Obstetrics and Gynecology Unit, Department of Obstetrics, Gynecology and Pediatrics, Department of Medical Area DAME, Udine University Hospital, 33100 Udine, Italy.
Clinic of Obstetrics and Gynecology, Department of Medical Area (DAME), Hospital of Udine, University of Udine, 33100 Udine, Italy.
Medicina (Kaunas). 2022 Jul 15;58(7):937. doi: 10.3390/medicina58070937.
Interstitial pregnancy (IP) is a type of ectopic pregnancy in which the embryo implants in the interstitial part of the Fallopian tube. It accounts for 2% of all ectopic pregnancies. Signs and symptoms appear later than the other forms of ectopic pregnancies because of its peculiar location. The gold standard for its diagnosis is transvaginal ultrasound. The treatment can be medical or surgical. Medical treatment is based on the systemic or local injection of methotrexate (MTX); a dose of mifepristone can be added with a reported 85-90% success rate. The surgical option is laparoscopic unilateral cornuostomy or unilateral salpingectomy. The therapeutic choice is based on symptoms, serum β-human chorionic gonadotropin (β-hCG) values, and sonographic features. Furthermore, the patient's fertility perspectives should be considered. We report a case of IP in a Caucasian woman of 29 years old, with a previous salpingectomy for ectopic pregnancy medically treated by a double dose of intramuscular MTX 50 mg/m combined with a single dose of leucovorin 15 mg and a single dose of mifepristone 600 mg orally. Medical therapy failed as suggested by the sudden onset of intense pelvic pain after 10 days. Because of the clinical symptoms and the sonographic suspicious of pregnancy rupture due to the modest amount of fluid in the pouch of Douglas, clinicians decided on an urgent unilateral laparoscopic salpingectomy. The hemoperitoneum was drained. The patient was discharged two days later and β-hCG serum levels became negative after 45 days. The advantages of fertility sparing should be weighted according to the patient's reproductive perspectives. Appropriate counseling is therefore key in managing the treatment of interstitial pregnancy.
间质部妊娠（IP）是一种胚胎种植于输卵管间质部的异位妊娠，约占所有异位妊娠的 2%。由于其特殊的位置，其症状和体征出现较晚于其他类型的异位妊娠。经阴道超声是其诊断的金标准。治疗可选择药物或手术。药物治疗基于全身或局部注射甲氨蝶呤（MTX）；也可加用米非司酮，报道其成功率为 85-90%。手术选择为腹腔镜单侧输卵管切开术或单侧输卵管切除术。治疗方案的选择取决于症状、血清β-人绒毛膜促性腺激素（β-hCG）值和超声特征。此外，还应考虑患者的生育前景。我们报告了 1 例 29 岁白人女性 IP 病例，该患者曾因异位妊娠接受过药物治疗（双侧 MTX 50mg/m 肌内注射，联合单剂量亚叶酸钙 15mg 和单剂量米非司酮 600mg 口服），因 10 天后突然出现剧烈盆腔痛而提示治疗失败。鉴于临床症状和经阴道超声提示因Douglas 窝积液量少而怀疑妊娠破裂，临床医生决定行紧急单侧腹腔镜输卵管切除术。引流了腹腔积血。患者术后 2 天出院，45 天后血清β-hCG 水平转为阴性。应根据患者的生殖前景权衡保留生育能力的优势。因此，适当的咨询是管理间质部妊娠治疗的关键。
