scholarly journals A rare case of heterotopic pregnancy: an avalanche of catastrophe

2020 ◽  
Vol 9 (11) ◽  
pp. 4702
Author(s):  
Rangan Bhattacharya ◽  
Rohini Raut ◽  
Beena Kumari ◽  
D. C. Hojai
Keyword(s):  
Ectopic Pregnancy ◽  
Exploratory Laparotomy ◽  
Heterotopic Pregnancy ◽  
Ultrasound Scan ◽  
Vitro Fertilization ◽  
Maternal Morbidity And Mortality ◽  
Life Threatening ◽  
Rising Incidence ◽  
Left Fallopian Tube

An ectopic pregnancy is the development of an embryo outside the uterus, a major cause of maternal morbidity and mortality. Heterotopic pregnancy is when an intrauterine implanted embryo develops simultaneously along with an extra uterine implantation. With rising incidence of assisted reproductive technology (ART), incidence of ectopic pregnancy is on a rise. We report a case of an elderly patient, conceived by in vitro fertilization and embryo transfer (IVF-ET), who had a catastrophe of events following conception, where she had an intrauterine twin gestation and an ectopic gestation in the left fallopian tube. She presented with vomiting and on ultrasound scan, we found a twin intra uterine gestation, with demise of one twin with no sign of ectopic implantation. Initially we decided to continue pregnancy. However, she had persistent spotting per vagina, and on a repeat ultrasound scan there was intrauterine demise of the other foetus also. Her uterus was then evacuated under anaesthesia. Post operatively, she became hemodynamic ally unstable and ultrasound was inconclusive of the cause. So, we subjected her to an MRI which showed a left adnexal ruptured ectopic pregnancy with hemoperitoneum. She was immediately taken up for exploratory laparotomy and left salpingectomy was done hemoperitoneum evacuated. Due to timely intervention and use of advanced techniques for diagnosis, she recovered successfully. Thus, heterotopic pregnancy can be a rare, life threatening complication of IVF, a vigilant eye and not shying away from the use of novel and advanced techniques for diagnosis, can help in early diagnosis and timely intervention and thus prove to be lifesaving.  

scholarly journals Heterotopic pregnancy after in vitro fertilization and embryo transfer: A case report

2012 ◽  
Vol 140 (7-8) ◽  
pp. 511-514 ◽  
Author(s):  
Radmila Sparic ◽  
Snezana Buzadzic ◽  
Rajka Argirovic ◽  
Danijela Bratic ◽  
Darko Plecas
Keyword(s):  
Abdominal Pain ◽  
In Vitro Fertilization ◽  
Ectopic Pregnancy ◽  
Transvaginal Ultrasound ◽  
Reproductive Age ◽  
Heterotopic Pregnancy ◽  
Vitro Fertilization ◽  
Life Threatening ◽  
In Pregnancy

Introduction. Heterotopic pregnancy is a life-threatening complication of pregnancy defined as coexistent intrauterine and ectopic gestation. Its diagnosis is frequently overlooked and delayed. Case Outline. A 28-year-old woman experienced acute abdominal pain in pregnancy achieved by in vitro fertilization. Since all previous checkups indicated a normal course of pregnancy, the ectopic pregnancy was not suspected on admission. However, due to persistent hypotension, this diagnosis was also considered. Transvaginal ultrasound performed by an experienced obstetrician revealed an adnexal mass highly indicative of ectopic pregnancy. No fetal heart beats were visualized and the diagnosis of a missed abortion was made. A prompt laparotomy revealed a ruptured right ampullary pregnancy, and salpingectomy was performed. Conclusion. Although rare, heterotopic pregnancy should be considered in the differential diagnosis of abdominal pain in pregnancy. Every physician treating women of reproductive age should bear in mind the possibility of heterotopic pregnancy not only in patients with predisposing risk factors but also in those without them.

scholarly journals Successful live birth after heterotopic ruptured cornual pregnancy with twin intrauterine gestation in an in vitro fertilization conception

2019 ◽  
Vol 8 (12) ◽  
pp. 5057
Author(s):  
Venus Bansal ◽  
Muskaan Chhabra ◽  
Rahul Chopra ◽  
Pooja Prajapati
Keyword(s):  
Heterotopic Pregnancy ◽  
Intrauterine Pregnancy ◽  
Omental Patch ◽  
Vitro Fertilization ◽  
Ultrasound Findings ◽  
Life Threatening ◽  
Intraperitoneal Bleeding ◽  
High Index Of Suspicion ◽  
Preterm Rupture Of Membranes

