Successful Procedure in Conservative Management of Interstitial (Cornual) Ectopic Pregnancy.

To the Editor,

We read the Pramayadi et al. published report in the Gynecol Minim Invasive Ther. Doi: 10.4103/GMIT. GMIT_9_18, with great interest.

Pramayadi et al. presented a successful laparoscopic management of interstitial (cornual) ectopic pregnancy.[1]

Pramayadi et al. stated in their introduction and conclusion that the interstitial (cornual) pregnancy is a rare type of ectopic pregnancy.[1]

We think that Pramayadi et al.[1] considered both the interstitial and the cornual pregnancy in their article as one type or one entity of ectopic pregnancy, although the interstitial pregnancy is totally different type of ectopic pregnancy than the cornual pregnancy.

Moawad et al. wrote “interstitial pregnancy sometimes is mistakenly referred to as cornual pregnancy and frequently confused with angular pregnancy.”[2]

Sargin et al. wrote “interstitial and cornual ectopic pregnancy can be used in the place of each other. However, they actually describe two different entities.”[3]

Rizk et al. stated that the term “cornual ectopic pregnancy” should only be used in a rudimentary uterine horn, a unicornuate uterus, the cornual region of a septate uterus, a bicornuate uterus, or a uterus didelphys.[4]

The current version of William's Obstetrics describes the cornual pregnancy as a conception that develops in the rudimentary horn of a uterus with a Müllerian anomaly [Figures 1 and 2].[5]

Figure 1

Diagram of the cornual pregnancy in the rudimentary uterine horn

Figure 2

Transvaginal ultrasound of cornual pregnancy in bicornuate uterus shows continuous endometrial line and no interstitial line sign

The diagnosis of interstitial pregnancy can be challenging in some cases, and the missed diagnosis of interstitial pregnancy may result in life-threatening internal hemorrhage.[5]

Pramayadi et al. mentioned the sonographic criteria of the intestinal pregnancy.[1] Moreover, an echogenic line detected by transvaginal ultrasound extends from the gestational sac to the endometrium cavity called interstitial line sign is highly sensitive and specific and represents the interstitial portion of the fallopian tube [Figures 3 and 4].[5]

Figure 3

Diagram of the interstitial line sign

Figure 4

Interstitial gestational sac separated from the endometrial line by the interstitial line and surrounded by thin <5-mm myometrium. Doane B, Perera P. Emergency ultrasound identification of a cornual ectopic pregnancy. West J Emerg Med 2012;13:315

Interstitial pregnancy is a totally different type of ectopic pregnancy than the cornual pregnancy. Interstitial pregnancy is an ectopic pregnancy occurs after implantation of pregnancy in the tubal segment traversing the muscular wall of the uterus. The term “cornual ectopic pregnancy” should only be used in a rudimentary uterine horn, a unicornuate uterus, the cornual region of a septate uterus, a bicornuate uterus, or a uterus didelphys.

COMMENT FROM THE EDITOR-IN-CHIEF

We thank Dr. Sakiyeva Kanshaiym et al. for the opinion of “Successful procedure in conservative management of interstitial (cornual) ectopic pregnancy.” Cornual pregnancy sometimes will be confused in gynecology; the clarification is necessary.

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Conflicts of interest

There are no conflicts of interest.