scholarly journals A case report of heterotopic pregnancy

Author(s):  
Keerathana R. ◽  
Sundar Narayanan S.

Heterotopic pregnancy is the presence of both intrauterine and extrauterine (ectopic) implantation as described by Reece in 1983 and is extremely rare. It accounts for 1 per 30000, in natural cycles and 9 per 10000, in assisted reproduction cycles. The aim of this report is to introduce this case as it poses a challenge to diagnosis due to its complex clinical and laboratory findings. A primigravida aged 30 at 6 weeks period of gestation, reported with minimal bleeding per vaginum. On performing a physical examination her vitals were stable and no significant findings were noted except for an enlarged uterus corresponding to 6 weeks with posterior forniceal fullness. Her beta-hCG was 23765 IU/ml and ultrasound showed a live intrauterine gestation with left adnexal mass- likely ectopic gestational sac. Laparoscopy showed a left tubal pregnancy and salpingectomy was done. The postoperative period was uneventful and she was discharged with a single live intrauterine gestation of 6-7 weeks. She carried on with her pregnancy and delivered a healthy baby at term. The diagnosis is possible only in cases when there is a high index of suspicion by the treating clinician. The adnexa must be inspected carefully in the confirmatory ultrasound. The early timely diagnosis gives a good maternal outcome and hence crucial in the management.

Author(s):  
Vipul R. Khandagale

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.


Medicina ◽  
2020 ◽  
Vol 56 (8) ◽  
pp. 365 ◽  
Author(s):  
Miglė Černiauskaitė ◽  
Brigita Vaigauskaitė ◽  
Diana Ramašauskaitė ◽  
Mindaugas Šilkūnas

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.


Author(s):  
Tamer Ali ◽  
Mohamed A. Tawab ◽  
Mona Abdel Ghaffar ElHariri ◽  
Alaa A. Ayad

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.


Author(s):  
Shikha Sharma ◽  
Anu Bala Chandel ◽  
Anupam Sharma ◽  
Aditi Ranaut

Heterotopic pregnancy is defined as multiple gestation in which intrauterine and extrauterine gestational sacs co-exist. The extra uterine gestational sac is most commonly tubal ectopic pregnancy. We presented case of a 26 years old multigravida who presented to emergency with complaints of pain abdomen and giddiness for 2-3 days. She was at period of gestation (POG) 7 weeks and on clinical examination patient was anxious with mild pallor, mildly tachycardiac and blood pressure (BP) was 90/60 mm of Hg. After thorough clinical examination and sonography diagnosis of heterotopic pregnancy with ruptured tubal ectopic was made. She was taken up for Emergency laparotomy after investigations and consent. Left salpingectomy was done and she was discharged with a single intrauterine live pregnancy on 6th post op day. For early detection of cases of heterotopic pregnancy careful evaluation of adnexa is mandatory in early gestation scan.


2021 ◽  
Vol 6 (3) ◽  

Heterotopic gestation is very rare in natural conception but can be common with assisted reproductive techniques; a high index of suspicion can help in timely diagnosis and appropriate intervention. We report a case of heterotopic pregnancy in a 32-year-old woman presented with hemoperitoneum from ruptured right sided tubal pregnancy with live intrauterine gestation at 12 weeks of amenorrhea, diagnosed on clinical and ultrasound examination.


2014 ◽  
Vol 7 (2) ◽  
pp. 40-42 ◽  
Author(s):  
B Sharma

We report a combined intra-uterine and ruptured tubal pregnancy following ovulation induction by clomiphene citrate(CC).She was a 35 year old multigravida who presented with a ruptured tubal pregnancy and underwent right salphingectomy. Three months later, she presented with amenorrhea from the time of operation and an intra-uterine pregnancy was confirmed. Previous ultrasound at her initial presentation, did not reveal an intra-uterine pregnancy. The second ultrasound dating indicated that the intra-uterine conception had occurred before the tubal pregnancy was diagnosed. Therefore, a high index of suspicion for heterotopic pregnancy is needed in woman taking ovulation inducing drugs. DOI: http://www.dx.doi.org/10.3126/njog.v7i2.11142   Nepal Journal of Obstetrics and Gynaecology / Vol 7 / No. 2 / Issue 14 / July-Dec, 2012 / 40-42


2020 ◽  
Vol 0 ◽  
pp. 1-4
Author(s):  
Sunita Dubey ◽  
Aayushi Kaushal

Heterotopic gestation is an uncommon entity with natural conception; however, rising trends have been seen with the use of artificial reproductive techniques. We are reporting a case of 22-year-old G3P1A1L1 who presented to us at 9 weeks of gestation with complaints of mild pain in the left adnexa from 3 days. Subsequently, her pain was increased in intensity and spread over to whole abdomen. She was referred with the left adnexal mass with persistent pain abdomen. On admission, ultrasound revealed single live intrauterine fetus with the left adnexal mass with fetal node along with hemoperitoneum. She underwent laparotomy and successfully managed with the left side salpingectomy along with blood transfusion. Later, she delivered a healthy baby at term. Ectopic pregnancy should be the first differential diagnosis when no other cause suspected in patients with adnexal mass. Follow-up ultrasound should be done in patients with persistent and localized pain in abdomen even in spontaneous conception. Diagnostic laparoscopy may be the reasonable option to make a final diagnosis as beta-human chorionic gonadotropin is not a reliable test to diagnose ectopic pregnancy in heterotopic pregnancy.


2020 ◽  
Vol 30 (5) ◽  
pp. 82-84
Author(s):  
Ilja Skalskis

Hirschsprung disease (HD) is a developmental disorder characterized by the absence of ganglia in the distal colon, resulting in a functional obstruction. Incidence of total colonic aganglionosis (TCA) is 1 in 500 000 and it accounts for 5-10% of all cases of HD. HD should be suspected in patients with typical clinical symptoms and a high index of suspicion is appropriate for infants with a predisposing condition such as Down Syndrome (DS), or for those with a family history of HD. The treatment of choice for HD is surgical, such as Swenson, Soave, and Duhamel procedures. The goals are to resect the affected segment of the colon, bring the normal ganglionic bowel down close to the anus, and preserve internal anal sphincter function. We present a clinical case report of TCA in a child with Down syndrome (DS) and review of literature.


Medicina ◽  
2021 ◽  
Vol 57 (5) ◽  
pp. 483
Author(s):  
Brîndușa Cimpoca ◽  
Amira Moldoveanu ◽  
Nicolae Gică ◽  
Corina Gică ◽  
Anca Marina Ciobanu ◽  
...  

Heterotopic pregnancy is the condition where both intrauterine and ectopic pregnancy are present. It rarely occurs after natural conception, but is more common with assisted reproductive techniques, when more than one embryo is transferred. Quadruplet heterotopic pregnancy is exceedingly rare. Methods: A literature review was conducted aiming to highlight the diagnosis difficulties and the management options in heterotopic quadruplet pregnancies. Results: Nine relevant studies were identified by researching PubMed up to 2021 for “heterotopic quadruplet pregnancy”, “quadruplet intrauterine and ectopic pregnancy”, “synchronous intrauterine and ectopic pregnancy”. Conclusions: In this paper, we present a case of heterotopic quadruplet pregnancy and address the difficulty in diagnosing this condition and make formal recommendations.


Author(s):  
B. Ouafidi ◽  
H. Kiram ◽  
H. Benaguida ◽  
A. Lamrissi ◽  
K. Fichtali ◽  
...  

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