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Obstetrics
Diagnosis
First Trimester
Ectopic Gestation
Interstitial Ectopic
Interstitial Ectopic
Paula J. Woodward, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          • Diagnostic Checklist

            TERMINOLOGY

            • Definitions

              • Terminology in literature is confusing and inconsistently applied
              • Interstitial ectopic pregnancy is preferred term
                • Blastocyst implants in interstitial portion of fallopian tube
              • Intramural ectopic pregnancy
                • Descriptively correct as interstitial portion of fallopian tube does transverse uterine wall but not technically accurate as blastocyst implants in tube not myometrium
              • Angular pregnancy
                • Pregnancy implanted at lateral angle of uterine cavity medial to uterotubal junction
                  • Located medial to round ligament
              • Cornual pregnancy often used interchangeably with interstitial ectopic, but there is great ambiguity
                • Some authors use term for any pregnancy in cornual region, which overlaps with angular pregnancy
                • Others use cornual to refer to pregnancy in 1 horn of duplication anomaly (septate or bicornuate uterus)
                • Recent literature recommends this term be dropped

            IMAGING

            • General Features

              • Ultrasonographic Findings

                • MR Findings

                  • Imaging Recommendations

                    DIFFERENTIAL DIAGNOSIS

                      PATHOLOGY

                      • General Features

                        • Microscopic Features

                          CLINICAL ISSUES

                          • Presentation

                            • Demographics

                              • Natural History & Prognosis

                                • Treatment

                                  DIAGNOSTIC CHECKLIST

                                  • Consider

                                    • Image Interpretation Pearls

                                      Selected References

                                      1. Chukus A et al: Uncommon implantation sites of ectopic pregnancy: thinking beyond the complex adnexal mass. Radiographics. 35(3):946-59, 2015
                                      2. Tanaka K et al: Management of interstitial ectopic pregnancy with intravenous methotrexate: An extended study of a standardised regimen. Aust N Z J Obstet Gynaecol. 55(2):176-80, 2015
                                      3. Arleo EK et al: Cornual, interstitial, and angular pregnancies: clarifying the terms and a review of the literature. Clin Imaging. 38(6):763-70, 2014
                                      4. Hiersch L et al: Effectiveness of medical treatment with methotrexate for interstitial pregnancy. Aust N Z J Obstet Gynaecol. 54(6):576-80, 2014
                                      5. Nezhat CH et al: Laparoscopically-assisted, hysteroscopic removal of an interstitial pregnancy with a fertility-preserving technique. J Minim Invasive Gynecol. 21(6):1091-4, 2014
                                      6. Pedroso C et al: Interstitial pregnancy rupture at 15 weeks of pregnancy. BMJ Case Rep. 2014, 2014
                                      7. Tanaka Y et al: Three-dimensional sonography in the differential diagnosis of interstitial, angular, and intrauterine pregnancies in a septate uterus. J Ultrasound Med. 33(11):2031-5, 2014
                                      8. Rheinboldt M et al: Atypical presentation of a large interstitial pregnancy. Emerg Radiol. 20(3):251-4, 2013
                                      9. Sagiv R et al: Interstitial pregnancy management and subsequent pregnancy outcome. Acta Obstet Gynecol Scand. 92(11):1327-30, 2013
                                      10. Cucinella G et al: Laparoscopic management of interstitial pregnancy: the "purse-string" technique. Acta Obstet Gynecol Scand. 91(8):996-9, 2012
                                      11. Tamarit G et al: Combined use of uterine artery embolization and local methotrexate injection in interstitial ectopic pregnancies with poor prognosis. Fertil Steril. 93(4):1348, 2010
