Interstitial Pregnancy - A Clinico - Sonographic Diagnostic Dilemma

Abstract

Ectopic pregnancy in the interstitial part of the fallopian tube is a rare event, constituting only 2-4 % of all tubal ectopic pregnancies and is associated with a high rate of complications. While all ectopic pregnancies are associated with a risk of hemorrhage, interstitial pregnancies are associated with the highest risk of massive, uncontrollable bleeding. There is a higher risk of maternal mortality due to delayed diagnosis and high vascularity of the myometrium. It presents a challenge for clinical as well as radiological diagnosis. We are reporting a case where the diagnostic dilemma persisted in a case of an early interstitial pregnancy and the expertise of two different sonologists was sought. The ectopic nature of the pregnancy could be confirmed in the follow up ultrasound after 2 weeks and appropriate management was instituted. Classical interstitial line sign with eccentrically placed gestational sac and thin endometrial mantle around it is diagnostic.