Regarding Cornual Pregnancy: An Eccentric Pregnancy

Dear Editor, There is ongoing controversy regarding the precise description of cornual ectopic pregnancy (EP). Most of the authors recognize "interstitial" and "corneal" as synonyms. Nevertheless, certain individuals employ the term "corneal" to describe pregnancies that occur in a uterus with a bicornuate or septate structure. A cornual pregnancy is characterized by the occurrence of implantation and subsequent growth of a gestational sac within the upper and lateral regions of the uterus, as per its established definition. The diagnosis and treatment of cornual pregnancy pose significant challenges due to the abundant vascular supply in this region and the resemblance of the implanted pregnancy to an eccentrically implanted intrauterine pregnancy. Maher and Grimwade argued that many providers labeled a pregnancy as cornual if located in the cornua of the uterus, whether it was in an anomalous uterus or normal uterus. They wrote, "the fact remains that any pregnancy occurring in the cornual region of a normal uterus is still referred by many gynecologists as a 'cornual pregnancy'."[1] Still, it is not uncommon in general practice to hear radiologists, ultrasonographers, and practitioners caring for reproductive-aged women to use the term cornual pregnancy to refer to a range of gestations that occur near the uterine cornua, including intracavitary and ectopic pregnancies in normal and anomalous uteri. The term "interstitial pregnancy" is also fairly consistently and clearly defined as a gestation that implants within the proximal tubal segment that lies within the muscular uterine wall.[2] Interstitial EP can be difficult to differentiate from eccentric intrauterine pregnancies that are eccentrically implanted in the uterine cavity cornuum. The development of best practice guidelines will require standardized terminology and diagnostic techniques. However, we could suggest to update the title as eccentric pregnancy as the new adoption in recent literature due to the confusion in literature. Least controversial is the term "interstitial EP," one which we would pose should remain in the lexicon. Existing circular and ultimately confusing arguments suggest that abandonment of the terms cornual and angular may be justified in favor of the singular term, eccentric pregnancy, that describes a pregnancy within the endometrial cavity that has implanted near but medial to the uterotubal junction.[3,4] However, we could suggest to update the title as eccentric pregnancy[4,5] as the new adoption in recent literature due to the confusion in literature, being very reductive the old definition of cornual pregnancies located "in one horn of a bicornuate uterus, or, by extension of meaning, in one lateral half of a uterus of bifid tendency."[6,7] Author contributions Damiani and Vitagliano reviewed the literature and wrote the letter of corrispondence. Data availability statement Data sharing is not applicable to this article as no datasets were generated or analyzed during the current study. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.