scholarly journals Heterotropic pregnancy: a common masquerade than ever thought?

2021 ◽  
Vol 10 (12) ◽  
pp. 1410
Author(s):  
Ayodele A. Olaleye ◽  
Boniface N. Ejikeme ◽  
Eziaha E. Okeke ◽  
Nwabunike E. S. Ede ◽  
Bartholomew I. Olinya ◽  
...  
Keyword(s):  
Ectopic Pregnancy ◽  
Exploratory Laparotomy ◽  
Heterotopic Pregnancy ◽  
Multiple Gestation ◽  
Intrauterine Pregnancy ◽  
Vacuum Aspiration ◽  
Products Of Conception ◽  
History Of ◽  
One Year ◽  
Attending Physician

Heterotopic pregnancy, coexistence of living or dead intrauterine pregnancy, single or multiple, with extra-uterine pregnancy located in the oviduct, ovary, uterine cornua, cervix or rarely peritoneal cavity. Heterotropic pregnancy is relatively uncommon in spontaneous conception with 1 in 30,000 cases reported, the incidence of heterotopic pregnancy increases to 1 in 3900 when conception is enhanced with various assisted reproduction techniques (ART). It is an ectopic pregnancy coexisting with intrauterine pregnancy. But is the incidence of heterotropic pregnancy rising? A case was reported from our centre in 2018 by Ejikeme et al, and we have recorded another two cases in the period of one year. Ectopic pregnancy has been described as a great masquerader, which makes diagnosis and management of heterotropic pregnancy a dilemma to attending physician. We present a case of an unbooked 26 years old G4P3+0 who has no family history of multiple gestation and presented at gestational age of 8 weeks and 5 days with 2 days history of abdominal pain and vaginal bleeding and 2 hours history of loss of consciousness. She later had exploratory laparotomy with left salpingectomy and manual vacuum aspiration of Retained Products of Conception with good outcome. In conclusion, spontaneous heterotropic pregnancy is a rare occurrence, however with advent of artificial reproductive technology and increase incidence of pelvic inflammatory disease, the incidence could be higher than earlier suspected.

HETEROTOPIC PREGNANCY WITH INEVITABLE ABORTION (RIGHT ADNEXAL LIVE ECTOPIC AND COEXISTING INTRAUTERINE TRIPLETS WITH ABSENT FETAL CARDIAC ACTIVITY)

2021 ◽  
pp. 58-59
Author(s):  
Jayanta Sarkar ◽  
Mini Sengupta
Keyword(s):  
Ectopic Pregnancy ◽  
Abdominal Cavity ◽  
Lower Abdominal Pain ◽  
Cardiac Activity ◽  
Exploratory Laparotomy ◽  
Sudden Onset ◽  
Heterotopic Pregnancy ◽  
Intrauterine Pregnancy ◽  
Short Period ◽  
The Right

Heterotopic pregnancy describes the occurrence of two or more pregnancies in different implantation sites simultaneously, intrauterine pregnancy coexists withectopic pregnancies (ampullary in 80%). A 27-year-old women (P ,L1) presented to the emergency department with a complaint of sudden onset of right-sided lower abdominal pain with 1+1 vaginal bleeding and had a short period of Amenorrhea. Ultrasonography demonstrated three intrauterine gestational sacwith foetal pole noted but Cardiac activity was absent . The right adnexa showed a heteroechoic area andmoderate amount of free uid was present in the lower abdominal cavity. Ectopic pregnancy was disturbed. An emergency exploratory laparotomy was performed under general anesthesia. Haemoperitoneum was found with a ruptured righttubal ectopic pregnancy as well. Both the ovaries appeared normaland a corpus luteal cyst was presentin right ovary. Right sided salpingectomy was performed with removal of the ectopic mass,heamostasis secured ,on table blood transfusion had been given.Suction evacuation had also been performed by manual vacuum aspirationon same sitting.Both the specimen send for histopathology. Histology conrmedGestational sac suggestive of an intra uterine pregnancy coexists with ectopic pregnancy. Left tube and both ovaries were found healthy. Episodes of PID also have a strong correlation with occurrence of ectopic gestation. Once diagnosis of heterotrophic pregnancy has been made the management is essentially surgical.

