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Unusual Ectopic Pregnancies
Fauzia Vandermeer, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          TERMINOLOGY

          • Definitions

            • Interstitial ectopic pregnancy (EP): Preferred term for pregnancy occurring in interstitial (intramural) portion of fallopian tube
              • Synonym: Intramural ectopic pregnancy
            • Cornual EP: Often used interchangeably with interstitial ectopic; more appropriately applied to pregnancy in the cornua of an abnormal uterus (horn of uni- or bicornuate uterus or lateral half of septate uterus)
            • Angular pregnancy: Pregnancy implanted at lateral angle of uterine cavity by ostium, medial to interstitial tube
            • Uterine scar EP: Implantation of pregnancy at the site of previous uterine surgery, e.g., myomectomy or cesarean section (C-section)
              • Synonyms: Scar EP, C-section scar EP
            • Cervical EP: Gestational sac (GS) implanted in the wall of the cervix below the level of the internal cervical os
            • Ovarian EP: Intraovarian implantation of a GS
            • Abdominal EP: Implantation in the peritoneal cavity
              • Primary: Direct peritoneal implantation; secondary: Re-implantation of ruptured extrauterine pregnancy in peritoneal cavity (more common than primary form)
            • Heterotopic pregnancy: Concurrent intrauterine and ectopic pregnancies

          IMAGING

          • General Features

            • Ultrasonographic Findings

              • MR Findings

                • Imaging Recommendations

                  DIFFERENTIAL DIAGNOSIS

                    CLINICAL ISSUES

                    • Presentation

                      • Demographics

                        • Natural History & Prognosis

                          • Treatment

                            DIAGNOSTIC CHECKLIST

                            • Consider

                              • Image Interpretation Pearls

                                Selected References

                                1. Ghaneie A et al: Unusual Ectopic Pregnancies: Sonographic Findings and Implications for Management. J Ultrasound Med. 34(6):951-962, 2015
                                2. 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
                                3. Poon LC et al: How feasible is expectant management of interstitial ectopic pregnancy? Ultrasound Obstet Gynecol. Epub ahead of print, 2013
                                4. Surbone A et al: Interstitial pregnancies' diagnosis and management: an eleven cases series. Swiss Med Wkly. 143:w13736, 2013
                                5. Wu R et al: Magnetic resonance imaging as an adjunct to ultrasound in evaluating cesarean scar ectopic pregnancy. J Clin Imaging Sci. 3:16, 2013
                                6. Parker RA 3rd et al: MR imaging findings of ectopic pregnancy: a pictorial review. Radiographics. 32(5):1445-60; discussion 1460-2, 2012
                                7. Verma U et al: Conservative management of nontubal ectopic pregnancies. Fertil Steril. 96(6):1391-1395, 2011
                                8. Moawad NS et al: Current diagnosis and treatment of interstitial pregnancy. Am J Obstet Gynecol. 202(1):15-29, 2010
                                9. Chetty M et al: Treating non-tubal ectopic pregnancy. Best Pract Res Clin Obstet Gynaecol. 23(4):529-38, 2009
                                10. 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
                                11. Oliver R et al: Management of extra-tubal and rare ectopic pregnancies: case series and review of current literature. Arch Gynecol Obstet. 276(2):125-31, 2007
                                12. Chan LY et al: Pitfalls in diagnosis of interstitial pregnancy. Acta Obstet Gynecol Scand. 82(9):867-70, 2003
                                13. Izquierdo LA et al: Three-dimensional transvaginal sonography of interstitial pregnancy. J Clin Ultrasound. 31(9):484-7, 2003
                                14. Bouyer J et al: Sites of ectopic pregnancy: a 10 year population-based study of 1800 cases. Hum Reprod. 17(12):3224-30, 2002
                                15. 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

