Diagnostic and management dilemmas of pregnancies at the utero‐tubal junction: A case series and management algorithm

• Published in: International journal of gynecology and obstetrics 2024-10, Vol.167 (1), p.413-419
• Main Authors: Mahey, Reeta, Singh, Shalini V., Gupta, Paridhi, Rana, Anubhuti, Rajput, Monika, Cheluvaraju, Rohitha, Manchanda, Smita, Jayraj, Aarthi K, Bhatla, Neerja
• Format: Article
• Language: English
• Subjects: 3D‐ultrasonography; angular pregnancy; eccentric ectopic pregnancy; interstitial ectopic pregnancy; intramural ectopic pregnancy
• ISSN: 0020-7292; 1879-3479; 1879-3479
• DOI: 10.1002/ijgo.15587

Objective A pregnancy at the utero‐tubal junction is a rare type of ectopic pregnancy and is associated with high maternal morbidity if it remains undetected. In the present study we discuss four cases of ectopic pregnancies at the utero‐tubal junction which caused diagnostic and management dilemmas. Methods Four cases of early pregnancies with the gestational sac (G‐sac) implanted near the utero‐tubal junction are described. In case 1 this was suspected after a failed attempt at dilatation and curettage at our hospital, cases 2 and 3 presented with amenorrhea and pain abdomen and case 4 was diagnosed on first pregnancy documentation scan after frozen embryo transfer. Results As initial two‐dimensional (2D) transvaginal scan (TVS) failed to diagnose the exact location of the G‐sac, three‐dimensional (3D) TVS helped to localize the exact location of pregnancy and subsequent individualized management. Case 1 had a partial intramural ectopic pregnancy managed by laparotomy and removal of the ectopic sac. The second and third cases were eccentric uterine pregnancies. The fourth was an interstitial ectopic pregnancy managed by a laparoscopic loop and stitch technique. Conclusion This case series describes the role of 3D TVS for the evaluation of pregnancies implanted at the utero‐tubal junction and individual management of eccentric intrauterine, interstitial ectopic and intramural ectopic pregnancies. A diagnostic algorithm for such types of cases and management options is discussed. Synopsis Four cases of pregnancies at the utero‐tubal junction along with diagnostic dilemmas, role of three‐dimensional ultrasound (3D USG) in diagnosis and management algorithm are described.