Key content:• The Confidential Enquiry into Maternal and Child Health report for 2000-02 stated that cornual pregnancy is a rare but dangerous type of ectopic pregnancy.• Four out of the 11 deaths from ruptured ectopic pregnancy were due to ruptured cornual pregnancy. In all four cases the diagnosis was made only after rupture.• Haemorrhage can be severe because pregnancy is often more developed than extrauterine tubal pregnancy and because of the large blood supply to the uterus.• Clinicians should be aware of the difficulties with both clinical and ultrasound diagnosis.• Many case reports have been written about sporadic cases of intact and ruptured cornual pregnancy and several treatment modalities discussed. There are very few publications collecting all management strategies, including both surgical and medical treatment, for this dangerous type of ectopic pregnancy. Learning objectives:• To understand recent advances in diagnosis and conservative laparoscopic and medical treatment.• To review the most reputable case reports discussing all modalities of treatment, including radical surgical and conservative laparoscopic methods and different types of medical treatment, with critical appraisal of each approach. Ethical issues:• How should a couple be counselled regarding future pregnancy risks and the optimum mode of delivery?

IntroductionA large number of hysterectomies are carried out for uterine prolapse, menorrhagia and other symptomatic but benign gynaecological conditions, which has increased interest in new approaches to treat these disorders. These new procedures are less invasive and offer reduced risk and faster recovery.Case presentationSacrohysteropexy can be carried out instead of vaginal hysterectomy in the treatment of uterine prolapse. It involves using a synthetic mesh to suspend the uterus to the sacrum; this maintains durable anatomic restoration, normal vaginal axis and sexual function. A laparoscopic approach has major advantages over the abdominal route including shorter recovery time and less adhesion formation. We describe a laparoscopic sacrohysteropexy in a 55-year-old Caucasian British woman that was technically difficult. An intramural uterine fibroid was encroaching just above the uterosacral ligament making mesh positioning impossible. This was removed and the procedure completed successfully.ConclusionPosterior wall fibroid is not a contraindication for laparoscopic sacrohysteropexy. This procedure has increasingly become an effective treatment of uterine prolapse in women who have no indication for hysterectomy.

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In this paper, we discuss a successful attempt to reduce the incidence of recurrent cornual pregnancy by ipsilateral tubal occlusion in a lady with two previous cornual pregnancies and a healthy looking contralateral tube.