Interstitial Pregnancy Resulting in a Viable Infant Coexistent with Massive Perivillous Fibrin Deposition: A Case Report and Literature Review

Abstract

Objective The objective of this report is to describe a rare case of interstitial pregnancy ultimately resulting in a viable infant coexistent with massive perivillous fibrin deposition (MPFD).

Study Design This study is a case report and literature review.

Results A 35-year-old female patient underwent cesarean section at 32 weeks of gestation due to fetal growth restriction (FGR) and breech presentation. During the operation, a diagnosis of interstitial pregnancy was established. There was no evidence of placental separation. We decided to complete surgery without removal of the placenta and waited until the placenta delivered spontaneously. The conservative management was successful, and the patient was discharged on postoperative day 13. The pathologic examination showed MPFD.

Conclusion If interstitial pregnancies are not diagnosed at an early gestational age, it can result in a viable fetus, but such pregnancies may be associated with FGR or placenta accreta.

Keywords

ectopic pregnancy - fetal growth restriction - interstitial pregnancy - massive perivillous fibrin deposition - placenta accreta

• References

• 1 Cunningham FG, Leveno KJ, Bloom SL, Hauth JC, Rouse DJ, Spong CY. Ectopic Pregnancy. In: Cunningham FG, Leveno KJ, Bloom SL, Hauth JC, Rouse DJ, Spong CY, , eds. Williams Obstetrics, 23rd ed. New York, NY: McGraw-Hill; 2010: 238-256
• 2 Jansen RP, Elliott PM. Angular intrauterine pregnancy. Obstet Gynecol 1981; 58 (2) 167-175
• 3 Lin EP, Bhatt S, Dogra VS. Diagnostic clues to ectopic pregnancy. Radiographics 2008; 28 (6) 1661-1671
• 4 Rheinboldt M, Ibrahim S. Atypical presentation of a large interstitial pregnancy. Emerg Radiol 2013; 20 (3) 251-254
• 5 Rosenzweig BA, Rotmensch S, Ressetar A. Term interstitial pregnancy resulting in a live infant. Obstet Gynecol 1988; 72 (3 Pt 2) 491-493
• 6 Bond AL, Grifo JA, Chervenak FA, Kramer EE, Harris MA. Term interstitial pregnancy with uterine torsion: sonographic, pathologic, and clinical findings. Obstet Gynecol 1989; 73 (5 Pt 2) 857-859
• 7 Ugwumadu AH, Hamid R, Ross LD. Live infant salvaged from a ruptured cornual (interstitial) pregnancy at 33-weeks gestation. Int J Gynaecol Obstet 1997; 58 (2) 247-249
• 8 Luckas MJ, Fishwick K, Martin-Hierro M, Shaw GC, Walkinshaw SA. Survival of intrauterine twins and an interstitial singleton fetus from a heterotopic in vitro fertilisation-embryo transfer pregnancy. Br J Obstet Gynaecol 1997; 104 (6) 751-752
• 9 Nishikawa A, Tanaka S, Kudo R. Full-term interstitial pregnancy with live birth. Int J Gynaecol Obstet 1998; 63 (1) 57-58
• 10 Idama TO, Tuck CS, Ivory C, Ellerington MC, Travis S. Survival of cornual (interstitial) pregnancy. Eur J Obstet Gynecol Reprod Biol 1999; 84 (1) 103-105
• 11 Ng PH, NorAzlin MI, Nasri NI. Term interstitial pregnancy with uterine conservation. Int J Gynaecol Obstet 2007; 99 (3) 251
• 12 Milićević S, Jovanović D, Vilendecić Z, Ljubić A, Bozanović T, Niketić L. Full-term interstitial retroperitoneal pregnancy with delivery of a healthy infant. J Obstet Gynaecol Res 2010; 36 (4) 869-871
• 13 Scarella A, Marquez R, Schilling H, Palomino A. Antenatal diagnosis of a third trimester interstitial pregnancy: a case report. J Obstet Gynaecol Res 2012; 38 (3) 570-573
• 14 Hill AJ, Van Winden KR, Cook CR. A true cornual (interstitial) pregnancy resulting in a viable fetus. Obstet Gynecol 2013; 121 (2 Pt 2, Suppl 1): 427-430
• 15 Steins Bisschop CN, Schaap TP, Vogelvang TE, Scholten PC. Invasive placentation and uterus preserving treatment modalities: a systematic review. Arch Gynecol Obstet 2011; 284 (2) 491-502
• 16 Sentilhes L, Ambroselli C, Kayem G , et al. Maternal outcome after conservative treatment of placenta accreta. Obstet Gynecol 2010; 115 (3) 526-534
• 17 Katzman PJ, Genest DR. Maternal floor infarction and massive perivillous fibrin deposition: histological definitions, association with intrauterine fetal growth restriction, and risk of recurrence. Pediatr Dev Pathol 2002; 5 (2) 159-164
• 18 Whitten AE, Romero R, Korzeniewski SJ , et al. Evidence of an imbalance of angiogenic/antiangiogenic factors in massive perivillous fibrin deposition (maternal floor infarction): a placental lesion associated with recurrent miscarriage and fetal death. Am J Obstet Gynecol 2013; 208 (4) 310.e1-310.e11
• 19 Romero R, Whitten A, Korzeniewski SJ , et al. Maternal floor infarction/massive perivillous fibrin deposition: a manifestation of maternal antifetal rejection?. Am J Reprod Immunol 2013; 70 (4) 285-298