SPONTANEOUS HETEROTOPIC PREGNANCY WITH UNSTABLE VITALS: A CASE REPORT

2021 ◽  
pp. 35-36
Author(s):  
Anshika Agarwal
Keyword(s):  
Early Diagnosis ◽  
Vaginal Bleeding ◽  
Clinical Symptoms ◽  
Transvaginal Ultrasound ◽  
Heterotopic Pregnancy ◽  
Intrauterine Pregnancy ◽  
Spontaneous Conception ◽  
Beta Hcg ◽  
Maternal Morbidity And Mortality ◽  
Life Threatening

A spontaneous heterotopic pregnancy is a rare obstetric entity which can be life threatening if early diagnosis is missed. There is co-existing intra uterine and extra uterine pregnancy, most often tubal and rarely cervical or ovarian. It is extremely rare in spontaneous conception but incidence is increasing with the use of ART’s. Early diagnosis is difcult probably because of the lacking clinical symptoms. It usually presents as a ruptured ectopic pregnancy. Timely diagnosis and intervention is of utmost importance to prevent maternal morbidity and mortality. Abdominal pain, swelling, peritoneal irritation, enlarged uterus, vaginal bleeding, pallor, tachycardia, features of shock may be a few presenting features. With the advances in technology, transvaginal ultrasound proves to be a great diagnostic tool in early diagnosis of heterotopic pregnancy. Serum beta-hcg levels is of importance. Intervention can be medical or surgical depending on the hemodynamic condition of the patient and the viability of the intrauterine pregnancy. Heterotopic pregnancy is an unusual diagnosis and so is often ignored in the presence of an intrauterine pregnancy. But as it can prove to be life threatening so its diagnosis as a differential should always be kept in mind. Early diagnosis and prompt and effective treatment can save a life or two!

scholarly journals Spontaneous heterotopic pregnancy with tubal rupture

2017 ◽  
Vol 6 (11) ◽  
pp. 5148 ◽  
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.

scholarly journals Heterotopic Pregnancy in a Natural Conception

2010 ◽  
Vol 1 (1) ◽  
pp. 41-43 ◽  
Author(s):  
Sumeet N Baheti ◽  
K Jayakrishnan
Keyword(s):  
Abdominal Pain ◽  
Hemorrhagic Shock ◽  
Transvaginal Ultrasound ◽  
Heterotopic Pregnancy ◽  
Intrauterine Pregnancy ◽  
Abnormal Pregnancy ◽  
Emergency Laparoscopy ◽  
Life Threatening ◽  
Natural Conception ◽  
High Index Of Suspicion

ABSTRACT Heterotopic pregnancy is rare in natural conception and most often presents as life threatening emergency like acute abdomen and hemorrhagic shock. In early unruptured stages, it presents nonspecifically, mimicking normal or abnormal pregnancy manifestations. A high index of suspicion and a definitive search for it even after confirming normal intrauterine gestation is needed. This little effort ensures a timely diagnosis and management thus preventing catastrophe. We hereby report a primigravida with unruptured heterotopic pregnancy following a natural conception, who presented as nonspecific abdominal pain. Transvaginal ultrasound was inconclusive. Emergency laparoscopy clinched the diagnosis and allowed conservative salpingostomy and continuation of intrauterine pregnancy.

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.

Acute abdomen or life-threatening heterotopic pregnancy with tubal rupture: where does imaging play a role?

2020 ◽  
Vol 13 (12) ◽  
pp. e239178
Author(s):  
Mark Kong ◽  
Kethesparan Paramesparan ◽  
Chhaya Keshvala ◽  
Amit Shah
Keyword(s):  
Transvaginal Ultrasound ◽  
Iliac Fossa ◽  
Heterotopic Pregnancy ◽  
Intrauterine Pregnancy ◽  
Contrast Resolution ◽  
Assisted Reproduction Techniques ◽  
Tissue Contrast ◽  
Life Threatening ◽  
Right Iliac Fossa Pain ◽  
Magnetic Resonance Imaging Mri

