In the management of interstitial (cornual) ectopic pregnancy, which intervention is preferred over salpingectomy and why?

• A Cornuostomy or cornual resection is preferred over salpingectomy as the interstitial segment is within the uterine wall; salpingectomy alone will not remove the ectopic ✓
• B Salpingectomy is still preferred as it avoids risk of uterine rupture in subsequent pregnancies
• C MTX medical management alone is preferred for all interstitial ectopics regardless of hCG level
• D Hysterectomy is always required for interstitial ectopic due to high vascular risk

Explanation

Interstitial (cornual) ectopic pregnancy is located within the intramural portion of the fallopian tube, surrounded by myometrium. Simple salpingectomy cannot adequately remove the entire ectopic as the gestational sac is embedded in the uterine wall. Surgical management requires cornuostomy (incision into the cornua) or wedge resection (cornual resection) of the affected myometrium. The uterus is then repaired meticulously as there is risk of subsequent uterine rupture in pregnancy. MTX can be used medically for early unruptured cases (hCG <10,000 mIU/mL, stable, no cardiac activity) but surgical management is preferred for larger or unstable cases. Interstitial ectopics have higher mortality than tubal ectopics due to delayed presentation and extensive hemorrhage.

Reference: Williams Obstetrics, 26th ed.

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Written and medically reviewed by the StethoPrep medical team.