Heterotopic tubal pregnancy with a naturally conceived live twin intrauterine pregnancy in a patient with systemic lupus erythematosus: A case report

Heterotopic cervical pregnancy: Case report and literature review

Heterotopic cervical ectopic pregnancy (CEP) is a rare form of ectopic pregnancy, that involves implantation of gestational sac in both the cervical canal and uterine cavity. This condition poses high risks of severe complications like lethal vaginal bleeding and abortion. Transvaginal ultrasonography is the primary diagnostic tool. Risk factors may vary from prior cesarean delivery to the utilization of Assisted Reproductive Technologies (ART). Despite the research conducted on this condition, the best treatment strategy has not been established. This study discusses a rare case of cervical heterotopic pregnancy, emphasizing early diagnosis. Our case underwent in-vitro fertilization (IVF). We used potassium chloride (KCL) and methotrexate (MTX) as treatment. At first, the cervical gestational sac was expelled but unfortunately, later, the intrauterine gestational sac was also aborted. We also reviewed 25 cases (1980-2024) which demonstrated the importance of early diagnosis of heterotopic cervical pregnancy and that most cases are likely to have positive outcomes.

A Rare Case of Spontaneous Heterotopic Pregnancy at 12 weeks of Gestation Following Natural Conception With Literature Review

BACKGROUND

Spontaneous heterotopic pregnancy is an uncommon and possibly serious problem characterized by maternities at unique implantation sites, with only one occurring in the intrauterine cavity. Its incidence is approximately 1 in 30,000 natural pregnancies, posing significant threats to maternal health. The complexity of clinical and laboratory findings complicates its diagnosis, necessitating a high index of suspicion for prompt intervention.

CASE PRESENTATION

We reported the case of a 36-year-old woman diagnosed with heterotopic pregnancy at 12 weeks of gestation following spontaneous conception, who presented with severe abdominal pain. Initial beta-human chorionic gonadotropin (β-hCG) levels were 57,278.00 mIU/mL. Transvaginal ultrasound (TVUS) revealed a single live fetus in the uterus, estimated at 12 weeks and six days, alongside a thick-walled cystic structure in the right ovary and an irregular hypoechoic mass inferior to the right ovary. An urgent laparoscopic salpingectomy was performed under general anesthesia, revealing a distended right fallopian tube (3.5 cm) with a thickened appearance, bluish-purple discoloration, and a 2 mm rupture with active bleeding surrounded by clots. Histopathological examination confirmed ectopic pregnancy. Postoperative β-HCG levels were 49,213 mIU/mL and 57,577 mIU/mL on the second and third days, respectively.

CONCLUSION

Clinicians should maintain vigilance for heterotopic pregnancy, especially in the absence of infertility treatments or known risk factors. Lower quadrant abdominal or pelvic pain should prompt consideration of heterotopic pregnancy, as the presence of an intrauterine pregnancy does not exclude a concurrent ectopic pregnancy.

Spontaneous Heterotopic Pregnancy with Ovarian Localization: Case Report

Heterotopic pregnancies are a rare phenomenon defined by the simultaneous occurrence of intrauterine and extrauterine pregnancy. The incidence of heterotopic pregnancy occurring through natural fertilization is low but is increased by risk factors such as assisted reproductive techniques or pelvic inflammatory disease increase. We report the case of a 36-year-old female patient in the 6th week of pregnancy who presented to the emergency unit with severe acute lower abdominal pain. Laboratory chemistry and sonography revealed a suspected heterotopic pregnancy. The patient was admitted for observation. The sonographic reevaluation on the next day confirmed the suspicion of extrauterine gravidity with intact intrauterine gravidity with additional decreasing hemoglobin and hematoperitoneum, so that laparoscopy was indicated. Intraoperatively, the mass on the left ovary was removed without complications. The patient could be discharged quickly postoperatively after a complication-free course and gave birth to a healthy child by spontaneous partus in the 38th week of gestation. Due to their rarity, there is limited research related to heterotopic pregnancies, and most scientific articles are case studies. Diagnostically, the most important thing in clinical practice is to think about the possibility of EUG even if there is evidence of an intact IUG. Transvaginal sonography is of particular importance in diagnostics. The performance of prospective cohort studies is desirable for the evidence-based diagnosis and therapy of affected patients in the future.

Cervical Twin Heterotopic Pregnancy: Overview of Ectopic Pregnancies and Scanning Detection Algorithm

Background: Ectopic pregnancy is the leading cause of gestation-related deaths during the first trimester. Cervical twin heterotopic pregnancies, when ectopic, constitute a small and rare part of gynecological surgery. Case Presentation: A 30-year-old pregnant woman (gravida 3, para 2) presented with mild pain in the lower abdomen and traces of bleeding per vaginum for three days. Transvaginal ultrasonography revealed a balloon-shaped cervical canal with a visible gestational sac measuring 3.5 × 3.9 cm. A second gestational sac was seen in the uterine cavity. The measurements of the gestational sacs corresponded to 7 + 4 weeks' pregnancy. A decision for medical abortion with mifepristone and misoprostol was made. However, due to an incomplete abortion and continuous bleeding, a curettage was performed. Conclusions: Spontaneous heterotopic pregnancy with the ectopic pregnancy located in the cervix is an extremely rare clinical condition requiring urgent treatment in order to reduce maternal mortality and morbidity and preserve fertility.