Treatment with methotrexate of a cornual pregnancy following endometrial resection

ABSTRACT

Objectives Endometrial resection is a procedure often performed for treatment of menorrhagia. Despite the fact that amenorrhoea frequently ensues, some normal endometrium can remain present and become the implantation site of a pregnancy. Such an event is uncommon (0.7%); however, the likelihood of an ectopic pregnancy is increased. This case report calls the reader's attention to the risk of intra- and extrauterine pregnancies and the necessity for contraception after endometrial resection, even in cases where amenorrhoea supervenes.

Case A 46-year-old woman with prior endometrial resection and subsequent amenorrhoea, was diagnosed with a cornual pregnancy. She was successfully treated with systemic methotrexate, which was given in an outpatient clinic.

Conclusion Clinicians should be aware of the increased likelihood of an ectopic pregnancy after endometrial resection. All women submitting to this procedure should be counselled about the need for contraception, even in cases where amenorrhoea develops.

KEYWORDS:

• Endometrial resection
• Cornual pregnancy
• Interstitial pregnancy
• Ectopic pregnancy
• Methotrexate
• Contraception
• Sterilisation

ACKNOWLEDGEMENTS

We are indebted to Dr Nir I. Weijl of the Department of Internal Medicine, Bronovo Hospital, for assistance in treating the patient, and to Anne Russcher and Sara Herd for having revised the manuscript.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and the writing of the paper.