Heterotopic pregnancies, especially in the cornual region which were a rarity till recent times, have become a more common occurrence due to increasing practice of assisted reproduction. Optimal management of such cases is imperative to manage the risk of hypotension and shock in case of rupture and to judiciously preserve the intrauterine pregnancy. Here we are reporting a case of IVF conception of twin intrauterine pregnancy with a cornual heterotopic pregnancy. Patient presented to the emergency department with features of acute abdomen, haemoperitoneum and shock. Ultrasound findings were suggestive of rupture of cornual heterotopic pregnancy, 1500 ml haemoperitoneum with live twin intrauterine gestation. Patient was resuscitated with iv fluids blood transfusion. Immediate laparotomy was done and cornual site repaired and covered with an omental patch while preserving the intrauterine gestations. Thereafter, pregnancy was carefully monitored with a high index of suspicion for rupture of site of cornual repair with advancing gestational age. Patient was readmitted at 24 weeks with pain abdomen and cornual site was found to be 4mm in thickness. She was managed conservatively till 27 weeks when she had preterm rupture of membranes and emergency LSCS was done. She delivered healthy twin male babies, 780 gmb and 795 gm respectively. This case demonstrates that cornual heterotopic pregnancy is a diagnosis which may be easily missed and can present as a life-threatening complication if it ruptures and significant intraperitoneal bleeding occurs. However, it is possible to successfully manage these cases with timely intervention, proper uterine reconstruction and monitoring of intrauterine gestation.

scholarly journals Spontaneous pregnancy following post in vitro fertilization ruptured tubal ectopic pregnancy

2020 ◽  
Vol 9 (11) ◽  
pp. 4738
Author(s):  
Kirty Nahar ◽  
Nikita Nahar
Keyword(s):  
In Vitro Fertilization ◽  
Ectopic Pregnancy ◽  
Polycystic Ovary ◽  
Exploratory Laparotomy ◽  
Assisted Reproductive Techniques ◽  
Obstetric Outcome ◽  
Tubal Ectopic Pregnancy ◽  
Vitro Fertilization ◽  
Reproductive Techniques

Ectopic pregnancy (EP) is a dramatic life threatening event in a woman’s reproductive life, especially after a long, expensive and difficult course of treatment for infertility. EP accounts around 1–2% of all natural conceptions, and this prevalence increases following assisted reproductive techniques, to range between 2.1% and 8.6% and it can reach up to 11% in women with tubal factors infertility history. A 32 year old female, primigravida presented at emergency department of Apollo Hospitals, Ahmedabad with complaints of amenorrhoea 2 months, severe pain abdomen associated with vomiting, difficulty in breathing and bleeding per vagina on and off. She was a case of primary infertility with polycystic ovary syndrome (PCOS) who had conceived after difficulty with in vitro fertilization (IVF), resulted in ruptured right tubal ectopic pregnancy. She underwent exploratory laparotomy followed by removal of right ectopic pregnancy, right salpingectomy and peritoneal lavage. Early diagnosis, timely intervention and prompt surgical management could save the patient’s life. Later on she conceived spontaneously and had an eventful and complicated pregnancy. She presented at 35 weeks of pregnancy with preterm labour pain and underwent emergency caesarean section for fetal distress. She delivered a healthy male child and had a successful obstetric outcome. Diagnosis of ruptured tubal ectopic pregnancy is made based on patient’s history, clinical acumen, serum beta human chorionic gonadotropin (hCG) levels and pelvic ultrasound. Ectopic pregnancy should be suspected in patients with an adnexal mass even in absence of risk factors. Clinicians must be alert to the fact that assisted reproductive techniques as a treatment for infertility can result into ectopic pregnancy. This case highlights the fact that patient who underwent IVF treatment resulting in ruptured tubal ectopic pregnancy can have spontaneous conception and a successful obstetric outcome.

Unilateral triplet ectopic pregnancy after in vitro fertilization and embryo transfer

2008 ◽  
Vol 90 (5) ◽  
pp. 2003.e17-2003.e20 ◽  
Author(s):  
Eniko Berkes ◽  
Gyorgy Szendei ◽  
Laszlo Csabay ◽  
Zsuzsanna Sipos ◽  
Jozsef Gabor Joo ◽  
...  
Keyword(s):  
In Vitro Fertilization ◽  
Ectopic Pregnancy ◽  
Embryo Transfer ◽  
Vitro Fertilization

Heterotopic pregnancy after in vitro fertilization

1995 ◽  
Vol 13 (6) ◽  
pp. 641-643 ◽  
Author(s):  
Andrew Sucov ◽  
Lura Deveau ◽  
Pat Feola ◽  
Lynne Sculli
Keyword(s):  
In Vitro Fertilization ◽  
Heterotopic Pregnancy ◽  
Vitro Fertilization

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.

Heterotopic pregnancy; case report

2019 ◽  
Vol 7 (05) ◽  
Author(s):  
Vipul R. Khandagale
Keyword(s):  
Risk Factors ◽  
Ectopic Pregnancy ◽  
Adnexal Mass ◽  
Heterotopic Pregnancy ◽  
Free Fluid ◽  
Threatening Condition ◽  
Life Threatening ◽  
Ectopic Pregnancies ◽  
High Index Of Suspicion ◽  
Low Risk Women

Heterotopic pregnancy is a rare clinical condition in which intrauterine and extrauterine pregnancies occur at the same time. It can be a life threatening condition and easily missed with the diagnosis. We present the case of a 37 year old patient who was treated for a heterotopic pregnancy with live intrauterine gestation and ruptured left adnexal gestation.The ectopic pregnancy was not suspected at her initial presentation. A high index of suspicion is needed in women with risk factors for an ectopic pregnancy and in low risk women who have free fluid with or without an adnexal mass with an intrauterine gestation.It is difficult to estimate exactly the incidence of ectopic pregnancies, but on an average it is approximately 1:300 normal pregnancies worldwide.

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