Intrauterine twin pregnancy complicated by cornual heterotopic pregnancy: A case report and narrative review

Background: Intrauterine twin pregnancy complicated by cornual heterotopic pregnancy is a rare pregnancy situation that demands effective intervention to avert rupture of the cornual pregnancy, while also striving to preserve the intrauterine fetus. Case description: A 31-year-old woman presented with a complex pregnancy scenario involving an intrauterine twin gestation alongside a cornual heterotopic pregnancy subsequent to in vitro fertilization (IVF) treatment. Under the guidance of abdominal ultrasound, a transabdominal puncture was performed to administer potassium chloride directly at the site of fetal heartbeats for the purpose of fetal reduction, and to aspirate a portion of the fluid within the gestational sac to reduce its volume. Two male infants via cesarean section at 31 weeks' gestation due to premature rupture of membranes. Postoperative follow-up revealed no abnormalities in the physical and intellectual development of the two boys. Conclusions: For cases of cornual pregnancy with concomitant intrauterine pregnancy, laparoscopic surgery is a treatment option with a relatively high success rate. However, selective fetal reduction may be more advantageous in reducing the miscarriage rate of the intrauterine pregnancy. Compared to transvaginal puncture for fetal reduction, transabdominal ultrasound-guided puncture potassium chloride injection for fetal reduction has a lower infection rate. Additionally, aspirating the fluid from the gestational sac during fetal reduction may help to reduce the size of the gestational sac, thereby lowering the risk of uterine rupture at the cornual region.