{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T01:08:22Z","timestamp":1782781702728,"version":"3.54.5"},"reference-count":36,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2023,1,26]],"date-time":"2023-01-26T00:00:00Z","timestamp":1674691200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>The term intramural (interstitial) ectopic pregnancy refers to a pregnancy developing outside the uterine cavity, with a gestational sac implanted into the interstitial part of the Fallopian tube, surrounded by a layer of the myometrium. The prevalence rate of interstitial pregnancy (IP) is 2\u20134% of all ectopic pregnancies. Surgery is the primary treatment for interstitial ectopic pregnancy; the pharmacological management of ectopic pregnancy, including IP, in asymptomatic patients includes systemic administration of methotrexate. In this report, we present two cases of this rare pregnancy type, reviewing our management technique and treatment ways presented in the literature. In our patients, the management was initially conservative and included methotrexate, administered as intravenous bolus injection, regular beta-human chorionic gonadotropins (\u03b2-HCG) level measurements in peripheral blood, and monitoring of the patient\u2019s general condition. Due to signs of intra-abdominal bleeding in patient A and inadequate \u03b2-HCG level reduction in patient B, both patients eventually underwent laparoscopic cornual resection. Pregnancy, implanted into the interstitial part of the Fallopian tube and surrounded by myometrial tissue with myometrial invasion of the trophoblast, poses a serious diagnostic challenge to modern gynecology due to particularly low sensitivity and specificity of symptoms, and may require both pharmacological and surgical treatment.<\/jats:p>","DOI":"10.3390\/medicina59020233","type":"journal-article","created":{"date-parts":[[2023,1,27]],"date-time":"2023-01-27T01:58:59Z","timestamp":1674784739000},"page":"233","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Interstitial Ectopic Pregnancy\u2014Case Reports and Medical Management"],"prefix":"10.3390","volume":"59","author":[{"given":"Ma\u0142gorzata","family":"Kampioni","sequence":"first","affiliation":[{"name":"Department of Maternal and Child Health, Poznan University of Medical Sciences, Polna 33, 69-535 Poznan, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karolina","family":"Chmaj-Wierzchowska","sequence":"additional","affiliation":[{"name":"Department of Maternal and Child Health, Poznan University of Medical Sciences, Polna 33, 69-535 Poznan, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9336-7060","authenticated-orcid":false,"given":"Katarzyna","family":"Wszo\u0142ek","sequence":"additional","affiliation":[{"name":"Department of Maternal and Child Health, Poznan University of Medical Sciences, Polna 33, 69-535 Poznan, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maciej","family":"Wilczak","sequence":"additional","affiliation":[{"name":"Department of Maternal and Child Health, Poznan University of Medical Sciences, Polna 33, 69-535 Poznan, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,1,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"471","DOI":"10.1007\/s13224-017-1078-0","article-title":"Interstitial and Cornual Ectopic Pregnancy: Conservative Surgical and Medical Management","volume":"68","author":"Dagar","year":"2018","journal-title":"J. Obs. Gynaecol. India"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Ilea, C., Ilie, O.-D., Marcu, O.-A., Stoian, I., and Doroftei, B. (2022). The Very First Romanian Unruptured 13-Weeks Gestation Tubal Ectopic Pregnancy. Medicina, 58.","DOI":"10.3390\/medicina58091160"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Stabile, G., Romano, F., Zinicola, G., Topouzova, G.A., Di Lorenzo, G., Mangino, F.P., and Ricci, G. (2021). Interstitial Ectopic Pregnancy: The Role of Mifepristone in the Medical Treatment. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18189781"},{"key":"ref_4","first-page":"715","article-title":"Asymptomatic rupture of a cornual ectopic in the third trimester","volume":"50","author":"Brewer","year":"2005","journal-title":"J. Reprod. