Hysteroscopy in the diagnosis of suspected interstitial pregnancy

Cornual gestation: a systematic literature review and two case reports of a novel treatment regimen

STUDY OBJECTIVE

To introduce a novel tubal-sparing regimen for the treatment of nonruptured cornual pregnancies.

DESIGN

Case report and systematic review of the literature.

SETTING

Tertiary Care University setting.

PATIENTS

Two patients referred for care in our subspecialty clinic.

INTERVENTIONS

Laparoscopic surgery, dilation and evacuation, and postoperative methotrexate injection. Systematic review of the literature.

MEASUREMENTS AND MAIN RESULTS

Both medical and surgical treatments for cornual gestation exist; however, each is not without its shortcomings. Medical treatment is associated with failure rates that may result in uterine rupture and catastrophic hemorrhage. Surgical treatment that involves hysterectomy causes a loss of future childbearing capability. Surgical treatment that involves resection of the involved cornual region is associated with decreased fertility rates and increased rates of uterine rupture in future pregnancies. Our treatment regimen is safe and effective and conserves future fertility.

CONCLUSION

A cornual gestation is one of the most hazardous types of ectopic gestation. The diagnosis and treatment of such a pregnancy is challenging and constitutes an urgent medical situation. We herein introduce a novel regimen for the treatment of nonruptured cornual pregnancies. The existing treatment regimens are also systematically reviewed.

Laparoscopic treatment of an interstitial pregnancy

Interstitial (cornual) pregnancies occur rarely, estimated at 1 for every 2500 to 5000 live births. Since the morbidity and mortality are high, the correct diagnosis must be made and treatment begun promptly. A number of management options have been described, including conservative treatments such as expectant management, methotrexate injections (local or systemic), potassium chloride injections (local), and prostaglandin administration. Among conservative surgical treatments, hysteroscopy has been performed successfully to diagnose and treat the condition. To my knowledge, this is the first report of laparoscopic treatment of interstitial pregnancy.