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Review
. 2021 Sep 17;18(18):9781.
doi: 10.3390/ijerph18189781.

Interstitial Ectopic Pregnancy: The Role of Mifepristone in the Medical Treatment

Guglielmo Stabile  1 , Federico Romano  1 , Giulia Zinicola  2 , Ghergana Alexandrova Topouzova  2 , Giovanni Di Lorenzo  1 , Francesco Paolo Mangino  1 , Giuseppe Ricci  1   2
Affiliations
Review

Interstitial Ectopic Pregnancy: The Role of Mifepristone in the Medical Treatment

Guglielmo Stabile et al. Int J Environ Res Public Health. .

Abstract

Interstitial pregnancy is defined as the presence of a gestational sac in the most proximal section of the fallopian tube. Management of interstitial pregnancy remains a debated topic. Depending on hemodynamic stability, size of pregnancy, depth of surrounding myometrium, and desires for future fertility, interstitial pregnancy can be managed medically or surgically. We reviewed the literature in December 2020 using keywords "interstitial pregnancy", "medical treatment", "methotrexate", and "mifepristone". Articles published from January 1991 until 2020 were obtained from databases EMBASE, SCOPUS, and PUBMED. We describe the case of a patient with an interstitial pregnancy that was managed with a total medical approach in August 2020 at Burlo Garofolo Hospital. The patient was asymptomatic and hemodynamically stable, with a high level of serum β-hCG (22,272 mUi/mL). We used the combination of methotrexate (MTX) and mifepristone. Medical therapy was effective leading to interstitial pregnancy resolution in 51 days without collateral effects for the patient. We found seven previous cases reported in the literature. Our purpose is to underline the efficacy of medical therapy with systemic multidose MTX associated with a single oral dose of mifepristone and also folinic acid when is present a viable fetus and a high serum β-hCG level.

Keywords: conservative treatment; ectopic pregnancy; fertility sparing; interstitial pregnancy; medical therapy; methotrexate; mifepristone.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Ultrasound findings of interstitial pregnancy (a) A 3-D ultrasonography: an empty uterine cavity with a gestational sac located > 1 cm from the sideward portion of the uterine cavity; the continuation of myometrial mantle around the ectopic sac is clearly viable. (b) A 2D-view of the interstitial pregnancy surrounded by a myometrial layer of less than 5 mm.
Figure 1
Figure 1
Ultrasound findings of interstitial pregnancy (a) A 3-D ultrasonography: an empty uterine cavity with a gestational sac located > 1 cm from the sideward portion of the uterine cavity; the continuation of myometrial mantle around the ectopic sac is clearly viable. (b) A 2D-view of the interstitial pregnancy surrounded by a myometrial layer of less than 5 mm.
See this image and copyright information in PMC

References

    1. Wright S.D., Busbridge R.C., Gard G.B. A conservative and fertility preserving treatment for interstitial ectopic pregnancy. Aust. N. Z. J. Obstet. Gynaecol. 2013;53:211–213. doi: 10.1111/ajo.12067. - DOI - PubMed
    1. Brincat M., Bryant-Smith A., Holland T.K. The diagnosis and management of interstitial ectopic pregnancies: A review. Gynecol. Surg. 2019;16:2. doi: 10.1186/s10397-018-1054-4. - DOI
    1. Koukoura O., Dragoumis G., Gorila G., Gkorezi-Ntavela I., Dafopoulos K., Pistofidis G. Spontaneous Intraoperative Rupture of a Large Interstitial Pregnancy: Laparoscopic Management. Case Rep. Obstet. Gynecol. 2020;2020:5626783. doi: 10.1155/2020/5626783. - DOI - PMC - PubMed
    1. Stabile G., Romano F., Buonomo F., Zinicola G., Ricci G. Conservative Treatment of Interstitial Ectopic Pregnancy with the Combination of Mifepristone and Methotrexate: Our Experience and Review of the Literature. BioMed Res. Int. 2020;2020:8703496. doi: 10.1155/2020/8703496. - DOI - PMC - PubMed
    1. Moawad N., Mahajan S.T., Moniz M.H., Taylor S.E., Hurd W.W. Current diagnosis and treatment of interstitial pregnancy. Am. J. Obstet. Gynecol. 2010;202:15–29. doi: 10.1016/j.ajog.2009.07.054. - DOI - PubMed

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