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Laparoscopic treatment of cornual pregnancy: a series of 20 consecutive cases
David Soriano1, Danielle Vicus, Roy Mashiach
1Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Israel (affiliated with Tel Aviv University).
Objective:
To determine the outcome of laparoscopic management of cornual pregnancy.
Design:
Retrospective cohort study (Canadian Task Force classification II-3).
Setting:
A tertiary referral hospital in Israel.
Patient(S):
Twenty-seven consecutive women with cornual pregnancy who were diagnosed and treated at our institute.
Intervention(S):
Laparoscopy was undertaken in 20 (74%) of the patients. Resection of the cornua and/or a Vicryl loop placement was performed. In 6 cases, laparoscopy was converted to laparotomy. In addition, laparotomy was performed in 2 other cases. Five cases were managed conservatively: 3 with systemic methotrexate (MTX) and leucovorin, 1 with transvaginal sonography-guided KCl injection to the amniotic sac, and 1 with hysteroscopic-guided MTX injection to the amniotic sac. Further treatment after surgery was required in 4 cases: transvaginal sonography-guided KCl injection, MTX or KCl + MTX (1 case each) injection to the amniotic sac, and systemic MTX injection.
Main Outcome Measure(S):
Successful laparoscopy, determined as not needing follow-up treatment.
Result(S):
The mean gestational age was 56 days. The average and median serum hCG levels were 31,199 and 6,653 IU/mL, respectively. Six of the women (22%) were admitted in hypovolemic shock. Nine patients (33.3%) were asymptomatic upon admission, 14 (52%) had abdominal pain, and 8 (29.6%) were evaluated for vaginal bleeding. One woman developed hypovolemic shock after admission. Only 15 (55.6%) of the 27 pregnancies were diagnosed as a cornual pregnancy by transvaginal sonography before the therapeutic procedure. Blood transfusion was given in seven cases (26%) during surgery. The mean number of days of hospitalization was 5.7 days for patients who underwent surgery and was 7.1 days for all patients. A comparison was made between the first 11 and the last 11 cases treated surgically. Although the two groups were similar in all parameters, conversion from laparoscopy to laparotomy was higher in the first group, although not at a statistically significant level.
Conclusion(S):
Improved laparoscopic technique, accumulated experience, and possibly earlier diagnosis have led to fewer operative failures or need to convert to laparotomy during treatment of cornual pregnancy. Conservative treatment, when possible, should be considered. If surgery is indicated, and as more laparoscopic skill is gained, laparoscopy should be considered the preferred method of treating cornual pregnancy. In experienced hands, laparoscopy is a safe and effective treatment for cornual pregnancy.
