Rudimentary horn pregnancy: clinical analysis of 12 cases and literature review / 中华妇产科杂志

Objective: To investigate the clinical characteristics, treatments and fertility recovery of rudimentary horn pregnancy (RHP). Methods: The clinical data of 12 cases with RHP diagnosed and treated in Peking University Third Hospital from January 1, 2010 to December 31, 2022 were retrospectively analyzed. Clinical informations, diagnosis and treatments of RHP and the pregnancy status after surgery were analyzed. Results: The median age of 12 RHP patients was 29 years (range: 24-37 years). Eight cases of pregnancy in residual horn of uterus occurred in type Ⅰ residual horn of uterus, 4 cases occurred in type Ⅱ residual horn of uterus; among which 5 cases were misdiagnosed by ultrasound before surgery. All patients underwent excision of residual horn of uterus and affected salpingectomy. After surgery, 9 patients expected future pregnancy, and 3 cases of natural pregnancy, 2 cases of successful pregnancy through assisted reproductive technology. Four pregnancies resulted in live birth with cesarean section, and 1 case resulted in spontaneous abortion during the first trimester of pregnancy. No uterine rupture or ectopic pregnancy occurred in subsequent pregnancies. Conclusions: Ultrasonography could aid early diagnosis of RHP while misdiagnosis occurred in certain cases. Thus, a comprehensive judgment and decision ought to be made based on medical history, physical examination and assisted examination. Surgical exploration is necessary for diagnosis and treatment of RHP. For infertile patients, assisted reproductive technology should be applied when necessary. Caution to prevent the occurrence of pregnancy complications such as uterine rupture, and application of cesarean section to terminate pregnancy are recommended.

Double trouble in an ectopic pregnancy / Philippine Journal of Obstetrics and Gynecology

@#Gestational trophoblastic diseases are histologically different types of tumors originating from the placenta with an incidence of 0.2–5.8/1000 pregnancies. Ectopic pregnancy is the implantation of the fertilized ovum outside the uterine cavity, and a 0.64% incidence is reported. Ectopic cornual pregnancy and molar pregnancy are rare cases, and a combination of these two rare entities occurring simultaneously is even rare and very few cases have been reported in the literature. A cornual pregnancy refers to the implantation and development of a gestational sac in one of the upper and lateral portions of the uterus, whereas an interstitial pregnancy is a gestational sac that implants within the proximal, intramural portion of the fallopian tube that is enveloped by the myometrium. We present one of the rare combinations of molar pregnancy and cornual/interstitial ectopic pregnancy in a 30‑year‑old G3 P1 who presented with a triad of amenorrhea, vaginal bleeding, and abdominal pain. Laparotomy was done in view of an ultrasound which was suggestive of a well‑defined complex thick‑walled lesion of size 3.2 × 3.3 with a gestational sac and no cardiac activity in the right fallopian tube/adnexa suggesting tubal ectopic pregnancy. Beta‑human chorionic gonadotropin (β‑hCG) levels were done and noted to be as high as 9998 mIU/mL. Intraoperatively, a cornual ectopic pregnancy was found with no hemoperitoneum which was excised. Histopathology showed chorionic villi with variable size and hydropic change, myxoid stromal changes, and cistern formation with polar trophoblastic proliferation, based on which a diagnosis of molar pregnancy was made. Although ultrasonography and higher than usual serum β‑hCG levels are diagnostic of uterine molar pregnancy, they do not yield a proper diagnosis in ectopic molar pregnancy, hence, making it difficult to distinguish between an early ectopic molar pregnancy from a nontrophoblastic tubal pregnancy. The final diagnosis is usually made only after histopathology. A high degree of clinical suspicion of cornual pregnancy followed by histopathological examination of the products of conception is the standard for arriving at an appropriate diagnosis. Serial serum β‑hCG level follow‑up is recommended to rule out its malignant potential.

