Abstract
We present a case of recurrent ruptured right cornual ectopic pregnancies conceived after IVF. Following the second episode, a sonohysterography was undertaken to identify possible areas of scar weakness that may rupture with uterine distension in a future pregnancy. The scan revealed asymmetrical muscle thickness in the cornual regions, the right (6 mm) being thinner than the left (1.6 cm). Subsequently, an elective laparotomy was undertaken, and the cornua were reconstructed and thickened in several layers by bringing the laterally retracted myometrial fibres onto the reconstruction site. A sono-hysterography after surgery showed satisfactory (3-4 cm) myometrial thickness all around. A further cycle of IVF resulted in a singleton pregnancy. Pelvic scans confirmed normal intrauterine pregnancy without any myometrial thinning. She was delivered by an uneventful elective caesarean section at term. We propose that, in those who intend to have further pregnancies after a cornual ectopic pregnancy, a sono-hysterography is possibly the best investigative tool to assess myometrial integrity. This case demonstrates that in women with areas of muscle weakness it is possible to successfully perform an interval elective reconstructive surgery on the uterus that can result in an uneventful pregnancy and birth.
Highlights
Cornual ectopic pregnancy is a life-threatening complication especially if it ruptures before diagnosis and significant intraperitoneal bleeding occurs
Our suggestion for further evaluation of uterine integrity is supported by a case report of recurrent ruptured cornual ectopic pregnancy in which a sonohysterography followed by an elective novel uterine reconstruction surgery resulted in a live birth
Optimal management of an index cornual ectopic gestation is important to minimise the risk of recurrence and uterine rupture in future pregnancies
Summary
Cornual (interstitial) ectopic pregnancy is a life-threatening complication especially if it ruptures before diagnosis and significant intraperitoneal bleeding occurs. A medline search for literature on recurrent cornual ectopic resulted in only one publication that based on their experience in a single institution, estimated this risk to be 0.3% whilst reporting their 4 recurrent cornual ectopics in 53 index cases [2]. This was a report on 4 cases that described laparoscopic management of recurrent ectopic gestations [2]. True incidence of recurrent cornual ectopic is not known for most women after a rupture is advised against a further pregnancy because of the risk of uterine scar dehiscence in pregnancy and its complications. Our suggestion for further evaluation of uterine integrity is supported by a case report of recurrent ruptured cornual ectopic pregnancy in which a sonohysterography followed by an elective novel uterine reconstruction surgery resulted in a live birth
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