Laparoscopic management of a heterotopic cornual pregnancy following first-trimester miscarriage – A case report and literature review

Abstract

Heterotopic pregnancies, defined by the simultaneous occurrence of an intrauterine and ectopic pregnancy, present a rare but potentially life-threatening diagnostic and surgical challenge. Heterotopic pregnancy is rare in spontaneously conceived pregnancies; however, a dramatic rise in the incidence is observed in patients undergoing assisted reproductive technology procedures. Moreover, cornual localization comprises only a minority of ectopic cases yet bears the highest maternal mortality rate due to the risk of catastrophic hemorrhage.

This report presents the case of a 33-year-old woman with a confirmed first-trimester miscarriage who remained asymptomatic but demonstrated persistently elevated β-hCG levels. Transvaginal ultrasonography identified a right cornual ectopic pregnancy. Laparoscopic wedge resection was performed with the preservation of uterine anatomy.

This case illustrates a critical vulnerability in the follow-up of early pregnancy loss, where residual or ectopic trophoblastic tissue may be misattributed to a slowly resolving miscarriage. It reinforces the value of repeat imaging and surveillance of β-hCG when clinical resolution is incomplete. This report presents one of the first documented cases of asymptomatic, spontaneously conceived heterotopic cornual pregnancy managed laparoscopically in the Caribbean; it contributes to the evolving literature on heterotopic pregnancies in low-risk women and supports early surgical intervention to preserve reproductive potential.