Uso de vasopresina y suturas transfixivas para el tratamiento quirúrgico de la gestación ectópica intersticial / Use of vasopressin and transfixive sutures for the surgical treatment of interstitial ectopic gestation

Resumen La gestación cornual, también conocida como intersticial, es una gestación ectópica infrecuente que ocurre en 1/2500 a 1/5000 de los embarazos cuando el embrión implanta en el trayecto intramiometrial de la porción proximal de la trompa. Puede debutar como shock hipovolémico en un 25% de los casos, conllevando una mortalidad de hasta un 2,5%. Mediante ecografía se encuentra un saco gestacional excéntrico y rodeado por una fina capa de miometrio. El tratamiento, en la mayoría de los casos, es quirúrgico, y el control de la hemostasia supone todo un reto. Se presentan dos casos clínicos de mujeres con diagnóstico de gestación intersticial en quienes se realizó exéresis por laparoscopia tras inyección de vasopresina, permitiendo así controlar el sangrado. En una de las pacientes se practicaron también puntos transfixivos transitorios en la arteria uterina y el ligamento útero-ovárico.

Abstract Cornual gestation, also known as interstitial, is a rare ectopic gestation that occurs in 1/2500 to 1/5000 of pregnancies when the embryo implants in the intramyometrial tract of the proximal tube. It can debut as hypovolemic shock in 25% of cases, leading to a mortality rate of up to 2.5%. Using ultrasound, we will find an eccentric gestational sac surrounded by a thin layer of myometrium. Treatment, in most cases, is surgical and control of hemostasis is a challenge. Two clinical cases are presented of women with a diagnosis of interstitial pregnancy in whom transient transfixive sutures were performed at the level of the uterine artery and uterine-ovarian ligament and injection of vasopressin prior to laparoscopic exeresis, thus allowing the bleeding to be controlled.

Embarazo ectópico en cuerno rudimentario izquierdo de útero unicorne con embarazo de 15 semanas: reporte de un caso / Ectopic pregnancy in rudimentary left horn of unicorne uterus with pregnancy of 15 weeks: a case report

INTRODUCCIÓN: El embarazo ectópico en el cuerno rudimentario de un útero unicorne tiene una incidencia de 1 en 76.000 embarazos. La aproximación diagnóstica se realiza con la ecografía y como estudio complementario con la resonancia magnética. El diagnóstico temprano con tratamiento oportuno es fundamental para la prevención de la morbimortalidad materna asociada. El objetivo es describir el diagnóstico y el tratamiento temprano de un caso de embarazo ectópico de 15 semanas en cuerno rudimentario no comunicante de útero unicorne. CASO CLÍNICO: Mujer de 38 años con embarazo de 15 semanas, asintomática, que ingresa al servicio de urgencias referida desde el servicio de ecografía por sospecha de embarazo ectópico. Se realizan ecografía y resonancia magnética que muestran embarazo con feto único de 15 semanas en cuerno uterino izquierdo rodeado de miometrio, sin comunicación con la cavidad endometrial. Con impresión diagnóstica de embarazo ectópico cornual en paciente con malformación mülleriana, se realizó manejo quirúrgico que confirmó útero unicorne con embarazo ectópico en cuerno rudimentario no comunicante. CONCLUSIONES: El embarazo ectópico en un cuerno rudimentario de útero unicorne es infrecuente y presenta un alto riesgo de rotura, con aumento de la morbimortalidad obstétrica. El tratamiento estándar, al igual que la confirmación diagnóstica, es la escisión quirúrgica completa.

INTRODUCTION: Ectopic pregnancy in the rudimentary horn of a unicornuate uterus has an incidence of 1 in 76,000 pregnancies; the diagnostic approach is carried out with ultrasound and magnetic resonance imaging as a complementary study; Early diagnosis with timely treatment is essential for the prevention of associated maternal morbidity and mortality. The objective is to describe the early diagnosis and treatment of a case of 15-week ectopic pregnancy in a rudimentary non-communicating horn of the unicornuate uterus. CASE REPORT: A 38-year-old patient with an asymptomatic 15-week pregnancy was admitted to the emergency department, referred to the ultrasound service for suspected ectopic pregnancy. Ultrasound and magnetic resonance imaging were performed with pregnancy with a single fetus of 15 weeks in the left uterine horn surrounded by myometrium, without communication with the endometrial cavity. With a diagnostic impression of cornual ectopic pregnancy in a patient with a Müllerian malformation, a surgical management was performed where a unicornuate uterus with a rudimentary non-communicating ectopic horn was confirmed. CONCLUSIONS: Ectopic pregnancy in rudimentary horn of the unicornuate uterus is rare, it presents a high risk of rupture with increased obstetric morbidity and mortality. The standard treatment as well as the diagnostic confirmation is complete surgical excision.

