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Bouab M, Wajih O, Gotni A, Assal A, Jalal M, Lamrissi A. Spontaneous heterotopic pregnancy: Diagnosis and surgical management. Int J Surg Case Rep 2024; 118:109582. [PMID: 38631194 PMCID: PMC11035084 DOI: 10.1016/j.ijscr.2024.109582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 03/19/2024] [Accepted: 03/22/2024] [Indexed: 04/19/2024] Open
Abstract
INTRODUCTION Heterotopic pregnancy is a rare form of pregnancy, defined by the coexistence of an ectopic and an intrauterine pregnancy. The diagnosis of heterotopic pregnancy remains one of the greatest challenges of the gynecological-obstetrical emergencies. CASE PRESENTATION We report a rare case of spontaneous heterotopic pregnancy of a 28-year-old woman, diagnosed with a heterotopic pregnancy by ultrasound and treated by laparotomy in emergency obstetrical department of Ibn Rochd University Hospital of Casablanca. DISCUSSION Heterotopic pregnancy is a rare form of pregnancy, defined by the coexistence of an ectopic and an intrauterine pregnancy. The most common functional signs are abdominal pain, vaginal bleeding, pelvic mass and peritoneal irritation. The first-line paraclinical examination is suprapubic and transvaginal pelvic ultrasound. Therapeutic management of heterotopic pregnancies involves rapid intervention on the ectopic pregnancy, while respecting the intrauterine pregnancy if it has progressed, in order to preserve the patient's fertility. CONCLUSION Diagnosis of heterotopic pregnancy is often difficult and management should be initiated as soon as possible given the risk of maternal mortality.
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Affiliation(s)
- Maryem Bouab
- Obstetrics And Gynecology Department, University Hospital Center Ibn Rochd, Morocco Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco.
| | - Oumaima Wajih
- Obstetrics And Gynecology Department, University Hospital Center Ibn Rochd, Morocco Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
| | - Aicha Gotni
- Obstetrics And Gynecology Department, University Hospital Center Ibn Rochd, Morocco Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
| | - Asmaa Assal
- Obstetrics And Gynecology Department, University Hospital Center Ibn Rochd, Morocco Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
| | - Mohamed Jalal
- Obstetrics And Gynecology Department, University Hospital Center Ibn Rochd, Morocco Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
| | - Amine Lamrissi
- Obstetrics And Gynecology Department, University Hospital Center Ibn Rochd, Morocco Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
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Agrawal M, Reddy LS, Patel D, Jyotsna G, Patel A. Fetal Reduction by Potassium Chloride Infusion in Unruptured Heterotopic Pregnancy: A Comprehensive Review. Cureus 2024; 16:e53618. [PMID: 38449926 PMCID: PMC10915710 DOI: 10.7759/cureus.53618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 02/05/2024] [Indexed: 03/08/2024] Open
Abstract
This comprehensive review explores the practice of fetal reduction through potassium chloride infusion in unruptured heterotopic pregnancies. Heterotopic pregnancies, characterized by the simultaneous occurrence of intrauterine and extrauterine gestations, present unique challenges in reproductive medicine. The review defines fetal reduction and underscores its significance in mitigating risks associated with heterotopic pregnancies, including the threat of rupture, maternal morbidity, and adverse outcomes. The analysis encompasses the background, methods, efficacy, ethical considerations, and future directions related to the procedure. Findings highlight the efficacy and safety of potassium chloride infusion, emphasizing the importance of proper patient selection and counseling. Implications for clinical practice underscore the procedure's viability in specific cases where the benefits outweigh the associated risks. The review concludes with recommendations for future studies, encouraging further research on procedural techniques, alternative methods, and the psychosocial impact on patients. This work is a foundation for advancing the management of unruptured heterotopic pregnancies, providing insights for clinicians and researchers to improve clinical outcomes and patient care.
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Affiliation(s)
- Manjusha Agrawal
- Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Lucky Srivani Reddy
- Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Drashti Patel
- Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Garapati Jyotsna
- Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Archan Patel
- Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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3
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Oyeh E, Ofori S, Hiadzi EK, Sefogah PE. Challenges in the diagnosis and management of a ruptured heterotopic gestation following ultrasound-guided embryo transfer in low resource settings: a case report. J Med Case Rep 2024; 18:28. [PMID: 38263261 PMCID: PMC10807105 DOI: 10.1186/s13256-023-04317-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 12/12/2023] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Heterotopic pregnancies are increasing in incidence with the advent of rising prevalence of in vitro fertilization and embryo transfer (IVF-ET) globally. Although rare, this condition is a serious potentially life-threatening gynaecological complication. CASE PRESENTATION We present the case of a 36-year-old Ghanaian woman who conceived following IVF and presented two weeks after confirmation of intrauterine gestation with sudden onset lower abdominal pain. A diagnosis of ruptured heterotopic pregnancy was made, laparotomy and salpingectomy was done followed with further management of the intrauterine gestation. CONCLUSION To the best of our knowledge, this is the first reported case of heterotopic pregnancy in Ghana. A high index of suspicion for heterotopic pregnancy is required even in the presence of a confirmed intrauterine gestation following IVF-ET.
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Affiliation(s)
- Ernest Oyeh
- Akai House Clinic, 1 Sixth Circular Rd, Accra, Ghana
| | - Samuel Ofori
- Lister Hospital and Fertility Centre, Airport Hills, Accra, Ghana
| | - Edem K Hiadzi
- Lister Hospital and Fertility Centre, Airport Hills, Accra, Ghana
| | - Promise E Sefogah
- Department of Obstetrics and Gynaecology, University of Ghana Medical School, Accra, Ghana.
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Zhang Y, Chen X, Lin Y, Lian C, Xiong X. Study on diagnosis and management strategies on heterotopic pregnancy: a retrospective study. J OBSTET GYNAECOL 2023; 43:2152660. [PMID: 36534044 DOI: 10.1080/01443615.2022.2152660] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Heterotopic pregnancy (HP) is a rare but potentially life-threatening event with a high risk of maternal death, which also jeopardise the coexisting intrauterine pregnancy (IUP), thus an early accurate diagnosis and prompt treatment can decrease adverse complications. We aimed to explore the early predictors for pregnancy outcomes of HP. We reviewed patients with HP following assisted reproductive technology in our institution between January 2013 and December 2020. The relationships between pregnancy outcomes and clinical features were analysed by logistic regression. We found that 29 patients (72.5%) of HP were accurately diagnosed by transvaginal ultrasonography (TVS). Eighteen patients in the surgery group had live births, three of whom delivered preterm. Additionally, the miscarriage rate was lower for patients with IUP cardiac activity than those without (16.7% vs. 90.0%, p < .001). Further by logistic regression analysis, an IUP with cardiac activity at HP diagnosis was identified as favourable independent predictor of live birth (p < .001). Therefore, early diagnosis and prompt surgical intervention are recommended to prevent the development of HP.Impact of statementWhat is already known on this subject? Heterotopic pregnancy (HP) has long been thought to be a rare but potentially life-threatening event with a high risk of complications. The early diagnosis of HP is challenging due to the co-existence of a viable intrauterine pregnancy (IUP) and the absence of typical clinical symptoms.What do the results of this study add? This stduy showed that symptoms combined with routine transvaginal ultrasonography (TVS) scans reduce the rates of misdiagnosis of HP and prompt surgical intervention after diagnosis may minimise the incidence of miscarriage of the IUP.What are the implications of these findings for clinical practice and/or further research? An IUP with cardiac activity at HP diagnosis is a predictor of a favourable prognosis of HP, and laparoscopy under general anaesthesia is effective and safe during the first trimester of pregnancy. Awareness, assessment and early interventions in view of symptoms combined with routine TVS is recommended to reduce the risk of miscarriage and ensure a favourable live birth rate.
