INTERSTITIAL LOCALIZATION OF ECTOPIC PREGNANCY: CLINICAL PICTURE, DIAGNOSIS, TREATMENT

Russian State Medical University, Russian Agency of Health Care, Moscow Objective. To develop methods for the timely diagnosis and treatment of interstitial pregnancy. Subjects and methods. Examinations were made in 57 surgically treated patients with interstitial pregnancy, including 38 with the egg being located in the interstitial part of the preserved fallopian tube (Group 1) and 19 with that in the remnant interstitial part of the fallopian tube after previous tubectomy (Group 2). Special methods, such as determination of serum human ß-chorionic gonadotropin (beta-hCG) and 2D/3D ultrasonography with Doppler color mapping, were applied. Results. The clinical picture of interstitial pregnancy in Group 1 patients (32/38) was ascertained to frequently correspond to that of progressive uterine pregnancy and in Group 2 patients (16/19) with tubal pregnancy. The diagnosis was established in 8 (21%) patients from Group 1 on 3D echography. Laparoscopy and laparotomy were used in 27 and 30 patients, respectively. No matter what access was applied, all the patients underwent dissection of the tubal angle, followed by bed suturing. In the early postoperative period, 3 patients were given methotrexate, if indicated, by taking into account beta-hCH titers. Conclusion. The findings suggest that laparotomy is an optimal surgical access in patients with interstitial localization and resection of the uterine angle with layered bed suturing is an optimal volume.

interstitial pregnancy, resection of the uterine angle, diagnosis of ectopic pregnancy