O papel da ressonância magnética na distinção das gestações intersticial, cornual e angular / The role of magnetic resonance imaging in distinguishing interstitial, cornual and angular pregnancies

Apesar da melhora no diagnóstico e tratamento, a gravidez ectópica ainda é a principal causa de mortalidade materna no primeiro trimestre da gravidez. Formas raras podem apresentar um desafio diagnóstico e, sem um diagnóstico adequado, a incidência de complicações e a mortalidade materna estão relacionadas a aumento de seus índices. Os termos "gravidez cornual" e "gravidez intersticial" têm sido utilizados de forma inconsistente na literatura, sendo frequentemente usados como sinônimos do termo "gravidez angular". Uma distinção estrita entre essas entidades pode ter implicações clínicas importantes, porque o curso natural, a propedêutica e os resultados diferem entre eles. A ressonância magnética não é o padrão-ouro para o diagnóstico de gravidez ectópica, no entanto possui relevância significativa no diagnóstico de possíveis complicações decorrentes dessa afecção. Nesse contexto, esta revisão aborda a importância da ressonância magnética na distinção dos tipos de gravidez mencionados, ilustrados por meio de casos do nosso serviço.(AU)

Despite the improvement in diagnostics and treatment, ectopic pregnancies are still the main cause of maternal mortality in the first trimester of pregnancy. Rare forms may present a diagnostic challenge and without adequate diagnosis, the incidence of complications and maternal mortality is greatly increased. The terms "cornual pregnancy" and "interstitial pregnancy" have been used inconsistently in the literature, frequently been used as synonyms and even used interchangeably with the term "angular pregnancy". A strict distinction among these entities can have important clinical implications because the natural course, management and outcomes differ among them. Magnetic resonance imaging is not the gold standard for the diagnosis of ectopic pregnancy, however, it can be useful in the diagnosis of complicated presentations of such ailment. In this context, this review highlights the importance of MRI in distinguishing the aforementioned types of pregnancies, illustrated with few cases from our service.(AU)

Embarazo ectópico cornual, diagnóstico y tratamiento: reporte de dos casos y revisión de la literatura / Cornual ectopic pregnancy, diagnosis and treatment: report of two cases and review of the literature

RESUMEN El embarazo cornual es un tipo de embarazo ectópico poco frecuente, caracterizado por la implantación del saco gestacional en los cuernos uterinos, cuyo diagnóstico es desafiante, ya que realizado de forma precoz disminuye considerablemente la morbimortalidad materna. En este trabajo se reportan dos casos de un embarazo cornual, ambos diagnosticados a través de una ecografía transvaginal: uno en una paciente asintomática, y el otro en una paciente cuyo síntoma principal fue metrorragia, ambos tratados exitosamente de forma quirúrgica. En la revisión describimos la incidencia, los métodos disponibles para su diagnóstico y distintas opciones de manejo del embarazo ectópico cornual de acuerdo al tiempo de evolución, además de su relación con la ley 21.030 de interrupción del embarazo en tres causales, promulgada el 2017.

ABSTRACT Cornual pregnancy is a non-frequent form of ectopic pregnancy, where the implantation of the gestational sac occurs in the uterine horns; its diagnosis is challenging, and an early diagnosis decreases the morbimortality of the mother. In this paper we report two cases of cornual pregnancy, both diagnosed with ultrasound, one of the cases is in an asymptomatic patient; the principal symptom in the second case was abnormal uterine bleeding, and both being successfully managed with surgery. In the literature review we describe the incidence, available diagnosis methods and different options for the treatment of cornual pregnancy accord to the evolution time; also its relationship with the law 21.030 of pregnancy interrumption on three grounds, published in 2017.