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Affiliation(s)
- Yan Zhang
- Department of Obstetrics and Gynecology, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Xiujuan Chen
- Department of Obstetrics and Gynecology, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Yuan Lin
- Department of Obstetrics and Gynecology, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Chengying Lian
- Department of Obstetrics and Gynecology, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Xiumei Xiong
- Department of Obstetrics and Gynecology, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
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5
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Le DN, Nguyen PN. Successful Management of Interstitial Heterotopic Pregnancy by Fetal Reduction Using Ultrasound-guided Laparoscopy. J Minim Invasive Gynecol 2023; 30:606-608. [PMID: 37031855 DOI: 10.1016/j.jmig.2023.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 03/26/2023] [Accepted: 03/29/2023] [Indexed: 04/11/2023]
Affiliation(s)
- Diep Ngoc Le
- Department of Laparoscopy (Dr. Le), Tu Du Hospital, Ho Chi Minh City, Vietnam
| | - Phuc Nhon Nguyen
- Department of High-risk Pregnancy (Dr. Nguyen), Tu Du Hospital, Ho Chi Minh city, Vietnam; Tu Du Clinical Research Unit (Dr. Nguyen), Tu Du Hospital, Ho Chi Minh City, Vietnam.
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Anjomrooz M, Farid Mojtahedi M, Abedi M. Quadruplet Heterotopic Pregnancy Following In Vitro Fertilization and Embryo Transfer with Laparotomic Removal of Ruptured Twin Tubal Ectopic Pregnancy: A Case Report. IRANIAN JOURNAL OF MEDICAL SCIENCES 2023; 48:425-429. [PMID: 37456204 PMCID: PMC10349159 DOI: 10.30476/ijms.2022.94399.2574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 06/01/2022] [Accepted: 06/27/2022] [Indexed: 07/18/2023]
Abstract
Heterotopic pregnancy (HP) is a rare occurrence in natural pregnancies. However, it can be a life-threatening condition and should be taken into account in all assisted reproductive treatments. Diagnosis and treatment of ectopic pregnancy are challenging issues in patients with HP. Here, we report a rare case of quadruplet HP following an in vitro fertilization-embryo transfer with a viable twin intrauterine pregnancy and ruptured live twin left tubal ectopic pregnancy. A 35-year-old woman (gravida 5, para 1, ectopic pregnancies 2, and abortion 1) was presented to the Emergency Department of Arash Women's Hospital (Tehran, Iran) in March 2021 with abdominal pain. The patient was at six weeks and five days of pregnancy following in vitro fertilization-embryo transfer. Transvaginal sonography (TVS) revealed a live twin intrauterine pregnancy with a ruptured live twin left tubal ectopic pregnancy. The latter was removed via laparotomy to preserve the intrauterine pregnancy. The patient subsequently delivered a female infant at 38 weeks of pregnancy.
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Affiliation(s)
- Mehran Anjomrooz
- Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Farid Mojtahedi
- Department of Obstetrics and Gynecology, Endocrinology and Female Infertility Unit, Arash Women’s Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahboubeh Abedi
- Department of Radiology, Arash Women’s Hospital, Tehran University of Medical Sciences, Tehran, Iran
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7
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Ge F, Ding W, Zhao K, Qu P. Management of heterotopic pregnancy: clinical analysis of sixty-five cases from a single institution. Front Med (Lausanne) 2023; 10:1166446. [PMID: 37234242 PMCID: PMC10206220 DOI: 10.3389/fmed.2023.1166446] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 04/17/2023] [Indexed: 05/27/2023] Open
Abstract
Objective This retrospective study aims to analyze the influence of different treatment modalities on viable intrauterine pregnancy and to summarize the clinical features of heterotopic pregnancy (HP) patients. Material and methods All patients diagnosed with HP between January 2012 and December 2022 in Tianjin Central Obstetrics and Gynecology Hospital were reviewed retrospectively. Results This study diagnosed 65 patients using transvaginal ultrasound (TVS), including two cases of natural pregnancy, seven cases of ovulation induction pregnancy, and 56 cases after in vitro fertilization and embryo transfer (IVF-ET). The gestational age was 50.2 ± 13.0 days at the time of diagnosis. The most frequent manifestations were abdominal pain (61.5%) and vaginal bleeding (55.4%), while 11 patients (16.9%) had no symptoms before the diagnosis. The primary treatment was expectant and surgical management, including laparotomy and laparoscopic surgery. In the expectant management group, four patients were transferred to surgery due to rupture of ectopic pregnancy or ectopic pregnancy mass gradually enlarged. In the surgical management group, 53 patients underwent laparoscopic surgery, and six underwent laparotomy. The laparoscopic group's mean operation time was 51.3 ± 14.2 min (range: 15-140 min), and the median intraoperative blood loss was 20 mL (range 5-200 mL). In contrast, the laparotomy group's mean operation time was 80.0 ± 25.3 min (range 50-120 min), and the median intraoperative blood loss was 22.5 mL (range 20-50 mL). Four patients had postoperative abortions. Sixty-one newborns had no birth abnormalities, and no developmental malformations were discovered after a median follow-up of 32 months. Conclusion Expectant treatment has a high failure rate in HP, and laparoscopic surgery is a safe and effective treatment for removing ectopic pregnancy without increasing the risk of abortion or newborn birth defects.
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Affiliation(s)
- Feng Ge
- Clinical School of Obstetrics and Gynecology Center, Tianjin Medical University, Tianjin, China
| | - Wei Ding
- Department of Gynecological Oncology, Tianjin Central Hospital of Gynecology and Obstetrics, Tianjin, China
| | - Kun Zhao
- Department of Gynecological Oncology, Tianjin Central Hospital of Gynecology and Obstetrics, Tianjin, China
| | - Pengpeng Qu
- Clinical School of Obstetrics and Gynecology Center, Tianjin Medical University, Tianjin, China
- Department of Gynecological Oncology, Tianjin Central Hospital of Gynecology and Obstetrics, Tianjin, China
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8
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Elsayed S, Farah N, Anglim M. Heterotopic Pregnancy: Case Series and Review of Diagnosis and Management. Case Rep Obstet Gynecol 2023; 2023:2124191. [PMID: 37187915 PMCID: PMC10181901 DOI: 10.1155/2023/2124191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 04/06/2023] [Indexed: 05/17/2023] Open
Abstract
Introduction Heterotopic pregnancy (HP) refers to the simultaneous presence of intrauterine pregnancy (IUP) and ectopic pregnancy, which is very rare but potentially life-threatening. The spontaneous incidence of HP in the general population is 1/30,000. With the widespread use of assisted reproductive technology (ART), the incidence rises to 1/1,000. Aims and Methods. This is a prospective case series looking at the cases of heterotopic pregnancies presenting to the early pregnancy unit (EPU) in a tertiary maternity hospital, from November 2015 to November 2016. The clinical presentation, ultrasound findings, and laparoscopy findings were all documented. The incidence of HP was calculated and compared with the quoted incidence in the literature. Outcomes. Five women with HP presented to the EPU over the course of a year. The first case describes a spontaneous HP with a previous salpingostomy. The second case describes an HP following ovulation induction. The third case describes a spontaneous HP with no known risk factors. The fourth and fifth cases describe heterotopic pregnancies following in vitro fertilisation with more than one embryo. All five cases of HP underwent laparoscopy and salpingectomy with uneventful recovery. The three women who had a viable IUP had no further complications in their pregnancies. Conclusion Early and accurate diagnosis of HP can be challenging. An early transvaginal ultrasound plays an important role in making the diagnosis in women with risk factors and following ART. A high index of suspicion is required for timely diagnosis and appropriate intervention, especially in spontaneous HP.
