[Interstitial pregnancies--a clinical challenge]

Interstitial pregnancy is a rare type of ectopic pregnancy, with a substantially increased morbidity and mortality. A pregnancy implanted in the interstitial part of the fallopian tube is often more difficult to diagnose and has multiple treatment modalities. The incidence seems to be increasing, but few gynaecological departments have guidelines regarding diagnosis and treatment. Our experience in managing this condition is presented.

Six cases diagnosed from August 2005 to September 2006 are presented.

There are numerous treatment regimens reported for this condition, both surgical and medical. Four different treatments were chosen for the six patients presented. Two patients received methotrexate and four received surgical treatment initially. Methotrexate is an option in haemodynamically stable patients where there is no sign of rupture at the implantation site, but the optimal dosing and mode of administration is unknown. Medical treatment of these patients requires a closer follow-up than that for other ectopic pregnancies. Surgery is indicated in patients who are haemodynamically unstable and in those with a possible rupture. Surgery should also be considered as initial treatment in advanced gestations and in women who are not interested in future childbearing.