STUDY OBJECTIVE: To introduce a novel tubal-sparing regimen for the treatment of nonruptured cornual pregnancies. DESIGN: Case report and systematic review of the literature. SETTING: Tertiary Care University setting. PATIENTS: Two patients referred for care in our subspecialty clinic. INTERVENTIONS: Laparoscopic surgery, dilation and evacuation, and postoperative methotrexate injection. Systematic review of the literature. MEASUREMENTS AND MAIN RESULTS: Both medical and surgical treatments for cornual gestation exist; however, each is not without its shortcomings. Medical treatment is associated with failure rates that may result in uterine rupture and catastrophic hemorrhage. Surgical treatment that involves hysterectomy causes a loss of future childbearing capability. Surgical treatment that involves resection of the involved cornual region is associated with decreased fertility rates and increased rates of uterine rupture in future pregnancies. Our treatment regimen is safe and effective and conserves future fertility. CONCLUSION: A cornual gestation is one of the most hazardous types of ectopic gestation. The diagnosis and treatment of such a pregnancy is challenging and constitutes an urgent medical situation. We herein introduce a novel regimen for the treatment of nonruptured cornual pregnancies. The existing treatment regimens are also systematically reviewed.
STUDY OBJECTIVE: To introduce a novel tubal-sparing regimen for the treatment of nonruptured cornual pregnancies. DESIGN: Case report and systematic review of the literature. SETTING: Tertiary Care University setting. PATIENTS: Two patients referred for care in our subspecialty clinic. INTERVENTIONS: Laparoscopic surgery, dilation and evacuation, and postoperative methotrexate injection. Systematic review of the literature. MEASUREMENTS AND MAIN RESULTS: Both medical and surgical treatments for cornual gestation exist; however, each is not without its shortcomings. Medical treatment is associated with failure rates that may result in uterine rupture and catastrophic hemorrhage. Surgical treatment that involves hysterectomy causes a loss of future childbearing capability. Surgical treatment that involves resection of the involved cornual region is associated with decreased fertility rates and increased rates of uterine rupture in future pregnancies. Our treatment regimen is safe and effective and conserves future fertility. CONCLUSION: A cornual gestation is one of the most hazardous types of ectopic gestation. The diagnosis and treatment of such a pregnancy is challenging and constitutes an urgent medical situation. We herein introduce a novel regimen for the treatment of nonruptured cornual pregnancies. The existing treatment regimens are also systematically reviewed.
Authors: Cristina Manea; Evangelia Pavlidou; Aline Andrey Urias; Jean Bouquet de la Jolinière; Jean Bernard Dubuisson; Anis Feki Journal: Front Surg Date: 2014-09-05