Recurrent Interstitial pregnancy: a new approach in diagnosis with MRI and management with systemic methotrexate along with intra foetal cardiac 10% potassium chloride


  • Prasad Lele Department of Obstetrics and Gynaecology, Command Hospital, King Gorge Medical University, Lucknow, India
  • Manoj Kumar Tangri Department of Obstetrics and Gynaecology, Command Hospital, West Bengal Medical University, Kolkata, India
  • Deepak Patil Department of Obstetrics and Gynaecology, Command Hospital, Pune, India
  • Rajesh Sharma Department of Obstetrics and Gynaecology, Command Hospital, Pune, India



Interstitial pregnancy, Interstitial sign, MRI, Hybrid combined systemic and foetal intra cardiac approach


We present a case of recurrent interstitial pregnancy in a setting of recurrent pregnancy loss where we used a new modality in the diagnosis and treatment. The patient after diagnosis of interstitial pregnancy by Ultrasonography was very keen to continue her pregnancy so the diagnosis was confirmed with MRI imaging showing the “interstitial sign” that convinced her for termination. In this case presence of active foetal cardiac activity and high Serum βhCG (43000 mIU/ml), made medical management a difficult proposition. Then we conceived a hybrid combined medical management of intra-foetal cardiac 10% KCl and adjuvant systemic multi-dose MTX therapy. This resulted in resolution of ectopic and conserves her fertility.


Valsky DV, Yagel S. Ectopic pregnancies of unusual location: management dilemmas. Ultrasound Obstet Gynecol. 2008;31(3):245-51.

Bourdel N, Roman H, Gallot D, Lenglet Y. Interstitial Pregnancy. Ultrasonographic diagnosis and contribution of MRI. A case report. Gynecol Obstet Fertil. 2007;35(2):121-4.

Faraj R, Steel M. Review Management of cornual (interstitial) pregnancy. Obstet & Gynecol. 2007;9:249-55.

Lin EP, Bhatt S, Dogra VS. Diagnostic clues to ectopic pregnancy. Radiographics. 2008;28(6): 1661-71.

Timor-Tritsch IE, Monteagudo A, Matera C, Veit CR. Sonographic evolution of cornual pregnancies treated without surgery. Obstet Gynecol. 1992;79:1044-9.

Tanaka Y, Mimura K, Kanagawa T, Kajimoto E, Takahashi K, Kakigano A. Three-Dimensional Sonography in the Differential Diagnosis of Interstitial, Angular, and Intrauterine Pregnancies in a Septate Uterus. JUM. 2014;33:2031-5.

Tamai K, Koyama T, Togashi K. MR features of ectopic pregnancy. Eur Radiol. 2007;17(12):3236-46.

Ansari A, Ahmad S, James JA, Jeppson CN, Holloway RW. Robotic-assisted laparoscopic resection of cornual ectopic pregnancy. A case report. J Reprod Med. 2015;60(1-2):58-64.

Pfeifer S, Goldberg J, Lobo R, Thomas M, Widra E,Licht M. Medical treatment of ectopic pregnancy: a committee opinion. Fertil Steril. 2013;100(3):638-44.

Szylit NA , Podgaec S, Traina E, Oliveira Rde C. Video laparoscopic intervention for an interstitial pregnancy after failure of clinical treatment. Sao Paulo Med J. 2012;130(3):202-7.

Naredi N, Sandeep K , Jamwal VDS. Interstitial implantation in a setting of recurrent ectopic pregnancy: A rare combination. MJAFI. 2015;71:194-6.

Swank ML, Harken TR, Porto M Management of interstitial ectopic pregnancies with a combined intra-amniotic and systemic approach. Obstet Gynecol. 2013;122(2):461-4.






Case Reports