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Obstetrics
Diagnosis
First Trimester
Ectopic Gestation
Interstitial Ectopic
Interstitial Ectopic
Roya Sohaey, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          TERMINOLOGY

          • Definitions

            • Terminology in literature is mixed, confusing, and inconsistently applied
            • Interstitial ectopic pregnancy (IEP) or interstitial pregnancy are preferred terms
              • Blastocyst implants in interstitial segment of fallopian tube
                • 1- to 2-cm intramural medial segment of tube
            • Intramural ectopic pregnancy (less preferred term)
              • Descriptively correct, as interstitial portion of fallopian tube does transverse uterine wall
              • Not technically accurate, as blastocyst implants in tube not myometrium
            • Cornual pregnancy (least preferred term)
              • Often used interchangeably with IEP, but recent literature urges avoiding this term altogether
              • HIstorically used to refer to pregnancy in 1 horn of duplication anomaly (septate or bicornuate uterus)
            • Angular pregnancy (AP) is different diagnosis
              • Key difference from IEP is that AP is intrauterine
              • Pregnancy implants at lateral angle of uterine cavity medial to uterotubal junction
                • Near ostia of fallopian tube
                • Located medial to round ligament

          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. Jensen KK et al: Imaging of acute pelvic pain: pregnant (ectopic and first-trimester viability updated). Radiol Clin North Am. 58(2):347-61, 2020
                                    2. Khan Z et al: In pursuit of understanding interstitial pregnancies: a rare yet high-risk ectopic pregnancy. Fertil Steril. 112(2):246-7, 2019
                                    3. Di Tizio L et al: Interstitial pregnancy: from medical to surgical approach-report of three cases. Case Rep Obstet Gynecol. 2018:2815871, 2018
                                    4. Marfori CQ et al: Angular vs. interstitial pregnancy: a case report highlighting diagnostic nuances with stark management differences. Case Rep Womens Health. 19:e00068, 2018
                                    5. Chukus A et al: Uncommon implantation sites of ectopic pregnancy: thinking beyond the complex adnexal mass. Radiographics. 35(3):946-59, 2015
                                    6. 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
                                    7. 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
                                    8. Hiersch L et al: Effectiveness of medical treatment with methotrexate for interstitial pregnancy. Aust N Z J Obstet Gynaecol. 54(6):576-80, 2014
                                    9. 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
                                    10. Pedroso C et al: Interstitial pregnancy rupture at 15 weeks of pregnancy. BMJ Case Rep. 2014, 2014
                                    11. 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
                                    12. Rheinboldt M et al: Atypical presentation of a large interstitial pregnancy. Emerg Radiol. 20(3):251-4, 2013
                                    13. Sagiv R et al: Interstitial pregnancy management and subsequent pregnancy outcome. Acta Obstet Gynecol Scand. 92(11):1327-30, 2013
                                    14. Cucinella G et al: Laparoscopic management of interstitial pregnancy: the "purse-string" technique. Acta Obstet Gynecol Scand. 91(8):996-9, 2012
                                    15. 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
                                    16. 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
                                    17. Deruelle P et al: Management of interstitial pregnancy using selective uterine artery embolization. Obstet Gynecol. 107(2 Pt 1):427-8, 2006
                                    18. 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
                                    19. 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
                                    20. Cassik P et al: Factors influencing the success of conservative treatment of interstitial pregnancy. Ultrasound Obstet Gynecol. 26(3):279-82, 2005
                                    21. Deruelle P et al: Management of interstitial pregnancy using selective uterine artery embolization. Obstet Gynecol. 106(5 Pt 2):1165-7, 2005
                                    22. Filhastre M et al: Interstitial pregnancy: role of MRI. Eur Radiol. 15(1):93-5, 2005
                                    23. Lee GS et al: Diagnosis of early intramural ectopic pregnancy. J Clin Ultrasound. 33(4):190-2, 2005
                                    24. Coric M et al: Laparoscopic approach to interstitial pregnancy. Arch Gynecol Obstet. 270(4):287-9, 2004
                                    25. Jermy K et al: The conservative management of interstitial pregnancy. BJOG. 111(11):1283-8, 2004
                                    26. Tarim E et al: Angular pregnancy. J Obstet Gynaecol Res. 30(5):377-9, 2004
                                    27. 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

