Hysteroscopic management of cornual ectopic pregnancy

BACKGROUND: Cornual ectopic pregnancies have traditionally been treated with systemic methotrexate, cornual resection, or hysterectomy. CASE: A 36-year-old newly gravida presented with an 8-week history of amenorrhea and a positive home pregnancy test. A transabdominal sonogram revealed a left cornual ectopic pregnancy. The patient was treated with multiple methotrexate doses, but the gestational sac persisted. Through the hysteroscope, the sac was ruptured, and the placental tissue was removed from the left cornu under sonographic guidance. Two weeks postoperatively, the patient's beta-human chorionic gonadotropin level was negative, and she had a normal pelvic examination and sonogram. CONCLUSION: Hysteroscopic removal under sonographic guidance after methotrexate treatment is a conservative option for the treatment of cornual ectopic pregnancy in some patients.