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Managing Rare Postoperative Complications in Cornual Heterotopic Pregnancy: Two Case Reports
Yanqing Hao1,2,3, Liaobing Xin1,2,3, Jianmin Chen1,2,3
1Assisted Reproduction Unit, Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People's Republic of China.
Objective:
To evaluate complications following laparoscopic cornuostomy or cornual repair in the management of cornual heterotopic pregnancy (CHP), and to assess the feasibility of repeat surgical interventions without compromising intrauterine pregnancy outcomes.
Methods:
We conducted a case-based review involving two patients diagnosed with CHP following assisted reproductive technology (frozen embryo transfer and IVF). Both underwent initial laparoscopic cornuostomy or cornual repair, with postoperative complications managed through further interventions. Diagnostic tools, surgical approaches, and pregnancy outcomes were analyzed.
Results:
In the first case, a 28-year-old woman developed a uterine arteriovenous fistula (AVF) after laparoscopic cornuostomy, detected by transvaginal ultrasound. Open AVF repair at 13 weeks under lumbar anesthesia resulted in a live birth at 32+ weeks. In the second case, a 30-year-old woman required laparotomy at 15+ weeks for removal of residual ectopic tissue after laparoscopic cornual repair; she subsequently delivered at term. Both cases demonstrated that repeat surgeries, including open procedures, can be safely performed without compromising ongoing intrauterine pregnancies.
Conclusion:
Minimally invasive surgery is effective for CHP, but complications such as AVF and persistent ectopic tissue can arise and require timely reintervention. Transvaginal ultrasonography is essential for early detection. With multidisciplinary care and careful surgical planning, even repeat open surgeries can result in favorable maternal and fetal outcomes.
