Considerations for management of interstitial ectopic pregnancies: two case reports.
BACKGROUND
Conventional treatment of interstitial pregnancies includes systemic methotrexate, direct methotrexate injection, wedge resection, or hysterectomy. We present two cases of interstitial pregnancies that were successfully managed by different minimally invasive surgical techniques. We also report the novel use of hysteroscopic urologic stone retrieval forceps in the transvaginal removal of persistent products of conception after systemic methotrexate for an interstitial pregnancy.


METHODS
Case 1 was a 28-year-old gravida 1 white woman at 8 weeks gestation; she was diagnosed with a left interstitial pregnancy. After laparoscopic confirmation of the interstitial pregnancy, successful ultrasound-guided suction dilation and curettage was performed. Case 2 was a 33-year-old gravida 3 para 1021 (one term pregnancy, no preterm pregnancies, one ectopic pregnancy and one spontaneous miscarriage, and one living child) Hispanic woman with persistent products of conception after systemic methotrexate for a left interstitial pregnancy. She underwent hysteroscopic-guided removal of the persistent products of conception, which was possible due to novel use of urologic stone retrieval forceps.


CONCLUSIONS
Successful minimally invasive treatment of interstitial pregnancies may be possible in certain cases. Collaboration between different specialties continues to be important for improving minimally invasive options.
Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Colorado Denver School of Medicine, Aurora, CO, USA. natalia.grindler@ucdenver.edu.
Natalia M
NM
Grindler
University of Colorado Denver School of Medicine, Aurora, CO, USA.
June
J
Ng
University of Colorado Denver School of Medicine, Aurora, CO, USA.|Division of Family Planning, Department of Obstetrics and Gynecology, University of Colorado Denver School of Medicine, Aurora, CO, USA.
Kristina
K
Tocce
Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Colorado Denver School of Medicine, Aurora, CO, USA.|Division of Reproductive Endocrinology & Infertility, Department of Obstetrics and Gynecology, Warren P. Alpert School of Medicine, Brown University, Providence, RI, USA.
Ruben
R
Alvero
D000020:Abortifacient Agents, Nonsteroidal / Q000627:therapeutic use*; D000027:Abortion, Incomplete / Q000601:surgery*; D000328:Adult; D004107:Dilatation and Curettage; D005260:Female; D006801:Humans; D015907:Hysteroscopy; D010535:Laparoscopy; D008727:Methotrexate / Q000627:therapeutic use*; D011247:Pregnancy; D065173:Pregnancy, Cornual / Q000628:therapy*
D000020:Abortifacient Agents, Nonsteroidal; D008727:Methotrexate
Cornual pregnancy; Ectopic pregnancy; Interstitial pregnancy; Minimally invasive surgery; Persistent products of conception