Angular pregnancy
Updates to Article Attributes
Angular pregnancypregnancies is a type of pregnancy that is located within the endometrial cavity at the lateral upper angle. It is one of the eccentriceccentrically located pregnancies atin the fundal region of the uterus.
Epidemiology:
RareA rare type of pregnancy carrying high rates of spontaneous abortion, uterine rupture, and placenta accreta.
Pathology:Clinical presentation
The embryo is implanted in the lateral angle of the uterine cavity medial to the uterotubal junction and round ligament. In contrast, the interstitial ectopic pregnancy is located in the muscular layer of the fallopian tube and is surrounded by myometrial layer. The critical differentiating feature is that the fertilized ovum of an interstitial pregnancy develops in the uterine wall, whereas in an angular pregnancy, it develops towards the uterine cavity . Anatomically the angular pregnancy is implanted medial to the round ligament.
Radiographic features:
Ultrasound:
- Pregnancy is eccentrically high in location.
- The gestational sac is located within the endometrial cavity at the lateral upper angle.
- On spectrum between normal centrally located and interstitial cornual pregnancies.
- Can mimic interstitial ectopic.
- 3D ultrasound helpful in precise location of sac.
- Should always have normal myometrial coverage which is thick usually more than 5mm, in contrast to interstitial ectopic where the myometrial covering is thin less than 5 mm..
- Grows towards the endometrial cavity and requires close follow-up to document gestational sac growing into cavity.
- GivenGiven the intrauterine location of angular pregnancies and the enveloping myometrium, these patients are likely to present with symptoms later than patients with ectopic pregnancies.
Pathology
The embryo is implanted in the lateral angle of the endometrial cavity medial to the uterotubal junction and round ligament. In contrast, an interstitial ectopic pregnancy is located in the muscular layer of the Fallopian tube and is surrounded by the myometrial layer. The critical differentiating feature is that the fertilised ovum of an interstitial pregnancy develops in the uterine wall, whereas in an angular pregnancy, it develops towards the endometrial cavity. Anatomically the angular pregnancy is implanted medial to the round ligament.
Radiographic features
Ultrasound
- 3D ultrasound can be helpful in the precise location of sac
- pregnancy is eccentrically high in location; the gestational sac is located within the endometrial cavity at the lateral upper angle on the spectrum between normal pregnancy and interstitial cornual pregnancies
- should always have normal myometrial coverage, which is thick and usually more than 5 mm
- grows towards the endometrial cavity and requires close follow-up to document the gestational sac growing into the cavity
Treatment and prognosis
Many of these pregnancies result in live birth, but hashave an increased complication rate.
Complications:-
- Spontaneous abortion (38.5%)
- Uterine rupture (13.6%)
- TrueThe true complication rate not known as cases reported as angular may have actually been interstitial. but complications include:
- spontaneous abortion (~40%)
- uterine rupture (~15%)
Differential Diagnosis:
1- Interstitial
- Located
-
located in the intramural portion of
fallopianFallopian tube. Implantation occurs in the most proximal segment of the fallopian tube where it traverses the uterine musculature. On the other hand, in the angular pregnancy the implantation occurs in one of the lateral angles of the uterus, medial to the uterotubal junction and the round ligament of the uterus. This distinction is important because angular pregnancies can be carried to term.- It is - also eccentrically located with respect to endometrial cavity but seen separately >
; 1;1 cm from the endometrial cavity.- Interstitial -
interstitial line sign
= an: an echogenic line in continuity from the ectopic to the endometrial echo complex.- Covered -
covered by myometrium
. Myometriumbut thinned to < 5;5 mm.- Can -
can grow to a larger size than the tubal ectopic pregnancy
.2- Cornual
- Present
-
presents in settings of
ana uterine anomaly such as unicornuate, bicornuate, or septate uterus with a rudimentary horn. The - gestational sac is located medial to the
fallopianFallopian tube including the anomalous part,often confused with the interstitial ectopic which is a separate entity.
