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The published Toumi et al\'s article is somewhat confusing to the readers. The cornual pregnancy (CP) defined as a pregnancy that occurs in a rudimentary horn of a uterus with a Müllerian anomaly according to William\'s textbook. The interstitial ectopic pregnancy (IEP) occurs in the interstitial part of the fallopian tube where it crosses the uterine muscular to enter the uterine cavity. The IEP sonographic findings include an empty uterus with an eccentrically placed gestational sac, located ≥1 cm from the endometrial margin and bordered by ≤ 5 mm myometrial rim.

UNASSIGNED: Cornual pregnancy, an infrequently reported form of ectopic pregnancy occurring in the uterine horn, is inadequately documented in medical literature, with an incidence below 2 %. This condition poses a substantial risk to maternal health due to delayed diagnosis and the potential for life-threatening bleeding after rupture.
METHODS: We present a case report following the SCARE guidelines that details a 32-year-old woman with abdominal pain and abnormal uterine bleeding. Clinical examination, β-HCG levels, and endovaginal ultrasound confirmed the presence of a 4 cm unruptured right cornual pregnancy. The patient underwent a minilaparotomy, which revealed the ectopic pregnancy, followed by a successful cornuostomy and right salpingectomy. Postoperative recovery was uneventful.
UNASSIGNED: Cornual pregnancy, comprising around 2 % of ectopic pregnancies, is associated with increased risks of rupture and maternal morbidity. Major risk factors include a history of pregnancy termination, miscarriage, STIs, and smoking. Diagnosis is often delayed, leading to an increased risk of bleeding. Pelvic pain is a common presenting symptom, and sonographic findings aid in accurate diagnosis.
CONCLUSIONS: Cornual pregnancy, though rare, represents a serious condition with a significant risk of maternal morbidity and mortality. A timely diagnosis is crucial for effective treatment, with ultrasound playing a pivotal role, complemented by the essential contribution of laparoscopy. This case underscores the importance of prompt intervention to mitigate the associated risks and improve patient outcomes.

Interstitial heterotopic pregnancy (IHP), an exceedingly rare and clinically intricate phenomenon, presents a diagnosis that challenges healthcare providers in obstetric care. This case report provides valuable insights into the complexities of diagnosing and managing IHPs, shedding light on the pivotal role of early and precise identification. Through a meticulous examination of a 28-year-old patient\'s clinical history and diagnostic journey, this report underscores the significance of advanced imaging techniques and swift decision making, ultimately leading to the accurate diagnosis of an IHP. Furthermore, it highlights the life-saving importance of cornuostomy as a safe and effective intervention, preserving the intrauterine pregnancy while successfully resolving the ectopic gestation. This case report serves as a compelling reminder of the critical need for timely diagnosis and individualized treatment in cases of IHPs, ultimately enhancing the understanding and management of this rare obstetric condition.

Background and Objectives: Cornual pregnancies (CPs) are rare forms of ectopic pregnancy. When abortion does not occur, it can be a life-threatening condition for the mother and can also impair future fertility. We present our experience in the diagnosis and management of CPs. A systematic review was also conducted to investigate the reproductive outcomes after treatment. Materials and Methods: Between January 2010 and December 2022, we performed a retrospective, cross-sectional, single-center, and descriptive data collection and analysis (ClinicalTrial ID: NCT06165770). The search for suitable articles published in English was carried out using the following databases (PROSPERO ID: CRD42023484909): MEDLINE, EMBASE, Global Health, The Cochrane Library (Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and Cochrane Methodology Register), Health Technology Assessment Database, Web of Science, and search register such as ClinicalTrial. Only studies describing the impact of CP treatment on fertility were selected. Results: Two studies were included in the systematic review. Seventeen patients suffering from CPs were selected. In our series, a pelvic ultrasound allowed for the diagnosis of a cornual localization in 35.30% of cases. Thirteen women (76.47%) underwent immediate surgical management. The laparoscopic approach was the most used (76.92%), with a laparotomic conversion rate of 30%. Four patients (23.52%) received medical treatment with methotrexate. After treatment, two patients managed to achieve pregnancy. Conclusions: CP is a rare form of ectopic pregnancy that can quickly become life-threatening for the mother. Ultrasound does not lead to a precise diagnosis in all cases. In the absence of complications and emergencies, laparoscopy is an approach that could be considered valid. For selected asymptomatic patients, medical treatment may be a valid alternative. The data from the studies included in the systematic review, although demonstrating a superiority of medical treatment in terms of future pregnancies, are heterogeneous and do not allow us to reach a definitive conclusion.

