Spontaneous interstitial pregnancy on a tubal stump after unilateral adenectomy followed by transvaginal colour Doppler ultrasound

Abstract

Transvaginal colour and angio Doppler blood flow analysis combined with serial measurement of human chorionic gonadotrophin (HCG) concentration is reported here for the first time to study the local vascularity of a cornual pregnancy and to monitor the effectiveness of medical therapy. Interestingly, a strong relationship between morphological changes of trophoblastic tissue and the intensity of neovascularization was noted. Systemic single-dose methotrexate (MTX) therapy allowed successful treatment of an interstitial ectopic pregnancy involving part of the proximal portion of a tubal stump. We suggest that, by adding colour Doppler to conventional transvaginal ultrasonography, the outpatient surveillance of ectopic pregnancy evolution following MTX therapy is greatly enhanced. This is of particular value in cornual pregnancies which are highly likely to develop harmful complications during surgical intervention or even during puncture for local MTX injection.