A 26-year-old woman is diagnosed with a non-tubal cornual ectopic pregnancy at 8 weeks. Which is the preferred primary management approach for an unruptured cornual ectopic with a living embryo and no haemodynamic compromise?

• A Expectant management with serial beta-hCG
• B Single-dose systemic methotrexate 50 mg/m²
• C Laparoscopic cornual resection or local methotrexate injection ✓
• D Hysteroscopic resection

Explanation

Cornual (interstitial) ectopic pregnancies carry a high risk of uterine rupture due to the relatively thicker surrounding myometrium allowing growth to larger size before rupture. Surgical treatment (laparoscopic cornual resection or cornuostomy) or local ultrasound-guided potassium chloride/methotrexate injection is preferred for living embryos, as systemic methotrexate success rates are lower for cornual ectopics. Hysteroscopic resection is not feasible as the ectopic is within the myometrial portion, not the endometrial cavity.

Reference: Williams Obstetrics, 26th ed.

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Written and medically reviewed by the StethoPrep medical team.