APPROACHES TO THE MANAGEMENT OF CORNUAL ECTOPIC PREGNANCY
K. Annaiah Thangamma ST-3 , Yousef Mohammed Consultant, Royal Alexandra Hospital, Paisley
INTRODUCTION
Cornual ectopic pregnancies account for 2-3% of all ectopic pregnancies. Their relatively late presentation and potential for catastrophic haemorrhage make them an important cause for maternal mortality accounting for 2- 2.5% of these.
Aim
To present a case of cornual ectopic pregnancy which was managed through laparoscopic surgery. To explore the various conservative treatment options for this rare condition.
Case Report
A 19 year old second gravida presented with 8 weeks of amenorrhoea and spotting per vaginum.. The Beta HCG was 3000mIU/L and scan revealed an empty intrauterine cavity, however a cornual ectopic pregnancy was suspected due to the presence of an eccentrically located gestational sac on the right side with a 3.7mm embryo revealing cardiac activity. Laparoscopy confirmed the ultrasound suspicion. The base of the ectopic gestation was ligated with 2 endoloops and subsequently removed with scissors. The raw area on the uterine surface was cauterised to achieve haemostasis. She made a speedy recovery in the post operative period.
Discussion
Early diagnosis of cornual ectopic pregnancy allows conservative management.
Medical management most commonly involves methotrexate.. A 5 year audit conducted by Amy Tang et al at the Royal Brisbane and Womens Hospital found successful outcome in 91%
Laparotomy followed by cornual resection or hysterctomy are the radical approaches which may well be warranted in a haemodynamically unstable person. Laparoscopic approaches include cornual resection which carries the same risk of infertility and rupture in subsequent pregnancy as laparotomy with the advantage of more rapid post op recovery. Laparoscopic cornuostomy and salpingostomy have also been described.. Laparoscopic injection of vasopressin followed by use of monopolar needle to evacuate the gestation has been described.Hill et al described the use of an endoloop to ligate the cornual end and subsequently used monopolar cautery to evacuate the pregnancy.Hysteroscopic procedures include a combination of injecting vasopressin into the cornual region, hystroscopically guided sac rupture, forceps to extract the trophoblastic tissue and even suction curretage.
Successful pregnancies have been described after treatment of cornual ectopic pregnancies. They however have the potential for rupture as early as 20-24weeks pregnancy. Most authors agree that cesarean section is the optimum mode of delivery in subsequent pregnancies.
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