Cornual heterotopic pregnancy: Contemporary management options

This review covers the clinical presentations, treatments, and outcomes of cornual heterotopic pregnancies reported in the literature. Infertile women with a history of ectopic pregnancy, tubal surgery, or disease are at incr eased risk for cornual heterotopic pregnancy when they undergo in vitro fer tilization. Women who have undergone bilateral salpingectomy also seem to b e predisposed to this condition when they undergo in vitro fertilization. W e recommend that these patients be followed up closely after a successful i n vitro fertilization cycle with monitoring of serum P-human chorionic gona dotropin levels and serial transvaginal ultrasonography because of the high associated morbidity. Laparotomy remains the treatment of choice for ruptu re of a cornual heterotopic pregnancy. In the absence of cornual rupture, h owever, medical management is an option that eliminates the risk of surgery and anesthesia and results in outcomes similar to those associated with su rgical treatment. Currently there is insufficient evidence to recommend any single treatment modality, and the decision should be based on such factor s as clinical presentation, surgeon's expertise, side effects, overall cost , and the patient's preference.