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Affiliation(s)
- Somaia Elsayed
- The Coombe Women and Infants University Hospital, Dublin, Ireland
| | - Nadine Farah
- The Coombe Women and Infants University Hospital, Dublin, Ireland
| | - Mary Anglim
- The Coombe Women and Infants University Hospital, Dublin, Ireland
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9
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Figueiredo J, Tomé A, Santos A, Bravo Í. Tubal heterotopic pregnancy: challenges when infertility is present. BMJ Case Rep 2023; 16:e254684. [PMID: 37041039 PMCID: PMC10105985 DOI: 10.1136/bcr-2023-254684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023] Open
Affiliation(s)
- Joana Figueiredo
- Obstetrics and Gynecology Department, Hospital Garcia de Orta EPE, Almada, Portugal
| | - Ana Tomé
- Obstetrics and Gynecology Department, Hospital Garcia de Orta EPE, Almada, Portugal
| | - Antónia Santos
- Obstetrics and Gynecology Department, Hospital Garcia de Orta EPE, Almada, Portugal
| | - Íris Bravo
- Obstetrics and Gynecology, Reproductive Medicine and Infertility Center, Hospital Garcia de Orta EPE, Almada, Portugal
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10
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Bhoi NR, Chandra V, Murdia K, Kawad K. Successful Management of Triplet Heterotopic Pregnancy (Interstitial) With an Intrauterine Monochorionic Diamniotic Twin Pregnancy Through Laparoscopy: A Case Report. Cureus 2023; 15:e37249. [PMID: 37162773 PMCID: PMC10164358 DOI: 10.7759/cureus.37249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2023] [Indexed: 05/11/2023] Open
Abstract
The simultaneous occurrence of intrauterine (IU) and extrauterine pregnancies is known as heterotopic pregnancy, an uncommon clinical condition that is challenging to manage. It can be a potentially fatal illness if it remains unnoticed. This is a case report of a woman who had heterotopic triplets after transferring two embryos produced through in vitro fertilization. An ultrasound scan diagnosed live interstitial heterotopic pregnancy and an intrauterine monochorionic twin pregnancy. Laparoscopic resection of interstitial heterotopic pregnancy was done. The monochorionic twin pregnancy was closely monitored by serial ultrasound, and at 36 weeks of gestation, two healthy twins were delivered by cesarean section. The fetal growth parameters were monitored, and a dopplers study was conducted to assess fetal blood flow. Even in heterotopic pregnancy, timely diagnosis and therapeutic intervention can preserve IU pregnancy with a successful outcome. Early meticulous monitoring and early detection can lead to a favorable outcome. Even in heterotropic pregnancy, a meticulous evaluation can lead to favorable outcomes by conserving IU pregnancy, and timely intervention can prevent maternal motility.
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Affiliation(s)
- Nihar R Bhoi
- Reproductive Medicine, Indira In Vitro Fertilization (IVF) Hospital Private Limited, Udaipur, IND
| | - Vipin Chandra
- Clinical Research and Operations, Indira In Vitro Fertilization (IVF) Hospital Private Limited, Udaipur, IND
| | - Kshitiz Murdia
- Reproductive Medicine, Indira In Vitro Fertilization (IVF) Hospital Private Limited, Udaipur, IND
| | - Kishor Kawad
- Reproductive Medicine, Indira In Vitro Fertilization (IVF) Hospital Private Limited, Ahmedabad, IND
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11
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Spontaneous Heterotopic Pregnancy: Diagnosis and Management. Case Rep Obstet Gynecol 2022; 2022:2994808. [PMID: 35928785 PMCID: PMC9345693 DOI: 10.1155/2022/2994808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 07/20/2022] [Indexed: 11/26/2022] Open
Abstract
Background Heterotopic pregnancies albeit rare are conceivably life-threatening if missed. With the development of assisted reproductive techniques, the incidence has increased. Confirmation of an intrauterine pregnancy (IUP) should not preclude the existence of a heterotopic pregnancy. Case A healthy 27-year-old patient (gravida 4, term 1, preterm 0, abortion 2, living 1) at approximately 5 weeks gestation through natural conception presented to the emergency room with acute abdominal pain and vaginal bleeding. Pelvic ultrasound showed evidence of an IUP and a right adnexal mass, raising suspicion for a heterotopic pregnancy. The patient underwent an uncomplicated laparoscopic right salpingectomy. An IUP was confirmed on ultrasound postoperatively. The patient had an early pregnancy loss at 8 weeks of gestation. Conclusion With a high index of suspicion from clinical presentation and pelvic imaging, heterotopic pregnancy, while rare, should not be ruled out.
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Kaguta M, Jusabani A, Gregory N, Jaiswal S, Fidaali Z, Ally P, Rubagumya D, Mgonja M, Seif F. Heterotopic gestation in polycystic ovary disease: Termination of tubal pregnancy and intrauterine pregnancy progressing to term. SAGE Open Med Case Rep 2022; 10:2050313X221094427. [PMID: 35495291 PMCID: PMC9039427 DOI: 10.1177/2050313x221094427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 03/29/2022] [Indexed: 12/03/2022] Open
Abstract
Heterotopic pregnancy is rare. We report a 27-year-old lady with polycystic ovarian disease. She presented at our health facility with acute abdomen. Her evaluation revealed heterotopic pregnancy. High index of suspicion for heterotopic pregnancy in any woman with early pregnancy presenting with acute abdomen is crucial. Therefore, correct and early diagnosis allows appropriate management while it preserves the intrauterine pregnancy as in the index case.
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Affiliation(s)
- Munawar Kaguta
- Department of Obstetrics and Gynecology, The Aga Khan Hospital, Dar es Salaam, Tanzania
| | - Ahmed Jusabani
- Department of Radiology, The Aga Khan Hospital, Dar es Salaam, Tanzania
| | - Ntiyakuze Gregory
- Department of Obstetrics and Gynecology, The Aga Khan Hospital, Dar es Salaam, Tanzania
| | - Shweta Jaiswal
- Department of Obstetrics and Gynecology, The Aga Khan Hospital, Dar es Salaam, Tanzania
| | - Zainab Fidaali
- Department of Radiology, The Aga Khan Hospital, Dar es Salaam, Tanzania
| | - Pilly Ally
- Department of Radiology, The Aga Khan Hospital, Dar es Salaam, Tanzania
| | - Davis Rubagumya
- Department of Family Medicine, The Aga Khan University, Dar es Salaam, Tanzania
- Department of Family Medicine, Premier Care Clinic-Masaki, Dar es Salaam, Tanzania
| | - Miriam Mgonja
- Department of Obstetrics and Gynecology, The Aga Khan Hospital, Dar es Salaam, Tanzania
| | - Farhat Seif
- Department of Obstetrics and Gynecology, The Aga Khan Hospital, Dar es Salaam, Tanzania
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Solangon SA, Otify M, Gaughran J, Holland T, Ross J, Jurkovic D. The risk of miscarriage following surgical treatment of heterotopic extrauterine pregnancies. Hum Reprod Open 2022; 2022:hoab046. [PMID: 35071800 PMCID: PMC8769667 DOI: 10.1093/hropen/hoab046] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 12/19/2021] [Indexed: 12/29/2022] Open
Abstract
STUDY QUESTION What is the risk of loss of a live normally sited (eutopic) pregnancy following surgical treatment of the concomitant extrauterine ectopic pregnancy? SUMMARY ANSWER In women diagnosed with heterotopic pregnancies, minimally invasive surgery to treat the extrauterine ectopic pregnancy does not increase the risk of miscarriage of the concomitant live eutopic pregnancy. WHAT IS KNOWN ALREADY Previous studies have indicated that surgical treatment of the concomitant ectopic pregnancy in women with live eutopic pregnancies could be associated with an increased risk of miscarriage. The findings of our study did not confirm that. STUDY DESIGN, SIZE, DURATION A retrospective observational case–control study of 52 women diagnosed with live eutopic and concomitant extrauterine pregnancies matched to 156 women with live normally sited singleton pregnancies. The study was carried out in three London early pregnancy units (EPUs) covering a 20-year period between April 2000 and November 2019. PARTICIPANTS/MATERIALS, SETTING, METHODS All women attended EPUs because of suspected early pregnancy complications. The diagnosis of heterotopic pregnancy was made on ultrasound scan and women were subsequently offered surgical or expectant management. There were three controls per each case who were randomly selected from our clinical database and were matched for maternal age, mode of conception and gestational age at presentation. MAIN RESULTS AND THE ROLE OF CHANCE In the study group 49/52 (94%) women had surgery and 3/52 (6%) were managed expectantly. There were 9/52 (17%, 95% CI 8.2–30.3) miscarriages <12 weeks’ gestation and 9/49 (18%, 95% CI 8.7–32) miscarriages in those treated surgically. In the control group, there were 28/156 (18%, 95% CI 12.2–24.8) miscarriages <12 weeks’ gestation, which was not significantly different from heterotopic pregnancies who were treated surgically [odds ratio (OR) 1.03 95% CI 0.44–2.36]. There was a further second trimester miscarriage in the study group and one in the control group. The live birth rate in the study group was 41/51 (80%, 95% CI 66.9–90.2) and 38/48 (79%, 95% CI 65–89.5) for those who were treated surgically. These results were similar to 127/156 (81%, 95% CI 74.4–87.2) live births in the control group (OR 0.87, 95% CI 0.39–1.94). LIMITATIONS, REASONS FOR CAUTION This study is retrospective, and the number of patients is relatively small, which reflects the rarity of heterotopic pregnancies. Heterotopic pregnancies without a known outcome were excluded from analysis. WIDER IMPLICATIONS OF THE FINDINGS This study demonstrates that in women diagnosed with heterotopic pregnancies, minimally invasive surgery to treat the extrauterine pregnancy does not increase the risk of miscarriage of the concomitant live eutopic pregnancy. This finding will be helpful to women and their clinicians when discussing the options for treating heterotopic pregnancies. STUDY FUNDING/COMPETING INTEREST(S) This work did not receive any funding. None of the authors has any conflict of interest to declare. TRIAL REGISTRATION NUMBER Research Registry: researchregistry6430.