scholarly journals Spontaneous Heterotopic Pregnancy: Dual Case Report and Review of Literature

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Annika Chadee ◽  
Shadi Rezai ◽  
Catherine Kirby ◽  
Ekaterina Chadwick ◽  
Sri Gottimukkala ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ectopic Pregnancy ◽  
Rare Complication ◽  
Heterotopic Pregnancy ◽  
Pelvic Surgery ◽  
Intrauterine Pregnancy ◽  
Fertility Treatments ◽  
Populations At Risk ◽  
History Of ◽  
High Index Of Suspicion

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.

scholarly journals Different Sonographic Faces of Ectopic Pregnancy

2017 ◽  
Vol 7 ◽  
pp. 6 ◽  
Author(s):  
Charu Chanana ◽  
Nishant Gupta ◽  
Itisha Bansal ◽  
Kusum Hooda ◽  
Pranav Sharma ◽  
...  
Keyword(s):  
Ectopic Pregnancy ◽  
Chorionic Gonadotropin ◽  
Vaginal Bleeding ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
First Trimester ◽  
Intrauterine Pregnancy ◽  
Pictorial Essay ◽  
History Of ◽  
Clinical Signs And Symptoms

Vaginal bleeding in the first trimester has wide differential diagnoses, the most common being a normal early intrauterine pregnancy, with other potential causes including spontaneous abortion and ectopic pregnancy. The incidence of ectopic pregnancy is approximately 2% of all reported pregnancies and is one of the leading causes of maternal mortality worldwide. Clinical signs and symptoms of ectopic pregnancy are often nonspecific. History of pelvic pain with bleeding and positive β-human chorionic gonadotropin should raise the possibility of ectopic pregnancy. Knowledge of the different locations of ectopic pregnancy is of utmost importance, in which ultrasound imaging plays a crucial role. This pictorial essay depicts sonographic findings and essential pitfalls in diagnosing ectopic pregnancy.

scholarly journals Heterotopic Pregnancy: A Clinical Case Report

1970 ◽  
Vol 39 (3) ◽  
Author(s):  
S Chowdhury ◽  
T Chowdhury
Keyword(s):  
Abdominal Pain ◽  
Case Report ◽  
Ectopic Pregnancy ◽  
Clinical Examination ◽  
Clinical Case ◽  
Lower Abdominal Pain ◽  
Tubal Pregnancy ◽  
Heterotopic Pregnancy ◽  
Intrauterine Pregnancy ◽  
Ectopic Pregnancies

Heterotopic pregnancy is coexistence of intrauterine and extrauterine pregnancies that is ectopic pregnancies. It is said to be rare. Here we report a case of 27 years old woman with heterotopic pregnancy. Patient had a typical presentation of severe lower abdominal pain following amenorrhoea for 2½ months. On clinical examination, there was suspicion of ectopic pregnancy but ultrasonography revealed early intrauterine pregnancy along with right tubal pregnancy with huge collection in abdomen . Immediate laparotomy was done and diagnosis was confirmed as a case of heterotopic pregnancy.DOI: http://dx.doi.org/10.3329/bmj.v39i3.9950 BMJ 2010; 39(3)

scholarly journals Uterine Rupture with Cesarean Scar Heterotopic Pregnancy with Survival of the Intrauterine Twin

2016 ◽  
Vol 2016 ◽  
pp. 1-4 ◽  
Author(s):  
Kimberly R. Lincenberg ◽  
Eric R. Behrman ◽  
James S. Bembry ◽  
Christine M. Kovac
Keyword(s):  
Ectopic Pregnancy ◽  
Uterine Rupture ◽  
Placental Abruption ◽  
Heterotopic Pregnancy ◽  
Multiple Gestation ◽  
Cesarean Scar ◽  
Safe Management ◽  
Life Threatening ◽  
Emergent Cesarean Section ◽  
Ruptured Uterus