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"989","DOI":"10.1007\/s40477-022-00668-1","article-title":"Diagnostic dilemma between angular and interstitial ectopic pregnancy: 3D ultrasound features","volume":"25","author":"Durand","year":"2022","journal-title":"J. Ultrasound"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"478","DOI":"10.5603\/GP.2020.0083","article-title":"Interstitial ectopic pregnancy following ipsilateral salpingectomy","volume":"91","author":"Piecha","year":"2020","journal-title":"Ginekol. Pol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"746","DOI":"10.5455\/2320-1770.ijrcog20131261","article-title":"Asymptomatic rupture of cornual gestation presented as abdominal mass","volume":"2","author":"Saichandran","year":"2016","journal-title":"Int. J. Reprod. Contracept. Obstet. Gynecol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"863","DOI":"10.1016\/j.rcl.2006.10.015","article-title":"Imaging of Pelvic Pain in the First Trimester of Pregnancy","volume":"44","author":"Eyvazzadeh","year":"2006","journal-title":"Radiol. Clin. N. Am."},{"key":"ref_9","first-page":"8","article-title":"Laparoscopic Treatment of an Interstitial Pregnancy","volume":"4","author":"Hamon","year":"2014","journal-title":"Gynecol. Obs."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1186\/s10397-018-1054-4","article-title":"The diagnosis and management of interstitial ectopic pregnancies: A review","volume":"16","author":"Brincat","year":"2019","journal-title":"Gynecol. Surg."},{"key":"ref_11","first-page":"569","article-title":"Successful treatment of ruptured interstitial pregnancy with laparoscopic surgery. A report of 2 cases","volume":"48","author":"Chan","year":"2003","journal-title":"J. Reprod. Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1576\/toag.9.4.249.27355","article-title":"Management of cornual (interstitial) pregnancy","volume":"9","author":"Faraj","year":"2007","journal-title":"Obs. Gynaecol."},{"key":"ref_13","first-page":"131","article-title":"Interstitial Pregnancy after In Vitro Fertilization and Embryo Transfer Following Bilateral Salpingectomy: Report of Two Cases and Literature Review","volume":"6","author":"Garavaglia","year":"2012","journal-title":"Int. J. Fertil. Steril."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"8703496","DOI":"10.1155\/2020\/8703496","article-title":"Conservative Treatment of Interstitial Ectopic Pregnancy with the Combination of Mifepristone and Methotrexate: Our Experience and Review of the Literature","volume":"2020","author":"Stabile","year":"2020","journal-title":"Biomed. Res. Int."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e15","DOI":"10.1111\/1471-0528.14189","article-title":"Diagnosis and management of ectopic pregnancy","volume":"123","author":"Elson","year":"2016","journal-title":"BJOG"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1186\/s40738-015-0008-z","article-title":"Incidence, diagnosis and management of tubal and nontubal ectopic pregnancies: A review","volume":"1","author":"Panelli","year":"2015","journal-title":"Fertil. Res. Pract."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"614","DOI":"10.1016\/j.jogc.2021.01.002","article-title":"Guideline No. 414: Management of Pregnancy of Unknown Location and Tubal and Nontubal Ectopic Pregnancies","volume":"43","author":"Po","year":"2021","journal-title":"J. Obs. Gynaecol. Can."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"73","DOI":"10.52054\/FVVO.13.1.009","article-title":"Methotrexate injection for interstitial pregnancy: Hysteroscopic conservative mini-invasive approach","volume":"13","author":"Casadio","year":"2021","journal-title":"Facts Views Vis. Obgyn."},{"key":"ref_19","first-page":"e8081","article-title":"Interstitial Pregnancy: Case Report of Atypical Ectopic Pregnancy","volume":"13","author":"Santos","year":"2020","journal-title":"Cureus"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1016\/S0015-0282(99)00242-3","article-title":"Conservative medical and surgical management of interstitial ectopic pregnancy","volume":"72","author":"Lau","year":"1999","journal-title":"Fertil. Steril."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1011","DOI":"10.1016\/j.jmig.2019.01.009","article-title":"Total hysteroscopic treatment of cervical pregnancy: The 2-step technique","volume":"26","author":"Mangino","year":"2019","journal-title":"J. Minim. Invasive Gynecol."