Α 42 year old woman presented to our clinic with positive pregnancy tests seeking to initiate a routine pregnancy monitoring schedule. The levels of her serum β-hCG were sequentially measured at regular intervals, however they demonstrated an abnormal increase pattern (Figure 1). The patient additionally mentioned vaginal bleeding and abdominal cramping during that time, thus raising clinical suspicion for further investigation. Her medical history included four instances of missed abortion, which were successfully resolved via dilation and curettage and a history of caesarean delivery of a healthy baby, complicated by massive obstetric hemorrhage, which was ultimately successfully managed. She had undergone a hysteroscopic procedure in the past, which included polypectomy and adhesiolysis in the context of fertility enhancement surgery.

Given the abnormal β-hCG levels and the past history of missed abortions, a transvaginal ultrasound was performed during the 6th week of gestation. Ultrasonographic findings included a thick endometrium and a round-shaped formation at the right uterine cornu, which however possessed no typical features of a gestational sac (Figure 2). Based on ultrasonographic evidence alone, no concrete conclusions could be extracted as to whether the pregnancy was intra- or extra-uterine. Therefore, the patient was advised to and ultimately underwent a Magnetic Resonance Imaging (MRI) scan, which confirmed the diagnosis of cornual ectopic pregnancy, visualized as a 16 by 23 mm region of abnormally increased signal intensity (Figure 3). Following consultation with the patient and discussion of the associated risks of such a pregnancy, the patient consented to undergo hysteroscopic resection of the gestational sac.

Pre-operative β-hCG levels reached their highest point at 11699 mIU/ml. During the procedure, the cervix was dilated by Hegar dilators up to 9.5 mm. A sorbitol/mannitol solution was used as the distention medium and was infused in the uterine cavity. Adequate infusion pressure was established with the use of a pressure cuff inflated up to 100 mmHg. The gestational sac was hysteroscopically located and resected using diathermy loop (Figure 4). There were no intra- or post-operative complications of note. A measurement of β-hCG levels 3 days post-operatively revealed significant decrease, down to 1692 mIU/ml, indicating successful termination of pregnancy and removal of embryonic tissue. Following a thorough assessment, the patient was in good overall condition, reporting only pink spotting and was subsequently discharged. During a follow-up examination, 2 weeks post-operatively, the patient was in excellent condition, without any ultrasonographic evidence of prior cornual pregnancy (Figure 5) while her β-hCG levels were 40 mIU/ml.