding medical treatment with systemic methotrexate andlaparoscopic conservative surgery.
ABSTRACT
El embarazo ectópico intersticial es una presentación rara del embarazo extrauterino. Ocurre cuando el embrión se implanta en la parte media de la unión útero-tubárica, cerca del ostium interno de la trompa de falopio. Se presenta el caso de una paciente con alrededor de 14 semanas de gestación, operada con el diagnóstico clínico de apendicitis aguda. En el acto quirúrgico se encontró un embarazo ectópico intersticial. Se le realizó resección cornual derecha junto al producto de la concepción y sutura uterina con refuerzo de epiplón libre. La evolución fue buena, con alta al cuarto día(AU)
Interstitial ectopic pregnancy is a rare presentation of extra-uterine pregnancy. It occurs when the embryo implants itself in the middle of the uterine-tubal junction, near the inner ostium of the fallopian tube. We presented the case of a patient with near 14 weeks of gestation and operated with the clinical diagnosis of acute appendicitis. During surgery, an interstitial ectopic pregnancy was found. She underwent cornual right resection together with the offspring, as well as uterine suture with free omentum reinforcement. The evolution was good, and she was discharged after the fourth day(AU)
Subject(s)
Humans , Female , Pregnancy , Pregnancy, Ectopic/surgery , Appendicitis/diagnosisABSTRACT
El embarazo ectópico intersticial es una entidad rara pero con una elevada tasa de mortalidad. El diagnóstico puede resultar difícil y tardío, dada la localización del embarazo en una porción intrauterina de la trompa de Falopio. La gestación puede evolucionar de manera asintomática hasta el segundo trimestre de la gestación, y debutar con una rotura uterina y shock hipovolémico por la proximidad del saco gestacional a la arteria uterina. El tratamiento suele consistir en una resección cornual por vía laparoscópica, aunque se individualizará en función de cada caso, primando ante todo la clínica de la paciente. Se expone el caso de un embarazo ectópico intersticial que debutó con rotura uterina a las 13 semanas de gestación.
Interstitial ectopic pregnancy is a rare but with a high mortality rate entity. Diagnosis can be difficult and late, given the location of the pregnancy in an intrauterine portion of the fallopian tube. Pregnancy can evolve asymptomatic until the second trimester, and debuting with uterine rupture and hypovolemic shock due to the proximity of the gestational sac to the uterine artery. Treatment usually consists of a laparoscopic cornual resection, although it will be individualized according to each case, giving priority to the patient clinic condition. The case of an interstitial ectopic pregnancy who presented with uterine rupture at 13 weeks of gestation is presented.
Subject(s)
Humans , Female , Adult , Uterine Rupture/etiology , Pregnancy, Interstitial/surgery , Pregnancy, Interstitial/diagnostic imaging , Pregnancy Trimester, First , Shock/etiology , Ultrasonography , Laparoscopy , Stillbirth , Abdomen, Acute/etiologyABSTRACT
Se describen 6 casos clínicos de mujeres con embarazo ectópico intersticial de menor incidencia entre las formas de la variedad tubárica, tratadas en el Hospital Ginecoobstétrico Docente "Tamara Bunke Bider" de Santiago de Cuba. Esta entidad clínica ha mostrado un incremento inusual en la población asistida (7,59 %) que resulta, 2,57 veces mayor que la media (2,95 %) del intervalo notificado en la bibliografía médica (1,9-4 %). Se exponen las historias individuales de las pacientes en forma tabulada y, asimismo, los autores ofrecen sus consideraciones a propósito de estas experiencias.
Six case reports of women with interstitial ectopic pregnancy of lower incidence among the forms of tubaric variety treated in "Tamara Bunke Bider" Teaching Gynecological and Obstetrical Hospital from Santiago de Cuba are described. This clinical entity has shown an unusual increase in the assisted population (7.59%), which is 2.57 times higher than the mean (2.95%) of the interval notified in the medical literature (1.9-4%). Tabulated individual medical records of the patients are exposed and, likewise, the authors offer their considerations concerning these experiences.