Angelika Rabensteiner, MD

I am a practicing OB-GYN, with 30 years of         experience.  In my experience, interstitial pregnancy is not as common as         described in literature: 2-4% of all ectopic pregnancies.  I submit a         short video case of a suspected         interstitial pregnancy at 9 weeks and welcome comments from         the audience of this forum.

In a transvaginal coronal plane, you can see on the         left-hand side of the fundus a flourishing pregnancy with an embryo of 9         weeks.  In the last pictures of the clip a thin hypoechogenic         endomiometrial layer is more easily seen.  The gestational sac is         very eccentric.  In none of the scans a connection of the chorion         to the endometrial-decidual layer could be demonstrated.  Although         described in literature (Ackerman, Radiology 1993,189/1/83), I cannot         recognize the "interstitial line sign".

The patient refused         treatment with methotrexate and left the hospital saying that she was         leaving for Serbia.  She returned on Saturday night with pain in         the left lower abdomen.  On Sunday night the pain worsened and on         Monday morning we decided to do a laparotomy for symptoms of         haemoparitoneum.  The patient had a previous laparotomy with         salpingectomy for a left tubal pregnancy.  On opening we found a         moderate haemoperitoneum.  The fundus uteri was covered with colon         firmly attached to it.  During accurate preparation and involuntary         pressure on the fundus a 2.5 cm long fetus jumped out of the field.          The thin layer of myometrium ruptured.  All the chorion was         accurately removed and the chorionic bed cleaned.  The uterine         opening was finally repaired with a continuous suture.

Please click on         the images below for a larger view.

The enlarged left uterine angle after partial removal of the                 large intestine. The miometrium appears very thin and partially                 translucent. In the center the uterus is ruptured and the                 translucent corion is visible.


Repair of the uterus with a continous suture after removal of                 the pregnancy from the left uterine angle.

Articles

In a transvaginal coronal plane, you can see on the left-hand side of the fundus a flourishing pregnancy with an embryo of 9 weeks.  In the last pictures of the clip a thin hypoechogenic endomiometrial layer is more easily seen.

Angelika Rabensteiner, MD

Articles

Diagnosis and Laparotomic Treatment of an Interstitial Pregnancy