Interstitial Pregnancy: A Case Report and Review of Literature

https://doi.org/10.1016/j.ijscr.2022.107744

Management of an isolated complete imperforate transverse vaginal septum: A case report

During the development of the female genital tract, any insult to the normal development process results in a set of intriguing abnormalities known as Mullerian duct abnormalities. The uterine didelphys is the second least common type of anomaly among these, which may commonly be associated with a longitudinal vaginal septum (lateral fusion defect). However uterine didelphys along with a transverse vaginal septum (lateral fusion plus resorption defect) is a very rare finding and to the best of our knowledge, thecase that we hereby report is the second one in literature.A 16-year-old unmarried girl presented with primary amenorrhoea and cyclical pain for 18months.On clinical examination and imaging, a case of uterine didelphys and transverse vaginal septum was found. Her urinary tract was normalon USG and MRI evaluation. Excision of the septum was done by abdomino-vaginal approach. The patient was discharged well.We conclude that a patient presenting with primary amenorrhea especially with cyclical dysmenorrhea with a transverse vaginal septum on examination should be thoroughly investigated for associated upper genital tract abnormalities as the treatment strategy and prognosis is largely dependent on the correct classification of the anomaly.

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Uterine Didelphys with Transverse Vaginal Septum – A Complex rare Müllerian Anomaly

Ectopic pregnancy is defined as implantation anywhere other than the endometrial cavity of the uterus. It is the leading cause of maternal death in the first trimester. When the gestational sac implants in the myometrial part of the proximal fallopian tube, it is called interstitial pregnancy. Angular pregnancy is an important differential diagnosis, where the embryo implants in the lateral angle of the uterine cavity. While angular pregnancy is present medial to the round ligament, interstitial pregnancy implants lateral to the round ligament. The term ‘cornual pregnancy’ often used interchangeably, refers to pregnancy in 1 horn of duplication anomaly (septate or bicornuate uterus). Important risk factors for interstitial pregnancy include prior history of ectopic pregnancy, previous ipsilateral or bilateral salpingectomy, tubal surgery, ovulation induction conception after in-vitro fertilization and history of STDs etc. Interstitial pregnancy has increased capability to expand, remain asymptomatic for 7-16 weeks of gestation.

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Misdiagnosis of interstitial pregnancy followed by circlage operation and failed induced midtrimester abortion: a case report

Endometrial stromal sarcoma (ESS) is a rare malignant tumor that constitutes about 0.2% of all uterine malignancies and 10% of uterine sarcomas. ESS is generally misdiagnosed as leiomyoma or endometrial polyp and typically discovered on histopathological examination postoperatively because of its rarity. Endometrial stromal tumors are composed of cells resembling normal endometrial stroma in its proliferative phase. The histologic diagnosis of the high grade is made if there is a high-grade sarcoma with a high mitotic index and nuclear anaplasia. The mean age of presentation of high-grade endometrial sarcoma is about 61 years with the most common presenting complaint is menorrhagia. The median overall survival for high-grade endometrial sarcoma is 53 months with optimal cytoreduction. A 49-year-old woman P2 L2 presented with nonspecific complaint of discharge and spotting per vaginum. In the present case, the provisional diagnosis by clinical findings as well as imaging was in favor of the inversion of submucous fibroid. Preoperative histopathological examination and immunohistochemistry confirmed the diagnosis of high-grade undifferentiated ESS. Haultain's operation followed by total abdominal hysterectomy and bilateral salpingo-oophorectomy was performed. The patient was referred to another center for radiotherapy. From there, she was lost to follow-up. Rarity of endometrial stromal tumor limits the clinician view to diagnose it preoperatively. We were fortunate to have preoperative histopathological diagnosis of ESS. Furthermore, as ESS is rare and undifferentiated stromal sarcoma is even rarer, literature is lacking on its optimal management. Hence, it is important for all clinicians to keep the high degree of suspicion for ESS while working up any case of abnormal uterine bleeding.

A High-Grade Undifferentiated Endometrial Stromal Sarcoma Presenting as Inversion of the Uterus: A Rare Case.

Background: Stillbirth rate is considered a health index. The worldwide stillbirth rate is 18.4/1000 total birth. This study was aimed to evaluate the prevalence and risk factors of intrauterine fetal death in pregnant women in one of the teaching centers in Northeastern India.Methods: This was a retrospective study. All cases of intrauterine fetal death admitted in the department of obstetrics gynecology of our institute were included over two and half years. Information was gathered from the medical records of the patients and data were analyzed.Results: During two and half year’s period, the total number of deliveries was 2696 and the total numbers of stillbirths were 96, hence the stillbirth rate was 35.6/1000. 93 (96.87%) were antenatal stillbirths and 3 (3.12%) were intrapartum stillbirths. 82 (85.41%) women were unbooked. 85 (90.4%) belonged to low socioeconomic status. 67 (69.79%) were preterm. Maximum 39 (40.62%) belonged to 28-35 weeks of gestational age. The most common cause of Intrauterine death (IUD) was antepartum hemorrhage (17.7%). 14 (14.5%) were abruption and 3 were placenta previa. The second most common cause (14.5%) was the hypertensive disorder of pregnancy.Conclusions: The stillbirth rate in our institute is higher than the national average. The most common causes of IUD were antepartum hemorrhage, preeclampsia, prematurity, and malpresentation which can be diagnosed and managed by increasing uptake of antenatal care which will lead to timely identification and proper management of maternal and fetal complications eventually reducing the preventable stillbirths.

Anusmita Saha

Papers

Uterine Didelphys with Transverse Vaginal Septum – A Complex rare Müllerian Anomaly

Misdiagnosis of interstitial pregnancy followed by circlage operation and failed induced midtrimester abortion: a case report

A High-Grade Undifferentiated Endometrial Stromal Sarcoma Presenting as Inversion of the Uterus: A Rare Case.

Analysis of the prevalence, etiology, and risk factors of stillbirth from a teaching institute of North Eastern India- a retrospective study