-<p>Angular pregnancy is a type of pregnancy that is located within the endometrial cavity at the lateral upper angle. It is one of the eccentric located pregnancies at the fundal region of the uterus.</p><h4>Epidemiology:</h4><p>Rare type of pregnancy carrying high rates of spontaneous abortion, uterine rupture, and placenta accreta.</p><h4>Pathology:</h4><p>The embryo is implanted in the lateral angle of the uterine cavity medial to the uterotubal junction and round ligament. In contrast, the interstitial ectopic pregnancy is located in the muscular layer of the fallopian tube and is surrounded by myometrial layer. The critical differentiating feature is that the fertilized ovum of an interstitial pregnancy develops in the uterine wall, whereas in an angular pregnancy, it develops towards the uterine cavity . Anatomically the angular pregnancy is implanted medial to the round ligament.</p><h4>Radiographic features:</h4><h5>Ultrasound:</h5><p>- Pregnancy is eccentrically high in location.</p><p>- The gestational sac is located within the endometrial cavity at the lateral upper angle.</p><p>- On spectrum between normal centrally located and interstitial cornual pregnancies.</p><p>- Can mimic interstitial ectopic. </p><p>- 3D ultrasound helpful in precise location of sac.</p><p>- Should always have normal myometrial coverage which is thick usually more than 5mm, in contrast to interstitial ectopic where the myometrial covering is thin less than 5 mm..</p><p>- Grows towards the endometrial cavity and requires close follow-up to document gestational sac growing into cavity.</p><p>- Given the intrauterine location of angular pregnancies and the enveloping myometrium, these patients are likely to present with symptoms later than patients with ectopic pregnancies.</p><h4>Treatment and prognosis</h4><p>Many of these pregnancies result in live birth, but has increased complication rate.</p><h4>Complications:-</h4><p>- Spontaneous abortion (38.5%)</p><p>- Uterine rupture (13.6%)</p><p>- True complication rate not known as cases reported as angular may have actually been interstitial.</p><h4>Differential Diagnosis:</h4><h5>1- Interstitial ectopic pregnancy: </h5><p>- Located in the intramural portion of fallopian tube. Implantation occurs in the most proximal segment of the fallopian tube where it traverses the uterine musculature. On the other hand, in the angular pregnancy the implantation occurs in one of the lateral angles of the uterus, medial to the uterotubal junction and the round ligament of the uterus. This distinction is important because angular pregnancies can be carried to term.</p><p>- It is also eccentrically located with respect to endometrial cavity but seen separately > 1 cm from the endometrial cavity.</p><p>- Interstitial line sign = an echogenic line in continuity from the ectopic to the endometrial echo complex.</p><p>- Covered by myometrium. Myometrium thinned to < 5 mm.</p><p>- Can grow to larger size than the tubal ectopic pregnancy.</p><h5>2- Cornual pregnancy:</h5><p>- Present in settings of an uterine anomaly such as unicornuate, bicornuate, or septate uterus with a rudimentary horn. The gestational sac is located medial to the fallopian tube including the anomalous part,often confused with the interstitial ectopic which is a separate entity.</p>- +<p><strong>Angular pregnancies</strong> is a type of pregnancy that is located within the endometrial cavity at the lateral upper angle. It is one of the eccentrically located pregnancies in the fundal region of the uterus.</p><h4>Epidemiology</h4><p>A rare type of pregnancy carrying high rates of spontaneous abortion, <a title="Uterine rupture" href="/articles/uterine-rupture">uterine rupture</a>, and <a title="Placenta accreta" href="/articles/placenta-accreta">placenta </a><a title="Placenta accreta" href="/articles/placenta-accreta">accreta</a>.</p><h4>Clinical presentation</h4><p>Given the intrauterine location of angular pregnancies and the enveloping myometrium, these patients are likely to present with symptoms later than patients with <a href="/articles/ectopic-pregnancy">ectopic pregnancies</a>.