Cornual, interstitial, isthmic, and subcornual pregnancies—importance of ultrasonographic differential diagnoses

Abstract

Objective: The aim of our study was to present the use of ultrasonography in making precise diagnoses and correlate with the course of pregnancies in the cornual-interstitial area.Methods: Twenty normal women of 20 to 42 years of age were examined with ultrasonography to define the “cornual points” and “interstitial lines,” which represent interstitial portion of the fallopian tube. Eight patients of 18 to 41 years of age (average 28 years) were examined with both transabdominal and endovaginal scanning including color Doppler in some patients.Results: The diagnoses of the 8 patienta were: cornual (n=4), subcornual (n=2), interstitial (n=1), and isthmic-interstitial (n=1) pregnancies, respectively. The patients with interstitial and isthmic-interstitial pregnancies and one patient with cournual pregnancy were operated upon, and diagnoses were proven. Three patients with cornual pregnancies had abortion (curettage) without complications. Two patients with subcornual pregnancies were delivered at term with normal babies.Conclusions: Contrary to previous belief that interstitial and cornual pregnancies cannot be differentiated on ultrasonography, our study indicates that precise diagnoses can be made on cornual, interstitial, isthmic-interstitial, and subcornual pregnancies when “cornual point” and “interstitial lines” were demonstrated. The diagnoses are important because of great differences in their prognoses and treatment, i.e., isthmic-interstitial and interstitial pregnancies are known to have much higher risk of rupture and catastrophic hemorrhage and may need surgery and/or methotrexate treatment. Although cornual pregnancy can also be treated with surgery or methotrexate, according to our study, cornual pregnancy can be safely treated with curettage in the early stage, and subcornual pregnancy does not require treatment. Subcornual pregnancy, therefore, should be differentiated from cornual pregnancy. It is impossible to differentiate subcornual from cornual pregnancies by old ultrasonographic criteria. Objective: The aim of our study was to present the use of ultrasonography in making precise diagnoses and correlate with the course of pregnancies in the cornual-interstitial area. Methods: Twenty normal women of 20 to 42 years of age were examined with ultrasonography to define the “cornual points” and “interstitial lines,” which represent interstitial portion of the fallopian tube. Eight patients of 18 to 41 years of age (average 28 years) were examined with both transabdominal and endovaginal scanning including color Doppler in some patients. Results: The diagnoses of the 8 patienta were: cornual (n=4), subcornual (n=2), interstitial (n=1), and isthmic-interstitial (n=1) pregnancies, respectively. The patients with interstitial and isthmic-interstitial pregnancies and one patient with cournual pregnancy were operated upon, and diagnoses were proven. Three patients with cornual pregnancies had abortion (curettage) without complications. Two patients with subcornual pregnancies were delivered at term with normal babies. Conclusions: Contrary to previous belief that interstitial and cornual pregnancies cannot be differentiated on ultrasonography, our study indicates that precise diagnoses can be made on cornual, interstitial, isthmic-interstitial, and subcornual pregnancies when “cornual point” and “interstitial lines” were demonstrated. The diagnoses are important because of great differences in their prognoses and treatment, i.e., isthmic-interstitial and interstitial pregnancies are known to have much higher risk of rupture and catastrophic hemorrhage and may need surgery and/or methotrexate treatment. Although cornual pregnancy can also be treated with surgery or methotrexate, according to our study, cornual pregnancy can be safely treated with curettage in the early stage, and subcornual pregnancy does not require treatment. Subcornual pregnancy, therefore, should be differentiated from cornual pregnancy. It is impossible to differentiate subcornual from cornual pregnancies by old ultrasonographic criteria.