                                      12. Moon HS et al: The outcomes of pregnancy following laparoscopic cornuotomy for interstitial pregnancy. Fertil Steril. 92(2):e24; author reply e25, 2009
                                      13. Takeda A et al: Successful management of interstitial pregnancy with fetal cardiac activity by laparoscopic-assisted cornual resection with preoperative transcatheter uterine artery embolization. Arch Gynecol Obstet. 280(2):305-8, 2009
                                      14. Lin EP et al: Diagnostic clues to ectopic pregnancy. Radiographics. 28(6):1661-71, 2008
                                      15. Valsky DV et al: Ectopic pregnancies of unusual location: management dilemmas. Ultrasound Obstet Gynecol. 31(3):245-51, 2008
                                      16. Araujo Júnior E et al: Three-dimensional transvaginal sonographic diagnosis of early and asymptomatic interstitial pregnancy. Arch Gynecol Obstet. 275(3):207-10, 2007
                                      17. Mavrelos D et al: Ultrasound diagnosis of ectopic pregnancy in the non-communicating horn of a unicornuate uterus (cornual pregnancy). Ultrasound Obstet Gynecol. 30(5):765-70, 2007
                                      18. Deruelle P et al: Management of interstitial pregnancy using selective uterine artery embolization. Obstet Gynecol. 107(2 Pt 1):427-8, 2006
                                      19. Klemm P et al: Sonographic monitoring of systemic and local methotrexate (MTX) therapy in patients with intact interstitial pregnancies. J Perinat Med. 34(2):149-57, 2006
                                      20. Tang A et al: A medical management of interstitial ectopic pregnancy: a 5-year clinical study. Aust N Z J Obstet Gynaecol. 46(2):107-11, 2006
                                      21. Cassik P et al: Factors influencing the success of conservative treatment of interstitial pregnancy. Ultrasound Obstet Gynecol. 26(3):279-82, 2005
                                      22. Deruelle P et al: Management of interstitial pregnancy using selective uterine artery embolization. Obstet Gynecol. 106(5 Pt 2):1165-7, 2005
                                      23. Filhastre M et al: Interstitial pregnancy: role of MRI. Eur Radiol. 15(1):93-5, 2005
                                      24. Lee GS et al: Diagnosis of early intramural ectopic pregnancy. J Clin Ultrasound. 33(4):190-2, 2005
                                      25. Coric M et al: Laparoscopic approach to interstitial pregnancy. Arch Gynecol Obstet. 270(4):287-9, 2004
                                      26. Jermy K et al: The conservative management of interstitial pregnancy. BJOG. 111(11):1283-8, 2004
                                      27. Tarim E et al: Angular pregnancy. J Obstet Gynaecol Res. 30(5):377-9, 2004
                                      28. Tulandi T et al: Interstitial pregnancy: results generated from the Society of Reproductive Surgeons Registry. Obstet Gynecol. 103(1):47-50, 2004
                                      29. Akrivis Ch et al: Early ultrasonographic diagnosis of unruptured interstitial pregnancy: a case report and review of the literature. Clin Exp Obstet Gynecol. 30(1):60-4, 2003
                                      30. Chan LY et al: Pitfalls in diagnosis of interstitial pregnancy. Acta Obstet Gynecol Scand. 82(9):867-70, 2003
                                      31. Izquierdo LA et al: Three-dimensional transvaginal sonography of interstitial pregnancy. J Clin Ultrasound. 31(9):484-7, 2003
                                      32. Bouyer J et al: Sites of ectopic pregnancy: a 10 year population-based study of 1800 cases. Hum Reprod. 17(12):3224-30, 2002
                                      33. Chen CL et al: Successful conservative treatment for advanced interstitial pregnancy. A case report. J Reprod Med. 47(5):424-6, 2002
                                      34. Ackerman TE et al: Interstitial line: sonographic finding in interstitial (cornual) ectopic pregnancy. Radiology. 189(1):83-7, 1993
                                      Related Anatomy
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                                      Related Differential Diagnoses
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                                      References
                                      Tables

