Publication:

A cornered conundrum: early diagnosis and management of an unruptured interstitial ectopic pregnancy

Constituting about 2.4% of all ectopic pregnancies, an interstitial ectopic pregnancy is a rare but life-threatening condition. Diagnosis can be challenging and it often presents late, with a high risk of catastrophic haemorrhage following rupture. Early diagnosis remains crucial for reducing maternal morbidity. We report a case of a spontaneously conceived interstitial ectopic pregnancy (IEP) diagnosed at an early gestational age in a hemodynamically stable patient presenting asymptomatically, for routine antenatal care, with no identifiable risk factors. Transvaginal ultrasonography and magnetic resonance imaging (MRI) pelvis revealed an eccentrically located gestational sac near the right uterine cornu, surrounded by a thin myometrial mantle, separate from the endometrial cavity. Serum β-hCG level was consistent with early gestation. Prompt diagnosis enabled timely surgical intervention before rupture. The postoperative course was uneventful and the patient recovered well. IEP poses significant diagnostic and therapeutic challenges due to its atypical location and risk of delayed rupture. Vigilant early imaging and high clinical suspicion are essential for timely intervention. Early recognition allows for planned surgical management, reducing maternal morbidity and mortality and improving reproductive outcomes.