Cornual Pregnancy

Abstract

A true cornual pregnancy is one in the rudimentary horn of a unicornuate uterus. The term is often used interchangeably in the medical literature with interstitial pregnancy but the 2 are distinct entities [ 1 Chetty M Elson J. Treating non-tubal ectopic pregnancy. Best Pract Res Clin Obstet Gynaecol. 2009; 23: 529-538 Google Scholar ]. With recent diagnostic advances, early detection is possible [ 2 Afifi Y Mahmud A Fatma A. Hemostatic techniques for laparoscopic management of cornual pregnancy: double-impact devascularization technique. J Minim Invasive Gynecol. 2016; 23: 274-280 Google Scholar ] The ultrasonographic criteria are an empty uterine cavity, a gestational sac located eccentrically and 1 cm from the most lateral wall of the uterine cavity, and a thin (less than 5 mm) myometrial layer surrounding the gestational sac. Treatment of cornual pregnancy has been surgical and may include hysterectomy or cornual resection by laparotomy or laparoscopy. However, increasingly, more conservative approaches are being used such as cornuostomy instead of cornual resection, as well as laparoscopy instead of laparotomy. Although patients with milder symptoms may be considered for medical therapy (methotrexate), those with serious signs and symptoms of ruptured ectopic pregnancy are likely to receive immediate surgical intervention [ 3 Dagar M Srivastava M Ganguli I Bhardwaj P Sharma N Chawla D. Interstitial and cornual ectopic pregnancy: conservative surgical and medical management. J Obstet Gynaecol India. 2018; 68: 471-476 Google Scholar ]. The treatment goal of cornual pregnancy conservative management is to remove the gestational sac without damaging the myometrium, an accident that causes massive bleeding and requires immediate, urgent, laparotomy [ 4 Tinelli R Stomati M Surico D Cicinelli E Trojano G Angioni S. Laparoscopic management of a cornual pregnancy following failed methotrexate treatment: case report and review of literature. Gynecol Endocrinol. 2020; 36: 743-745 Google Scholar , 5 Damiani GR Landi S Tartagni M Bettocchi S Loverro G Pellegrino A. Cornual pregnancy after surgical treatment of an incarcerated fallopian tube: a case report. J Reprod Med. 2013; 58: 550-552 Google Scholar ]. Different authors have reported many types of suture to reduce intraoperative blood loss and gain optimal myometrial reconstruction: •Square suture: carried through the posterior and anterior cornual walls and then carried back through the anterior and posterior wall at a point 2 cm lateral to the initial knot. The knot is tied intracorporeally, achieving hemostasis by compression. •Encircling suture: around the base of the cornual ectopic, acts like a tourniquet •Endoloop device •Electrocoagulation (high risk of damaging myometrium) •Automatic staplers •Endo GIA (Covidien) stapler simultaneously excises and stitches the uterine cornua.