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Tantchev, L., Kotzev, A., and Yordanov, A.A. (2019). Disturbed interstitial pregnancy: A first case of successful treatment using a mini-laparoscopic approach. Medicina, 55.","DOI":"10.3390\/medicina55050215"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"197","DOI":"10.4293\/108680813X13753907292836","article-title":"Interstitial Ectopic Pregnancy: Conservative Surgical Management","volume":"18","author":"Warda","year":"2014","journal-title":"J. Soc. Laparoendosc. Surg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1016\/j.ajog.2009.07.054","article-title":"Current diagnosis and treatment of interstitial pregnancy","volume":"202","author":"Moawad","year":"2010","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_25","first-page":"87","article-title":"Mini-cornual excision: A simple stepwise laparoscopic technique for the treatment of cornual pregnancy","volume":"13","author":"Moawad","year":"2009","journal-title":"J. Soc. Laparoendosc. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1016\/S1074-3804(05)60483-5","article-title":"Surgical management of interstitial pregnancy","volume":"7","author":"Bremner","year":"2000","journal-title":"J. Am. Assoc. Gynecol. Laparosc."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1016\/S0002-9378(00)70499-6","article-title":"New simple endoscopic operations for interstitial pregnancies","volume":"182","author":"Moon","year":"2000","journal-title":"Am. J. Obs. Gynecol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"613","DOI":"10.1016\/j.jmig.2019.04.029","article-title":"Interstitial Pregnancy after Ipsilateral Salpingectomy: Analysis of 46 Cases and a Literature Review","volume":"27","author":"Gao","year":"2020","journal-title":"J. Minim. Invasive Gynecol."},{"key":"ref_29","unstructured":"Haestier, A. (2022, September 27). Guideline for the Medical Management of Ectopic Pregnancy with Methotrexate, Version 5. Norfolk and Norwich University Hospitals. NHS Foundation Trust. Date Approved: 17 July 2020. Available online: https:\/\/www.google.com\/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&cad=rja&uact=8&ved=2ahUKEwiI1euUjJ_7AhVii8MKHertBL4QFnoECAoQAQ&url=https%3A%2F%2Fwww.nnuh.nhs.uk%2Fpublication%2Fdownload%2Fectopic-pregnancy-with-methotrexate-treatment-g27v5%2F&usg=AOvVaw0Kl_UTnnD55Jma5ehZYR_J."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1097\/01.AOG.0000109218.24211.79","article-title":"Interstitial pregnancy: Results generated from the Society of Reproductive Surgeons\u2019 Registry","volume":"103","author":"Tulandi","year":"2004","journal-title":"Obs. Gynecol."},{"key":"ref_31","first-page":"135","article-title":"Interstitial ectopic pregnancy: A case report","volume":"11","author":"Alagbe","year":"2017","journal-title":"Pan. Afr. Med. J."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1113","DOI":"10.1067\/mob.2003.258","article-title":"Combined hysteroscopy and laparoscopy in the treatment of interstitial pregnancy","volume":"188","author":"Katz","year":"2003","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"e29730","DOI":"10.1097\/MD.0000000000029730","article-title":"Surgical treatment of interstitial pregnancy without cornual resection: A case report","volume":"101","author":"Feng","year":"2022","journal-title":"Medicine"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"476","DOI":"10.12669\/pjms.332.12093","article-title":"Management options for interstitial ectopic pregnancies: A case series","volume":"33","author":"Kahramanoglu","year":"2017","journal-title":"Pak. J. Med. Sci."},{"key":"ref_35","first-page":"299","article-title":"A systematic review and meta-analysis of laparotomy compared with laparoscopic management of interstitial pregnancy","volume":"12","author":"Marchand","year":"2021","journal-title":"Facts Views Vis. Obgyn."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"156","DOI":"10.5468\/ogs.20299","article-title":"Management of interstitial pregnancy in the era of laparoscopy: A meta-analysis of 855 case studies compared with traditional techniques","volume":"64","author":"Marchand","year":"2021","journal-title":"Obs. Gynecol. Sci."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/59\/2\/233\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:16:23Z","timestamp":1760120183000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/59\/2\/233"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1,26]]},"references-count":36,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2023,2]]}},"alternative-id":["medicina59020233"],"URL":"https:\/\/doi.org\/10.3390\/medicina59020233","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,1,26]]}}}