Laparoscopic management of heterotopic pregnancy: a review

Purse-string suture technique to enable laparoscopic management of the interstitial gestation of a heterotopic pregnancy

OBJECTIVE

To describe the laparoscopic management of an interstitial gestation of a heterotopic pregnancy.

DESIGN

Case report and technique description.

SETTING

Tertiary-level private practice.

PATIENT(S)

Woman with a 6-week gestation spontaneous heterotopic twin pregnancy: one twin intrauterine, one interstitial.

INTERVENTION(S)

A purse-string suture was applied to the proximal portion of the interstitial heterotopic pregnancy.

MAIN OUTCOME MEASURE(S)

To enable a cornual resection to be performed with minimal bleeding and without recourse to laparotomy.

RESULT(S)

At 8 weeks gestation an ultrasound scan confirmed a viable singleton intrauterine pregnancy, but a scan at 12 weeks showed a missed miscarriage.

CONCLUSION(S)

The embedding of the suture into the uterine serosa prevents slipping of the ligature that could occur with a pretied loop.

Heterotopic Trigeminal Pregnancy in Infertile Women after Ovulation Stimulation and Embolisation of a Uterine Myoma

Heterotopic pregnancy is a simultaneous occurrence of intra-uterine pregnancy and ectopic pregnancy. The incidence of ectopic pregnancy has increased as a consequence of assisted reproduction and ovulation stimulation agents. In this report, we describe the case of a 34-year-old nulliparous woman who became pregnant after ovulation induction with clomiphene. According to her gynaecologic history, she had embolisation of a uterine myoma. The report presents a case of ectopic and twin intra-uterine pregnancy. After total laparoscopic salpingectomy, she had normal intra-uterine pregnancy.