Background. Heterotopic pregnancy is a multiple gestation with both intrauterine and ectopic fetuses. A cesarean scar ectopic pregnancy is when the fetus has implanted over the previous hysterotomy site. A known complication of cesarean scar ectopic pregnancy is uterine rupture, which can cause great morbidity and mortality. Case. 28-year-old G5P3105 at 10 weeks with a dichorionic diamniotic gestation was found to have a ruptured uterus with expulsion of a cesarean scar ectopic pregnancy and retention of the intrauterine fetus. After uterine repair, the singleton gestation reached viability was delivered by emergent cesarean section for placental abruption. Conclusion. Safe management of cesarean ectopic pregnancy requires early diagnosis by ultrasonography. With early detection, management can focus on preventing maternal morbidity of uterine rupture and life-threatening hemorrhage.

scholarly journals Laparoscopic Management of an Abdominal Pregnancy

2014 ◽  
Vol 2014 ◽  
pp. 1-3
Author(s):  
Aarthi Srinivasan ◽  
Suzanne Millican
Keyword(s):  
Ectopic Pregnancy ◽  
Transvaginal Ultrasound ◽  
Lower Abdominal Pain ◽  
Pain Patient ◽  
Prior History ◽  
Intrauterine Pregnancy ◽  
Beta Hcg ◽  
Maternal Morbidity And Mortality ◽  
History Of ◽  
The Right

Background. Ectopic pregnancy is one of the leading causes of significant maternal morbidity and mortality. Abdominal surgeries increase the risk of postoperative adhesions. We here present a case of omental ectopic pregnancy in a patient with a prior history of cesarean section.Case. A 20-year-old female presented with a two-day history of crampy lower abdominal pain. Patient was hemodynamically stable with a beta HCG of 1057 mI/mL. Transvaginal ultrasound did not show an intrauterine pregnancy but revealed an ill-defined mass in the midline pelvis extending to the right of the midline. Diagnostic laparoscopy revealed large clots in the pelvis with normal uterus and adnexa. Intra-abdominal survey revealed an omental adhesion close to the right adnexa with a hematoma. Partial omentectomy was completed and the portion of the omentum with the hematoma was sent to pathology for confirmation. Final pathology confirmed the presence of chorionic villi consistent with products of conception.Conclusion. Omental ectopic pregnancy is a rare diagnosis and often missed. We recommend careful intra-abdominal survey for an ectopic pregnancy in the presence of hemoperitoneum with normal uterus and adnexa. This can be safely achieved using laparoscopy in early gestational ages when the patient is hemodynamically stable.

scholarly journals Undiagnosed Ectopic Pregnancy among Unsupervised use of Medical Abortion pills

2017 ◽  
Vol 11 (2) ◽  
pp. 12-15
Author(s):  
Arun Prasad Joshi ◽  
NS Chitrakar ◽  
J Pariyar ◽  
I Shrestha ◽  
R Maharjan ◽  
...  
Keyword(s):  
Ectopic Pregnancy ◽  
Lower Abdominal Pain ◽  
Medical Practitioner ◽  
Medical Abortion ◽  
World Health ◽  
History Of ◽  
One Year ◽  
Health Organization ◽  
Operative Findings ◽  
A Prospective Study

