Interstitial Ectopic Pregnancy Associated With Painless and Severe Vaginal Bleeding: A Rare, Atypical Clinical Presentation

Abstract

Interstitial ectopic pregnancy is rare (2%-4% of ectopic pregnancies). The atypical clinical presentation of interstitial ectopic pregnancy associated with massive vaginal bleeding is extremely rare and makes early preoperative diagnosis even more difficult. The presentation of our case concerns the early diagnosis and surgical treatment of a patient with an interstitial ectopic pregnancy without rupture, which presented atypically with painless, severe vaginal bleeding. A 27-year-old fourth-term pregnant woman presented with massive painless vaginal bleeding. Secondary amenorrhea was calculated at eight weeks and four days. Transvaginal ultrasound and transvaginal Doppler ultrasound combined with the quantification of beta-chorionic gonadotropin hormone raised the suspicion of interstitial ectopic pregnancy. Intraoperatively, the presence of a large swelling of the right horn of the uterus was established, and a wedge resection was performed with the removal of the corresponding fallopian tube. Three weeks after surgery, the serum beta-chorionic gonadotropin hormone value was zero. In this paper, the rarity of interstitial ectopic pregnancy, the difficulties related to early and correct preoperative diagnosis, and the selection of the appropriate available therapeutic procedures are emphasized, the correct application of which can significantly contribute to reducing the morbidity and mortality of these patients.

Keywords: case report; chorionic gonadotropin hormone; doppler ultrasound; interstitial ectopic pregnancy; magnetic resonance imaging; medical treatment; surgical treatment; transvaginal ultrasound.

Figure 1. Transvaginal ultrasound imaging showing an interstitial ectopic pregnancy

The body of the uterus is visible, as is the presence of a gestational sac with fetal elements without cardiac function (red arrow) in contact with the body of the uterus.

Figure 2. Transvaginal Doppler ultrasound imaging of the interstitial ectopic pregnancy

Increased blood flow is an important criterion in the preoperative diagnosis of interstitial ectopic pregnancy.