A 'potentially safer' route for puncture and injection of cornual ectopic pregnancies

Puncture and injection (usually by methotrexate) of ectopic pregnancies are relatively new modalities of treatment. Lately, these have been applied to cornual ectopic pregnancies. We describe here a proposed transvaginal ultrasound-guided puncture route, leading the needle into the cornual ectopic pregnancy, first traversing the myometrium and approaching the gestational sac from the medical aspect. After extracting the needle, there is potentially less chance for rupture and bleeding. In six of the seven injected cornual pregnancies, this technique was used without complication. The only one punctured from the lateral aspect bled and required laparoscopic intervention. This technique may enable the wider use of this treatment modality by lowering the complication rate caused by bleeding at the puncture site.