**3. Epidemiology**

Interstitial (cornual) pregnancy is a rare type of ectopic pregnancy, accounting for 2–4% of all tubal pregnancies (Lau S& Tulandi T, 1999) .The surrounding myometrial tissue allows progression of the pregnancy into the second trimester but rupture at such an advanced gestation may result in catastrophic haemorrhage with a mortality rate of up to 2 %. This high mortality rate is partially due to the difficult challenging diagnosis as well as the speed of haemorrhage. (Tulandi T&Al-Jaroudi D, 2004; Vicino M et al, 2000; Dilbaz S et al, 2005; Rock J et al, 2003)

Modern Management of Cornual Ectopic Pregnancy 239

One third of patients who conceive after a tubal ligation are reported to experience an ectopic pregnancy. Ectopic pregnancies following tubal ligation usually occur 2 or more years after sterilization, rather than immediately after. In the first year, only about 6% of

The risk of ectopic pregnancy increases if the patient has conceived following an assisted reproductive technique, such as in vitro fertilization (IVF) or gamete intrafallopian transfer (GIFT). The ectopic pregnancy rate quoted as 1.6% and the heterotopic pregnancy rate as

Conception with an IUD in place is coupled with 3-4% risk of ectopic pregnancy which again more than double the background risk. This is more prominent as IUD decreases the

Women over 40 years of age have a 3 – 4 fold increase in the risk for developing an ectopic pregnancy compared to women aged 15-24 years. This has been attributed to a possible progressive loss of myoelectrical activity along the fallopian tube with ageing or to the

Smoking has been shown to increase the risk of ectopic pregnancy by 3 fold. To date, no study has supported a specific mechanism by which cigarette smoking affects the incidence of ectopic pregnancy however, delayed ovulation, altered tubal motility, or altered

Previous pelvic surgeries have shown to increase the risk of ectopic pregnancy. Right ectopic pregnancy seems to be more frequent than left due to history of appendicitis or even

Salpingitis isthmica nodosum like any other inflammation of the tubes has been thought to

The wide spread of specialised early pregnancy units and the abundance of ultrasound facilities led to early diagnosis of cornual ectopics. There is an increasing incidence of asymptomatic ectopics compared with more traditional presentation of lower abdominal

Ruptured ectopics can however present with typical signs of haemorrhagic shock, which include pallor, tachycardia, hypotension and oliguria. The assessment of the uterine size is

rarely helpful and cervical excitation is not a specific sign in cornual ectopic.

sterilization failures result in ectopic pregnancy. (DeStefano F, 1982)

**4.5 Use of an intrauterine contraceptive device (IUD)** 

intrauterine conception rate. (Ory HW, 1981)

deterioration in the quality of the fertilised egg.

immunity have been suggested. (Coste J et al, 1991)

subclinical subacute inflammation of the appendix.

be associated with increase incidence of ectopic pregnancy.

**4.8 Previous pelvic surgeries** 

**4.4 Assisted reproductive technology** 

13%.

**4.6 Increasing age** 

**4.7 Smoking** 

**4.9 Other** 

**5. Presentation** 

pains and vaginal bleeding.

Fig. 1. Sites and frequencies of ectopic pregnancy.
