Interstitial and Cornual Ectopic Pregnancy: Conservative Surgical and Medical Management

Abstract

Background Interstitial and cornual ectopic pregnancy is rare, accounting for 2-4% of ectopic pregnancies and remains the most difficult type of ectopic pregnancy to diagnose due to low sensitivity and specificity of symptoms and imaging. The classic triad of ectopic pregnancy-abdominal pain, amenorrhea and vaginal bleeding-occurs in less than 40% of patients. The site of implantation in the intrauterine portion of fallopian tube and invasion through the uterine wall make this pregnancy difficult to differentiate from an intrauterine pregnancy on ultrasound. The high mortality in this type of pregnancy is partially due to delay in diagnosis as well as the speed of hemorrhage. Methods Three cases of interstitial pregnancy were retrospectively analyzed. Result Successful laparoscopic cornuostomy and removal of products of conception were performed in two cases, while one case was successfully managed by local injection with KCL and methotrexate followed by systemic methotrexate. Conclusion Early diagnosis and timely management are key to the management of interstitial and cornual ectopic pregnancy. With expertise in ultrasound imaging and advances in laparoscopic skills progressively, conservative

Methotrexate for Cornual Ectopic Pregnancy

“…Cornual ectopic pregnancy (interstitial pregnancy) is a rare type of ectopic pregnancy that occurs in roughly 2%-4% of ectopic pregnancies and 1/2,500-1/5,000 of all pregnancies [1][2][3][4][5][6]. The embryo embeds itself into the funnel-shaped area where the uterus connects to the fallopian tubes [1].…”

“…Choice of treatment depends mostly on clinical situation, stability of the patient's condition, and expertise [2,4]. Ideally in this case, after the failure of MTX, had the patient's condition remained stable, the next step would be to wedge resect the ectopic pregnancy and cornual region of the uterus in order to preserve uterine integrity [8].…”

“…MTX was recommended to halt trophoblastic cell growth. This strategy is generally effective and is a fertility sparing method for treating unruptured cornual pregnancies [4]. A risk versus benefit analysis was discussed with the patient.…”

“…In about 4% of ectopic pregnancy, it can involve the cornua [1][2][3][4][5][6]. Cornual pregnancy is a rare type of ectopic pregnancy in which the embryo implants in the junction between the fallopian tube and the uterus [4,7]. Diagnosis is challenging because on ultrasound, the pregnancy often appears to be intrauterine.…”

Pregnancy in the rudimentary uterine horn

“…Так как эндометрий рудиментарного рога более тонкий, миометрий меньше васкуляризирован и имеется преобладание соединительнотканного компонента, то риск врастания плаценты с последующим разрывом матки высок, что чаще регистрируется при сроке беременности 8-16 недель [2]. Разрыв матки сопровождается массивным кровотечением, геморрагическим шоком и угрожает жизни женщины [3]. Течение беременности обычно осложняет абдоминальный болевой синдром, который рассматривается как угроза прерывания беременности и приводит к неоднократным госпитализациям [1].…”