A case of hybrid medical management of advanced cornual ectopic pregnancy

Shilpa Bajpai, Prasad Lele


Cornual ectopic pregnancy is perilous and treacherous entity which accounts for 2-4% of all ectopic pregnancies and has a maternal mortality of 2-2.5%. There is always a dilemma in diagnosis due to the area being in close proximity to the endometrial cavity. The precise localisation is difficult till the gestation is advanced, which poses problems in its subsequent management. Surgical approach in this highly vascular area leads to excessive bleeding is a daunting nightmare for a surgeon and also imposes a great threat to the future fertility of the patient. Here we present a case of 26 year old spontaneously conceived primigravida who presented for booking visit at 10 week period of gestation. On transvaginal sonography, there was a suspicion of right cornual ectopic pregnancy which was later confirmed on magnetic resonance imaging (MRI). Despite due to advanced viable gestation, with an evident cardiac activity and very high serum β-human chorionic gonadotropin (βhCG) (more than 1 lakh mIU/ml), we tried a pioneering technique of conservative hybrid approach with intracavitary instillation and systemic antimetabolite drug methotrexate, in view to safeguard her future fertility by diminishing the likelihood of hysterectomy. While on the treatment, patient developed hyper reaction to methotrexate, which was managed with a multidisciplinary approach. She responded very well to the therapy with complete resolution of the cornual ectopic pregnancy.


Cornual ectopic pregnancy, βhCG, Methotrexate, Hybrid approach

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