Gestational trophoblastic diseases are histologically different types of tumors originating from the placenta with an incidence of 0.2–5.8/1000 pregnancies. Ectopic pregnancy is the implantation of the fertilized ovum outside the uterine cavity, and a 0.64% incidence is reported. Ectopic cornual pregnancy and molar pregnancy are rare cases, and a combination of these two rare entities occurring simultaneously is even rare and very few cases have been reported in the literature. A cornual pregnancy refers to the implantation and development of a gestational sac in one of the upper and lateral portions of the uterus, whereas an interstitial pregnancy is a gestational sac that implants within the proximal, intramural portion of the fallopian tube that is enveloped by the myometrium. We present one of the rare combinations of molar pregnancy and cornual/interstitial ectopic pregnancy in a 30‑year‑old G3 P1 who presented with a triad of amenorrhea, vaginal bleeding, and abdominal pain. Laparotomy was done in view of an ultrasound which was suggestive of a well‑defined complex thick‑walled lesion of size 3.2 × 3.3 with a gestational sac and no cardiac activity in the right fallopian tube/adnexa suggesting tubal ectopic pregnancy. Beta‑human chorionic gonadotropin (β‑hCG) levels were done and noted to be as high as 9998 mIU/mL. Intraoperatively, a cornual ectopic pregnancy was found with no hemoperitoneum which was excised. Histopathology showed chorionic villi with variable size and hydropic change, myxoid stromal changes, and cistern formation with polar trophoblastic proliferation, based on which a diagnosis of molar pregnancy was made. Although ultrasonography and higher than usual serum β‑hCG levels are diagnostic of uterine molar pregnancy, they do not yield a proper diagnosis in ectopic molar pregnancy, hence, making it difficult to distinguish between an early ectopic molar pregnancy from a nontrophoblastic tubal pregnancy. The final diagnosis is usually made only after histopathology. A high degree of clinical suspicion of cornual pregnancy followed by histopathological examination of the products of conception is the standard for arriving at an appropriate diagnosis. Serial serum β‑hCG level follow‑up is recommended to rule out its malignant potential.
Pregnancy, Cornual ; Pregnancy, Ectopic ; Hydatidiform Mole

Cornual pregnancy is one of the diseases caused by embryo embedment at abnormal site. Since few women with cornual pregnancy continue to a middle or late gestation are at a relatively increased risk of uterus rupture,placenta accrete,postpartum hemorrhage and some other severe obstetric complications. We reported two cases of cornual pregnancy at the third trimester, including their clinical symptoms, diagnoses, treatments and obstetric outcomes. Patient 1 had regular prenatal examination. The ultrasound scan at the second trimester showed that the placenta was located at the right fundus of uterus and the myometrium was thin. She had sudden-onset abdominal pain and hypovolemic shock at the end of 33 weeks of gestation. Emergency laparotomy revealed right cornual pregnancy rupture and delivered a dead fetus. After removing the residual gestational tissue and repairing the uterine defect, a live infant was born by cesarean section three years later. Patient 2 was found an unusually located placenta accreta at the right cornu when cesarean section was performed for twin pregnancy and pre-eclampsia. Conservative treatments were tried to reduce bleeding, such as strong contractive drugs, B-Lynch suture,bilateral ascending branch of uterine artery ligation, but they all failed. The patient developed to disseminated intravascular coagulation and had to accept hysterectomy at last. Through analysis of the above two cases and review of related literature, we explored the diagnoses and management of the patients with cornual pregnancy at the late trimester. Ultrasonography is essential to diagnose cornual pregnancy, especially at the early stage, and the abnormal images need special attention during the whole term. Besides magnetic resonance imaging is an alternative method to evaluate the location and placenta accrete. Since cornual pregnancy is always accompanied with placenta accrete, which tends to result in uncontrollable postpartum hemorrhage and increase maternal mortality, cesarean section is suggested once diagnosed and individualized treatment strategy is made according to specific circumstances, including age, bearing requirement, severity of the disease, underlying disease and so on. Therefore, adequate preparation is very important and necessary before surgery. Drugs and conservative surgeries should be considered first when hemorrhage happens, however, hysterectomy is the last method to save patients' lives when other treatment doesn't work.
Adult ; Cesarean Section ; Female ; Humans ; Hysterectomy ; Placenta Accreta ; Pregnancy ; Pregnancy Trimester, Second ; Pregnancy Trimester, Third ; Pregnancy, Cornual ; Pregnancy, Ectopic

