Conservative treatment of interstitial pregnancy

Objective To report a case of interstitial pregnancy diagnosed and treated laparoscopically by cornual resection, and to review the literature in order to provide a perspective on alternative treatment options for this condition. Case report A 42-year-old woman with persistent pelvic pain, elevated levels of beta-human chorionic gonadotrophin (beta-hCG) and a negative ultrasound scan had an initial negative diagnostic laparoscopy. Symptoms continued and repeat ultrasound suggested an asymmetric fundal pregnancy. Repeat laparoscopy revealed an interstitial pregnancy and laparoscopic cornual resection was undertaken. Recovery was uneventful and she was discharged 2 days postoperatively. Current perspective When interstitial pregnancy is detected early, treatment options include expectant management, systemic methotrexate, or local injection of methotrexate, potassium chloride or prostaglandin into the gestational sac. Surgical intervention by hysteroscopic removal or laparoscopic cornual excision/cornuostomy can be employed in the case of failed medical treatment or advanced pregnancy. Conclusion The early diagnosis of interstitial pregnancy should enable a conservative approach, whether medical or surgical, to be undertaken when treating this rare and potentially fatal condition.