15 Modern Management of Cornual Ectopic Pregnancy (original) (raw)

Challenges in the diagnosis and management of interstitial and cornual ectopic pregnancies

Middle East Fertility Society Journal, 2013

Interstitial ectopic pregnancy is a term loosely used in the literature to describe three different entities. The first is the true interstitial ectopic pregnancy, which occurs in the interstitial or intramural segment of the Fallopian tubes. The term cornual ectopic pregnancy should be reserved for pregnancy in women with a single uterine horn, a bicornuate uterus, or a septate uterus. Angular pregnancy is a term that is rarely used and should be limited to a pregnancy in one of the angles of the uterus, but not inside the Fallopian tube.

An interstitial ectopic pregnancy managed with laparoscopic cornual resection

Sri Lanka Journal of Obstetrics and Gynaecology, 2021

Introduction: Interstitial ectopic pregnancy is a rare type of tubal ectopic pregnancy associated with increased case fatality rate due to profuse haemorrhage. It is initially asymptomatic and ruptured later than other tubal ectopic pregnancies. Case report: A 31 years old primigravida presented with per vaginal bleeding at period of amenorrhoea of six weeks. Her examination findings were unremarkable and transvaginal scan revealed left sided interstitial pregnancy. Her initial serum beta human Chorionic Gonadotropin (β-hCG) level was 7300 mIU/ml. As she was haemodynamically stable, there were no signs of rupture and serum β-hCG was dropping, she was initially managed expectantly. As she developed abdominal pain with per vaginal bleeding and drop in serum β-hCG was slow, expectant management was abandoned and surgical management was planned. Laparoscopy was performed and revealed a left sided interstitial pregnancy with thinned out myometrium. As laparoscopy guided transcervical suction evacuation has failed, laparoscopic cornual resection was performed after vasopressin infiltration into myometrium. She had uneventful recovery and was followed up until her serum β-hCG became less than 30 IU/L. Discussion: An Interstitial ectopic pregnancy must be differentiated from cornual and angular pregnancies with clearly defined ultrasound diagnostic criteria. Three dimensional (3D) ultrasound and magnetic resonance imaging (MRI) will further help in diagnosis of interstitial ectopic pregnancy. It can be managed expectantly, medically or surgically depending on the patient's clinical condition, preference and serum β-hCG level.

Cornual ectopic pregnancy: a rare case report

Int J Biol Med Res. 2025; 16(1): 7948-7951

Introduction: Ectopic pregnancy, defined as the implantation of a blastocyst outside the uterine cavity, primarily occurs in the fallopian tubes, accounting for 96% of cases. Cornual or interstitial ectopic pregnancies, which occur in the upper segment of the fallopian tube near the uterine corner, are less common, representing only 7.3% of ectopic pregnancies. Due to the absence of a submucosal layer in the fallopian tubes, the fertilized ovum can penetrate through the epithelial layer into the muscularis, potentially causing tubal rupture. Risk factors for ectopic pregnancies include previous ectopic pregnancies, pelvic inflammatory disease (PID), tubal surgeries, and the use of assisted reproductive technologies or certain contraceptive methods. Method: A 35-year-old female, Gravida 3 Para 2, with a history of two previous term vaginal deliveries and no known pelvic infections or reproductive treatments, presented with 5+3 weeks of amenorrhea, lower abdominal pain for one week, general weakness, and vomiting. Diagnostic workup included a urine pregnancy test and a series of ultrasounds. An initial abdominal ultrasound identified a simple ovarian cyst but no focal uterine lesions. Emergency transvaginal ultrasound revealed a hyperechoic lesion in the left adnexa, with associated hemoperitoneum and a “ring of fire” appearance indicative of an ectopic pregnancy. Laboratory tests showed elevated serum beta-HCG levels and moderate anemia. An exploratory laparotomy confirmed a ruptured cornual ectopic pregnancy and hemoperitoneum, leading to a left cornual resection and salpingectomy. Conclusion: The diagnosis of a ruptured cornual ectopic pregnancy was confirmed through imaging and surgical exploration. The patient experienced significant hemoperitoneum but responded well to surgical intervention and postoperative care. Post-surgery, the patient’s recovery was uneventful. The patient was advised on future pregnancy management to minimize risks associated with uterine rupture and potential subsequent ectopic pregnancies. This case highlights the importance of considering cornual ectopic pregnancy in differential diagnoses, particularly when presented with atypical symptoms and imaging findings.

Cornual Ectopic Pregnancy: Case Series

Nepal Journal of Obstetrics and Gynaecology, 2015

Three cases of cornual pregnancies encountered within three weeks at Paropakar Maternity and Women's Hospital had diverse presentations. Fortunately, in all three case series, cornual resection was performed successfully. Cornual pregnancy is difficult to diagnose preoperatively with low ultrasonographic sensitivity and is easily confused with tubal ectopic pregnancy or a normal intrauterine pregnancy. Diagnosis before rupture is essential to prevent mortality and potential loss of fertility. The surgical management of diagnosed cornual pregnancy consists of hemostasis, resection, repair and reconstruction.

Unruptured Left Cornual Ectopic Pregnancy

Journal of Gynecologic Surgery, 2013

Background: A cornual pregnancy is an ectopic pregnancy that develops in the interstitial portion of the Fallopian tube, invading through the uterine wall. Cornual pregnancies often rupture later than other tubal pregnancies because the myometrium is thick and more distendable than the Fallopian tubes are. Cornual pregnancy is usually associated with high vascularity, which may result in severe hemorrhage and death. Morbidity and mortality of cornual pregnancy are directly related to length of time for diagnosis. Case: A 30-year-old woman in her eighth week of pregnancy had abdominal pain and vaginal spotting. Ultrasound (US) examination showed a bulky uterus together with a gestational sac situated in the left cornual region. Left cornual resection was carried out with preservation of the uterus. Results: The patient's postoperative course and follow-up were uneventful. Conclusions: Cornual pregnancy is a very rare and potentially dangerous condition. Diagnosis of cornual pregnancy can be made via US examination. Cornual resection was done in the present case without immediate or long-term complications (J GYNECOL SURG 29:314).

Interstitial Ectopic Pregnancy—Case Reports and Medical Management

Medicina

The term intramural (interstitial) ectopic pregnancy refers to a pregnancy developing outside the uterine cavity, with a gestational sac implanted into the interstitial part of the Fallopian tube, surrounded by a layer of the myometrium. The prevalence rate of interstitial pregnancy (IP) is 2–4% of all ectopic pregnancies. Surgery is the primary treatment for interstitial ectopic pregnancy; the pharmacological management of ectopic pregnancy, including IP, in asymptomatic patients includes systemic administration of methotrexate. In this report, we present two cases of this rare pregnancy type, reviewing our management technique and treatment ways presented in the literature. In our patients, the management was initially conservative and included methotrexate, administered as intravenous bolus injection, regular beta-human chorionic gonadotropins (β-HCG) level measurements in peripheral blood, and monitoring of the patient’s general condition. Due to signs of intra-abdominal bleedin...