                                            TERMINOLOGY

                                            • Definitions

                                              • Terminology in literature is mixed, confusing, and inconsistently applied
                                              • Interstitial ectopic pregnancy (IEP) or interstitial pregnancy are preferred terms
                                                • Blastocyst implants in interstitial segment of fallopian tube
                                                  • 1- to 2-cm intramural medial segment of tube
                                              • Intramural ectopic pregnancy (less preferred term)
                                                • Descriptively correct, as interstitial portion of fallopian tube does transverse uterine wall
                                                • Not technically accurate, as blastocyst implants in tube not myometrium
                                              • Cornual pregnancy (least preferred term)
                                                • Often used interchangeably with IEP, but recent literature urges avoiding this term altogether
                                                • HIstorically used to refer to pregnancy in 1 horn of duplication anomaly (septate or bicornuate uterus)
                                              • Angular pregnancy (AP) is different diagnosis
                                                • Key difference from IEP is that AP is intrauterine
                                                • Pregnancy implants at lateral angle of uterine cavity medial to uterotubal junction
                                                  • Near ostia of fallopian tube
                                                  • Located medial to round ligament

                                            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. Jensen KK et al: Imaging of acute pelvic pain: pregnant (ectopic and first-trimester viability updated). Radiol Clin North Am. 58(2):347-61, 2020
                                                                      2. Khan Z et al: In pursuit of understanding interstitial pregnancies: a rare yet high-risk ectopic pregnancy. Fertil Steril. 112(2):246-7, 2019
                                                                      3. Di Tizio L et al: Interstitial pregnancy: from medical to surgical approach-report of three cases. Case Rep Obstet Gynecol. 2018:2815871, 2018
                                                                      4. Marfori CQ et al: Angular vs. interstitial pregnancy: a case report highlighting diagnostic nuances with stark management differences. Case Rep Womens Health. 19:e00068, 2018
                                                                      5. Chukus A et al: Uncommon implantation sites of ectopic pregnancy: thinking beyond the complex adnexal mass. Radiographics. 35(3):946-59, 2015
                                                                      6. 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
                                                                      7. 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
                                                                      8. Hiersch L et al: Effectiveness of medical treatment with methotrexate for interstitial pregnancy. Aust N Z J Obstet Gynaecol. 54(6):576-80, 2014
                                                                      9. 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
                                                                      10. Pedroso C et al: Interstitial pregnancy rupture at 15 weeks of pregnancy. BMJ Case Rep. 2014, 2014
                                                                      11. 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
                                                                      12. Rheinboldt M et al: Atypical presentation of a large interstitial pregnancy. Emerg Radiol. 20(3):251-4, 2013
                                                                      13. Sagiv R et al: Interstitial pregnancy management and subsequent pregnancy outcome. Acta Obstet Gynecol Scand. 92(11):1327-30, 2013
                                                                      14. Cucinella G et al: Laparoscopic management of interstitial pregnancy: the "purse-string" technique. Acta Obstet Gynecol Scand. 91(8):996-9, 2012
                                                                      15. 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
                                                                      16. 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
                                                                      17. Deruelle P et al: Management of interstitial pregnancy using selective uterine artery embolization. Obstet Gynecol. 107(2 Pt 1):427-8, 2006
                                                                      18. 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
                                                                      19. 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
                                                                      20. Cassik P et al: Factors influencing the success of conservative treatment of interstitial pregnancy. Ultrasound Obstet Gynecol. 26(3):279-82, 2005
                                                                      21. Deruelle P et al: Management of interstitial pregnancy using selective uterine artery embolization. Obstet Gynecol. 106(5 Pt 2):1165-7, 2005
                                                                      22. Filhastre M et al: Interstitial pregnancy: role of MRI. Eur Radiol. 15(1):93-5, 2005
                                                                      23. Lee GS et al: Diagnosis of early intramural ectopic pregnancy. J Clin Ultrasound. 33(4):190-2, 2005
                                                                      24. Coric M et al: Laparoscopic approach to interstitial pregnancy. Arch Gynecol Obstet. 270(4):287-9, 2004
                                                                      25. Jermy K et al: The conservative management of interstitial pregnancy. BJOG. 111(11):1283-8, 2004
                                                                      26. Tarim E et al: Angular pregnancy. J Obstet Gynaecol Res. 30(5):377-9, 2004
                                                                      27. Ackerman TE et al: Interstitial line: sonographic finding in interstitial (cornual) ectopic pregnancy. Radiology. 189(1):83-7, 1993