Successful Laparoscopically Assisted Transcervical Suction Evacuation of Interstitial Pregnancy following Failed Methotrexate Injection in a Community Hospital Setting
We report on a case of a patient with an early diagnosed cornual ectopic pregnancy following failed methotrexate treatment. The patient was subsequently taken to the operating room for a laparoscopic guided transcervical suction curettage of the cornual ectopic. The surgery was successful and the patient was followed up until her urine pregnancy test was negative. We conclude that in properly selected patients, cornual ectopic pregnancy may be treated with transcervical suction curettage. 1. Introduction Interstitial pregnancy, commonly referred to as cornual pregnancy, is a rare form of tubal pregnancy accounting for approximately 2–4% of tubal pregnancies [1]. The incidence of interstitial pregnancies is on the rise presumably due to the increase in assisted reproductive technologies [2]. Early diagnosis of interstitial ectopic pregnancies is crucial, as they often remain asymptomatic until rupture occurs and carry a mortality rate as high as 2.5% [3]. Historically, diagnosis of interstitial ectopic pregnancy was most often made intraoperatively in an emergent fashion, following patient presentation with an acute abdomen and/or shock [4]. This would lead to either an interstitial resection or a hysterectomy. With advances in sensitive beta human chorionic gonadotropin (BHCG) assays and ultrasound technologies, earlier diagnosis of interstitial pregnancy is being made. Despite these advances, a large portion of interstitial pregnancies are treated with interstitial resection, even when treated laparoscopically [3]. Removal of the interstitial portion of the uterus carries potential complications in subsequent pregnancies including risks of uterine rupture [5]. Patients with previous interstitial resection will likely undergo elective cesarean section in subsequent pregnancies due to fear of rupture. We report a case of an early diagnosed interstitial pregnancy treated with laparoscopic guided transcervical evacuation following intramuscular methotrexate administration. 2. Case Report The patient was a 37？y/o gravida 7 para 3033 and presented for an ultrasound due to a positive urine pregnancy and vaginal spotting. She stated that her last menstrual period was approximately 7-weeks prior. Aside from vaginal spotting, the patient denied abdominal tenderness or any other complaints. Her past obstetrical history was significant for a full-term normal spontaneous vaginal delivery followed by 2 full-term cesarean sections that were uncomplicated. She had two elective terminations of pregnancy and one first trimester spontaneous abortion. Her gynecological
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