Ultrasound diagnosis of ectopic pregnancy in the non-communicating horn of a unicornuate uterus (cornual pregnancy).

OBJECTIVE

To prospectively evaluate ultrasound criteria for the diagnosis of pregnancy in the rudimentary horn of a unicornuate uterus (cornual pregnancy).

METHODS

This was a prospective observational study over a period of 90 months in a tertiary referral center in a London teaching hospital. A diagnosis of cornual pregnancy was made when all the following ultrasound criteria were met: (1) a single interstitial portion of Fallopian tube in the main uterine body; (2) a gestational sac, mobile and separate from the uterus, surrounded by myometrium; and (3) a vascular pedicle joining the gestational sac to the unicornuate uterus. In cases where the ultrasound criteria were met the pregnancy was followed up and the final outcome was recorded, including operative and histological findings.

RESULTS

Over the study period eight cases of cornual pregnancy were diagnosed. Six women had a single case of cornual pregnancy. One woman was managed expectantly in her first cornual pregnancy and subsequently suffered a recurrence. Surgical management varied depending on viability of the pregnancy and gestational age at presentation. In all the women who underwent surgery the diagnosis was eventually confirmed at operation and on histological examination. During the study period there were no false positive or false negative results in our unit using the above criteria.

CONCLUSION

The proposed ultrasound criteria appear accurate and may be applied in clinical practice to facilitate preoperative diagnosis of cornual ectopic pregnancy.