Laparoscopic treatment of heterotopic pregnancy

[Heterotopic pregnancies: 8 cases]

Heterotopic pregnancy is the combination of intra-uterine pregnancy and ectopic pregnancy in the same patient whatever is the localization of the ectopic pregnancy. The aim of this work was to summarize the epidemics and clinical factors, the diagnostic means and the therapeutic methods for the spontaneous heterotopic pregnancy in Moroccan context. In a period of 6 years (1993-1998), 8 patients were treated for heterotopic pregnancy in Lalla Meryem Maternity of Casablanca, with a rate of 0.2/1000. Patients' ages ranged from 19 to 37. The backgrounds were: abortions (4 cases), secondary sterility (2 cases) and genital infection (2 cases). Five patients consulted for metrorrhagia associated with pelvic pain. Two for pelvic pain and one for metrorrhagia. The diagnosis was confirmed before echography in 5 cases. All patients were operated on, 3 in a condition of haemorrhagic shock. Ectopic pregnancy lay at the level of the fallopian tube in 7 cases and at the level of the ovary in one. The treatment consisted of a salpingectomy in the 7 patients with tubal localisations, the ovary pregnancy benefited from ovariectomy. Evolution has been marked by expulsion of intra-uterine pregnancy in 6 cases. Two women were able to carry out their pregnancy. Heterotopic pregnancy is more and more frequent because of genital infection increase and especially the wide diffusion of the assisted medical procreation.

Laparoscopic management of heterotopic pregnancy: a review

Laparoscopic management of ectopic pregnancies is becoming more common. Having recently successfully treated one case of heterotopic pregnancy by laparoscopy in our department, the object of the present paper is to review the literature regarding laparoscopically treated cases of heterotopic pregnancy in order to assess benefits, complications and safety of this procedure. A Medline search yielded 10 additional cases with ampullary, interstitional or cornual tubal pregnancy, respectively. All surgical procedures were uncomplicated and all in utero pregnancies progressed normally. Despite a small number of cases, lack of complications in these reports is encouraging feasibility of laparoscopic management of heterotopic pregnancy.

Laparoscopic surgery for heterotopic pregnancies: a case report and a brief review

A heterotopic pregnancy is in effect a multiple pregnancy with one or more intrauterine pregnancies coexisting with an ectopic pregnancy and is rarely spontaneous. With the increasing popularity of ovulation induction performed during assisted reproductive techniques, it will not be surprising to observe that this phenomenon has increased significantly. However, diagnosis is often delayed because of its rarity and difficulty. We report a case of a woman with a viable intrauterine pregnancy who had a complication of ovarian hyper-stimulation syndrome secondary to ovulation induction following in vitro fertilization and embryo transfer, but who, during hospitalization, presented with clinically progressive abdominal pain. An unruptured ectopic pregnancy of the right fallopian tube was diagnosed accidentally by laparoscopy and laparoscopic salpingectomy was immediately performed. Post-operative follow-up revealed that the intrauterine pregnancy continued normally. She delivered a normal female baby at 38 weeks of gestation. The promising neonatal outcome might suggest that laparoscopy might be safely performed to aid differential diagnosis in an uncertain condition during pregnancy: therefore, laparoscopic surgery might be an appropriate method to manage some carefully selected patients with HP. A brief review of the published literature on the role of laparoscopy in the diagnosis and management of heterotopic pregnancy is given.