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Affiliation(s)
- S A Solangon
- Gynaecology Diagnostics and Outpatient Treatment Unit, University College London Hospital, London, UK
| | - M Otify
- Early Pregnancy and Gynaecology Unit, King’s College Hospital, London, UK
- Liverpool Women’s Hospital, Liverpool, UK
| | - J Gaughran
- Early Pregnancy and Gynaecology Unit, Guy’s and St Thomas’ Hospital, London, UK
| | - T Holland
- Early Pregnancy and Gynaecology Unit, Guy’s and St Thomas’ Hospital, London, UK
| | - J Ross
- Early Pregnancy and Gynaecology Unit, King’s College Hospital, London, UK
| | - D Jurkovic
- Gynaecology Diagnostics and Outpatient Treatment Unit, University College London Hospital, London, UK
- Institute for Women’s Health, University College London, London, UK
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Didziokaite G, Vitaityte M, Zykute G, Paliulyte V, Samuilis A. Angular Heterotopic Pregnancy: Successful Differential Diagnosis, Expectant Management and Postpartum Care. Medicina (B Aires) 2021; 57:medicina57111207. [PMID: 34833425 PMCID: PMC8625167 DOI: 10.3390/medicina57111207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 10/21/2021] [Accepted: 10/29/2021] [Indexed: 11/23/2022] Open
Abstract
Heterotopic pregnancy is a rare, difficult to diagnose and life-threatening pathology, which requires timely decisions made by an experienced multidisciplinary team. In this type of multiple pregnancy there are both intrauterine and ectopic pregnancies present. Its incidence increases in pregnancies conceived by assisted reproductive technology or in pregnancies with ovulation induction. This article presents an angular heterotopic pregnancy case in a 34-year-old multigravida. The patient was admitted on the 14th week of gestation due to abdominal pain on the left side with suspicion of heterotopic pregnancy. Transabdominal ultrasound and magnetic resonance imaging (MRI) were performed to confirm the diagnosis of heterotopic angular pregnancy in the left cornu of the uterus. Multidisciplinary team made a decision to keep monitoring the growth of both pregnancies by ultrasound while maternal vitals were stable. Due to intensifying abdominal pain, diagnostic laparoscopy was performed. No signs of uterine rupture were observed, and no additional surgical procedures were performed. Maternal status and ultrasonographic findings were closely monitored. The mass in the left cornu of the uterus did not change significantly and the fetal growth of the intrauterine pregnancy matched its gestational age throughout pregnancy. At the 41st week of gestation, a healthy female neonate was born via spontaneous vaginal delivery. The incidence rate of heterotopic pregnancy tends to grow due to an increased number of pregnancies after assisted reproductive technology and ovulation induction. It is important to always assess the risk factors. The main methods for diagnosing heterotopic pregnancies are ultrasonography and MRI. The main management tactics for heterotopic pregnancy include expectant management as well as surgical or medical termination of the ectopic pregnancy. Expectant management may be chosen as an option only in a limited number of cases, if the clinical situation meets the specific criteria. When applicable, expectant management may reduce the frequency of unnecessary interventions and help to prevent patients from its complications.
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Affiliation(s)
- Gabija Didziokaite
- Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania; (M.V.); (G.Z.)
- Center of Obstetrics and Gynecology, Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, 08661 Vilnius, Lithuania;
- Correspondence:
| | - Monika Vitaityte
- Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania; (M.V.); (G.Z.)
| | - Gerda Zykute
- Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania; (M.V.); (G.Z.)
| | - Virginija Paliulyte
- Center of Obstetrics and Gynecology, Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, 08661 Vilnius, Lithuania;
| | - Arturas Samuilis
- Center of Radiology and Nuclear Medicine, Faculty of Medicine, Institute of Biomedical Sciences, Vilnius University, 08661 Vilnius, Lithuania;
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Nomura S, Kyozuka H, Jin T, Fujimori M, Suzuki D, Sato K, Imamura T, Nomura Y. First trimester heterotopic pregnancy with shock treated laparoscopically, followed by uneventful term pregnancy and normal birth. Fukushima J Med Sci 2021; 67:168-171. [PMID: 34707040 PMCID: PMC8784197 DOI: 10.5387/fms.2021-14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Heterotopic pregnancy (HP), a coexistence of intrauterine and ectopic pregnancies, is extremely rare. Although there have been many reports of maternal outcomes in pregnant women with HP, they have not described fetal neurodevelopmental outcomes and survival. A 30-year-old Japanese woman in early gestation who had undergone two previous cesarean deliveries was transferred to our hospital with vital signs of shock. HP was confirmed by ultrasonography and laparoscopic surgery, and right salpingectomy was performed. At term, a 2,875 g neonate was delivered via cesarean section without any complications.
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Affiliation(s)
- Shinji Nomura
- Department of Obstetrics and Gynecology, Ohta Nishinouchi Hospitale
| | - Hyo Kyozuka
- Department of Obstetrics and Gynecology, Ohta Nishinouchi Hospitale
| | - Toki Jin
- Department of Obstetrics and Gynecology, Ohta Nishinouchi Hospitale
| | - Mimori Fujimori
- Department of Obstetrics and Gynecology, Ohta Nishinouchi Hospitale
| | - Daisuke Suzuki
- Department of Obstetrics and Gynecology, Ohta Nishinouchi Hospitale
| | - Kenichi Sato
- Department of Pediatrics, Ohta Nishinouchi Hospital
| | | | - Yasuhisa Nomura
- Department of Obstetrics and Gynecology, Ohta Nishinouchi Hospitale
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16
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Maleki A, Khalid N, Rajesh Patel C, El-Mahdi E. The rising incidence of heterotopic pregnancy: Current perspectives and associations with in-vitro fertilization. Eur J Obstet Gynecol Reprod Biol 2021; 266:138-144. [PMID: 34653918 DOI: 10.1016/j.ejogrb.2021.09.031] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 07/18/2021] [Accepted: 09/26/2021] [Indexed: 12/27/2022]
Abstract
Heterotopic pregnancy is the simultaneous occurrence of an intrauterine and ectopic pregnancy. This study aims to review the current literature regarding heterotopic pregnancy with a focus on its diagnosis and associations with in-vitro fertilization (IVF). Studies have shown that ovarian hyperstimulation syndrome and multiple embryo transfer during IVF are associated with an increased risk of heterotopic pregnancy. Tubal abnormalities such as pelvic inflammatory disease and previous tubal or abdomino-pelvic surgery have also been identified as risk factors. Diagnosis is challenging as the falsely reassuring presence of an intrauterine fetus frequently delays early intervention. Treatment should be individualised, but is often prompt surgical intervention, and focuses on terminating the ectopic pregnancy while minimizing harm to the mother and intrauterine fetus.
