A 30-year-old woman presents with a 4 cm ectopic pregnancy at the right cornu visible on laparoscopy; however, the trophoblastic tissue is within the uterine wall at the intramural portion. Her contralateral tube is absent. What is the MOST appropriate management?
- A Laparoscopic cornuostomy with local methotrexate injection ✓
- B Systemic methotrexate (single-dose protocol)
- C Laparoscopic salpingectomy
- D Hysteroscopic resection
Correct answer: A. Laparoscopic cornuostomy with local methotrexate injection
Explanation
Interstitial (cornual) ectopic pregnancy is a high-risk variant with a 2–2.5% maternal mortality due to delayed rupture and massive hemorrhage. For women wishing to preserve fertility (especially with absent contralateral tube), laparoscopic cornuostomy (cornuotomy) with local methotrexate injection is preferred over cornual resection or systemic methotrexate alone. A 4 cm interstitial ectopic poses rupture risk that makes systemic methotrexate less safe without close surgical backup.
Reference: Williams Obstetrics, 26th ed.
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Written and medically reviewed by the StethoPrep medical team.