Management options for interstitial ectopic pregnancies: A case series

Objective: Ectopic pregnancy in the interstitial part of the Fallopian tubes can be life-threatining considering the thin myometrial tissue surrounding the gestational sac and highly vascularization which may result in catastrophic haemorrhage when interstitium is ruptured. The diagnosis and management is challenging. Conservative, medical, and surgical treatment options should be considered based on individual patient factors.

Methods: Four women were diagnosed with interstitial pregnancy in last five years in our tertiary center. Four different treatment modalities, including single dose methotrexate, laparotomy, hysteroscopy followed by vacuum aspiration, and vacuum aspiration under laparoscopy were performed according to patients’ characteristics.

Results: Successful outcome was achieved in all patients.

Conclusion: Interstitial pregnancy can be successfully treated with a single dose systemic methotrexate when all criteria are met. The classical cornual wedge resection remains lifesaving operation for cases of ruptured interstitial pregnancy. Less invasive procedures such as laparoscopic assisted transcervical vacuum aspiration and diagnostic hysteroscopy followed by vacuum aspiration can be performed in selected cases.