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Affiliation(s)
- Aryan Maleki
- Queen Mary University of London, Barts and The London School of Medicine and Dentistry, London, UK
| | - Noorulain Khalid
- Queen Mary University of London, Barts and The London School of Medicine and Dentistry, London, UK
| | - Chandni Rajesh Patel
- Queen Mary University of London, Barts and The London School of Medicine and Dentistry, London, UK
| | - Essam El-Mahdi
- Department of Obstetrics and Gynaecology, Newham University Hospital, Barts Health NHS Trust, London, UK
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17
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Ectopic pregnancy: a resident's guide to imaging findings and diagnostic pitfalls. Emerg Radiol 2021; 29:161-172. [PMID: 34618256 DOI: 10.1007/s10140-021-01974-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 07/20/2021] [Indexed: 10/20/2022]
Abstract
Ectopic pregnancy (EP) is a term used to describe any pregnancy which does not implant into the uterine cavity. There are several types of EPs: tubal, interstitial, ovarian, abdominal, heterotopic, cervical, and cesarean scar. Ectopic pregnancies can acutely rupture and are the number one cause of maternal death in the first trimester of pregnancy. Therefore, prompt recognition and accurate localization have significant clinical implications on patient outcome. Unfortunately, EPs have many mimickers, which can make the diagnosis challenging in certain cases. In this review, we aim to describe and illustrate sonographic findings of each type of EP, as well as present mimickers and various imaging pitfalls. We will clarify how to avoid potential misdiagnoses that could adversely affect patient outcomes. Lastly, we will briefly address management of each type of EP and discuss potential complications.
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18
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Diagnosis and management of a spontaneous heterotopic pregnancy: Rare case report. Int J Surg Case Rep 2021; 84:106184. [PMID: 34280972 PMCID: PMC8274282 DOI: 10.1016/j.ijscr.2021.106184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 07/06/2021] [Accepted: 07/06/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction and importance Heterotopic pregnancy is the occurrence of pregnancies in at least two different implantation sites in the same time. The diagnosis of heterotopic pregnancy remains one of the greatest challenges of the gynecological-obstetrical emergencies. Case presentation We report a rare case of spontaneous heterotopic pregnancy of a 32-year-old woman, diagnosed with a heterotopic pregnancy by ultrasound and treated by laparotomy in emergency obstetrical department of Ibn Rochd University Hospital of Casablanca. Clinical discussion The existence of intrauterine pregnancy does not exclude an ectopic pregnancy. The occurrence of a spontaneous heterotopic pregnancy without risk factors is a rare event, the clinical symptomatology is often related to a threatened or ongoing abortion, the diagnosis of heterotopic pregnancy is not made until the appearance of signs of hemoperitoneum secondary to a ruptured EP, hence the importance of a systematic ultrasound examination of the adnexa during first trimester ultrasound. The standard treatment is conservative surgery, preferably by laparoscopy. Laparotomy retains its indications especially in forms with hemorrhagic shock. With the aim of preserving intrauterine pregnancy while removing ectopic pregnancy. Conclusion The diagnosis of heterotopic pregnancy should not be excluded by the discovery of a UGI in a spontaneous cycle. Diagnosis is often difficult and management should be initiated as soon as possible given the risk of maternal mortality. Heterotopic pregnancy is rare when at least two pregnancies are present simultaneously in different implantation sites. The diagnostic of heterotopic pregnancy is often delayed due to the visualization of the intrauterine sac. Treatment of heterotopic pregnancy aims to preserve the intrauterine pregnancy while removing the ectopic pregnancy.
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Lv S, Wang Z, Liu H, Peng J, Song J, Liu W, Yan L. Management strategies of heterotopic pregnancy following in vitro fertilization-embryo transfer. Taiwan J Obstet Gynecol 2020; 59:67-72. [PMID: 32039803 DOI: 10.1016/j.tjog.2019.11.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2019] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE The purpose of this study was to evaluate the efficiency and safety of different treatment modalities for heterotopic pregnancy (HP) in vitro fertilization-embryo transfer (IVF-ET) cycles to avoid influence on intrauterine pregnancy (IUP). MATERIALS AND METHODS Cases of HP (n = 90) were from the IVF/ICSI registry database at the Reproductive Hospital Affiliated to Shandong University. An additional 360 women were randomly selected as controls. The primary outcome to examine the risk factors, diagnostic modalities and the impact of different treatment modalities for HP. RESULTS Our results showed that surgical treatment had a certain effect on improving the live-birth rate, although the effect was not statistically significant (87.9% vs. 70.8%, P = 0.055). The risk factors for HP included previous tubal surgery and hydrosalpinx. Fourteen days after embryo transfer, the serum levels of β-human chorionic gonadotropin (β-hCG) and estradiol (E2) were lower in the HP group than in the IUP group (P < 0.05). Furthermore, age and endometrial thickness showed a significant difference between the early abortion and the live-birth groups of HP. CONCLUSIONS In our retrospective study, we supported early surgical laparoscopic intervention to minimize the incidence of abortion of IUP, which resulted in a better live-birth rate. A history of ectopic pregnancy and previous tubal surgery may increase the risk of HP. Low levels of serum β-hCG and E2 on the 14th day after embryo transfer could indicate the incidence of HP.
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Affiliation(s)
- Shangge Lv
- School of Medicine, Shandong University, Ji'nan, Shandong, 250012, China; Center for Reproductive Medicine, Reproductive Hospital Affiliated to Shandong University, Ji'nan, Shandong, China
| | - Zhe Wang
- The Fifth People's Hospital of Ji'nan, Ji'nan, Shandong, China
| | - Hailing Liu
- Department of Reproductive Medicine, People's Hospital of Rizhao, 276800, China
| | - Jin Peng
- Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, Ji'nan, Shandong, China
| | - Jialun Song
- Center for Reproductive Medicine, Reproductive Hospital Affiliated to Shandong University, Ji'nan, Shandong, China
| | - Wei Liu
- School of Medicine, Shandong University, Ji'nan, Shandong, 250012, China; Center for Reproductive Medicine, Reproductive Hospital Affiliated to Shandong University, Ji'nan, Shandong, China
| | - Lei Yan
- School of Medicine, Shandong University, Ji'nan, Shandong, 250012, China; Center for Reproductive Medicine, Reproductive Hospital Affiliated to Shandong University, Ji'nan, Shandong, China.
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20
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Ali T, Tawab MA, ElHariri MAG, Ayad AA. Heterotopic pregnancy: a case report. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2020. [DOI: 10.1186/s43055-020-00325-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Heterotopic pregnancy describes the occurrence of two pregnancies in different implantation sites simultaneously, which is rare, yet it is a challenge to diagnose such a problem due to complex clinical and laboratory findings. In the current study, we present a case of first trimester heterotopic pregnancy diagnosed by ultrasound (US) and magnetic resonance imaging (MRI) and was managed successfully.
Case presentation
A 22-year-old primigravida lady with spontaneous pregnancy was presented by increasing lower abdominal pain for 5 days with brownish vaginal discharge, nausea, and vomiting episodes. Trans-abdominal and endovaginal ultrasound was performed and revealed a viable intrauterine pregnancy of 8 weeks and 1 day, associated with a heterogeneous complex right adnexal mass. MR imaging revealed a right adnexal mass intimately anterior to the normal right ovary. Laparascopy was done; it revealed a distended right fallopian tube with pregnancy while the right ovary was not seen (impeded in the pouch of Douglas), and right salpingectomy was done. The specimen was sent for histopathology. The patient tolerated the procedure well and was then taken to the recovery room in stable condition. The histopathological report confirmed the diagnosis of ectopic pregnancy.
Conclusion
However, heterotopic is a rare condition, any pregnant woman presenting with alarming abdominal pain and adnexal abnormality; heterotopic pregnancy should be among the differential diagnosis possibilities. The patient should be thoroughly investigated using ultrasound and MRI if needed, to exclude this rare diagnosis and allow on-time proper management.