Embarazo ectópico intersticial tratado con metotrexato y cirugía: caso clínico / Interstitial ectopic pregnancy treated with methotrexate and surgery: clinical case

RESUMEN Antecedentes: El embarazo intersticial es muy inusual y representa <2,4% de todos las gestaciones ectópicas. Objetivo: Se presenta el caso de un embarazo ectópico intersticial tratado de forma médica y quirúrgica. Se realiza una revisión literaria sobre las opciones de manejo y tratamiento. Caso clínico: Paciente primigesta de 36 años con gestación ectópica cornual derecha tras 11 días de la transferencia de un embrión criopreservado. Se decide tratamiento con metotrexato (MTX) sin éxito y con progresión del embarazo, obligándonos por lo tanto a realizar una evacuación quirúrgica de la gestación, exponiendo a la paciente tanto a los efectos secundarios del tratamiento médico como a los del abordaje quirúrgico. Conclusión: El embarazo ectópico intersticial sigue siendo un reto para el ginecólogo. El diagnóstico muy temprano de estas patologías, aunque difícil, podría evitar la opción quirúrgica, siendo el MTX más eficaz en los casos tratados precozmente.

ABSTRACT Background: Interstitial pregnancy is very unusual, and it represents <2,4% of all ectopic pregnancies. Objective: We present the case of an interstitial ectopic pregnancy treated medically and surgically. A literary review is also made about the management and treatment options. Clinical case: A 36-year-old patient with a diagnosis of right cornual ectopic pregnancy after 11 days of a cryopreserved embryo's transfer. Methotrexate (MTX) treatment was applied as the initial step but without lasting results. Because of the progression of the pregnancy, further therapy was focused on its surgical evacuation exposing the patient to the side effects of both medical treatment and surgical approach. Conclusion: Interstitial ectopic pregnancy remains a challenge for the gynecologist. Very early diagnosis of these pathologies, although difficult, could avoid the surgical outcome, being MTX more effective in cases intervened initially.

Cornual pregnancy in 2 cases / 北京大学学报(医学版)

Cornual pregnancy is one of the diseases caused by embryo embedment at abnormal site. Since few women with cornual pregnancy continue to a middle or late gestation are at a relatively increased risk of uterus rupture,placenta accrete,postpartum hemorrhage and some other severe obstetric complications. We reported two cases of cornual pregnancy at the third trimester, including their clinical symptoms, diagnoses, treatments and obstetric outcomes. Patient 1 had regular prenatal examination. The ultrasound scan at the second trimester showed that the placenta was located at the right fundus of uterus and the myometrium was thin. She had sudden-onset abdominal pain and hypovolemic shock at the end of 33 weeks of gestation. Emergency laparotomy revealed right cornual pregnancy rupture and delivered a dead fetus. After removing the residual gestational tissue and repairing the uterine defect, a live infant was born by cesarean section three years later. Patient 2 was found an unusually located placenta accreta at the right cornu when cesarean section was performed for twin pregnancy and pre-eclampsia. Conservative treatments were tried to reduce bleeding, such as strong contractive drugs, B-Lynch suture,bilateral ascending branch of uterine artery ligation, but they all failed. The patient developed to disseminated intravascular coagulation and had to accept hysterectomy at last. Through analysis of the above two cases and review of related literature, we explored the diagnoses and management of the patients with cornual pregnancy at the late trimester. Ultrasonography is essential to diagnose cornual pregnancy, especially at the early stage, and the abnormal images need special attention during the whole term. Besides magnetic resonance imaging is an alternative method to evaluate the location and placenta accrete. Since cornual pregnancy is always accompanied with placenta accrete, which tends to result in uncontrollable postpartum hemorrhage and increase maternal mortality, cesarean section is suggested once diagnosed and individualized treatment strategy is made according to specific circumstances, including age, bearing requirement, severity of the disease, underlying disease and so on. Therefore, adequate preparation is very important and necessary before surgery. Drugs and conservative surgeries should be considered first when hemorrhage happens, however, hysterectomy is the last method to save patients' lives when other treatment doesn't work.

