Background:
Cornual ectopic pregnancies are implanted in the interstitial portion of the fallopian tube and, if ruptured, can cause potentially fatal hemorrhage. Traditional management is a cornual wedge resection of the cornual region of the uterus. Growing interest in conservative approaches to the management of cornual ectopic has resulted in several successful minimally invasive techniques. This is the first report of a conservatively treated cornual ectopic pregnancy in a patient with a bicornuate uterus.
Case:
A 29-year-old multiparous patient with a bicornuate uterus presented to Labor and Delivery triage with first-trimester vaginal bleeding. A cornual ectopic pregnancy was diagnosed by sonogram. Initially, the patient refused any surgery but agreed to a trial of methotrexate with inpatient observation. After 5 days, the ectopic pregnancy enlarged, and she then agreed to surgical management. Hysteroscopy was used to identify the ectopic in the left uterine horn. Under laparoscopic guidance, a suction curettage was performed with successful removal of the pregnancy. No bleeding was encountered, and the patient had an uncomplicated recovery. Subsequently, the patient became pregnant with an intrauterine pregnancy and delivered full-term without complications.
Conclusions:
Conservative surgical techniques applied to the management of cornual ectopics offer management with less morbidity and a quicker recovery. Avoiding myometrial entry also allows the option for a trial of labor with future pregnancies. In selected patients, laparoscopic-guided suction curettage is useful and offers a less-invasive surgical option.
