Interstitial pregnancy is a rare variety of ectopic pregnancy, it can have disturbed 8-16 weeks of amenorrhea (later than the distal tubal ectopic pregnancy), due to the dispensability of the myometrium covering the interstitial segment of the fallopian tube, with subsequent massive internal hemorrhage. A 29-years-old female, Gravida 3, Para 2, presented with severe abdominal pain, vomiting, and syncope 3 days after her missing period, and positive pregnancy test. Trans-vaginal ultrasound showed empty uterine cavity, free pelvic fluid with severe cervical motion tenderness. She was diagnosed with ruptured ectopic pregnancy. Ruptured ectopic pregnancy in the proximal segment of right fallopian tube was confirmed with laparotomy. The ruptured pregnancy was managed by right salpingectomy, and hemostatic stitches at the right uterine corn. Her hemoglobin was 8 gr on admission, and she received 3 units of packed RBCs (one intraoperative, and two post-operative). Her post-operative hemoglobin was 10.5 gr, and she was discharged from the hospital on the 3rd post-operative day in good general condition for follow up in the outpatients` department. This case report represents a rare variety of ectopic pregnancy, which is the interstitial pregnancy, because it can rupture few days or weeks after the missed period with subsequent massive internal hemorrhage. Interstitial pregnancy is a rare form of ectopic pregnancy, the obstetricians should be aware of rare forms of ectopic pregnancies, it can have disturbed few days or weeks after the missed period leading to subsequent significant morbidity.
1. Tulandi T, Al-Jaroudi D. Interstitial pregnancy: results generated from the Society of Reproductive Surgeons Registry. Obstet Gynecol 2004;103(1):47-50.
2. Chopra S, Keepanasseril A, Rohilla M, Bagga R, Kalra J, Jain V. Obstetric morbidity and the diagnostic dilemma in pregnancy in rudimentary horn: retrospective analysis. Arch Gynecol Obstet 2009;280(6):907-10.
3. Pluchino N, Ninni F, Angioni S, Carmignani A, Genazzani AR, Cela V. Spontaneous cornual pregnancy after homolateral salpingectomy for an earlier tubal pregnancy: a case report and literature review. J Minim Invasive Gynecol. 2009;16(2):208-11.
4. Walid MS, Heaton RL. Diagnosis and laparoscopic treatment of cornual ectopic pregnancy. Ger Med Sci 2010 Jul 27;8. pii: Doc16.
5. Timor-Tritsch IE, Monteagudo A, Matera C, Veit CR. Sonographic evolution of cornual pregnancies treated without surgery. Obstet Gynecol 1992;79(6):1044-9.
6. Ackerman TE, Levi CS, Dashefsky SM, Holt SC, Lindsay DJ. Interstitial line: sonographic finding in interstitial (cornual) ectopic pregnancy. Radiology 1993;189(1):83-7.
7. Parker RA 3rd, Yano M, Tai AW, Friedman M, Narra VR, Menias CO. MR imaging findings of ectopic pregnancy: a pictorial review. Radiographics 2012; 32(5):1445-60; discussion 1460-2.
8. Tenore JL. Ectopic pregnancy. Am Fam Physician. 2000; 61(4):1080-8.
9. Agrawal R, Kumar P. Ectopic pregnancy in tubal stump after ipsilateral salpigo-oohorectomy: An unusual and rare case report. Journal of Infertility and Reproductive Biology 2015;3(40):234-6.
10. Lozeau AM, Potter B. Diagnosis and management of ectopic pregnancy. Am Fam Physician. 2005; 72(9):1707- 14.
11. Nama V and Manyonda I. Tubal ectopic pregnancy: diagnosis and management. Arch Gynecol Obstet 2009:279: 443.
12. Hajenius PJ, Mol F, Mol BW, Bossuyt PM, Ankum WM, van der Veen F Interventions for tubal ectopic pregnancy. Cochrane Database Syst Rev 2007 Jan 24;(1):CD000324.
13. Katz DL, Barrett JP, Sanfilippo JS, Badway DM. Combined hysteroscopy and laparoscopy in the treatment of interstitial pregnancy. Am J Obstet Gynecol 2003; 188(4):1113-4.
14. Timmerman E, Roovers JP, Ankum WM, Hajenius PJ. [Interstitial pregnancy: a rare type of ectopic pregnancy]. Ned Tijdschr Geneeskd 2008;152(14):787-91.
15. Tanaka K, Baartz D, Khoo SK. Management of interstitial ectopic pregnancy with intravenous methotrexate: An extended study of a standardised regimen. Aust N Z J Obstet Gynaecol. 2015;55(2):176-80.