Tratamiento con metotrexate para el embarazo ectópico cornual / Metotrexate Treatment Cornual Ectopic Pregnancy

El embarazo ectópico cornual o intersticial es una entidad rara, con alta morbilidad y mortalidad materna. El objetivo del trabajo es presentar un caso de embarazo ectópico cornual y tratado conservadoramente en el Hospital Ciro Redondo García. Artemisa. Cuba. La paciente es una mujer de 26 años que se atiende por infertilidad secundaria, quien acudió a consulta por amenorrea de 7 semanas, con prueba positiva para hormona gonadotrófica coriónica en orina. La ecografía mostró una imagen compatible con saco gestacional en región cornual derecha sin actividad cardíaca. La cavidad endometrial estaba vacía. Es tratada con dos dosis de metotrexate y conducta expectante. No presentó complicación en relación al embarazo ectópico cornual ni al uso del metotrexate y a los seis meses tuvo un nuevo embarazo que cursó sin complicaciones. El diagnóstico precoz del embarazo ectópico cornual y el uso de metotrexate representan una opción de tratamiento médico conservador y eficaz que evita la intervención quirúrgica(AU)

The cornual ectopic pregnancy is a rare entity, with high morbilidad and maternal mortality. The objective of paper is to present a case of cornual ectopic pregnancy treated conservatively at Ciro Redondo García Hospital, Artemisa, Cuba. The patient is a 26-year-old woman who was treated for secondary infertility, she attended the consultation for amenorrhea of 7 weeks, with positive test for HGC in urine. The ultrasound showed an image compatible with a gestational sac in the right cornual region without cardiac activity. The endometrial cavity was empty. She was treated with two doses of methotrexate and watchful waiting. There was no complication in relation to ectopic cornual pregnancy or the use of methotrexate and at six months. She had a new pregnancy with no complications. The early diagnosis of cornual ectopic pregnancy and the use of methotrexate represent a conservative and effective medical treatment option that avoids surgical intervention(AU)

Therapeutic methods and their effects on patients with cornual pregnancy / 中南大学学报(医学版)

OBJECTIVE@#To evaluate the therapeutic methods and their effects on patients with cornual pregnancies.
@*METHODS@#A retrospective study was performed on 83 patients, who were diagnosed as cornual pregnancy at Drum Tower Hospital from June 2010 to April 2015. The patients were divided into 5 groups: a laparoscope group, angle resection and uterine repair guided by laparoscope (n=16); a surgery group, operated with angle resection and uterine repair (n=49); an abortion group, guided by ultrasound or laparoscope (n=6); a drug group, treated by methotrexate and mifepristone (n=8) and a pregnancy bursal puncture group (n=4). We compared the general conditions, surgery circumstances and average days in hospital among the laparoscope group, the surgery group, and the abortion group. Moreover, we also investigated the outcomes of the drug group and pregnancy bursal puncture group.
@*RESULTS@#Compared with the surgery group, the intraoperative blood loss in the laparoscope group and abortion group was less (P0.05). The length of procedure in the abortion group was less than that in the laparoscope group or the surgery group (P<0.05). The cure rate was 100%.
@*CONCLUSION@#The therapeutic methods based on patient's condition can improve the curative effect and prognosis in cornual pregnancy, which can keep the integrity of generative organs with less injury. The laparoscope might be a main therapeutic method for cornual pregnancy due to its safety, effectiveness, and minimal invasion.

Cornual Pregnancy and its Management: A Case Report.

Ectopic gestation can be present at various parts of the tube; the most common site being the ampulla. If it occurs in the interstitial region, it is called cornual gestation. 2-4% of ectopic gestation can be in the cornual region. Management depends upon the time at diagnosis. Early cornual gestation can be managed medically while advanced cornual gestation needs surgery that may range from conservative to radical depending upon clinical presentation. Th e mortality rate due to rupture of a cornual pregnancy can range from 2 to 2.5% if not managed promptly. Th e high mortality rate is due to the presence of increased vascularity of the cornual region. A case report of a cornual pregnancy and its management is being presented.

A cornual ectopic pregnancy case: diagnosis, etiology and its management.

This is a report of a case of cornual ectopic pregnancy, with transvaginal ultrasonography done for early detection, screening, β-hCG measuring, also discussed was the role of methotrexate therapy prior to operative procedure with conservative management. Multiple intramural myomas (22 myomas) in this case were strongly believed as the etiology of the cornual pregnancy.