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21
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Elhadidi A, Alhariri A, Hosny Garib M, Mansour A, Almutiri B. Ruptured Heterotopic Pregnancy: A Rare Encounter in Acute Surgical Care Settings. Cureus 2020; 12:e11782. [PMID: 33409029 PMCID: PMC7779178 DOI: 10.7759/cureus.11782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Heterotopic pregnancy is a rare, life-threatening clinical entity with an overall incidence of about 1:30,000 in spontaneous natural conception cases, especially in cases of delayed diagnosis or conflicting clinical features. Here, we present an unusual case of heterotopic pregnancy in a 22-year-old multigravida presented to the emergency department (ED) with a clinical picture of the acute abdomen following recent abdominal trauma. Abdominal ultrasound revealed hemoperitoneum and a single viable intrauterine pregnancy at seven weeks' gestation. Following surgical exploration, the patient underwent removal of the ectopic pregnancy tissue with right salpingectomy. Since the presence of a conflicting history or equivocal physical signs and symptoms makes it difficult to diagnose heterotopic pregnancy, ED physicians and surgeons must consider the diagnosis even when dealing with viable intrauterine pregnancies. Besides, acute abdominal pain associated with shock should be regarded as suggestive of heterotopic pregnancy. Thus, prompt evaluation and a high index of suspicion are of paramount importance to prevent unwanted sequelae.
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22
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Murewanhema G, Madombi S, Hlathswayo L, Simango N. Concurrent ruptured spontaneous heterotopic pregnancy and ruptured appendix with delayed presentation in the first trimester: a case report. Pan Afr Med J 2020; 37:222. [PMID: 33520061 PMCID: PMC7821793 DOI: 10.11604/pamj.2020.37.222.26182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 10/30/2020] [Indexed: 11/18/2022] Open
Abstract
Acute appendicitis is the commonest non-gynaecological surgical emergency in pregnancy. However, the concurrent occurrence of acute appendicitis with a heterotopic pregnancy is a rare event and presents diagnostic challenges to unsuspecting clinicians and sonographers. We present a case of a woman who had a heterotopic pregnancy and was noted to have a gangrenous appendicitis at laparotomy, illustrating how a diagnosis of acute appendicitis could easily be missed in pregnancy. We report the case of a 34-year-old woman in the first trimester of pregnancy who had a missed diagnosis of acute appendicitis after she had complained of vague abdominal symptoms for three weeks. She presented to a gynaecologist with vaginal bleeding for three days and was noted to have a heterotopic pregnancy on ultrasound scan. At laparotomy, she was noted to have a gangrenous appendicitis with pyoperitoneum concurrent with a ruptured left fimbrial ectopic pregnancy. Left salpingectomy and saline lavage were done and she had uneventful post-operative recovery. Unsuspecting clinicians, in patients without risk factors, can miss both heterotopic pregnancy and acute appendicitis. As assisted reproductive techniques become widespread, the possibility of heterotopic pregnancies must always be considered and any patient who presents with vague abdominal symptoms must be suspected to have the possibility of acute appendicitis. Because of the unreliability of laboratory investigations and clinical predictive scores in pregnancy, sonographers must be specifically asked to scan for heterotopic pregnancy and appendicitis in suspected cases.
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Affiliation(s)
- Grant Murewanhema
- Department of Obstetrics and Gynaecology, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Simbarashe Madombi
- Department of Obstetrics and Gynaecology, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Lynette Hlathswayo
- Department of Obstetrics and Gynaecology, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Ndabaningi Simango
- Department of Obstetrics and Gynaecology, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
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Vaginal Delivery at Term in a Woman with a Spontaneous Heterotopic Pregnancy Treated with Laparoscopic Salpingectomy. Case Rep Obstet Gynecol 2020; 2020:8892273. [PMID: 32934856 PMCID: PMC7484683 DOI: 10.1155/2020/8892273] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 08/26/2020] [Indexed: 12/04/2022] Open
Abstract
Background. The coexistence of an intrauterine pregnancy and an ectopic pregnancy (heterotopic pregnancy) is an extremely rare, yet major, complication during pregnancy. The early diagnosis of a heterotopic pregnancy is of great importance for fetal viability, maternal safety, and the progression of an uncomplicated intrauterine pregnancy. Case Presentation. We report a case of a naturally conceived heterotopic tubal pregnancy in a 37-year-old primigravida. The patient presented with continuous, dull, lower abdominal pain and a positive urine pregnancy test which was conducted a week prior to the start of the pain. The patient was hospitalized, and based on the clinical image and after strict monitoring, she was diagnosed with a heterotopic pregnancy. She was treated with laparoscopic salpingectomy after the rupture of the ectopic pregnancy while the desired intrauterine gestation continued without any complications. The pregnancy resulted in the birth of a healthy infant through vaginal delivery. Discussion. Strict monitoring with multiple sonographic evaluations should always be conducted in women with abnormal serum beta-hCG, adnexal abnormalities, or clinical symptoms, while heterotopic pregnancy should be in differential diagnosis and treatment should not be delayed since emerge management is important for the progression of the intrauterine pregnancy.
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Černiauskaitė M, Vaigauskaitė B, Ramašauskaitė D, Šilkūnas M. Spontaneous Heterotopic Pregnancy: Case Report and Literature Review. ACTA ACUST UNITED AC 2020; 56:medicina56080365. [PMID: 32707853 PMCID: PMC7466362 DOI: 10.3390/medicina56080365] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 07/17/2020] [Accepted: 07/17/2020] [Indexed: 11/16/2022]
Abstract
Heterotopic pregnancy is defined as a condition when intrauterine and extrauterine pregnancy occur simultaneously. It is a life-threatening condition that requires immediate and accurate diagnostics and treatment. We present a case of a 28-year-old primigravida female who conceived spontaneously and at her seventh week of gestation and was presented to the emergency department with weakness and acute pain in lower abdomen. Laboratory tests and transvaginal ultrasonography revealed the diagnosis of heterotopic pregnancy. Urgent laparoscopic salpingotomy was chosen as a treatment option. The ectopic pregnancy was successfully removed with the preservation of the intrauterine embryo and fallopian tubes. The course of pregnancy after the surgery was without complications, and a healthy baby was delivered at the 39th week of gestation. When treated properly and on time, a heterotopic pregnancy can result in live childbirth with favorable outcomes for both the child and the mother.
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Affiliation(s)
- Miglė Černiauskaitė
- Faculty of Medicine, Vilnius University, M. K. Čiurlionio g. 21, 03101 Vilnius, Lithuania
- Correspondence: ; Tel.: +370-622-36-570
| | - Brigita Vaigauskaitė
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University Clinic of Obstetrics and Gynaecology, Vilnius University Hospital Santaros Clinics, Santariškių g. 2, 08661 Vilnius, Lithuania; (B.V.); (D.R.); (M.Š.)
| | - Diana Ramašauskaitė
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University Clinic of Obstetrics and Gynaecology, Vilnius University Hospital Santaros Clinics, Santariškių g. 2, 08661 Vilnius, Lithuania; (B.V.); (D.R.); (M.Š.)
| | - Mindaugas Šilkūnas
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University Clinic of Obstetrics and Gynaecology, Vilnius University Hospital Santaros Clinics, Santariškių g. 2, 08661 Vilnius, Lithuania; (B.V.); (D.R.); (M.Š.)
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Wang Y, Niu Z, Tao L, Yang Y, Ma C, Li R. Early intervention for heterotopic caesarean scar pregnancy to preserve intrauterine pregnancy may improve outcomes: a retrospective cohort study. Reprod Biomed Online 2020; 41:290-299. [PMID: 32553465 DOI: 10.1016/j.rbmo.2020.03.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 03/19/2020] [Accepted: 03/24/2020] [Indexed: 02/07/2023]
Abstract
RESEARCH QUESTION What is the best intervention time and method for patients who are diagnosed with heterotopic caesarean scar pregnancy (HCSP) wishing to preserve intrauterine pregnancy. DESIGN Four patients diagnosed with HCSP from January 2014 to May 2019 were enrolled. Because HCSP is rare, data on 27 published cases were extracted to augment the analysis. Clinical characteristics and medical documents related to fetal reduction and subsequent maternal-neonate outcomes were analysed. RESULTS The intervention time was significantly earlier in the full-term birth group (6.76 ± 1.05 weeks) compared with pre-term birth group (8.02 ± 1.55 weeks; P = 0.042). The cumulative full-term delivery rate was 91.48% when the intervention was at 6 weeks' gestation and decreased to 42.02% at 8 weeks. The maternal-neonate outcome was similar among the selective fetal reduction and surgical removal groups as was delivery time (34.68 ± 3.12 versus 34.80 ± 6.64 weeks; P = 0.955). In the four cases undergoing selective fetal reduction, the residual mass grew by 1.16-7.07 times compared with the area before reduction. The maximum size of the residual mass was observed at 12-13 weeks and 22-25 weeks. CONCLUSIONS Most patients with HCSP who choose to keep intrauterine pregnancy will be able to carry the fetus to term. Selective fetal reduction would be the first intervention of choice and should take place immediately after diagnosis. The residual mass after reduction could continue to grow throughout the whole pregnancy, although this should not be considered as an indication for termination. With good supervision and careful management, the pregnancy could be maintained and carried to term.
