“Cornual” Ectopic Pregnancies: Diagnostic Approach to Pregnancies Presenting Within the Uterine Cornua

Abstract

Study Objective

In this video we aim to present the diagnostic work up for 3 different types of ectopic pregnancies (angular, interstitial, and intramural) that all occurred within the uterine cornua and the subtle ultrasonographic and surgical differences identified between them in their work ups that led to their correct diagnoses.

Design

Surgical Video.

Setting

Tertiary care center.

Patients or Participants

Three patients with differing pregnancies all implanted within the uterine cornea.

Interventions

Patients underwent diagnostic imaging (ultrasound/MRI) and surgical management if appropriate (laparoscopy/hysteroscopy) for 3 different ectopic pregnancies.

Measurements and Main Results

The angular pregnancy was identified on ultrasound as eccentrically located intrauterine pregnancy within the uterine cornea with < 5mm surrounding myometrium. Our patient did not undergo laparoscopy, however, if she had, uterine distention medial to the round ligament would have been visualized. The interstitial pregnancy was identified on ultrasound with interstitial line and a <5mm myometrial thickness surrounding trophoblastic tissue. On laparoscopy the ectopic was found distending the uterine body laterally to the round ligament. The intramural pregnancy was identified on MRI without evidence of clear uterine distention on laparoscopy and no clear evidence of intrauterine-pregnancy on hysteroscopy.

Conclusion

The use of imaging and minimally invasive surgical procedures are useful in diagnosing ectopic pregnancies presenting at the uterine cornea. Furthermore, accurate terminology is important when describing ectopic pregnancies, as each of these might have incorrectly been called cornual ectopics, however, workup and management plans are different. The term interstitial pregnancy is preferred to the term cornual pregnancy for pregnancies located within the intrauterine portion of the proximal fallopian tube.