DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20205275

A case of hybrid medical management of advanced cornual ectopic pregnancy

Shilpa Bajpai, Prasad Lele

Abstract


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.


Keywords


Cornual ectopic pregnancy, βhCG, Methotrexate, Hybrid approach

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References


Lin EP, Bhatt S, Dogra VS. Diagnostic clues to ectopic pregnancy. Radiographics. 2008;28(6):1661-71.

Intapibool S. Unruptured left cornual pregnancy: case report. J Med Assoc Thai. 2005;88(8):1137-9.

Shendy M, Atalla R. Modern Management of Cornual Ectopic Pregnancy, Ectopic Pregnancy - Modern Diagnosis and Management. Michael Kamrava. 2011.

Royal College of Obstetricians and Gynaecologists. The Management of Tubal Pregnancy. Green Top Guideline. 2004;21.

Dey M, Lele PR, Tiwari S. Diverse Management of Cornual Ectopic Pregnancy. Int J Med Pharm. 2016;6(2):1-5.

Lele P, Tangri MK, Patil D, Sharma R. Recurrent Interstitial pregnancy: a new approach in diagnosis with MRI and management with systemic methotrexate along with intra foetal cardiac 10% potassium chloride; Int J Reprod Contracept Obstet Gynecol. 2016;5(2):539-41.

Timor-Tritsch IE, Monteagudo A, Matera C, Veit CR. Sonographic evolution of cornual pregnancies treated without surgery. Obstet Gynecol. 1992;79:1044-9.

Api M, Api O. Laparoscopic cornuotomy in the management of an advanced interstitial ectopic pregnancy: a case report. Gynecol Endocrinol. 2010;26(3):208-12.

MacRae R, Olowu O, Rizzuto MI, Odejinmi F. Diagnosis and laparoscopic management of 11 consecutive cases of cornual ectopic pregnancy. Arch Gynecol Obstet. 2009;280(1):59-64.

Tinelli A, Malvasi A, Pellegrino M, Pontrelli G, Martulli B, Tsin DA. Laparoscopical management of cornual pregnancies: a report of three cases. Eur J Obstet Gynecol Reprod Biol. 2010;151(2):199-202.

Surekha SM, Chamaraja T, Singh N, Singh LB, Neeraja TS. A ruputured lef cornual pregnancy: A case report. J Clin Diagn Res. 2013;7(7):1455-6.

Elson CJ, Salim R, Potdar N, Chetty M, Ross JA, Kirk EJ. Diagnosis and management of ectopic pregnancy. Int J Obstet Gynaecol. 2016;123(13):15-55.

Ackerman TE, Levi CS, Dashefsky SM, Holt SC, Lindsay DJ. Interstitial line: Sonographic finding in interstitial (cornual) ectopic pregnancy. Radiology. 1993;189(1):83-7.

Cassik P, Ofili-Yebovi D, Yazbek J, Lee C, Elson J, Jurkovic D. Factors influencing the success of conservative treatment of interstitial pregnancy. Ultrasound Obstet Gynecol. 2005;26(3):279-82.

Dilbaz S, Demir B, Dilbaz B. Treating cornual pregnancy with a single methotrexate injection—a case report of 3 cases. J Reprod Med Obstet Gynecol. 2005;50(2):141-4.

Gherman RB, Stitely M, Larrimore C. Low dose methotrexate treatment for interstitial pregnancy: a case report. J Reprod Med Obstet Gynecol. 2000;45(2):142-4.

Kim MJ, Cha JH, Bae HS, Kim MK, Yun BS, Kim YS, et al. Therapeutic outcomes of methotrexate injection in unruptured interstitial pregnancy: Obstet Gynecol Sci. 2017;60(6):571-8.