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doi:10.1111/jog.12250
J. Obstet. Gynaecol. Res. Vol. 40, No. 3: 829–832, March 2014
Conservative treatment for interstitial monochorionic twin pregnancy: Case report and review of the published work Roberto Berretta1, Carla Merisio1, Andrea Dall’Asta1, Carla Verrotti1, Martino Rolla1, Stefano Bruni2 and Alberto Bacchi Modena1 1 Department of Obstetrics, Gynaecology and Neonatology, University of Parma, and 2Department of Diagnostic Imaging-Emergency Radiology Unit, University Hospital of Parma, Parma, Italy
Abstract Interstitial pregnancy is considered one of the most hazardous types of ectopic pregnancies, with a mortality rate of 2–2.5%. We describe a case of a viable monochorionic twin pregnancy in a 35-year-old woman successfully treated with systemic methotrexate associated with bilateral uterine arteries’ embolization. β-hCG was undetectable 67 days after the first administration of methotrexate and the ultrasonography performed on day 67 showed the remnant of the gestational sac in the right uterine horn, a thin endometrium and a normal myometrial vascularization. Conservative treatment allowed us to avoid surgical treatment and to preserve the patient’s fertility. Key words: interstitial pregnancy, monochorionic twin pregnancy, uterine artery embolization.
Introduction
Case Report
Ectopic pregnancy accounts for 2% of all pregnancies.1 Interstitial pregnancy accounts for 2.4% of ectopic pregnancies and occurs when the site of implantation is the proximal portion of the fallopian tube, lying within the muscular wall of the uterus.2 The vascular supply of this area is particularly rich because it contains anastomoses between uterine and ovarian arteries.3 The history of ipsilateral or bilateral salpingectomy are suspected risk factors for interstitial ectopic pregnancy; in vitro fertilization (IVF) have been linked with increased frequency of interstitial pregnancy as well as monochorionic and dichorionic twin pregnancy.4 We report a case of interstitial monochorionic twin pregnancy after IVF in a patient with history of bilateral salpingectomy for two previous tubal pregnancies. Conservative treatment allowed us to avoid surgical treatment and to preserve the patient’s fertility.
A 35-year-old patient was admitted to our hospital with the diagnosis of ectopic monochorionic twin pregnancy with interstitial implant at 7 weeks. On admission, the patient’s clinical condition was stable and no symptoms were reported; neither pain nor tenderness were evocated during abdominal examination; uterine size was slightly increased but uterine shape was regular; no adnexal masses were reported. Transabdominal and transvaginal 2-D and 3-D ultrasound scan showed a chorionic sac containing two embryos with crown-to-rump length of 10 mm and cardiac activity eccentrically located outside an empty uterine cavity and surrounded by a thin myometrial layer (
doi:10.1111/jog.12250
J. Obstet. Gynaecol. Res. Vol. 40, No. 3: 829–832, March 2014
Conservative treatment for interstitial monochorionic twin pregnancy: Case report and review of the published work Roberto Berretta1, Carla Merisio1, Andrea Dall’Asta1, Carla Verrotti1, Martino Rolla1, Stefano Bruni2 and Alberto Bacchi Modena1 1 Department of Obstetrics, Gynaecology and Neonatology, University of Parma, and 2Department of Diagnostic Imaging-Emergency Radiology Unit, University Hospital of Parma, Parma, Italy
Abstract Interstitial pregnancy is considered one of the most hazardous types of ectopic pregnancies, with a mortality rate of 2–2.5%. We describe a case of a viable monochorionic twin pregnancy in a 35-year-old woman successfully treated with systemic methotrexate associated with bilateral uterine arteries’ embolization. β-hCG was undetectable 67 days after the first administration of methotrexate and the ultrasonography performed on day 67 showed the remnant of the gestational sac in the right uterine horn, a thin endometrium and a normal myometrial vascularization. Conservative treatment allowed us to avoid surgical treatment and to preserve the patient’s fertility. Key words: interstitial pregnancy, monochorionic twin pregnancy, uterine artery embolization.
Introduction
Case Report
Ectopic pregnancy accounts for 2% of all pregnancies.1 Interstitial pregnancy accounts for 2.4% of ectopic pregnancies and occurs when the site of implantation is the proximal portion of the fallopian tube, lying within the muscular wall of the uterus.2 The vascular supply of this area is particularly rich because it contains anastomoses between uterine and ovarian arteries.3 The history of ipsilateral or bilateral salpingectomy are suspected risk factors for interstitial ectopic pregnancy; in vitro fertilization (IVF) have been linked with increased frequency of interstitial pregnancy as well as monochorionic and dichorionic twin pregnancy.4 We report a case of interstitial monochorionic twin pregnancy after IVF in a patient with history of bilateral salpingectomy for two previous tubal pregnancies. Conservative treatment allowed us to avoid surgical treatment and to preserve the patient’s fertility.
A 35-year-old patient was admitted to our hospital with the diagnosis of ectopic monochorionic twin pregnancy with interstitial implant at 7 weeks. On admission, the patient’s clinical condition was stable and no symptoms were reported; neither pain nor tenderness were evocated during abdominal examination; uterine size was slightly increased but uterine shape was regular; no adnexal masses were reported. Transabdominal and transvaginal 2-D and 3-D ultrasound scan showed a chorionic sac containing two embryos with crown-to-rump length of 10 mm and cardiac activity eccentrically located outside an empty uterine cavity and surrounded by a thin myometrial layer (
