Title: Diagnosis pitfall of interstitial pregnancy: a case report of a term pregnancy with

abnormal placentation
Author/s: Fatemeh Sadat Najib, Homeira Vafaei, Amin Abolhasan Foroughi & Niloofar
Namazi
Year Published: 2021
Article link: https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-
021-04153-1
Summary:
There is a type of ectopic pregnancy known as interstitial pregnancy (IP) where the
pregnancy product is implanted in the tube's intramural segment. A rough estimate that its
percentage of ectopic pregnancies is less than 3%. Even though it might not show any
symptoms at first, during the first 14–16 weeks of pregnancy, it mostly ruptures. The first
trimester causes severe bleeding because of high vascularity. There are only rare cases
of interstitial full-term pregnancies. A 32-year-old Iranian woman who was 38 weeks
pregnant and a primigravida had no prior history of infertility, significant medical
conditions, or major surgeries. Her first trimester of pregnancy progressed normally and
neither the sonogram nor the lab results showed any pathologic findings. A local doctor
transferred her to the operating room after she had extreme abdominal pain and vomiting
at 26 weeks of pregnancy. At 36 weeks and 4 days gestation, she was referred to high-
risk perinatal clinic due to a suspicion of cervical cancer.
The patient underwent a cesarean section at 38 weeks gestation. The unusual
discovery of a term interstitial pregnancy included the growth of a placenta that was
eluding the myometrium from the serosa. (reversely from the outside to the interior of the
uterus), which a pathology study confirmed (Fig. 2). A child was born weighing 2840g and
having an APGAR score of 8 to 9 in the first and fifth minutes. A hysterectomy was
performed. The patient underwent surgery and stabilized in terms of the blood loss with a
misdiagnosed impression when this IP ruptured and the patient got acute abdominal and
internal bleeding. After termination, a term IP with placenta increta that was the cause of
the increased vascularity around the cervix in her MRI and the mistaken cervical cancer
diagnosis was discovered.
As laparoscopic cornuostomy is presented as the method of option, the chosen
surgical approach can vary depending on the scope and results of the procedure.
According to a recent meta-analysis, laparoscopic approach is recommended as the first
line of therapy with the advantage of an average amount of bleeding of 168 cc, which
depends on the gravidity and length of the patient's amenorrhea. Despite the fact that this
method increases the risk of developing uterine rupture in a subsequent pregnancy. The
benefit of hysteroscopy has recently been confirmed by using morcellation procedures to
prevent several difficulties with the surgical management of IP, particularly the retained
tissues.
Particularly if it goes undetected during normal prenatal screenings, it is likely that
some interstitial pregnancy disorders exist that can result in a full-term pregnancy. In order
to more effectively manage such pregnancies, doctors are advised to be aware of them
and to pay attention to any accompanying issues such placenta accreta.

Nursing Implication:
Upon reading this case, which is considered a very rare case during pregnancy
and delivery, I came to realize that becoming pregnant is never easy, that it holds so much
care and responsibility, not only to the part of the mother and her family, but also to the
healthcare providers as they seek and weigh the best possible medical treatment
necessary for each case among the options available at hand. In this case report, the
pregnant woman was misdiagnosed of having cervical cancer when in fact, she really has
interstitial pregnancy. From this fact alone, the doctors may be held liable for
misdiagnosing the patient because there is a high possibility that the patient will die once
the interstitium rupture due to severe bleeding. In relation to this, as nurses, we are taught
of proper assessment to make our diagnosis precise. Once the diagnosis is incorrect, the
planning and interventions are also not effective in treating the root problem, and in worst
case, it may even complicate the disease and put the clients in danger. In here, I
acknowledge the importance of checking the patient thoroughly and properly while
preserving their safety. Interstitial pregnancy is a type of ectopic pregnancy and we are
much aware of its danger to the mother and the fetus during its growth and development.
If the site of implantation ruptures, it will cause severe complications such as bleeding/
hemorrhage. And so, we have to do our duties properly by rendering nursing interventions
likes ensuring that appropriate physical needs are addressed and monitors for
complications, assessing the vital signs, bleeding, and pain and providing client and family
teaching to relieve anxiety. Also, it is a must to explain the condition and expected
outcome to the family as it will help them become more open about this certain medical
condition.

Learning Insights:
Because interstitial pregnancy is one of the riskiest types of ectopic pregnancy, I
believe that it must be accurately diagnosed and should be done as early in the pregnancy
as possible. A ruptured ectopic pregnancy causes excruciating stomach discomfort and
copious vaginal bleeding. The mother will die if these are not addressed right away.
Hence, if I had to make a choice about whether to keep this kind of pregnancy going or
not, I would advise the mother and let her know about the risks if the pregnancy goes all
the way to term. In order to protect the mother's interstitial area and her own health, it is
advisable to remove it before it begins to rupture. There is this called laparoscopic
cornuostomy wherein it is highly recommended for such case since it is less invasive and
gives less complications. It preserves the uterine architecture as well as it maintains
fertility. It is considered to cause less tubal damage than other types of procedures like
cornual resection, and lastly, it may promote better pregnancy outcome in the future.
However, the procedure still depends on the severity of the case .

Reference (in APA format)

Najib, F., Vafaei, H., Foroughi, A., & Namazi, N. Diagnosis pitfall of interstitial pregnancy:
a case report of a term pregnancy with abnormal placentation. BMC Pregnancy and
Childbirth. Retrieved October 18, 2021, from
https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-021-04153-