A case of heterotopic pregnancy with intrauterine and cervical pregnancy coexisting: intrasacular KCl injection, intrauterine pregnancy being preserved, and then massive bleeding at 32 weeks

Failure of implantation with the formation of heterotopic pregnancy is, unfortunately, continues to accompany the IVF. This may be due to the inability of the impact on endometrial receptivity. Changing characteristics of endometrial receptivity in conducting IVF determines the probability of formation of this kind of complications. The lack of standards for the conduct of heterotopic uterine and cervical pregnancy include the woman to the group at high risk for bleeding, a subsequent hysterectomy and loss of fertility. Promptly detection of ectopic localization of the ovum by means of methods of ultrasonic diagnostics allows in some cases to carry out organ-sparing surgery. Currently, there is a need for improved approaches to preimplantation training. The article describes a clinical case of heterotopic pregnancy with successful selective reduction of cervical localization of one of the two fertilized eggs and preservation of intrauterine pregnancy.

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

10.36106/ijsr/9522431 ◽

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.

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Spontaneous heterotopic triplet pregnancy with intrauterine monochorionic-monoamnionic twins

Case Reports in Perinatal Medicine ◽

10.1515/crpm-2016-0019 ◽

2016 ◽

Vol 5 (2) ◽

pp. 117-119

Author(s):

Alexander Kotlyar ◽

Jennifer Eaton ◽

Katherine Singh ◽

Uma Perni

Keyword(s):

Abdominal Pain ◽

Assisted Reproductive Technologies ◽

Reproductive Technologies ◽

Heterotopic Pregnancy ◽

Second Trimester ◽

Triplet Pregnancy ◽

Intrauterine Pregnancy ◽

Chorionic Villi ◽

Prior Use ◽

Unusual Phenomenon

Abstract Heterotopic pregnancies are an unusual phenomenon, which have recently become more prevalent with assisted reproductive technologies (ART). Triplets that are part of a heterotopic pregnancy are exceedingly rare. Here, we describe a case of a woman who presented at 15+1 weeks of gestational age with a known monochorionic-monoamniotic intrauterine pregnancy with several days of abdominal pain with an otherwise unremarkable gastrointestinal (GI) assessment. Salpingectomy was performed, and pathology revealed chorionic villi within the fallopian tube consistent with a heterotopic triplet pregnancy. This pregnancy was conceived spontaneously. Even without the prior use of ART, physicians need to be aware of the risk of heterotopic pregnancy in a patient with a known twin gestation. In addition, this case highlights how heterotopic triplets can present even within the second trimester.

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Bilateral Simultaneous Tubal Ectopic Pregnancy with a Third Intrauterine Pregnancy: A Rare Case of Heterotopic Pregnancy

Journal of Gynecologic Surgery ◽

10.1089/gyn.2017.0140 ◽

2018 ◽

Vol 34 (6) ◽

pp. 301-303

Author(s):

Mohamed Fouad Selim ◽

Manal Mohamed Ali Abdou ◽

Ghada Al-Bahrani

Keyword(s):

Ectopic Pregnancy ◽

Rare Case ◽

Heterotopic Pregnancy ◽

Intrauterine Pregnancy ◽

Tubal Ectopic Pregnancy

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Heterotopic pregnancy: case report of a successful first trimester metacyesis management and a viable third trimester outcome

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20185448 ◽

2018 ◽

Vol 8 (1) ◽

pp. 332

Author(s):

Arvind Kumar Singh ◽

Shazia Khan

Keyword(s):

Case Report ◽

Maternal Morbidity ◽

Assisted Reproductive Technologies ◽

First Trimester ◽

Reproductive Technologies ◽

Heterotopic Pregnancy ◽

Third Trimester ◽

Intrauterine Pregnancy ◽

The Past ◽

Maternal Morbidity And Mortality

Heterotopic pregnancies are rare combined intra and extrauterine pregnancies, the incidence of which has shown an increase over the past decade with the rising trend in assisted reproductive technologies (0.75-1.5%). Authors report a case of a 29 year old primigravida, a post IVF conception who presented at 6 weeks POG with a ruptured tubal and a viable intrauterine pregnancy. She underwent an emergency laparoscopic right salpingectomy and continued with her intrauterine pregnancy successfully till term. The article emphasizes the need of scanning the adnexa carefully in early pregnancy to diagnose and manage heterotopic pregnancy as early as possible to prevent catastrophic haemorrhage and maternal morbidity and mortality later.