                                      Tables

                                      KEY FACTS

                                      • Terminology

                                        • Imaging

                                          • Top Differential Diagnoses

                                            • Clinical Issues

                                              • Diagnostic Checklist

                                                TERMINOLOGY

                                                • Definitions

                                                  • Terminology in literature is confusing and inconsistently applied
                                                  • Interstitial ectopic pregnancy is preferred term
                                                    • Blastocyst implants in interstitial portion of fallopian tube
                                                  • Intramural ectopic pregnancy
                                                    • Descriptively correct as interstitial portion of fallopian tube does transverse uterine wall but not technically accurate as blastocyst implants in tube not myometrium
                                                  • Angular pregnancy
                                                    • Pregnancy implanted at lateral angle of uterine cavity medial to uterotubal junction
                                                      • Located medial to round ligament
                                                  • Cornual pregnancy often used interchangeably with interstitial ectopic, but there is great ambiguity
                                                    • Some authors use term for any pregnancy in cornual region, which overlaps with angular pregnancy
                                                    • Others use cornual to refer to pregnancy in 1 horn of duplication anomaly (septate or bicornuate uterus)
                                                    • Recent literature recommends this term be dropped

                                                IMAGING

                                                • General Features

                                                  • Ultrasonographic Findings

                                                    • MR Findings

                                                      • Imaging Recommendations

                                                        DIFFERENTIAL DIAGNOSIS

                                                          PATHOLOGY

                                                          • General Features

                                                            • Microscopic Features

                                                              CLINICAL ISSUES

                                                              • Presentation

                                                                • Demographics

                                                                  • Natural History & Prognosis

                                                                    • Treatment

                                                                      DIAGNOSTIC CHECKLIST

                                                                      • Consider

                                                                        • Image Interpretation Pearls

                                                                          Selected References

                                                                          1. Chukus A et al: Uncommon implantation sites of ectopic pregnancy: thinking beyond the complex adnexal mass. Radiographics. 35(3):946-59, 2015
                                                                          2. Tanaka K et al: Management of interstitial ectopic pregnancy with intravenous methotrexate: An extended study of a standardised regimen. Aust N Z J Obstet Gynaecol. 55(2):176-80, 2015
                                                                          3. Arleo EK et al: Cornual, interstitial, and angular pregnancies: clarifying the terms and a review of the literature. Clin Imaging. 38(6):763-70, 2014
                                                                          4. Hiersch L et al: Effectiveness of medical treatment with methotrexate for interstitial pregnancy. Aust N Z J Obstet Gynaecol. 54(6):576-80, 2014
                                                                          5. Nezhat CH et al: Laparoscopically-assisted, hysteroscopic removal of an interstitial pregnancy with a fertility-preserving technique. J Minim Invasive Gynecol. 21(6):1091-4, 2014
                                                                          6. Pedroso C et al: Interstitial pregnancy rupture at 15 weeks of pregnancy. BMJ Case Rep. 2014, 2014
                                                                          7. Tanaka Y et al: Three-dimensional sonography in the differential diagnosis of interstitial, angular, and intrauterine pregnancies in a septate uterus. J Ultrasound Med. 33(11):2031-5, 2014
                                                                          8. Rheinboldt M et al: Atypical presentation of a large interstitial pregnancy. Emerg Radiol. 20(3):251-4, 2013
                                                                          9. Sagiv R et al: Interstitial pregnancy management and subsequent pregnancy outcome. Acta Obstet Gynecol Scand. 92(11):1327-30, 2013
