Delayed uterine rupture after fetal reduction in a case of cornual heterotopic pregnancy

Objective: Assisted reproductive technology has contributed to the rising rate of multiple and ectopic pregnancies. We report a case of heterotopic cornual pregnancy with delayed uterine rupture despite successful fetal reduction. To our knowledge, this has not been previously reported. Case Report: A 32-year-old woman, gravida 2, para 0, had secondary infertility. She had undergone laparoscopic tuboplastyfor bilateral tubal obstruction and laparoscopic bilateral salpingectomy for hydrosalpinx. Successful pregnancy was achieved after transfer of five frozen embryos for this pregnancy. At 7 weeks of gestation, routine pelvic sonography identified three gestational sacs, two in the intrauterine cavity and one in the right cornua. Fetal reduction with potassium chloride injection into the cornual pregnancy was performed at 8 weeks of gestation in a private clinic. At 13 weeks of gestation, she had sudden-onset low abdominal pain and hypovolemic shock. Emergency laparotomy revealed right cornual rupture, with a 3.4-cm translucent sac extruding into the peritoneal cavity. The uterus was repaired by simple closure of the right cornua. The twins survived the operation and were born smoothly at 34 weeks of gestation by cesarean section due to preterm labor and malpresentation. Conclusion: Uterine rupture can occur in women who have undergone successful fetal reduction for cornual heterotopic pregnancy.