Live unilateral twin ectopic pregnancy in a fallopian tube remnant after previous ipsilateral salpingectomy

Rare Unilateral Twin Ectopic Pregnancy After Frozen Embryo Transfer: A Case Report and Literature Review

Background

Unilateral twin ectopic pregnancy is extremely rare in natural pregnancy, with an incidence rate of only 1 in 200,000-2,500,000, represents a major health risk for reproductive-aged women, leading to even life-threatening complications. There is a lack of data on the prevalence of this rare disease after in-vitro fertilization-embryo transfer (IVF-ET) cycles.

Case Report

We present a case of a 51-year-old woman with rare unilateral twin ectopic pregnancy after frozen embryo transfer treated with bilateral salpingectomy, followed by a review of the literature.

Conclusion

Twin ectopic pregnancy is a very rare type of pregnancy that requires a high index of suspicion to diagnose and treat early to prevent complications and maternal death.

Sonographically Positive Fetal Heartbeat in Unilateral Tubal Twin Pregnancy as a Rare Case With Literature Review

Ectopic pregnancies occur when a fertilized egg implants outside the uterus, usually in the fallopian tube. Twin ectopic pregnancies are rare and pose significant diagnostic and management challenges. This case report presents the clinical details and management of a unilateral twin ectopic pregnancy in a 31-year-old female patient. The purpose of this report is to highlight the complexities associated with the diagnosis and management of this uncommon condition. In this case, we performed the left salpingectomy. We confirmed pathologically and histologically in pregnancy in the same tube.

Unilateral Twin Ectopic Pregnancy: A Case Report from the Eastern Part of Ethiopia, Harar

Introduction

Twin ectopic pregnancy is the implantation of both embryos outside of the endometrial lining occurring in 1 in 20,000 up to 1 in 125,000 pregnancies. Commonly, twin ectopic pregnancies occur inside the fallopian tube either unilateral or bilateral. Unless early diagnosis and interventions are made, it may rupture causing intraperitoneal bleeding with a high risk of maternal death.

Case Report

I am reporting a rare type of ectopic pregnancy: unilateral twin ectopic pregnancy with positive cardiac activity on the left side of the fallopian tube in a 30 years old gravida III para II mother. Left side salpingectomy was done for her and discharged from the hospital after two postoperative days.

Conclusion

Twin ectopic pregnancy with a live embryo is a very rare type of pregnancy that needs a high index of suspicion to diagnose and treat early to prevent complications and maternal death.

Management of a spontaneously conceived live unilateral twin ectopic pregnancy in Australia: A case report

Introduction

Unilateral twin ectopic pregnancies are exceedingly rare, occurring in one in every 250,000 pregnancies. While clear guidelines exist regarding the management of singleton ectopic pregnancies, no such recommendations exist for multi-gestational ectopic pregnancies.

Case presentation

A 36-year-old woman, gravida 3 para 1, presented to the emergency department at 6 weeks and 4 days of gestation with a live twin ectopic pregnancy diagnosed on a dating ultrasound scan. Given the high likelihood of rupture, she underwent a laparoscopic salpingectomy and was discharged home the following day. The patient was followed-up with weekly serum β-hCG tests, to ensure there was no remaining pregnancy.

Discussion

While the morbidity and mortality associated with singleton ectopic pregnancies has gradually declined, the risk of rupture is higher in twin ectopic pregnancies and rupture is estimated to occur in 30–50% of cases. Surgical intervention remains the mainstay of treatment for these pregnancies.

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Unilateral live twin ectopic pregnancies are extremely rare.

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Five of 21 previously reported cases of unilateral live ectopic pregnancy were asymptomatic on diagnosis.

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No international guidelines specifically address multiple ectopic pregnancies.

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There are no reported cases of medical management of live unilateral ectopic pregnancy.

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Surgical intervention appears the most appropriate course of management.

A rare case of spontaneous live unilateral twin tubal pregnancy with both fetuses presenting with heart activities and a literature review

Ectopic pregnancy is an extrauterine pregnancy, and 98% of which occur in the fallopian tube. The incidence of twin tubal pregnancy is rare but is increasing due to assisted reproductive technology. Spontaneous unilateral twin tubal pregnancy is extremely rare, and only a small number of case reports have been made. We herein report a rare case of spontaneous unilateral twin tubal pregnancy with both fetuses presenting with heart activities and a literature review. Right salpingectomy was performed in this case. Pathologic and histologic assessment confirmed the 2 distinct pregnancies in the same tube. The twins were dichorionic and diamniotic.

Spontaneous live recurrent ectopic pregnancy after ipsilateral partial salpingectomy leading to tubal rupture

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This is the first reported case in the literature describing a recurrent ectopic pregnancy with a fetal heartbeat after ipsilateral salpingectomy that led to tubal rupture.

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Although exceptionally rare, recurrent ectopic pregnancy may occur after ipsilateral salpingectomy.

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Physicians should be aware that ectopic pregnancies may not only occur repeatedly but may also present atypically.

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We recommend when performing a salpingectomy that efforts be undertaken to minimize the length of the tubal remnant and to assure adequate coagulation of tissue so as to reduce the risk of recurrence.

Introduction

Ectopic pregnancy accounts for 1–2% of all pregnancies in the United States. The most common site of implantation for an ectopic pregnancy is the fallopian tube. We present the first case describing a recurrent ectopic pregnancy with a fetal heartbeat after ipsilateral salpingectomy that led to tubal rupture.

Presentation of case

The patient presented with abdominal pain approximately six weeks after her last menstrual period. Seven years prior to presentation, a laparoscopic partial right salpingectomy had been performed for a tubal ectopic pregnancy. Physical exam was significant for diffuse abdominal tenderness and guarding. Ultrasonography revealed a right tubal pregnancy with a fetal pole and a fetal heart rate that was calculated to be 108 beats per minute. Free fluid was also noted. 1.5 l of hemoperitoneum was subsequently evacuated and the right fallopian tube remnant with the ectopic pregnancy was removed. Pathology of the tubal remnant showed immature chorionic villi and fetal parts.

Discussion

The mechanism by which a recurrent ectopic pregnancy after ipsilateral salpingectomy occurs is unclear, but is theorized to be secondary to contralateral fertilization and/or tubal recanalization that may occur due to inadequate diathermy.

Conclusion

Physicians should be aware that ectopic pregnancies may not only occur repeatedly but may also present a typically. We recommend when performing a salpingectomy that efforts be undertaken to minimize the length of the tubal remnant and to assure adequate coagulation of tissue so as to reduce the risk of recurrence.