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Affiliation(s)
- Yang Wang
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China; National Clinical Research Center for Obstetrics and Gynecology, Beijing 100191, China; Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing 100191, China; Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing 100191, China
| | - Ziru Niu
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China; National Clinical Research Center for Obstetrics and Gynecology, Beijing 100191, China; Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing 100191, China; Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing 100191, China
| | - Liyuan Tao
- Research Center of Clinical Epidemiology, Peking University Third hospital, Beijing 100191, China
| | - Yan Yang
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China; National Clinical Research Center for Obstetrics and Gynecology, Beijing 100191, China; Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing 100191, China; Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing 100191, China
| | - Caihong Ma
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China; National Clinical Research Center for Obstetrics and Gynecology, Beijing 100191, China; Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing 100191, China; Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing 100191, China
| | - Rong Li
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China; National Clinical Research Center for Obstetrics and Gynecology, Beijing 100191, China; Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing 100191, China; Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing 100191, China.
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26
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Shang J, Peng R, Zheng J, Lin M. The indicator of clinical outcomes for patients with heterotopic pregnancy following in-vitro fertilization with embryo transfer. Taiwan J Obstet Gynecol 2020; 58:827-832. [PMID: 31759536 DOI: 10.1016/j.tjog.2019.09.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2019] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE To explore the early predictors for pregnancy outcomes in patients with heterotopic pregnancy (HP) following in-vitro fertilization with embryo transfer (IVF-ET). MATERIAL AND METHODS This retrospective study reviewed 81 patients with HP following IVF-ET in our institution between January 2003 and September 2017. The relationships between clinical outcomes and general characteristics, sonographic features and different management options were analyzed by logistic regression analysis. RESULTS The gestational age at the time of diagnosis was 50.9 ± 12.3 days. Among these cases, 76 were accurately diagnosed by TVS, 1 was misdiagnosed as adnexal torsion by TVS, and 4 were confirmed to have IUPs after the surgical treatment. Hence, the sensitivity of TVS for detecting HP was 93.8% (76/81). However, forty-seven patients (58.0%) had suspected HP when they underwent the initial TVS. Among these patients, live births occurred for 60 patients, 11 of whom delivered preterm. The miscarriage rate was 58.3% (14/24) for patients without IUP cardiac activity at HP diagnosis, and 12.3% (7/57) for patients with IUP cardiac activity; a significant correlation was identified (χ2 = 18.651, P < 0.001). Additionally, the abortion rate of patients following fresh non-donor embryo was higher than patients after frozen-thawed embryo (χ2 = 10.437, P = 0.001). Further by logistic regression analysis, patients following frozen-thawed embryo and an IUP with cardiac activity at HP diagnosis were identified as two independent factors of pregnancy outcome. (OR = 0.060, 95%CI = 0.008-0.471, P = 0.007; OR = 0.010, 95%CI = 0.001-0.124, P<0.001). CONCLUSIONS Patients following frozen-thawed embryo and an IUP with cardiac activity at HP diagnosis could be the independent predictors for a favorable prognosis.
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Affiliation(s)
- Jianhong Shang
- Department of Ultrasonic Medicine, Fetal Medical Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
| | - Ruan Peng
- Department of Ultrasonic Medicine, Fetal Medical Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ju Zheng
- Department of Ultrasonic Medicine, Fetal Medical Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Meifang Lin
- Department of Ultrasonic Medicine, Fetal Medical Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Aziz M, Arronte J. A case of spontaneous heterotopic pregnancy in natural conception complicated with hemoperitoneum. Heliyon 2020; 6:e03373. [PMID: 32072059 PMCID: PMC7013160 DOI: 10.1016/j.heliyon.2020.e03373] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 10/25/2019] [Accepted: 02/02/2020] [Indexed: 11/25/2022] Open
Abstract
Heterotopic pregnancy, defined as simultaneous intrauterine and ectopic gestations, is an uncommon occurrence in women who conceive without assisted reproduction techniques. We present the case of 28 years old female with strong family history of multiple gestations, who presented with acute severe abdominal pain and diagnosed with spontaneous heterotopic pregnancy in natural conception. Ectopic pregnancy was successfully removed surgically to conserve the uterine pregnancy. After one week, patient presented with vaginal bleeding and diagnosed with missed abortion and lost her desired uterine pregnancy. This case report discusses the significance of early diagnosis and treatment of heterotopic pregnancy to avoid both fetal and maternal morbidity and mortality. Practitioners should carry a high index of suspicion for heterotopic pregnancy in patients presenting with common symptoms and carry a family history of multiple gestation pregnancies.
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Affiliation(s)
- Muhammad Aziz
- Family Medicine Center, West Kendall Baptist Hospital, Baptist Health South Florida, Miami, FL, USA.,Florida International University, Department of Humanities, Health, and Society (HHS), Herbert Wertheim College of Medicine, Miami, FL, USA.,Center for Healthcare Advancement & Outcomes, Baptist Health South Florida, Miami, FL, USA
| | - Julio Arronte
- Family Medicine Center, West Kendall Baptist Hospital, Baptist Health South Florida, Miami, FL, USA.,West Kendall OBGYN, West Kendall Baptist Hospital, Miami, FL, USA
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28
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Alqahtani HA. A case of heterotopic pregnancy after clomiphene-induced ovulation. SAGE Open Med Case Rep 2019; 7:2050313X19873794. [PMID: 31489198 PMCID: PMC6713962 DOI: 10.1177/2050313x19873794] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 08/13/2019] [Indexed: 11/17/2022] Open
Abstract
Heterotopic pregnancy is a rare condition in which both intrauterine and extrauterine pregnancies occur simultaneously. It was reported to be very rare in normal conceived pregnancy. However, with the considerable progress of the assisted reproductive techniques, the incidence of heterotopic pregnancy increased. Furthermore, the incidence also increases in previous abortions. In this case report, we will present and discuss a patient who had heterotopic pregnancy after clomiphene-induced ovulation as well as a history of previous abortion where the extrauterine fallopian tube ruptured and was managed surgically while the intrauterine pregnancy was preserved.
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Affiliation(s)
- Hanoof Ali Alqahtani
- Department of Obstetrics and Gynecology, Abha Maternity and Children Hospital, Abha, Saudi Arabia
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29
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Ciebiera M, Słabuszewska-Jóźwiak A, Zaręba K, Jakiel G. Heterotopic pregnancy - how easily you can go wrong in diagnosing? A case study. J Ultrason 2019; 18:355-358. [PMID: 30763022 PMCID: PMC6444310 DOI: 10.15557/jou.2018.0052] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2018] [Indexed: 12/12/2022] Open
Abstract
Introduction: Heterotopic pregnancy is a rare, but potentially life-threatening pathology. The diagnosis of heterotopic pregnancy is still one of the biggest challenges in modern gynecology. The incidence of those pregnancies in natural conception is about 1:30000. Case presentation: We present an unusual case of a heterotopic pregnancy which was misdiagnosed in the first trimester as a dichorionic twin pregnancy. At 13 weeks of gestation, the patient presented with an acute abdomen, she was diagnosed with a heterotopic pregnancy, and therefore was operated on, with the excision of the ruptured fallopian tube and the ectopic pregnancy performed. Discussion: The presence of an intrauterine pregnancy does not rule out the presence of a coexisting ectopic pregnancy. Clinicians should always keep in mind that a heterotopic pregnancy may occur in a woman of reproductive age. Careful ultrasound scan of the uterus and appendages is a must in all women of reproductive age with clinical symptoms. Introduction: Heterotopic pregnancy is a rare, but potentially life-threatening pathology. The diagnosis of heterotopic pregnancy is still one of the biggest challenges in modern gynecology. The incidence of those pregnancies in natural conception is about 1:30000. Case presentation: We present an unusual case of a heterotopic pregnancy which was misdiagnosed in the first trimester as a dichorionic twin pregnancy. At 13 weeks of gestation, the patient presented with an acute abdomen, she was diagnosed with a heterotopic pregnancy, and therefore was operated on, with the excision of the ruptured fallopian tube and the ectopic pregnancy performed. Discussion: The presence of an intrauterine pregnancy does not rule out the presence of a coexisting ectopic pregnancy. Clinicians should always keep in mind that a heterotopic pregnancy may occur in a woman of reproductive age. Careful ultrasound scan of the uterus and appendages is a must in all women of reproductive age with clinical symptoms.
