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Oct 22, 2019

The 27th World Congress on Controversies in Obstetrics, Gynecology & Infertility

DISTINGUISHING BETWEEN CORNUAL AND ECCENTRICALLY LOCATED INTRAUTERINE PREGNANCY AFTER INTRAUTERINE INSEMINATION - A CASE REPORT STUDY

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Cornual pregnancy

Eccentrically located intrauterine pregnancy

Intrauterine insemination

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Cornual pregnancy

Eccentrically located intrauterine pregnancy

Intrauterine insemination

Abstract

Problem statement Ectopic pregnancies occur in 1–2% of all pregnancies. Cornual pregnancy is a rare and dangerous type of ectopic gestation that poses a diagnostic and therapeutic challenge: Eccentrically located, intrauterine gestational sac can be misinterpreted as cornual pregnancy on ultrasound evaluation. To distinguish between these two, sonographic criteria can be applied: empty uterine cavity; sac <1 cm from the most lateral edge of the uterine cavity and a thin myometrial layer surrounding the sac. The more frequent use of assisted reproductive technologies, including ovulation induction, intrauterine insemination (IUI), in vitro fertilization (IVF), and intracytoplasmic sperm injection (ICSI), leads to a rise in ectopic pregnancy. Methods We describe the clinical presentation, management, and outcome of a patient with eccentrally located intrauterine pregnancy that was presented to us with the suspiction of cornual pregnancy. Results A 36-year-old, nullipara, presented with mild abdominal pain and spotting since three days, 4 weeks after IUI. Referred to the emergency for ultrasound suspicion of cornual pregnancy. General physical examination was normal. Pelvic examination revealed bulky uterus without any adnexal pathology. Clinical features were suggestive of either ectopic pregnancy or threatened abortion. Transvaginal sonography was performed but it could not differentiate whether it is eccentrically located intrauterine gestational sac or cornual pregnancy. β-HCG levels were 95,000 IU/ml. We performed a weekly ultrasound surveillance and observed complaints disappearance, gestational sac implanted near the right tubal orifice and embryo with cardiac activity. Conclusion Although ultrasound imaging has made great improvement over the last decades, diagnosing a cornual pregnancy remains challenging. The use of other imaging modalities, such as magnetic resonance imaging and three-dimensional ultrasound seem to be promising in the diagnosis. However, the higher cost and lower availability of these technologies make them most appropriate for cases in which two-dimensional ultrasound scans are inconclusive. We draw your attention to the necessary balance between surveillance of a potentially life-threatening situation and untimely attitudes that can end a life in its early stages.

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© Copyright 2019 Morressier GmbH.
All rights reserved.