Management of Spontaneous Cornual Heterotopic Pregnancy in Low-Resources Setting

Abstract

Objective: To report management of spontaneous cornual heterotopic pregnancy in low-resources setting in Ende District, Flores, East Nusa Tenggara. Methods: Case report. Case: A 34 year old primigravida with history of 8-9 weeks amenorrhea came to Obstetrics ER with chief complaint of vaginal bleeding and lower abdominal pain. Ultrasound shows intrauterine pregnancy (IUP), an ectopic pregnancy (EP) in right uterine cornu, and free fl uid in hepatorenal space, splenorenal space, and pouch of douglas suggesting the occurrence of hemoperitoneum and heterotopic pregnancy. We performed cornual resection by laparotomy and administered progesterone orally before and after the surgery. Successful outcome was achieved. Discussion: Heterotopic pregnancy (HP) rarely occurs, especially in natural conception. Thus, early diagnosis and treatment of HP are quite a challenge for physicians especially in rural area. Due to the condition of our patient and limited resources, laparotomy was conducted to remove the EP, rather than laparoscopy despite its advantage to lower risk of IUP abortion. Progesterone was then administered orally to prevent threatened abortion of the IUP. Conclusion: Despite its challenge in diagnosing and treating HP, it is a life-threatening condition that requires accurate and prompt treatment. The treatment goal is to remove the EP and preserve the IUP. Treatment of choice should be decided by takeing the patient’s condition and availability of resources into account. Surgical along with administration of progesterone before and after the surgery would likely improve the outcome of the patient and the intrauterine pregnancy.