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

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.

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Heterotopic Pregnancy After In Vitro Fertilization Ending with a Successful Term Labor, a Case Report

Gene Cell and Tissue ◽

10.5812/gct.114142 ◽

2021 ◽

Vol In Press (In Press) ◽

Author(s):

Somayeh Livani ◽

Alireza Fatemi

Keyword(s):

Abdominal Pain ◽

Case Report ◽

In Vitro Fertilization ◽

Vaginal Bleeding ◽

Inflammatory Diseases ◽

Medical Center ◽

Heterotopic Pregnancy ◽

Normal Delivery ◽

Vitro Fertilization

Introduction: Heterotopic pregnancy is defined as the simultaneous presence of intrauterine and ectopic pregnancies, manifesting with abdominal pain and vaginal bleeding. Previous tubal surgeries and pelvic inflammatory diseases increase the risk of this anomaly. In this case report, heterotopic pregnancy after in vitro fertilization (IVF) in an 18-year-old female was reported. Case Presentation: An 18-year-old female was referred to our medical center, presenting with abdominal pain and vaginal bleeding. She had IVF pregnancy seven weeks ago without a history of any other illness or consuming a specific drug. According to ultrasound results, heterotopic pregnancy was diagnosed. Therefore, we decided to perform the salpingectomy and laparotomy of the fetus. The patient had a normal delivery via cesarean section at term (the 38th week of pregnancy). The patient remained stable without any further referral for the mentioned condition. Conclusions: Due to the importance of heterotopic pregnancy and its prevalence among women using fertility procedures and assisted reproduction techniques (such as IVF), even in the presence of a gestational sac containing yolk sac and after the detection of the embryo in the endometrium cavity, the adnexa should be well checked to rule out heterotopic pregnancy to obviate the risk of abortion and other fatal outcomes.

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A rare case of heterotopic pregnancy: an avalanche of catastrophe

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20204837 ◽

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.

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

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20195372 ◽

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.

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