Use of Transvaginal Ultrasound in the Management of an Interstitial Pregnancy

Lily Eghdami, MD, Sonia Elguero, MD, Bansari Patel, MD, Mohamed A. Bedaiwy, MD, PhD

Department of Obstetrics and Gynaecology (Drs. L. Eghdami and M. A. Bedaiwy), Division of Reproductive Endocrinology and Infertility (Dr. M. A. Bedaiwy), University of British Columbia, Vancouver, BC, Canada; Department of Obstetrics and Gynecology and Women’s Health Institute, Cleveland Clinic, Cleveland, OH, USA (Drs. S. Elguero and B. Patel).

ABSTRACT

An interstitial pregnancy is an ectopic pregnancy that is implanted in the interstitial segment of the fallopian tube and embedded within the muscular layer of the uterus. Because of the rich vascular supply of this region, maintaining hemostasis during surgical management of interstitial pregnancies is a recognized challenge. Visualizing the entirety of the gestational sac beneath the uterine serosa can also present a challenge, especially in cases of uncomplicated interstitial ectopic pregnancies. Here we present a case in which intraoperative transvaginal ultrasound was used to assist with a laparoscopic cornual wedge resection in a 24-year-old woman with a confirmed interstitial pregnancy. The use of intraoperative transvaginal ultrasound during the laparoscopy helped accurately delineate the location and extent of invasion of the interstitial pregnancy. It guided the placement of the uterine incision and helped ensure that the entire gestational sac and products of conception had been removed. This case demonstrates that transvaginal ultrasound can be used as an intraoperative tool to enhance surgical safety and minimize patient risk.

Key Words: Ultrasonography, Pregnancy, Ectopic, Laparoscopy.

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