A Cornual Ectopic Pregnancy Case: Diagnosis, Etiology and Its Management
A Cornual Ectopic Pregnancy Case: Diagnosis, Etiology and Its Management
A Cornual Ectopic Pregnancy Case: Diagnosis, Etiology and Its Management
Med J Indones
Hadisaputra
Abstrak
Tulisan ini menyajikan laporan kasus mengenai kehamilan ektopik, peran ultrasonografi transvaginal dalam
mendeteksi secara dini, penapisan, pengukuran hCG, serta peran methotrexate sebagai terapi sebelum melakukan
tindakan operatif pada kehamilan ektopik kornu yang ditatalaksana secara konservatif. Mioma intramural multiple
(22 buah) pada kasus ini ditengarai sebagai penyebab kehamilan kornunya. (Med J Indones 2008; 18: 64-8)
Abstract
This is a report of a case of cornual ectopic pregnancy, with transvaginal ultrasonography done for early detection,
screening, -hCG measuring, also discussed was the role of methotrexate therapy prior to operative procedure with
conservative management. Multiple intramural myomas (22 myomas) in this case were strongly believed as the
etiology of the cornual pregnancy. (Med J Indones 2008; 18: 64-8)
Keywords: Cornual ectopic pregnancy, multiple myomas, ultrasonography, methotrexate
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Ultrasound Imaging
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Med J Indones
Hadisaputra
Table 1. Randomized clinical trial which compare methotrexate (MTX) with laparoscopic salphingostomy (LS) for
ectopic pregnancy.9
The success rate of therapy (%)
Other outcome
Comments
MTX
LS
Differences of Rate
Hajenius et all,
1997 (100)
82
72
NS
No differences in the
level of tuba preservation
Fernandez et al,
1990 (100)
88
96
NS
Future pregnancy
rate is higher in the
MTX Group (96% vs.
62%, p<0.05) but not
for repeated ectopic
pregnancy
Sarajetal, 1998
(75)
95
91
NS
Theres no differences in
the patency level or the
rate of future pregnancy
Sowteretal,
2001 (62)
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91
95% Cl 10-47
Day 7
- Measure serum concentration of -hCG
- Inject the second dose of MTX if the descent
of -hCG is <25%
Weekly
- Measure serum concentration of -hCG until
the cocentration is < 15 IU/l
- Do an USG transvaginal
Everytime
Perform a laparascopy if the patient has acute
abdomen or severe abdominal pain or the ultra
sonography showed an intrabdominal bleeding
> 100 ml.
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CASE ILLUSTRATION
Mrs Z, 42 years old, with primary infertility for 2 years
was admitted to the hospital at August 15th 2008 (in
Bunda Maternity hospital, Jakarta) suffering slight
vaginal bleeding, her last menstrual period was June
10th 2008. The laboratory result: Hb 13,3 g%, Leucocyte
12.500/mm3, Blood group O Rh +, Glucose 97 mg/dl,
ECG was within normal limit.
Transvaginal ultrasonography examination found multiple
myomas in the uterus measuring vary between 4,5 cm
up to 1,0 cm (approximately 22 myomas). The uterine
cavity was empty, but gestational sac present in the left
cornu with the presentation of the fetal pole diameter
1,7 cm correspond to 8-10 weeks gestational age. The
patient was decided to undergo laparatomy. Prior to the
surgery, double dose of 25 mg of methotrexate (MTX)
was administered with the interval of 24 hours. Patient
underwent laparotomy on August 31st 2008.
During laparotomy, considering that the patient had
taken MTX, the operator performed linear incision
longitudinally in the left cornual, approximately 2 cm,
to remove the fetus and placenta completely (Figure
1) the bleeding was completely controlled by two layer
stitching using vicryl no. 1 then the surgery followed
by myomectomy, taken out the 22 myomas (diameter
of 4,5 until 1,0 cm), occupied diffusely in the uterine
corpus (Figure 2).
Total surgical bleeding was approximately 200 ml.
Patient were not received blood transfusion at all. Post-
DISCUSSION
The cornual gestation which is most often surgically
excised, require the removal of a portion of myometrium
as well. A minimum amount of tissue must be excised in
order to prevent possible uterine rupture in the future. 11
Regarding this case, it was very surprising that MTX
administered prior to surgery is invaluable with minimal
bleeding at the time of cornual incision. So, only a
linear cornu incision was needed. With the availability
of transvaginal ultrasonography early diagnosis of
cornual pregnancy can be performed and thus rupture
complication can be prevented.8
The etiology of the cornual ectopic pregnancy in this
case was strongly believed as due to the presence of
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Med J Indones
Hadisaputra
2.
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