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. 2018 Dec;68(6):471-476.
doi: 10.1007/s13224-017-1078-0. Epub 2017 Nov 28.

Interstitial and Cornual Ectopic Pregnancy: Conservative Surgical and Medical Management

Mamta Dagar  1 , Mala Srivastava  1 , Indrani Ganguli  1 , Punita Bhardwaj  1 , Nidhish Sharma  1 , Deepak Chawla  1
Affiliations

Interstitial and Cornual Ectopic Pregnancy: Conservative Surgical and Medical Management

Mamta Dagar et al. J Obstet Gynaecol India. 2018 Dec.

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 medical and surgical measures are being used to treat interstitial and cornual ectopic pregnancy successfully.

Keywords: Cornual pregnancy; Interstitial pregnancy; Laparoscopic cornuostomy; Methotrexate.

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Conflict of interest statement

The authors declare that they have no conflict of interest.This article does not contain any studies with human participants or animals performed by any of the authors.For this type of study formal consent is not required.

Figures

Fig. 1
Fig. 1
Transvaginal two-dimensional ultrasonography scan in transverse view showing left interstitial ectopic pregnancy in case 1
Fig. 2
Fig. 2
Case 1; (i) laparoscopic view of left interstitial ectopic pregnancy; (ii) after injection of diluted vasopressin, (iii) removal of POCs after incision, (iv) final result of surgery, interrupted sutures
Fig. 3
Fig. 3
Laproscopic view of right interstitial ectopic pregnancy in case 2
Fig. 4
Fig. 4
Transvaginal two-dimensional ultrasonography scan in transverse view showing right-sided cornual ectopic pregnancy
See this image and copyright information in PMC

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