                                          • Interstitial ectopic pregnancy (EP): Preferred term for pregnancy occurring in interstitial (intramural) portion of fallopian tube
                                            • Synonym: Intramural ectopic pregnancy
                                          • Cornual EP: Often used interchangeably with interstitial ectopic; more appropriately applied to pregnancy in the cornua of an abnormal uterus (horn of uni- or bicornuate uterus or lateral half of septate uterus)
                                          • Angular pregnancy: Pregnancy implanted at lateral angle of uterine cavity by ostium, medial to interstitial tube
                                          • Uterine scar EP: Implantation of pregnancy at the site of previous uterine surgery, e.g., myomectomy or cesarean section (C-section)
                                            • Synonyms: Scar EP, C-section scar EP
                                          • Cervical EP: Gestational sac (GS) implanted in the wall of the cervix below the level of the internal cervical os
                                          • Ovarian EP: Intraovarian implantation of a GS
                                          • Abdominal EP: Implantation in the peritoneal cavity
                                            • Primary: Direct peritoneal implantation; secondary: Re-implantation of ruptured extrauterine pregnancy in peritoneal cavity (more common than primary form)
                                          • Heterotopic pregnancy: Concurrent intrauterine and ectopic pregnancies

                                        IMAGING

                                        • General Features

                                          • Ultrasonographic Findings

                                            • MR Findings

                                              • Imaging Recommendations

                                                DIFFERENTIAL DIAGNOSIS

                                                  CLINICAL ISSUES

                                                  • Presentation

                                                    • Demographics

                                                      • Natural History & Prognosis

                                                        • Treatment

                                                          DIAGNOSTIC CHECKLIST

                                                          • Consider

                                                            • Image Interpretation Pearls

                                                              Selected References

                                                              1. Ghaneie A et al: Unusual Ectopic Pregnancies: Sonographic Findings and Implications for Management. J Ultrasound Med. 34(6):951-962, 2015
                                                              2. 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
                                                              3. Poon LC et al: How feasible is expectant management of interstitial ectopic pregnancy? Ultrasound Obstet Gynecol. Epub ahead of print, 2013
                                                              4. Surbone A et al: Interstitial pregnancies' diagnosis and management: an eleven cases series. Swiss Med Wkly. 143:w13736, 2013
                                                              5. Wu R et al: Magnetic resonance imaging as an adjunct to ultrasound in evaluating cesarean scar ectopic pregnancy. J Clin Imaging Sci. 3:16, 2013
                                                              6. Parker RA 3rd et al: MR imaging findings of ectopic pregnancy: a pictorial review. Radiographics. 32(5):1445-60; discussion 1460-2, 2012
                                                              7. Verma U et al: Conservative management of nontubal ectopic pregnancies. Fertil Steril. 96(6):1391-1395, 2011
                                                              8. Moawad NS et al: Current diagnosis and treatment of interstitial pregnancy. Am J Obstet Gynecol. 202(1):15-29, 2010
                                                              9. Chetty M et al: Treating non-tubal ectopic pregnancy. Best Pract Res Clin Obstet Gynaecol. 23(4):529-38, 2009
                                                              10. 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
                                                              11. Oliver R et al: Management of extra-tubal and rare ectopic pregnancies: case series and review of current literature. Arch Gynecol Obstet. 276(2):125-31, 2007
                                                              12. Chan LY et al: Pitfalls in diagnosis of interstitial pregnancy. Acta Obstet Gynecol Scand. 82(9):867-70, 2003
                                                              13. Izquierdo LA et al: Three-dimensional transvaginal sonography of interstitial pregnancy. J Clin Ultrasound. 31(9):484-7, 2003
                                                              14. Bouyer J et al: Sites of ectopic pregnancy: a 10 year population-based study of 1800 cases. Hum Reprod. 17(12):3224-30, 2002
                                                              15. Ackerman TE et al: Interstitial line: sonographic finding in interstitial (cornual) ectopic pregnancy. Radiology. 189(1):83-7, 1993