Design: Case series with surgical video.

Setting: Tertiary care hospital.

Patients or Participants: Four patients.

Interventions: Four patient cases are reviewed with one patient’s surgical case presented. Three of these patients were found to have 1st trimester active angular ectopic pregnancies with overlying myometrium measuring <5mm on ultrasound. The fourth patient, whose surgery is presented, had undergone medication abortion and then was suspected to have a cornual ectopic pregnancy on bedside ultrasound prior to D&C for retained products of conception. The diagnosis of angular ectopic pregnancy with overlying myometrium of 1.5mm was made on formal ultrasound and the patient was referred for management. Hysteroscopic resection of the pregnancies with a resectoscope was recommended for these patients due to the high risk of rupture with such thin overlying myometrium, risk of perforation with blind D&C, and less morbidity than laparoscopic cornual wedge resection. Resection was performed primarily through blunt dissection with the resectoscope, though energy use was available for coagulation. Energy was used sparingly for dissection to avoid perforation and thermal injury.

Measurements and Main Results: Resection was successfully performed in all four cases without perforation or need for laparoscopic intervention. All four patients recovered well, with two opting for contraception post-operatively, and two successfully conceiving normally located intrauterine pregnancies.

Conclusion: Despite angular pregnancies being continuous with the intrauterine cavity, they still pose a high risk for cornual rupture. Hysteroscopic resection is a feasible and minimally invasive option for angular pregnancies with thin overlying myometrium (<5mm).