Transvaginal B ultrasound-guided embryo reduction under laparoscopic monitoring in the treatment of intrauterine pregnancy with cornual heterotopic pregnancy after assisted reproductive technology: A report of four cases

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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Heterotopic pregnancy associated with assisted reproductive technology

American Journal of Obstetrics and Gynecology ◽

10.1016/0002-9378(89)90879-x ◽

1989 ◽

Vol 160 (6) ◽

pp. 1520-1524 ◽

Cited By ~ 30

Author(s):

Frank R. Gamberdella ◽

Richard P. Marrs

Keyword(s):

Assisted Reproductive Technology ◽

Reproductive Technology ◽

Heterotopic Pregnancy

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Double Trouble: Heterotopic Pregnancy

Journal of SAFOG with DVD ◽

10.5005/jp-journals-10006-1298 ◽

2014 ◽

Vol 6 (3) ◽

pp. 167-170

Author(s):

Shruthi Krishnamoorthy ◽

G Usha Rani ◽

O Syamala ◽

Rukshana LNU ◽

Naveen Alexander

Keyword(s):

Ectopic Pregnancy ◽

Assisted Reproductive Technology ◽

South Asian ◽

Surgical Intervention ◽

Case Series ◽

First Trimester ◽

Reproductive Technology ◽

Heterotopic Pregnancy ◽

Life Threatening ◽

Threatening Situation

ABSTRACT A heterotopic pregnancy is defined as the presence of a combined intrauterine and ectopic pregnancy. Its estimated incidence is as between 1/7000 and 1/30,000 pregnancies. It is also reported to be as high as 1% after the use of assisted reproductive technology. Heterotopic pregnancies are diagnostic and therapeutic challenges for obstetricians. If they continue without diagnosis, a life-threatening situation may occur even when timely surgical intervention with laparotomy is performed. Here, we report a case series of three patients having three different scenarios, who were diagnosed with heterotopic pregnancies in the first trimester and managed successfully. How to cite this article Krishnamoorthy S, Rani GU, Syamala O, Rukshana, Alexander N. Double Trouble: Heterotopic Pregnancy J South Asian Feder Obst Gynae 2014;6(3):167-170.

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The effect of local aspiration and methotrexate injection on live interstitial pregnancy coexisting with live intrauterine pregnancy after assisted reproductive technology

Journal of Obstetrics and Gynaecology Research ◽

10.1111/jog.13975 ◽

2019 ◽

Vol 45 (7) ◽

pp. 1296-1302 ◽

Cited By ~ 3

Author(s):

Xinyun Yang ◽

Linling Zhu ◽

Fang Le ◽

Yanjing Wang ◽

Hangying Lou ◽

...

Keyword(s):

Assisted Reproductive Technology ◽

Reproductive Technology ◽

Intrauterine Pregnancy ◽

Interstitial Pregnancy

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Clinical Analysis of 47 Cases of Heterotopic Pregnancy After Assisted Reproductive Technology

10.21203/rs.3.rs-645168/v1 ◽

2021 ◽

Author(s):

Qiaoli Bei ◽

Huanrong Liu ◽

Shaohua Xu

Keyword(s):

Assisted Reproductive Technology ◽

Pregnancy Outcome ◽

Adnexal Mass ◽

Clinical Analysis ◽

Reproductive Technology ◽

Heart Beat ◽

Yolk Sac ◽

Heterotopic Pregnancy ◽

Term Birth ◽

Anechoic Area

Abstract Background: Heterotopic pregnancy is rare in natural pregnancy. In recent years, with the development of assisted reproductive technology, the incidence of heterotopic pregnancy is increasing. Heterotopic pregnancy not only affects the development of intrauterine embryo, but also threatens the life of patients. There is no unified standard for the treatment of heterotopic pregnancy until now. So we research the clinical features and the effect of different intervention time on pregnancy outcome in patients with heterotopic pregnancy (HP) after assisted reproductive technology (ART).Methods: A retrospective analysis was conducted on the patients who were diagnosed as HP in Shanghai first maternal and infant hospital after conception through ART from January 2014 to June 2019. We analyzed the clinical characteristics, therapeutic method and intervention time to explore their impact on the outcome of HP.Results：47 patients with HP after ART were treated in our hospital and have complete clinical data. Among them, 18 cases treated with conservative therapy and 29 cases treated with operation. 29 cases delivered (including 3 cases of pre-term birth and 26 cases of full-term birth) and 18 cases aborted. In HP patients, β Human chorionic gonadotropin (β-HCG, 0.617) and extrauterine mass size (0.242) are not much guiding significance for the treatment. Transvaginal ultrasonography (TVS) examination on admission found that different conditions of ectopic (anechoic area, adnexal mass, heart beat, yolk sac) was independent risk factors of different treatment methods (P=0.005). And the intervention time before six weeks can get better pregnancy outcome (p=0.034).Conclusions：Patients with ART should be examined by TVS as early as possible. If abnormal TVS (anechoic area, adnexal mass, heart beat, yolk sac) results are found, patients should be operated by laparoscopy. And the best intervention time of laparoscopy is before 6 weeks.

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