Cornual Heterotopic Pregnancy - a Rare Cause for Haemorrhagic Shock

Abstract

Heterotopic pregnancy represents an intrauterine gestational sac in the presence of an ectopic pregnancy. It is a very rare occurrence in spontaneous pregnancy but its incidence has increased with the use of assisted reproductive techniques, being identified in up to 1% of these cases. There aren't any guidelines regarding the management of heterotopic pregnancies, but the general principles include: elimination of the ectopic pregnancy, conservation of the intrauterine pregnancy and haemostasis. In this article we are going to present the case of a 26 year old woman that presented with haemorrhagic shock secondary to a ruptured spontaneous cornual heterotopic pregnancy at 8 weeks gestation. She underwent emergency laparotomy, excision of the right uterine cornua and aspiration of the uterine pregnancy. The intrauterine pregnancy was removed because, during the cornual excision, the intrauterine gestational sac was ruptured. She had a non-complicated postoperative evolution and was discharged 4 days later.

Figure 1.

Figure 1. Transabdominal ultrasound of the uterus (transverse plane) showing intrauterine gestational sac (SG INTRACAV) and right cornual gestational sac (SG 2), diagnostic findings or cornual heterotopic pregnancy; Note the very close proximity between the two gestational sacs.

Figure 2.

Figure 2. Intraoperative image showing the uterus with a ruptured right cornual pregnancy.

Table 1.

Table 1. Ultrasound criteria for the diagnosis of cornual pregnancy (6).