What is the surgical approach for a cornual (interstitial) ectopic pregnancy?

From the Guidelines

Laparoscopic cornual resection is the preferred surgical approach for a cornual (interstitial) ectopic pregnancy due to its minimally invasive nature and reduced risk of fetal adverse effects, as seen in a study comparing laparotomy versus laparoscopy in pregnant women 1.

Key Considerations for Surgery

• The procedure should be carried out in the early second trimester when possible, to minimize the risk of miscarriage and allow for better access to the uterus 1.
• Local or regional anesthesia is preferred, but general anesthesia may be necessary for longer procedures, and the left lateral tilt position is advised to maintain hemodynamic stability 1.
• Laparoscopy is feasible in pregnancy, but it depends on the gestational age, surgeon's experience, and type of procedure, with recommendations for low intra-abdominal pressure and an experienced surgeon 1.

Surgical Technique

• The procedure involves identifying the cornual pregnancy, injecting vasopressin around the cornua to reduce bleeding, making an incision over the cornual mass, removing the ectopic pregnancy, and suturing the defect with absorbable sutures.
• In cases of extensive damage or uncontrollable bleeding, cornual wedge resection or even hysterectomy may be necessary.
• Preoperative methotrexate may be administered to reduce vascularity and facilitate surgery in selected cases.

Postoperative Care

• Patients should be monitored for bleeding, and serial β-hCG levels should be followed until undetectable.
• Future pregnancies after cornual resection carry a risk of uterine rupture, so cesarean delivery is typically recommended.
• The surgical approach is necessary due to the high rupture and mortality risks associated with cornual pregnancies, which are located in the proximal interstitial portion of the fallopian tube, close to major blood vessels 1.

From the Research

Surgical Approach for Cornual Ectopic Pregnancy

The surgical approach for a cornual (interstitial) ectopic pregnancy can be managed through various laparoscopic techniques, including:

• Laparoscopic removal of ectopic pregnancy through cornual resection, as described in 2
• Double-impact devascularization (DID) technique for hemostatic control, as presented in 3
• Vasopressin Injection Purse-String Ectopic Resection technique, which involves administering dilute vasopressin into the myometrium surrounding the pregnancy, placing a purse-string stitch, and excising the pregnancy by cornual wedge resection, as described in 4
• Cornual wedge resection, which can be used to treat interstitial pregnancies while preserving uterine architecture, as discussed in 5

Key Considerations

When managing cornual ectopic pregnancies, key considerations include:

• Hemostatic control to minimize blood loss and reduce the risk of conversion to laparotomy, as highlighted in 3 and 4
• Preservation of uterine architecture to maintain fertility and decrease the risk of future uterine rupture, as discussed in 5
• Choice of surgical technique, which requires careful consideration of the individual patient's needs and circumstances, as noted in 5

Laparoscopic Techniques

Laparoscopic techniques for managing cornual ectopic pregnancies have been shown to be effective and safe, with benefits including:

• Reduced risk of hysterectomy, as mentioned in 3
• Minimized blood loss and reduced risk of conversion to laparotomy, as described in 4
• Preservation of fertility and decreased risk of future uterine rupture, as discussed in 5