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Laparoscopic management of heterotopic pregnancy in an IVF conception

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20180932 ◽

2018 ◽

Vol 7 (3) ◽

pp. 1255 ◽

Cited By ~ 1

Author(s):

Nitin H. Shah ◽

Riddhi J. Shah ◽

Swapnali Kshirsagar

Keyword(s):

Minimally Invasive ◽

Spinal Anaesthesia ◽

Heterotopic Pregnancy ◽

Intrauterine Pregnancy ◽

Laparoscopic Management ◽

Reproductive Techniques ◽

Laparoscopic Salpingectomy

Heterotopic Pregnancy cases are on the rise in the era of Artificial Reproductive Techniques and managing these pregnancies can be challenging especially in safeguarding the precious intrauterine pregnancy. These were traditionally managed by laparotomy and there are few cases reported wherein salpingectomy is done laparoscopically. We would like to report this case of a 7 weeks intrauterine pregnancy with 5 weeks tubal ectopic treated by laparoscopic salpingectomy under spinal anaesthesia while safeguarding the intrauterine viable gestation. In the light of increased incidence of abnormal implantations and growing demand and expertise of minimally invasive surgeries, laparoscopy is the treatment of choice for heterotopic pregnancies, especially in the interest of the intrauterine pregnancy.

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Spontaneous heterotopic pregnancy with tubal rupture

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20175042 ◽

2017 ◽

Vol 6 (11) ◽

pp. 5148 ◽

Cited By ~ 1

Author(s):

Spandana J. C. ◽

Suresh S. Kanakannavar ◽

Umashankar K. M. ◽

Manuja N.

Keyword(s):

Maternal Morbidity ◽

Surgical Intervention ◽

Heterotopic Pregnancy ◽

Successful Outcome ◽

Intrauterine Pregnancy ◽

Pregnant Females ◽

Maternal Morbidity And Mortality ◽

Threatening Condition ◽

Life Threatening ◽

Ultrasound Assessment

Heterotopic pregnancy is the coexistence of intrauterine pregnancy (IUP) and extrauterine gestation. It is a rare and dangerous life-threatening condition that is difficult to diagnose and easily missed. The incidence in the general population is estimated to be 1 in 30,000. We report a case of a 24-year-old multigravida who was seen in the emergency department with a diagnosis of a ruptured ectopic pregnancy. A careful ultrasound assessment led to the diagnosis of a heterotopic pregnancy despite lack of any notable risk factors. Immediate surgical intervention with supportive measures resulted in a successful outcome. An obstetrician should keep in mind the occurrence of a heterotopic pregnancy while dealing with pregnant females. It also demonstrates that early diagnosis is essential in order to salvage the intrauterine pregnancy and avoid maternal morbidity and mortality.

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Spontaneous Heterotopic Pregnancy with Unaffected Intrauterine Pregnancy: Systematic Review of Clinical Outcomes

Medicina ◽

10.3390/medicina56120665 ◽

2020 ◽

Vol 56 (12) ◽

pp. 665

Author(s):

Mihaela Oancea ◽

Razvan Ciortea ◽

Doru Diculescu ◽

Alexandra-Andreea Poienar ◽

Mihaela Grigore ◽

...

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Case Reports ◽

Laparoscopic Approach ◽

Rare Condition ◽

Heterotopic Pregnancy ◽

Intrauterine Pregnancy ◽

First Semester ◽

Cochrane Reviews ◽

Reproductive Techniques

Background and objective: Spontaneous heterotopic pregnancy (SHP) is a rare condition represented by the synchronous coexistence of an intrauterine and an ectopic pregnancy. It rarely occurs with natural conception and is usually a consequence of assisted reproductive techniques. Diagnosis of SHP can be a challenge for the clinician. The evolution of the intrauterine pregnancy is dependent on many factors, such as the location of the heterotopic pregnancy, gestational age at the time of diagnosis, the surgical procedure, the presence of other risk factors, early or delayed management. The aim of this systematic review of the literature was to extract existing evidence on spontaneous heterotopic pregnancy with otherwise unaffected intrauterine pregnancy. Materials and Methods: From a total of 1907 database entries identified in PubMed, EMBASE and Cochrane reviews, we selected 18 papers for narrative synthesis, for which we explored the diagnostic options, treatment, and outcome of these extremely rare epidemiologic occurrences. Manuscripts were assessed using the CARE guidelines for reporting case reports. Results: The main symptom was abdominal pain, and the preferred treatment approach was surgical, more precisely, using a laparoscopic approach. Most cases presented no risk factors, and the diagnosis was mostly made in the first semester. Conclusions: Normal follow-up and evolution of intrauterine pregnancy have been observed regardless of surgical approach (open or laparoscopic). Early diagnosis and treatment are advised, as they impact maternal and fetal outcomes. Evidence on this topic is scarce, predominantly comprised of case reports with variable degrees of adherence to dissemination guidelines. More studies on this topic are required to optimize care protocols for this type of pregnancy.

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