Expectant Management of Bilateral Cornual Ectopic Pregnancy Resulting in Live Birth: A Case Report

Objective Review management of cornual ectopic pregnancy in a patient with a complex anatomical variant. Design Literature review and case report Materials and Methods A literature review was conducted with search terms cornual ectopic pregnancy, bicornuate uterus, and assisted reproductive technology (ART). The patient’s chart was reviewed for case details. Results A 33 year old G0 with oligomenorrhea and infertility was thought to have polyendocrine metabolic ovarian syndrome versus hypothalamic hypogonadism given her history of extreme exercise. The patient attempted ovulation induction (OI) with timed intercourse, but was unsuccessful. She then trialed monitored injectable gonadotropin stimulation which resulted in a total of 2 mature and 1 intermediate follicle with trigger shot. This cycle resulted in pregnancy. An ultrasound revealed a dichorionic-diamniotic twin gestation in a bicornuate uterus, with a pregnancy in each uterine horn. The myometrial mantle was thin in both horns, concerning for a dual cornual ectopic pregnancy. The patient was counseled by Maternal Fetal Medicine (MFM) and offered pregnancy termination due to threat to life, but declined. A plan was made for close monitoring and strict return precautions. Twin 2 later met criteria for early pregnancy loss. Twin 1 remained viable and the cornual positioning resolved. During monitoring, the patient was also diagnosed with mosaic Turner syndrome after a detailed history revealed she had a myxomatous mitral valve. The singleton pregnancy continued to 32 weeks of gestation and was delivered via Cesarean section for severe fetal growth restriction with abnormal dopplers. Conclusions Current guidelines for management of cornual ectopic pregnancies are not clear, especially in the setting of a highly desired pregnancy and desire for future fertility. This case highlights that conservative management may be a feasible option for patients in stable condition with reliable follow up.