OBJECTIVE: To evaluate the therapeutic methods and their effects on patients with cornual pregnancies.
 METHODS: A retrospective study was performed on 83 patients, who were diagnosed as cornual pregnancy at Drum Tower Hospital from June 2010 to April 2015. The patients were divided into 5 groups: a laparoscope group, angle resection and uterine repair guided by laparoscope (n=16); a surgery group, operated with angle resection and uterine repair (n=49); an abortion group, guided by ultrasound or laparoscope (n=6); a drug group, treated by methotrexate and mifepristone (n=8) and a pregnancy bursal puncture group (n=4). We compared the general conditions, surgery circumstances and average days in hospital among the laparoscope group, the surgery group, and the abortion group. Moreover, we also investigated the outcomes of the drug group and pregnancy bursal puncture group.
 RESULTS: Compared with the surgery group, the intraoperative blood loss in the laparoscope group and abortion group was less (P<0.05). The length of procedure and average days in hospital between the surgery group and the laparoscope group were not statistically significant (P>0.05). The length of procedure in the abortion group was less than that in the laparoscope group or the surgery group (P<0.05). The cure rate was 100%.
 CONCLUSION The therapeutic methods based on patient's condition can improve the curative effect and prognosis in cornual pregnancy, which can keep the integrity of generative organs with less injury. The laparoscope might be a main therapeutic method for cornual pregnancy due to its safety, effectiveness, and minimal invasion.
Abortion, Induced ; Female ; Humans ; Laparoscopy ; Methotrexate ; therapeutic use ; Mifepristone ; therapeutic use ; Pregnancy ; Pregnancy, Cornual ; drug therapy ; surgery ; Retrospective Studies

Objective: To investigate the clinical characteristics, treatments and fertility recovery of rudimentary horn pregnancy (RHP). Methods: The clinical data of 12 cases with RHP diagnosed and treated in Peking University Third Hospital from January 1, 2010 to December 31, 2022 were retrospectively analyzed. Clinical informations, diagnosis and treatments of RHP and the pregnancy status after surgery were analyzed. Results: The median age of 12 RHP patients was 29 years (range: 24-37 years). Eight cases of pregnancy in residual horn of uterus occurred in type Ⅰ residual horn of uterus, 4 cases occurred in type Ⅱ residual horn of uterus; among which 5 cases were misdiagnosed by ultrasound before surgery. All patients underwent excision of residual horn of uterus and affected salpingectomy. After surgery, 9 patients expected future pregnancy, and 3 cases of natural pregnancy, 2 cases of successful pregnancy through assisted reproductive technology. Four pregnancies resulted in live birth with cesarean section, and 1 case resulted in spontaneous abortion during the first trimester of pregnancy. No uterine rupture or ectopic pregnancy occurred in subsequent pregnancies. Conclusions: Ultrasonography could aid early diagnosis of RHP while misdiagnosis occurred in certain cases. Thus, a comprehensive judgment and decision ought to be made based on medical history, physical examination and assisted examination. Surgical exploration is necessary for diagnosis and treatment of RHP. For infertile patients, assisted reproductive technology should be applied when necessary. Caution to prevent the occurrence of pregnancy complications such as uterine rupture, and application of cesarean section to terminate pregnancy are recommended.
Pregnancy ; Humans ; Female ; Young Adult ; Adult ; Cesarean Section/adverse effects* ; Retrospective Studies ; Pregnancy, Ectopic/surgery* ; Pregnancy, Cornual/surgery* ; Uterus/surgery* ; Uterine Rupture/etiology* ; Abortion, Spontaneous