Abstract
ObjectiveThere are two major management approach for cornual heterotopic pregnancy, transvaginal cornual embryo reduction with ultrasound guidance, or laparoscopic cornual resection. This no consensus on the optimal management for cornual heterotopic pregnancy. Here, we are trying to determine the optimal management approach for patients with viable cornual heterotopic pregnancy following embryo transfer.MethodsThis is a retrospective cohort study conducted at the locally largest reproductive center of a tertiary hospital. A total of 14 women diagnosed as viable cornual heterotopic pregnancy following embryo transfer. Six patients were treated with cornual pregnancy reduction under transvaginal ultrasound guidance without the use of feticide drug (treatment 1), and eight patients were treated with laparoscopic cornual pregnancy resection (treatment 2).ResultsAll 14 patients of cornual heterotopic pregnancy following embryo transfer due to fallopian tubal factor, among which, 12 patients had cornual pregnancy occurred in the ipsilateral uterine horn of tubal pathological conditions. Nine (64.29%) showed a history of ectopic pregnancy. Thirteen (92.86%) patients were transferred with two embryos and only one patient had single embryo transferred. Six patients received treatment 1, and 2 (33.33%) had uterine horn rupture and massive bleeding which required emergency laparoscopic surgery for homostasis. No cornual rupture occurred among patients received treatment 2. Each treatment group had one case of spontaneous miscarriage. The remaining 5 cases in treatment 1 group and the remaining 7 cases in treatment 2 group delivered healthy live offspring.ConclusionPatients with tubal factors attempting for embryo transfer, especially those aiming for multiple embryos transfer, should be informed with risk of cornual heterotopic pregnancy and the subsequent cornual rupture. Compared with cornual pregnancy reduction under transvaginal ultrasound guidance, laparoscopic cornual resection might be a favorable approach for patients with viable cornual heterotopic pregnancy.
Highlights
Heterotopic pregnancies refers to the coexistence of two or more implantation locations [1]
Two main therapeutic strategies were reported in literatures and used in clinical practice, gestational sac removal by cornual incision under laparoscopy/laparotomy, and transvaginal embryo reduction under sonography monitoring [1, 7, 8]
Clinical data of 17 cornual heterotopic pregnancies following in vitro fertilization (IVF)/intra-cytoplasmic sperm injection (ICSI) and embryo transfer were collected from the electrical database of reproductive center and in-hospital medical archives
Summary
Heterotopic pregnancies refers to the coexistence of two or more implantation locations [1]. Heterotopic pregnancies are extremely rare in natural conceptions, with an incidence of 1 in 30,000 pregnancies [2]. For patients received ART treatment, the incidence of heterotopic pregnancy ranged from 1:100 to 1:500 [3,4,5]. Among various ectopic pregnancy sites, cornual pregnancy is quite rare, with an estimated incidence of 1 in every 3600 pregnancies following ART [6]. Only a few case reports proposed the above management strategies and the comparison of prognosis between the two treatment options are even rarer. No consensus on the ideal treatment options for cornual heterotopic pregnancy [1, 9], since no sufficient evidences were available to recommend any management strategy
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