Surgical Management of an Interstitial Ectopic Molar Pregnancy

Study Objective: The objective of this video is to demonstrate the use of laparoscopic cornuostomy for the removal of an interstitial molar pregnancy. Design: video demonstrate of laparoscopic cornuostomy for interstitial pregnancy Setting: N/A Patients or Participants: The patient is a nulliparous 29 year old who presented for preconception counseling. At her visit, she disclosed having abdominal pain and was found to have a positive urine pregnancy test. Given the complaint in early pregnancy, she was worked up for possible abnormal pregnancy. She had a markedly elevated quantitative beta hCG to over 58 thousand miu/ml and pelvic ultrasound with a multicystic collection at the fundus without a discernible intrauterine gestation. Subsequent MRI was highly suspicious for interstitial ectopic pregnancy and the multicystic appearance in the setting of the markedly elevated quantitative beta hCG increased concern for an interstitial molar pregnancy. After an unsuccessful trial of methotrexate, decision was made to proceed with surgical management. Interventions: Initial surgical plan was for laparoscopic wedge resection. Intraoperatively, after careful evaluation of the location of the pregnancy, decision was made to perform a laparoscopic cornuostomy to preserve the significant uterine volume that would be lost with wedge resection. Measurements and Main Results: Laparoscopic cornuostomy was able to effectively remove the abnormal pregnancy tissue as evidenced by a significant drop in quantitative beta hCG (68.4 thousand miu/ml just prior to procedure to 6 thousand miu/ml on postoperative day 2) while maintaining uterine volume and retention of the fallopian tube. Conclusion: This video demonstrates the feasibility of laparoscopic cornuostomy as an alternative surgical approach to the removal of an interstitial ectopic molar pregnancy. This alternative approach can decrease the intraoperative morbidity while also improving long term obstetrical outcomes as compared to wedge resection.