SPR Unknown # 98 -- FINAL

Erika Rubesova, MD

Stanford University

Lucile Packard Children’s Hospital

Abstract


Publication Date: 2013-10-12

History

40-year-old patient referred to the prenatal diagnostic center from an outside institution for “abnormal pregnancy”. The patient was at 19 weeks of gestational age and an ultrasound was performed to evaluate the fetal anatomy. The findings were discussed with the patient and a fetal MRI was performed to confirm the sonographic diagnosis.

Findings

Both imaging modalities demonstrated an interstitial pregnancy in the left horn of the uterus.

Discussion

The patient refused termination at the time of the diagnosis and was admitted to the hospital. Two days after admission, she complained of severe abdominal pain and vaginal bleeding. The patient was taken immediately to the operating room for an exploratory laparotomy and repair of uterine rupture. She was discharged after spending a few days in the hospital.

Interstitial pregnancies, also called corneal pregnancies in patients with bicornuate or septated uterus, account for 2-4% of ectopic pregnancies and are more frequent in patients that have undergone assisted reproductive technology. They are usually diagnosed later and may result in uterine rupture and severe hemorrhage from the adjacent uterine artery.

On ultrasound they typically present as an intrauterine eccentric gestational sac with the surrounding myometrium measuring less than 5mm. While generally the diagnosis can be done by ultrasound alone, fetal MRI may be helpful when the sonographic diagnosis is unclear.

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