                                                                          10. Cucinella G et al: Laparoscopic management of interstitial pregnancy: the "purse-string" technique. Acta Obstet Gynecol Scand. 91(8):996-9, 2012
                                                                          11. Tamarit G et al: Combined use of uterine artery embolization and local methotrexate injection in interstitial ectopic pregnancies with poor prognosis. Fertil Steril. 93(4):1348, 2010
                                                                          12. Moon HS et al: The outcomes of pregnancy following laparoscopic cornuotomy for interstitial pregnancy. Fertil Steril. 92(2):e24; author reply e25, 2009
                                                                          13. Takeda A et al: Successful management of interstitial pregnancy with fetal cardiac activity by laparoscopic-assisted cornual resection with preoperative transcatheter uterine artery embolization. Arch Gynecol Obstet. 280(2):305-8, 2009
                                                                          14. Lin EP et al: Diagnostic clues to ectopic pregnancy. Radiographics. 28(6):1661-71, 2008
                                                                          15. Valsky DV et al: Ectopic pregnancies of unusual location: management dilemmas. Ultrasound Obstet Gynecol. 31(3):245-51, 2008
                                                                          16. Araujo Júnior E et al: Three-dimensional transvaginal sonographic diagnosis of early and asymptomatic interstitial pregnancy. Arch Gynecol Obstet. 275(3):207-10, 2007
                                                                          17. Mavrelos D et al: Ultrasound diagnosis of ectopic pregnancy in the non-communicating horn of a unicornuate uterus (cornual pregnancy). Ultrasound Obstet Gynecol. 30(5):765-70, 2007
                                                                          18. Deruelle P et al: Management of interstitial pregnancy using selective uterine artery embolization. Obstet Gynecol. 107(2 Pt 1):427-8, 2006
                                                                          19. Klemm P et al: Sonographic monitoring of systemic and local methotrexate (MTX) therapy in patients with intact interstitial pregnancies. J Perinat Med. 34(2):149-57, 2006
                                                                          20. Tang A et al: A medical management of interstitial ectopic pregnancy: a 5-year clinical study. Aust N Z J Obstet Gynaecol. 46(2):107-11, 2006
                                                                          21. Cassik P et al: Factors influencing the success of conservative treatment of interstitial pregnancy. Ultrasound Obstet Gynecol. 26(3):279-82, 2005
                                                                          22. Deruelle P et al: Management of interstitial pregnancy using selective uterine artery embolization. Obstet Gynecol. 106(5 Pt 2):1165-7, 2005
                                                                          23. Filhastre M et al: Interstitial pregnancy: role of MRI. Eur Radiol. 15(1):93-5, 2005
                                                                          24. Lee GS et al: Diagnosis of early intramural ectopic pregnancy. J Clin Ultrasound. 33(4):190-2, 2005
                                                                          25. Coric M et al: Laparoscopic approach to interstitial pregnancy. Arch Gynecol Obstet. 270(4):287-9, 2004
                                                                          26. Jermy K et al: The conservative management of interstitial pregnancy. BJOG. 111(11):1283-8, 2004
                                                                          27. Tarim E et al: Angular pregnancy. J Obstet Gynaecol Res. 30(5):377-9, 2004
                                                                          28. Tulandi T et al: Interstitial pregnancy: results generated from the Society of Reproductive Surgeons Registry. Obstet Gynecol. 103(1):47-50, 2004
                                                                          29. Akrivis Ch et al: Early ultrasonographic diagnosis of unruptured interstitial pregnancy: a case report and review of the literature. Clin Exp Obstet Gynecol. 30(1):60-4, 2003
                                                                          30. Chan LY et al: Pitfalls in diagnosis of interstitial pregnancy. Acta Obstet Gynecol Scand. 82(9):867-70, 2003
                                                                          31. Izquierdo LA et al: Three-dimensional transvaginal sonography of interstitial pregnancy. J Clin Ultrasound. 31(9):484-7, 2003
                                                                          32. Bouyer J et al: Sites of ectopic pregnancy: a 10 year population-based study of 1800 cases. Hum Reprod. 17(12):3224-30, 2002
                                                                          33. Chen CL et al: Successful conservative treatment for advanced interstitial pregnancy. A case report. J Reprod Med. 47(5):424-6, 2002
                                                                          34. Ackerman TE et al: Interstitial line: sonographic finding in interstitial (cornual) ectopic pregnancy. Radiology. 189(1):83-7, 1993
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