Aims: To identify and share the experience of clinical presentation and management of ectopic pregnancy (EP) in women who presented with unsupervised use of Medical abortion (MA) pills.Methods: A prospective study was conducted in department of Obstetrics and Gynaecology of Civil Service Hospital over one year (March 2015- February 2016). Women with a history of unsupervised use of MA pills were taken into study group as there has been a trend of taking theses pills without consultation in recent days. Detail clinical, menstrual, obstetrics and MA history were taken. Relevant investigations and Ultrasonography were done. Women diagnosed to have ectopic pregnancy were followed and their operative findings were recorded. Results: Ninety-six women presented with unsupervised use of MA, among which 8 (8.33%) diagnosed to have EP. Most women were 20-30 years of age and 37.5% were unmarried.  They gave history of taking MA from pharmacy. Among eight women, 37.5 % had taken MA at the period of gestation <5 weeks, 37.5% between 5-7 weeks and 25% >7-9 weeks. Fifty percent attended hospital after seventy- two hours of MA. Majority (50%) presented with lower abdominal pain and ruptured EP with hemoperitoneum (>one litre) requiring blood transfusion. History of easy availability and social reasons for MA intake were given by 37.5% each.Conclusions: Even though medical abortion is easily accessible, affordable and available, it should also be safer. It is of utmost importance to take it from health facility or a registered medical practitioner following World Health Organization (WHO) guidelines, one of which is excluding extra-uterine pregnancy.

scholarly journals A Case of Heterotopic Pregnancy

2015 ◽  
Vol 14 (1) ◽  
pp. 64-66 ◽  
Author(s):  
Kaberi Majumder ◽  
Anisul Moula
Keyword(s):  
Ectopic Pregnancy ◽  
Ultrasound Examination ◽  
Clinical Suspicion ◽  
Heterotopic Pregnancy ◽  
Free Fluid ◽  
Intrauterine Pregnancy ◽  
Sense Of Security ◽  
Risk Of Rupture ◽  
False Sense ◽  
Gestational Sac

We are presenting a case report of heterotopic pregnancy, which is diagnosed during ultrasound examination of a gravid woman, 23 year old, referred from outpatient department. Heterotopic pregnancy is a rare obstetrics phenomenon and carries a significant natural morbidity and mortality due to risk of rupture of the ectopic pregnancy. Clinicians and sonographers may fall into a false sense of security when an intrauterine gestational sac is identified. This results in inadequate inspection of the adnexae and remaining structures during ultrasonography despite a strong initial clinical suspicion of ectopic pregnancy. Hence, a thorough ultrasonographic examination is needed in managing these patients, especially when there is a high suspicion of ectopic pregnancy or in the presence of pelvic free fluid even when an intrauterine pregnancy is identified. DOI: http://dx.doi.org/10.3329/cmoshmcj.v14i1.22888 Chatt Maa Shi Hosp Med Coll J; Vol.14 (1); Jan 2015; Page 64-66

scholarly journals Case Report of Spontaneous Bilateral Ovarian Pregnancy in a Nulliparous Lady

2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Abdulrahman D. Mahroofi ◽  
Jawaher K. Alsaqer ◽  
Nawal Saad Alabdulla ◽  
Rihab Ismael ◽  
Stephanie Hsu ◽  
...  
Keyword(s):  
Ectopic Pregnancy ◽  
Iliac Fossa ◽  
Specific Patient ◽  
Ovarian Pregnancy ◽  
Products Of Conception ◽  
History Of ◽  
Laboratory Investigations ◽  
Us Findings ◽  
Ectopic Pregnancies ◽  
The Right

Nontubal ectopic pregnancies, especially ovarian ones, are rare. Here, we report a case of spontaneous bilateral ovarian pregnancy in a 23-year-old nulliparous lady who presented with a three-day history of abdominal pain localized to the right iliac fossa. Laboratory investigations and pelvic US and transvaginal US findings were suggestive of a right ovarian ectopic pregnancy and left ovarian cyst. Following the patient’s consent, the gynaecologist laparoscopically removed the right ovarian ectopic pregnancy and performed a left ovarian cystectomy. Histopathology revealed findings of trophoblastic tissue and chorionic villi with products of conception in both ovaries leading to the diagnosis of bilateral spontaneous ectopic pregnancy. Physicians must be mindful in cases that have a similar clinical presentation because an early diagnosis leads to a reduction in the morbidity and mortality of this specific patient population and helps to improve their overall prognosis.

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