Laparoscopic treatment of cornual heterotopic pregnancy: A retrospective cohort study.

OBJECTIVE: To report on our experience of laparoscopic cornuostomy or cornual repair for cornual heterotopic pregnancy.

STUDY DESIGN: A single center, retrospective review of patients who were diagnosed as cornual heterotopic pregnancy, which developed after in vitro fertilization and embryo transfer (IVF/ET) between January 2009 and June 2014. All patients were managed by laparoscopic cornuostomy or cornual repair.

RESULTS: 14 patients were enrolled and 4 patients were finally confirmed to have a ruptured cornu. 4/4 presented as acute abdominal pain and 3/4 as metrorrhagia. The blood pressure of all the patients were stable. The earliest ruptured patient of this series happened at 23 days after IVF/ET. The hemoglobin levels of the 4 ruptured patients were significantly lower than the other patients (8.6 ± 1.8 g/dl versus 12.2 ± 1.1 g/dl, p < 0.001). Internal bleeding before operation was significantly higher in the ruptured patients than in the intact patients (1050.0 ± 369.8 ml versus 0.0 ± 0.0 ml, p < 0.001). All 14 patients were managed by laparoscopic cornuostomy or cornual repair. No one was converted to laparotomy. Post-operation pregnancy was uneventful. All neonates were delivered by cesarean section with no evident complications.

CONCLUSION: Laparoscopic cornuostomy or cornual repair appears to be an effective treatment for cornual heterotopic pregnancy, even in ruptured ones. These operations can be safely performed in an institution with well-trained gynecological laparoscopists with experienced support teams.