Laparoscopic approach to cornual ectopic: a step-by-step demonstration

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Authors:

Rachel M. Whynott, M.D., Emad Mikhail, M.D.

Abstract:

Objective

To concisely review what is known about cornual ectopic pregnancies and to provide a step-by-step demonstration of the resection of a large cornual ectopic pregnancy, highlighting various laparoscopic techniques.

Design

A video review of cornual ectopic pregnancy and a laparoscopic approach for treatment featuring a patient case at 9 weeks gestation.

Setting

Tertiary care facility.

Patients

A 31-year-old G2P1001 at 9 weeks 0 days by transvaginal ultrasound and with a beta human chorionic gonadotropin of 13,099 presented to the emergency department for vaginal bleeding and cramping left lower quadrant pain. She was hemodynamically stable. Her ultrasound was suspicious for a cornual ectopic pregnancy, which was confirmed by magnetic resonance imaging.

Interventions

The patient was taken to the operating room for resection, given the size of the pregnancy, concern for intraoperative blood loss, concern for persistent pregnancy, and concern that patient would not be able to reliably follow up for multiple appointments. Patient underwent laparoscopic resection of a large cornual ectopic pregnancy. Included is a short review of laparoscopic suturing techniques.

Main Outcome Measures

Pathology, decline in beta hCG, and post-operative course.

Results

The patient's pathology was confirmatory for cornual ectopic pregnancy. Her beta human chorionic gonadotropin decreased as expected, and she had a normal post-operative course.

Conclusions

Laparoscopic cornual resection is a safe and effective method for management of large cornual ectopic pregnancy, and fertility outcomes are similar to patients after salpingectomy for non-interstitial ectopic pregnancy.


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Fertility and Sterility

Editorial Office, American Society for Reproductive Medicine

Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders. The journal publishes juried original scientific articles in clinical and laboratory research relevant to reproductive endocrinology, urology, andrology, physiology, immunology, genetics, contraception, and menopause. Fertility and Sterility® encourages and supports meaningful basic and clinical research, and facilitates and promotes excellence in professional education, in the field of reproductive medicine.

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