Management of Corneal Pregnancy- Heterotopic Interstitial Pregnancy. Case Report and Literature Review

Introduction: Management of corneal pregnancy becomes more challenging when simultaneous intrauterine pregnancy is present.

Aim + Methods & Materials: By presenting case report and review of the literature, we hope to promote a guideline (EBM) for management of HCP (cornual= interstitial)

Case report: 36 year-old women, status post bilateral salpingectomy, on her 8^th IVF cycle achieved intrauterine monochorionic diamniotic twin pregnancy, presented on her 7^th week of gestation with vaginal bleeding. On Ultrasound, an additional interstitial pregnancy was demonstrated. Each of the three sacs contained viable embryos. Selective feticide by aspiration of the interstitial pregnancy was conducted, while maintaining the viability of the intrauterine twin pregnancy. Two weeks later, she presented with abdominal pain and vaginal bleeding, corneal rupture was suspected due to hemodynamic instability, T.V.S demonstrated no cardiac activity (twin embryos) with intra-abdominal bleeding. An emergent laparoscopy was performed and revealed a ruptured cornua. Cornual resection and aspiration curettage were carried out. performed.

Discussion: Reported cases of aspiration(non surgical) are few. It seems they had similar outcome to KCL injection. Non surgical (although invasive) treatment for H.C.P is an acceptable treatment, most of the literature compares local KCL injection to surgery (wedge resection), cornual rupture following KCL injection has not been reported. However the management is not well established.

Conclusion: Although the safety of feticide by KCL to the remaining embryos has never been evaluated, it may be safer for the mother in cases of interstitial heterotopic pregnancy when comparing it to aspiration only.