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This chapter provides a summary of each type of non-tubal ectopic pregnancy, with particular emphasis on the ultrasound diagnosis and management options. Interstitial pregnancy is characterised by the implantation of the conceptus in the interstitial portion of the fallopian tube, which is surrounded by the muscular wall of the uterus. The advances in high-resolution transvaginal ultrasonography and the establishment of early pregnancy units have facilitated the early non-invasive diagnosis of interstitial pregnancy before complications occur. This has opened the door for more conservative management options such as medical treatment with methotrexate. The management of interstitial pregnancy was surgical, in the form of cornual resection or hysterectomy. The reason for this was the late detection of this condition, which used to be diagnosed at laparotomy following tubal rupture. Medical management using methotrexate, a folate antagonist, has been increasingly used in the treatment of women identified as having an unruptured interstitial pregnancy.
The presence of an ovarian cyst is traditionally considered to be an indication for operative intervention for fear of ovarian cancer and acute complications of ovarian cysts, such as torsion, rupture and obstruction of labour. Two studies described the prevalence of ovarian cysts in pregnancy before the routine use of ultrasound, when the diagnosis was based on clinical examination of women with symptoms suggestive of an adnexal mass. The vast majority of adnexal cystic masses detected in early pregnancy are functional cysts, such as corpus luteum cysts or follicular cysts. Dermoid cysts or mature cystic teratomas are the most common complex ovarian masses encountered in pregnancy, making up 24-40% of all ovarian tumours. Fimbrial cysts are usually seen on ultrasound examination as thin-walled, anechoic, unilocular adnexal masses. Ultrasound-guided cyst aspiration offers a less invasive alternative to the traditional techniques employed for surgical management of ovarian cysts in pregnancy.
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