Rare Type Of Ectopic Pregnancy
An article published in The Obstetrician & Gynaecologist (TOG) talks about how to treat women with cornual (interstitial) pregnancies. This is an unusual type of ectopic pregnancy in which the fertilized egg implants inside the part of the fallopian tube that is sunk into the wall of the uterus. It can be hard to tell the difference between a normal pregnancy and a cornual pregnancy, since on scanning, the pregnancy may appear as though it is located inside the uterus. Cornual pregnancies are more dangerous than other types of ectopic pregnancies since it is usual for them to rupture later than other tubal pregnancies, making its effects, such as hemorrhaging, even more severe.
Cornual pregnancies are considered to be medical emergencies of the highest priority. Hemorrhaging and shock are the main concerns with a cornual rupture. In one set of statistics, four out of 11 maternal deaths due to ectopic pregnancy were the result of cornual rupture. Physicians hope that the newest ultrasound technologies, for instance 4D imaging, may lend assistance in finding cornual pregnancies, because the enhanced images produced by this technology can show the exact spot where the embryo can be found.
Conventional treatment of a cornual pregnancy is surgical removal of the ectopic tissue. However, the area is very vascular in nature, and bleeding at the site of surgery sometimes necessitates complete removal of the uterus (hysterectomy). Even where the uterus is preserved, the risk for future uterine rupture in the event of a repeat pregnancy is increased. For this reason, surgeons and obstetricians are researching new techniques for treating this condition.
While conventional surgical treatment for cornual pregnancy involves opening the abdomen, laparoscopic procedures for the condition are on the rise. In these procedures, a laparoscope, or small surgical scope, is inserted into an incision at the umbilicus with a few more tiny cuts made a bit lower to allow access to very small surgical instruments, which are guided by ultrasound. Only a skilled laparoscopic surgeon should perform this type of delicate surgery, even in the event of a medical emergency. The results of this type of surgery for treating cornual pregnancy have been very good with shorter hospital stays, quicker recovery, and lowered costs in health care.
As an alternative, hysteroscopic and laparoscopic surgery can be followed with a medication called methotrexate. With this combined treatment, the bleeding from a cornual rupture is minimized and the uterus is spared for possible future pregnancies.