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Interstitial, Cornual, and Angular Pregnancy
Published in Botros Rizk, A. Mostafa Borahay, Abdel Maguid Ramzy, Clinical Diagnosis and Management of Gynecologic Emergencies, 2020
An interstitial pregnancy is an uncommon type of ectopic pregnancy that results from embryonic implantation in the myometrium surrounding the interstitial part of the fallopian tube and includes 2% to 4% of all ectopic pregnancies [3]. Wang et al. found the incidence of interstitial pregnancy after in vitro fertilization (IVF)/embryo transfer (ET) to be 2.3%, with slightly higher rates after fresh ET (2.6%) than after frozen ET (2.2%) [4]. A higher incidence of interstitial pregnancy with IVF is likely due to the high rate of tubal infertility and undergoing procedures such as salpingectomy before IVF [4]. A cornual pregnancy is defined as implantation of the embryo in the fundal intrauterine portion of the anomalous bicornuate or septate uterus. Angular pregnancy is defined as implantation of the embryo into the lateral superior angle of the uterine cavity [3].
Ectopic Pregnancy and Pregnancy of Unknown Location
Published in Arianna D'Angelo, Nazar N. Amso, Ultrasound in Assisted Reproduction and Early Pregnancy, 2020
Similar to interstitial pregnancy, in around 50% of cases, the pregnancy can remain symptom free in the early weeks of gestation until it ruptures in the second trimester with major internal bleeding. The sonographic features are shown in Box 17.10 [65,200–207] (Figures 17.31–17.33).
Haemorrhage
Published in Daryl Dob, Griselda Cooper, Anita Holdcroft, Philip Steer, Gwyneth Lewis, Crises in Childbirth Why Mothers Survive, 2018
There were 11 deaths due to ectopic pregnancy reported in the CEMD report for 2000–2002, of which eight sought medical care. This is similar to the figures in previous reports. In 4 of the 11 cases the ectopic pregnancy was in the portion of the Fallopian tube within the wall of the uterus. This type of ectopic pregnancy is called a cornual or interstitial pregnancy. Interstitial pregnancies account for a small proportion of ectopic pregnancies but have a high mortality rate.8
Study on diagnosis and management strategies on heterotopic pregnancy: a retrospective study
Published in Journal of Obstetrics and Gynaecology, 2023
Yan Zhang, Xiujuan Chen, Yuan Lin, Chengying Lian, Xiumei Xiong
Patients with HP after tubal ligation or bilateral salpingectomy were represented by several case reports; this reminds clinicians of the possibility of such rare and potentially fatal presentations after ART even in these patients, since early diagnosis and prompt treatment can yield a favourable prognosis. The most common location of EP is the fallopian tube. We compared the risk factors, treatment and pregnancy outcomes between HP-interstitial and HP-tube (except interstitial) pregnancies. In the HP-tube group, previous tubal surgery was lower than in the HP-interstitial group. Although there was still no general consensus on the best optimal treatment for tubal interstitial pregnancy (Jeon et al. 2016), we were more inclined to recommend surgical procedure in our centre. The rate of live birth was higher in the HP-tube group, whereas previous study indicated that miscarriage rate had marginal significance between two groups based on the site of the HP (Warda et al. 2014).
The efficacy of mifepristone combined with methotrexate for the treatment of ectopic pregnancy: a systematic review and meta-analysis*
Published in Annals of Medicine, 2022
Qiling Su, Huiyan Feng, Tian Tian, Xiaoqian Liao, Yunhui Li, Xiaomao Li
In recent years, there have been many studies on mifepristone combined with methotrexate therapy [11], some of them showed that the combination therapy can dissolve trophoblast cells more quickly than methotrexate therapy, so the combination therapy has a lower risk of salpingorrhexis or peritoneal hemorrhage [12]. A number of studies have shown that the curative effect of combination therapy is better than mifepristone therapy and methotrexate therapy, while the incidence rates of the three therapies are not significantly different [13]. The mechanism of the combination therapy on EP is still unclear. It is speculated that the effect of methotrexate on the trophoblast may enhance the anti-decidual effect of mifepristone, leading to the destruction of the cervical trophoblast [14]. Some researchers believe that this is because the mechanisms and therapeutic targets of two drugs treating EP are different, so their combination can play a synergism and enhance their curative effect. Studies have shown that mifepristone combined with methotrexate is effective in the treatment of cervical pregnancy and interstitial pregnancy [15]. Probably the effect of Mifepristone on decidua is the reason for his efficacy in the treatment of intrauterine pregnancy or interstitial pregnancy [16].
Hysteroscopic diagnosis of an intrauterine pregnancy mimicking an interstitial pregnancy on ultrasound
Published in Journal of Obstetrics and Gynaecology, 2021
Yu-Hung Lin, Lee-Wen Huang, Jiann-Loung Hwang, I-Fang Yang, Ting-Chi Huang
Interstitial pregnancy is a rare type of ectopic pregnancy that is difficult to diagnose preoperatively. Its ultrasonographic appearance varies from a viable pregnancy to a solid inhomogeneous mass (Hafner et al. 1999). An interstitial pregnancy is suspected when ultrasonography demonstrates a gestational sac at the cornus of the uterus. Nonetheless, the difference between an interstitial pregnancy and an eccentrically located intrauterine pregnancy is often ambiguous. The most popular diagnostic criteria for interstitial pregnancy was proposed by Timor-Tritsch as: (1) an empty uterine cavity, (2) a chorionic sac separated by >1 cm from the most lateral edge of the uterine cavity and (3) a thin myometrial layer surrounding the sac (Timor-Tritsch et al. 1992). However, in a report of 32 cases, correct diagnosis was made in only 71.4% of the patients (Tulandi and Al-Jaroudi 2004).