Introduction: Angular ectopic pregnancies implant in the intrauterine portion of the fallopian tube. Delay in diagnosis due to rarity of the condition causes high morbidity. Transvaginal two/ three-dimensional (2D/3D) ultrasound (USG) in combination with serial â-human chorionic gonadotropin (hCG) or laparoscopy confirms the diagnosis.
Materials and methods: This is a retrospective case series of all angular ectopic pregnancies seen in a 40-month period (Jan 2014–April 2017) in the Obstetrics and Gynecology Department of a tertiary referral center. Of a total 245 ectopic pregnancies, 13 cases were angular pregnancy. Data pertaining to diagnosis, USG findings, treatment, and outcomes were analyzed.
Results: Among 13 angular pregnancies, one underwent immediate surgery for rupture. All the other 12 were diagnosed at initial scan. The 2D USG followed by 3D USG was used for confirmation of diagnosis in all cases. Additional magnetic resonance imaging (MRI) was required to confirm diagnosis in 2 of the 13 patients. Methotrexate was successful in 6 of 12 cases. Four underwent single-dose regime (mean â-hCG = 1,688 mIU/mL; range: 1,105–2,401 mIU/mL) and two required multiple doses (â-hCG: 87,590 and 36,590 mIU/mL). Surgical management included suction and evacuation under USG guidance in three, laparoscopic cornuostomy in two, and one laparoscopic bilateral cornuostomy with unilateral salpingostomy.
Conclusion: The 3D USG aids in the diagnosis of suspected angular pregnancy. Early recognition reduces morbidity, enabling fertility preservation. Medical and skilled surgical therapies are required for optimal outcome.