</p><h4>Pathology</h4><p>The embryo is implanted in the lateral angle of the endometrial cavity medial to the uterotubal junction and round ligament. In contrast, an <a title="Interstitial ectopic pregnancy" href="/articles/interstitial-ectopic-pregnancy">interstitial ectopic pregnancy</a> is located in the muscular layer of the Fallopian tube and is surrounded by the myometrial layer. The critical differentiating feature is that the fertilised ovum of an interstitial pregnancy develops in the uterine wall, whereas in an angular pregnancy, it develops towards the endometrial cavity. Anatomically the angular pregnancy is implanted medial to the round ligament.</p><h4>Radiographic features</h4><h5>Ultrasound</h5><ul>
- +<li>3D ultrasound can be helpful in the precise location of sac</li>
- +<li>pregnancy is eccentrically high in location; the <a title="Gestational sac" href="/articles/gestational-sac">gestational sac</a> is located within the endometrial cavity at the lateral upper angle on the spectrum between normal pregnancy and interstitial cornual pregnancies</li>
- +<li>should always have normal myometrial coverage, which is thick and usually more than 5 mm</li>
- +<li>grows towards the endometrial cavity and requires close follow-up to document the gestational sac growing into the cavity</li>
- +</ul><h4>Treatment and prognosis</h4><p>Many of these pregnancies result in live birth but have an increased complication rate.</p><h5>Complications</h5><p>The true complication rate not known as cases reported as angular may have actually been interstitial but complications include:</p><ul>
- +<li>spontaneous abortion (~40%)</li>
- +<li>uterine rupture (~15%)</li>
- +</ul><h4>Differential Diagnosis</h4><ul>
- +<li>
- +<a title="Interstitial ectopic pregnancy" href="/articles/interstitial-ectopic-pregnancy">interstitial ectopic pregnancy</a><ul>
- +<li>located in the intramural portion of Fallopian tube</li>
- +<li>also eccentrically located with respect to endometrial cavity but seen separately >1 cm from the endometrial cavity</li>
- +<li>
- +<a title="Interstitial line sign" href="/articles/interstitial-line-sign">interstitial line sign</a>: an echogenic line in continuity from the ectopic to the endometrial echo complex</li>
- +<li>covered by myometrium but thinned to <5 mm</li>
- +<li>can grow to a larger size than the <a title="Tubal ectopic pregnancy" href="/articles/tubal-ectopic-pregnancy">tubal ectopic pregnancy </a>
- +</li>
- +</ul>
- +</li>
- +<li>
- +<a title="Tubal ectopic pregnancy" href="/articles/tubal-ectopic-pregnancy">cornual pregnancy</a><ul>
- +<li>presents in settings of a uterine anomaly such as unicornuate, bicornuate, or septate uterus with a rudimentary horn</li>
- +<li>gestational sac is located medial to the Fallopian tube including the anomalous part</li>
- +</ul>
- +</li>
- +</ul>
References changed:
- 1. Alanbay İ, Öztürk M, Karaşahin KE, Yenen MC. Angular pregnancy. (2016) Turkish journal of obstetrics and gynecology. 13 (4): 218-220. <a href="https://doi.org/10.4274/tjod.42402">doi:10.4274/tjod.42402</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/28913126">Pubmed</a> <span class="ref_v4"></span>
- 2. Arleo E & DeFilippis E. Cornual, Interstitial, and Angular Pregnancies: Clarifying the Terms and a Review of the Literature. Clin Imaging. 2014;38(6):763-70. <a href="https://doi.org/10.1016/j.clinimag.2014.04.002">doi:10.1016/j.clinimag.2014.04.002</a>
- 1. Alanbay I, Öztürk M, Karaşahin KE, Yenen MC. Angular pregnancy. Turk J Obstet Gynecol. 2016 Dec;13(4):218-220. doi: 10.4274/tjod.42402. Epub 2016 Dec 15.
- 2. Arleo EK, DeFilippis EM. Cornual, interstitial, and angular pregnancies: clarifying the terms and a review of the literature. Clin Imaging. 2014 Nov-Dec;38(6):763-70. doi: 10.1016/j.clinimag.2014.04.002. Epub 2014 Apr 16.
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