A cornual pregnancy is a type of ectopic pregnancy in which the gestational sac develops within the cornua of a bicornuate or septate uterus or in the interstitial part of the fallopian tube. It accounts for less than 1% of all ectopic pregnancies and as the interstitial portion of the myometrium is more distensible, 20% of cornual pregnancies advancing up to 12 weeks of gestation tend to rupture [1]. Despite the availability of modern diagnostic tests, the early detection of a cornual pregnancy remains challenging [2].

Patients with cornual pregnancy can present with acute abdominal pain following intrabdominal rupture of the gestational sac and an adnexal mass accompanied by features of hemodynamic compromise (hypotension, tachycardia, and shock). Other features of early pregnancy such as amenorrhea, breast tenderness, fatigue, cramps, dyspareunia, and shoulder pain (in the case of peritoneal irritation) may also be present. Occasionally, a cornual gestational sac may be noticed in a patient with amenorrhea during a pelvic ultrasound.

The risk factors for a cornual pregnancy are endometriosis with peri and intra-tubular adhesions, pelvic inflammatory disease, transfer of too many embryos, transferring embryos close to the uterine horn, exerting pressure during embryo injection, problems during embryo transfer [3], congenital rudimentary uterine horn [4], or bilateral salpingectomy [5].

• Atrial Septal Defect

  The infant was discharged on hospital day 83 with chronic lung disease, stage 1 retinopathy of prematurity, atrial septal defect and a right clubfoot; there were no additional findings at the 4-month follow-up. [ncbi.nlm.nih.gov]

• Weight Gain

  There is now less emphasis on severe restriction of the mother's dietary intake to maintain a limited weight gain. [medical-dictionary.thefreedictionary.com]

• Perseveration

  You may, like me have a bit of a struggle to get pregnant in the rioght place but if you can bear the heartache of losses I would encourage you to persevere. www.ectopic.org.uk were fantastic at supporting me at my lowest. GOOD LUCK! [mumsnet.com]

• Vaginal Discharge

  // Woman's Era;May2012, p120 The article presents questions and answers related to pregnancy including whether surgical removal is the only option for ectopic pregnancy, possible causes of a thick vaginal discharge in a pregnant woman, and possible [connection.ebscohost.com]

• Chadwick's Sign

  Early in labor this plug is expelled and there is slight bleeding; expulsion of the mucous plug is known as show and indicates the beginning of cervical dilatation. chadwick's sign of pregnancy refers to a bluish color of the vagina which is a result [medical-dictionary.thefreedictionary.com]

Clinical acumen and suspicion of ectopic pregnancy in a woman presenting with acute abdominal pain, amenorrhea, adnexal tenderness or mass and hemodynamic collapse form the crux of early diagnosis. Missed diagnosis can result in life-threatening hemorrhage and mortality. A detailed menstrual history is crucial as is a history of embryo transfer. Guidelines [6] based on evidence have been established for the workup and management of ectopic pregnancies and have to be followed rigorously. Serum and urine beta-human chorionic gonadotropin (beta-hCG) levels, blood group and rhesus factor (Rh) antibody screening along with complete blood count, liver function tests should be obtained in all patients.

Using ultrasonographic criteria, a cornual pregnancy can be diagnosed in a patient with positive pregnancy test [7]. The ultrasonography criteria are - an absence of a gestational sac within the uterine cavity; location of an asymmetrical gestational sac in the proximity of the uterus and the presence of a myometrial wall around the gestational sac. A skilled ultrasonographer with a transvaginal ultrasound can identify a cornual pregnancy as a gestational sac located laterally in the uterine fundus with the classic endometrial stripe around 9 to 12 weeks [2]. In addition, advanced radiological techniques like three-dimensional transvaginal ultrasound scanning can detect the exact location of the gestational sac in relation to the uterine cornu by reproducing the coronal plane of the uterus [8].

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2. Walid MS, Heaton RL. Diagnosis and laparoscopic treatment of cornual ectopic pregnancy. Ger Med Sci. 2010; 8: Doc 16
3. Chang Y, Lee JN, Yang CH, Hsu SC, Tsai EM. An unexpected quadruplet heterotopic pregnancy after bilateral salpingectomy and replacement of three embryos, Fertil Steril 2003;80: 218-220.
4. Chopra S, Keepanasseril A, Rohilla M, Bagga R, Kalra J, Jain V. Obstetric morbidity and the diagnostic dilemma in pregnancy in rudimentary horn: retrospective analysis. Arch Gynecol Obstet. 2009;280(6):907–910.
5. Agarwal SK, Wisot AL, Garzo G, Meldrum DR. Cornual pregnancies in patients with prior salpingectomy undergoing in vitro fertilization and embryo transfer, Fertil Steril 1996;65: 659-660.
6. Mol F, van den BoohaardE, van Mello NM, et al. Guideline adherence in ectopic pregnancy management. Hum Reprod. 2011 Feb; 26 (2): 307 -15
7. Graham M, Cooperberg PL. Ultrasound diagnosis of interstitial pregnancy: findings and pitfalls. J Clin Ultrasound 1979;7: 433-437.
8. Valsky DV, Hamani Y, Verstandig A, Yagel S. The use of 3D rendering, VCI-C, 3D power Doppler and B-flow in the evaluation of interstitial pregnancy with arteriovenous malformation treated by selective uterine artery embolization. Ultrasound Obstet Gynecol. 2007;29: 352-355.