Clinical Analysis Of Interventional Treatment In Interstitial Pregnancy

BACKGROND & AIMSInterstitial pregnancy means pregnancy occurring in interstitial portion of fallopian tube,which represent a small fraction of ectopic gestations. The risk of ectopic pregnancy is increased in conditions that alter normal tubal function such as pelvic inflammatory disease, previous tubal surgery, previous ectopic pregnancy, endometriosis and pregnancies from in vitro fertilization. Interstitial pregnancies differ from tubal ectopics in that patients often do not complain of symptoms until catastrophic uterine rupture occurs. In the interstitial pregnancy myometrium surrounds the gestational sac, allowing it to enlarge painlessly for a relatively long time. That is why it can grow to a larger size than tubal ectopics. The diagnosis can be suggested when an intrauterine pregnancy is visualized high in the fundus that is not surrounded in all planes by 5 mm of myometrium. While interstitial pregnancies represent a small fraction of ectopic gestations, they are especially feared due to their often devastating outcomes. The standard treatment for interstitial pregnancies has been laparotomy and cornual resection with hysterctomy required in many cases inorder to control bleeding. Over the past 15' years, medical therapy with methotexate (MTX) interventional treatment has become an accepted practice for managing early tuba 1 pregnancies.The study is to investigate the means of interventional treatment in interstitial pregnancy through the review of 5 clinal cases.METHODSThe data of 5 patients, including age, history of pregnancy, anamnesis,clinical manifestations, laboratorial results, imaging, endoscopy and the course of diagnosis and treatment were reviewed. And all cases were followed up.RESULTSFive cases age from twenty-eight to thirty-six,and the average is 31.8 years old.One case has undergone production while others not,and all cases have history of abortion one to three times.One case has history of interstitial pregnancy with therapy of inventional treatment,one has history of uterine leiomyoma resection,and one becomes pregnant with IUD.Time of amenorrhea vary from 43 to 90 days with symptoms include suprapubic pain and irregularly vaginal bleeding.The physical inspection suggests a soft blue-purple cervix,enlarged uterus and a mass on the fundal portion of the uterus, blood β-HCG from 415.13 to 27524 mIU/ml.Pelvic ultrasound show. The pelvic ultrasound show an enlarged uterus,combined with protuberance of one corner in which a mixed mass can be detected, it has enriched blood supply and part wall of uterus becomes thinner Both uterus arterial infusion and embolism are effective to 5 cases in clinic.After the operation ,all sufferers don't have symptoms including bellyache,vaginal bleeding,fever, gastrointestinal reaction and marrow restrain.on clinical evaluation and ultrasound, suspected a left comualectopic pregnancy. 6 to 10 day after interventional treatment,4 cases' repeated blood β—HCG drop obviously, the pelvic ultrasound show that the corner of the uterus is smaller thanbefore and completely disappeared in 38 to 52 days combined with Chinese traditional medicine.The case that has the history of interstitial pregnancy with therapy of inventional treatment finally has the operation of left uterus corner dissection and particular MTX injection,the process is quite smooth,and the bleeding is little. All cases follow up for 6 to 28 months, they all have regular emmenia, normal quantity. One case which has the require of bearing becomes pregnant now without any abnormity.CONCLUSIONSInterstitial pregnancy represent a small fraction of ectopic gestations, only 2—4% of all ectopic pregnancies,the symptoms and sighs are similar with other type of fallopian tube pregnancy including amenorrhea,nausea and vomiting,repeated bellyache and vaginal bleeding which appear later than other types.The diagnosis is made based on clinical representation, the pelvic ultrasound which suggests an enlarged uterus corner with embryo inside and nothing in the capacity of uterus,otherwise the risen of blood β—HCG The standard treatment for interstitial pregnancies has been laparotomy and cornual resection with hysteectomy required in many cases in order to control bleeding. With advances in transvaginal ultrasound technology and the sensitivity of pregnancy detection, interstitial gestations can now be identified at an early stage, while the patient is asymptomatic and when medical intervention would be most effective. By summarizing the various treatment options, monitoring parameters, and criteria for patient selection, we propose to assist clinicians in choosing a reasonable course of management for this rare, but dangerous, condition.