Treatment of unruptured cornual pregnancies by local injections of methotrexate or potassium chloride under transvaginal ultrasonographic guidance

Abstract

Objective:To demonstrate the outcome of intralesional management and show the safety of local treatment of cornual pregnancy.Methods:Eight patients were treated with local methotrexate or potassium chloride injection. All patients underwent transvaginal ultrasound examination and were diagnosed by the criteria defined by Timor-Tritsch. In the case of fetal heart beat observation, potassium chloride was injected; and in the case of no heart beat detection, methotrexate was used. A follicle aspiration needle was inserted directly into the gestational sac under transvaginal guidance.Results:Although it has been considered to be a risk factor, none of the patients in our study had previous ectopic pregnancy, history of infertility / in vitro fertilization, or cornual pregnancy. One of the patients had a medical history of abortion. In four cases, methotrexate was injected, and three patients received potassium chloride as a local treatment. None of the patients had any complication in the peri- or postoperative period.Conclusion:Using a local approach, the treatment agent can reach the area of the cornual pregnancy in high concentrations. Based on this case series, a local approach seems to be an effective and fertility-sparing method for treating unruptured cornual pregnancies.

Methotrexate for Cornual Ectopic Pregnancy

“…Cornual ectopic pregnancy (interstitial pregnancy) is a rare type of ectopic pregnancy that occurs in roughly 2%-4% of ectopic pregnancies and 1/2,500-1/5,000 of all pregnancies [1][2][3][4][5][6]. The embryo embeds itself into the funnel-shaped area where the uterus connects to the fallopian tubes [1].…”

“…Cornual ectopic pregnancy (interstitial pregnancy) is a rare type of ectopic pregnancy that occurs in roughly 2%-4% of ectopic pregnancies and 1/2,500-1/5,000 of all pregnancies [1][2][3][4][5][6]. The embryo embeds itself into the funnel-shaped area where the uterus connects to the fallopian tubes [1]. Cornual pregnancies pose a diagnostic and therapeutic challenge with significant high morbidity and mortality (2.2%-2.5%) and are associated with massive intraperitoneal bleeding during the first trimester [2,3,5,13].…”

“…Traditionally, cornual resection and hysterectomy were the preferred surgical treatments; however, future fertility is affected [1,13,14]. Successful management includes early ultrasonographic diagnosis, laparoscopic resection, and suturing of the uterine cornua [2].…”

“…Women desiring to preserve their fertility may consider systemic MTX or intralesional and or local MTX [1,10]. Systemic MTX has greater maternal risk, including higher morbidity and mortality, and systemic side effects (e.g hematologic or hepatic) versus local therapy [1].…”

“…Ectopic pregnancy is a pregnancy outside of the uterine cavity. In about 4% of ectopic pregnancy, it can involve the cornua [1][2][3][4][5][6]. Cornual pregnancy is a rare type of ectopic pregnancy in which the embryo implants in the junction between the fallopian tube and the uterus [4,7].…”