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Sir,

In their case report on the hysteroscopic management of a cornual pregnancy,1 the authors are probably referring to the management of an interstitial pregnancy.2 It is not clear how they made the diagnosis of interstitial pregnancy, as distinguished from an angular pregnancy. The ultrasound examination cannot be considered conclusive and the exact findings during the hysteroscopic and laparoscopic examinations were not documented. Angular pregnancy occurs when an embryo is implanted medial to the uterotubal junction in the lateral angle of the uterine cavity, close to the internal ostium of the fallopian tube. The distinction is important because, in angular pregnancy, a normal outcome may be expected, while in interstitial pregnancy, rupture will inevitably occur.3 It is doubtful whether surgical intervention is indicated at all as the patient is entirely asymptomatic. It is even more difficult to understand why resection of the entire cornual endometrium was done after suction curettage. Nobody would perform an endometrial resection after suction curettage performed for silent miscarriage! It was fortunate that the uterus was not perforated and I cannot concur in the recommendation that suction evacuation followed by hysteroscopic resection is a safe management option.

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