OBJECTIVE: Ectopic pregnancies include cesarean scar (CSP), cornual and cervical pregnancies. Various treatment modalities have been- described, but no standardized procedure has been defined so far. The aim of our analysis was to evaluate the diagnostics and treatment at the Department of Obstetrics and Gynecology, LMU University Hospital, Munich.
METHODS: In this retrospective, single-center analysis, 24 patients treated between 2015 and 2020 were analyzed. After verification of the diagnosis by imaging and HCG-analysis, the treatment was individually determined: therapy with methotrexate (MTX) locally with or without simultaneous systemic treatment, surgical treatment via curettage, excision with uterine reconstruction even hemi hysterectomy.
RESULTS: Ten patients presented with CSP, six with cervical and eight with cornual pregnancies. Median age was 34.6 years. CSP was treated with local MTX in six cases; five required additional treatment with systemic MTX or curettage. Primary curettage or surgery was performed in four cases. In cervical pregnancies the primary therapy with local MTX injection and systemic treatment was performed in 50%. One patient was treated with MTX and insertion of a Bakri balloon. Trachelectomy was required in one case. 50% of cornual pregnancies were treated with MTX locally and intramuscularly and 50% received surgery.
CONCLUSIONS: Treatment strategies were based on the patient\'s individual risk parameters. The results of this study show, that simultaneous treatment with local and systemic MTX had good outcomes and could avoid surgeries.

Pregnancy in rudimentary horn is an uncommon presentation of an ectopic pregnancy. It needs a very high degree of suspicion for diagnosis and the diagnosis becomes difficult in cases with previous vaginal deliveries. A 25-year-old female patient with two spontaneous vaginal deliveries and a history of spontaneous abortion at five months visited the obstetric emergency department with a history of five months of amenorrhea with pain abdomen and breathlessness for one day. On abdominal examination abdomen was distended, and rigid, and tenderness was present. Paracentesis was done where blood was present. On bimanual examination, cervical motion tenderness was present, and left-sided fornices fullness was present. The patient was admitted, and her sonography was done for suspicion of a ruptured uterus or ectopic pregnancy. The sonography report showed a bulky uterus with decidual reactions and a well-defined pregnancy of 21 weeks and 6 days in the right adnexal region with hemoperitoneum suggesting suspicion of ruptured ectopic pregnancy. After initial treatment and arrangement of two units of packed red blood cells after proper grouping and cross-matching for the patient, laparotomy was done. At the time of surgery, there was a right-sided rupture of non-communicating rudimentary horn pregnancy with a unicornuate uterus. A dead fetus of 600 grams lies in the peritoneal cavity with two liters of hemoperitoneum. Timely diagnosis and laparotomy saved the life of the patient.

The patient was a 32-year-old woman, gravida three, para one with one prior cesarean section. She became pregnant spontaneously, but the pregnancy implanted in the isthmus of the right fallopian tube, and therefore, she underwent laparoscopic right salpingectomy. Eight months later, another spontaneous pregnancy occurred. the patient experienced abdominal pain and an ultrasound examination revealed a hematoma around the right cornual region. A wedge-shaped incision was made in the cornual pregnancy using monopolar cauterization, and the myometrium was sutured with a single nodule suture. We report a case of spontaneous cornual pregnancy after ipsilateral salpingectomy for an isthmic pregnancy.

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