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Affiliation(s)
- Michał Ciebiera
- 1st Department of Obstetrics and Gynecology, Centre of Postgraduate Medical Education , Warsaw , Poland
| | | | - Kornelia Zaręba
- 1st Department of Obstetrics and Gynecology, Centre of Postgraduate Medical Education , Warsaw , Poland
| | - Grzegorz Jakiel
- 1st Department of Obstetrics and Gynecology, Centre of Postgraduate Medical Education , Warsaw , Poland
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30
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Na ED, Jung I, Choi DH, Kwon H, Heo SJ, Kim HC, Kang SH, Cho H. The risk factors of miscarriage and obstetrical outcomes of intrauterine normal pregnancy following heterotopic pregnancy management. Medicine (Baltimore) 2018; 97:e12233. [PMID: 30212954 PMCID: PMC6156031 DOI: 10.1097/md.0000000000012233] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
To investigate the clinical characteristics and risk factors for miscarriage of intrauterine normal pregnancy of patients with a heterotopic pregnancy (HP) after treatment.This was a retrospective study of medical records from CHA Bundang Medical Center. Sixty-four patients who were diagnosed with a HP between February 2006 and July 2017 were included in this study. All analyses were performed using SAS software, version 9.4 (SAS Institute, Inc., Cary, NC). P values < .05 were considered statistically significant.Forty-eight patients had tubal ectopic pregnancies (EP), 10 patients had cornual EPs, 1 patient had a cesarean section scar EP, 4 patients had an ovarian EP, and 1 patient had bilateral tubal EP. Among the 64 patients, 14.1% (9/64) miscarried before 10 weeks of gestation after management. Mean gestational age (GA) at treatment was 5.97 ± 0.50 weeks and 6.80 ± 1.04 weeks for miscarriage and nonmiscarriage group, respectively (P = .008). Significant differences were observed between 2 groups in terms of ultrasonographic features at the time HP was diagnosed (P = .040) Logistic regression models indicated that gestational age at treatment showed significant differences between 2 groups (OR: 0.003, 95% CI: 0.001-0.604).Immediate management after diagnosis could expect favorable prognosis of HP. GA at treatment was the only independent risk factor for miscarriage in patients with HP regardless of treatment methods.
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Affiliation(s)
- Eun Duc Na
- Department of Obstetrics and Gynecology, CHA Bundang Medical Center, CHA University, Seongnam
| | - Inkyung Jung
- Division of Biostatistics, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul
| | - Dong Hee Choi
- Fertility Center of CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Hwang Kwon
- Fertility Center of CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Seok Jae Heo
- Division of Biostatistics, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul
| | - Hyeon Chul Kim
- Department of Obstetrics and Gynecology, CHA Bundang Medical Center, CHA University, Seongnam
| | - Suk Ho Kang
- Department of Obstetrics and Gynecology, CHA Bundang Medical Center, CHA University, Seongnam
| | - HeeYoung Cho
- Department of Obstetrics and Gynecology, CHA Bundang Medical Center, CHA University, Seongnam
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31
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Nakanishi K, Miyamoto T, Murakami K, Ono M, Nozawa A, Sengoku K, Kitamura S. Naturally conceived heterotopic pregnancy treated with abdominal wall-lifting laparoscopic salpingectomy using spinal anaesthesia. J OBSTET GYNAECOL 2017. [PMID: 28631498 DOI: 10.1080/01443615.2017.1322047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Kentaro Nakanishi
- a Department of Obstetrics and Gynecology , Nayoro City General Hospital , Nayoro , Japan
| | - Toshinobu Miyamoto
- b Department of Obstetrics and Gynecology , Asahikawa Medical University , Asahikawa , Japan
| | - Koji Murakami
- a Department of Obstetrics and Gynecology , Nayoro City General Hospital , Nayoro , Japan
| | - Masatada Ono
- a Department of Obstetrics and Gynecology , Nayoro City General Hospital , Nayoro , Japan
| | - Akemi Nozawa
- a Department of Obstetrics and Gynecology , Nayoro City General Hospital , Nayoro , Japan
| | - Kazuo Sengoku
- b Department of Obstetrics and Gynecology , Asahikawa Medical University , Asahikawa , Japan
| | - Shinitsu Kitamura
- a Department of Obstetrics and Gynecology , Nayoro City General Hospital , Nayoro , Japan
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32
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Lyu J, Ye H, Wang W, Lin Y, Sun W, Lei L, Hao L. Diagnosis and management of heterotopic pregnancy following embryo transfer: clinical analysis of 55 cases from a single institution. Arch Gynecol Obstet 2017; 296:85-92. [DOI: 10.1007/s00404-017-4384-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 04/25/2017] [Indexed: 12/24/2022]
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33
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Pratilas GC, Chatzis P, Panteleris N, Chatzistamatiou K, Zeipiridis L, Dinas K. Concealed heterotopic pregnancy at 12 weeks, with no coexisting risk factors: Lessons to be learned. J Obstet Gynaecol Res 2016; 43:228-231. [DOI: 10.1111/jog.13157] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 08/08/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Georgios C. Pratilas
- Second Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki; Ippokrateio Hospital of Thessaloniki; Thessaloniki Greece
| | - Panagiotis Chatzis
- Second Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki; Ippokrateio Hospital of Thessaloniki; Thessaloniki Greece
| | - Nikolaos Panteleris
- Second Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki; Ippokrateio Hospital of Thessaloniki; Thessaloniki Greece
| | - Kimon Chatzistamatiou
- Second Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki; Ippokrateio Hospital of Thessaloniki; Thessaloniki Greece
| | - Leonidas Zeipiridis
- First Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki; Papageorgiou Hospital of Thessaloniki; Thessaloniki Greece
| | - Konstantinos Dinas
- Second Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki; Ippokrateio Hospital of Thessaloniki; Thessaloniki Greece
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34
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Spontaneous Heterotopic Pregnancy: Dual Case Report and Review of Literature. Case Rep Obstet Gynecol 2016; 2016:2145937. [PMID: 27413561 PMCID: PMC4930808 DOI: 10.1155/2016/2145937] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Revised: 05/22/2016] [Accepted: 06/01/2016] [Indexed: 11/18/2022] Open
Abstract
Introduction. Heterotopic pregnancy is a rare complication usually seen in populations at risk for ectopic pregnancy or those undergoing fertility treatments. It is a potentially dangerous condition occurring in only 1 in 30,000 spontaneous pregnancies. With the advent of Assisted Reproduction Techniques (ART) and ovulation induction, the overall incidence of heterotopic pregnancy has risen to approximately 1 in 3,900 pregnancies. Other risk factors include a history of pelvic inflammatory disease (PID), tubal damage, pelvic surgery, uterine Mullerian abnormalities, and prior tubal surgery. Heterotopic pregnancy is a potentially fatal condition, rarely occurring in natural conception cycles. Most commonly, heterotopic pregnancy is diagnosed at the time of rupture when surgical management is required. Case. This paper represents two cases of heterotopic pregnancies as well as a literature review. Conclusion. Heterotopic pregnancy should be suspected in patients with an adnexal mass, even in the absence of risk factors. Clinicians must be alert to the fact that confirming an intrauterine pregnancy clinically or by ultrasound does not exclude the coexistence of an ectopic pregnancy. A high index of suspicion in women is needed for early and timely diagnosis, and management with laparotomy or laparoscopy can result in a favorable and successful obstetrical outcome.
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