Successful expectant management for a cornual heterotopic pregnancy

Objective: To report the obstetric outcome after expectant management for a right cornual heterotopic pregnancy. Design: Case report. Setting: University hospital. Patient(s): A 33-year-old salpingectomized woman with an 8-year history of primary infertility who conceived after in utero transfer of two embryos obtained by in vitro fertilization. Intervention(s): Expectant management and close ultrasonographic and clinical monitoring. Main Outcome Measure(s): Obstetric outcome. Result(s): The intrauterine pregnancy proceeded unremarkably. A caesarean section was performed for dystocia and allowed the delivery of a healthy 4170 g male infant. The examination of the uterus showed a prerupture of the right uterine horn. Conclusion(s): Expectant management for cornual heterotopic pregnancy could be considered a successful option in a symptom-free patient where the ectopic embryo has a limited craniocaudal length with no cardiac activity. Our case also suggests that elective cesarean section could be the optimal mode of delivery for rare cases of successful management for cornual heterotopic pregnancy, regardless of the therapeutic option chosen for the cornual pregnancy, due to the theoretical increase risk of uterine rupture during labor. (Fertil Steril (R) 2009;91:934.e11-e13. (C) 2009 by American Society for Reproductive Medicine.)