Hysteroscopic Treatment of Angular Pregnancy

A 6mm diagnostic hysteroscope was then advanced through the cervical os without need for cervical dilation. Thick decidualization was noted. Hysteroscope was advanced to fundus, right ostium was visualized. Left ostium poorly visualized as it was obscured by the pregnancy, which was noted to be adherent near the ostium, approximately at 2 o'clock position. A SideKick cystoscopy needle was then advanced through the hysteroscopic port into the cavity. Methotrexate was then injected via this needle into the gestational sac, as well as into myometrium deep to the gestational sac.
The needle was removed. Examination of the uterine cavity and gestational sac was notable for excellent hemostasis. The hysteroscope was removed. All instruments were then removed and the cervix was noted to be hemostatic. The patient tolerated the procedure well. Sponge, needle and instrument counts were correct x2. The patient was taken to the recovery room in stable condition.

G2P0010 female who presents for hysteroscopic evaluation of previously diagnosed left angular pregnancy. She was undergoing in-vitro fertilization and preimplantation genetic testing and conceived after frozen embryo transfer. Ultrasound was suspicious for an angular pregnancy which was confirmed by MRI. The patient was treated with multiple doses of systemic methotrexate but failed. The decision was made after a thorough discussion with the patient and her spouse to proceed with diagnostic hysteroscopy with an injection of methotrexate into the gestational sac under direct visualization in order to preserve uterus for future fertility

Kidney and Liver disease

N/A

The patient was placed in the dorsal lithotomy position with Allen stirrups. The patient was prepped and draped in the normal sterile fashion. A bivalve speculum was inserted into the vagina, cervix was visualized, and a single tooth tenaculum was used to grasp the anterior lip of the cervix.

MRI and US

The uterus is slightly retroverted. There is a single intrauterine
pregnancy which appears to be angular on the left. Surrounding myometrium
is approximately as thin as 5 mm. Intrauterine gestational sac measuring
2.8 x 1.8 x 2.1 cm.

Vaginal bleeding, failed methotrexate administration, and

No disclosures

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2.Laus, Katharina, Pooja Louis, and Laura Douglass. “A Novel Approach to Management of Angular Pregnancies: A Case Series.” Journal of Minimally Invasive Gynecology 26, no. 1 (2019): 178–81. https://doi.org/10.1016/j.jmig.2018.08.002.
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