Heterotopic pregnancy (HP) is a rare, potentially life-threatening complication of an intrauterine pregnancy with a simultaneous ectopic pregnancy. There is a higher incidence with assisted reproduction techniques (ART) and radiology can be pivotal in its diagnosis. A 28-year-old woman underwent ART and at 7 weeks’ gestation presented with acute right iliac fossa pain. Transvaginal ultrasound (US) imaging confirmed a viable intrauterine pregnancy. The patients’ pain persisted however, and transabdominal US demonstrated a complex, heterogeneous right adnexal mass. Subsequent magnetic resonance imaging (MRI) confirmed an HP with a ruptured ectopic and haemoperitoneum. Emergency laparoscopic surgery and right salpingo-oopherectomy were performed without complication. We highlight the importance of considering HP as a diagnosis in the acute gravid abdomen, especially when initial investigations have confirmed a viable intrauterine pregnancy. Furthermore, this case highlights MRI as a useful modality in complex cases due to its high soft tissue contrast resolution using non-ionising radiation.

scholarly journals Vaginal Delivery at Term in a Woman with a Spontaneous Heterotopic Pregnancy Treated with Laparoscopic Salpingectomy

2020 ◽  
Vol 2020 ◽  
pp. 1-5 ◽  
Author(s):  
Michail Diakosavvas ◽  
Nikolaos Blontzos ◽  
Georgios Daskalakis ◽  
Athanasios Protopapas ◽  
Nikolaos Kathopoulis ◽  
...  
Keyword(s):  
Ectopic Pregnancy ◽  
Vaginal Delivery ◽  
Clinical Symptoms ◽  
Lower Abdominal Pain ◽  
Major Complication ◽  
Heterotopic Pregnancy ◽  
Clinical Image ◽  
Intrauterine Pregnancy ◽  
Beta Hcg ◽  
Laparoscopic Salpingectomy

Background. The coexistence of an intrauterine pregnancy and an ectopic pregnancy (heterotopic pregnancy) is an extremely rare, yet major, complication during pregnancy. The early diagnosis of a heterotopic pregnancy is of great importance for fetal viability, maternal safety, and the progression of an uncomplicated intrauterine pregnancy. Case Presentation. We report a case of a naturally conceived heterotopic tubal pregnancy in a 37-year-old primigravida. The patient presented with continuous, dull, lower abdominal pain and a positive urine pregnancy test which was conducted a week prior to the start of the pain. The patient was hospitalized, and based on the clinical image and after strict monitoring, she was diagnosed with a heterotopic pregnancy. She was treated with laparoscopic salpingectomy after the rupture of the ectopic pregnancy while the desired intrauterine gestation continued without any complications. The pregnancy resulted in the birth of a healthy infant through vaginal delivery. Discussion. Strict monitoring with multiple sonographic evaluations should always be conducted in women with abnormal serum beta-hCG, adnexal abnormalities, or clinical symptoms, while heterotopic pregnancy should be in differential diagnosis and treatment should not be delayed since emerge management is important for the progression of the intrauterine pregnancy.

scholarly journals Heterotopic Pregnancy after In Vitro Fertilisation and Embryo Transfer Post-unilateral Salpingectomy: A Case Report and Literature Review

2022 ◽  
Author(s):  
Arjola Agolli ◽  
Hanyou Loh ◽  
Olsi Agolli
Keyword(s):  
Embryo Transfer ◽  
Clinical Symptoms ◽  
Transvaginal Ultrasound ◽  
Reproductive Age ◽  
Heterotopic Pregnancy ◽  
In Vitro Fertilisation ◽  
Simultaneous Occurrence ◽  
Intrauterine Pregnancy ◽  
Reproductive Techniques

Heterotopic pregnancy (HP) is the simultaneous occurrence of intrauterine and ectopic pregnancies (EP). The incidence of HPs occurring spontaneously ranges from 1 in 10,000 to 1 in 30,000. However, this incidence is reported to be 1 in 100 pregnancies following artificial reproductive techniques. HP is a potentially life-threatening condition that is frequently misdiagnosed, as most diagnoses for HPs are delayed, and are only made after rupture of the EP. A high index of suspicion is, therefore, required for an accurate and timely diagnosis in order to reduce maternal morbidity and mortality, which currently stands at 1 in 200,000 live births. The most common risk factors include pelvic inflammatory disease, previous EP, assisted reproduction techniques, and ovarian hyperstimulation syndrome. Transvaginal ultrasound is the gold standard for diagnosis. As detection of an intrauterine pregnancy often leads to the mistaken exclusion of a concomitant EP, a careful transvaginal scanning of the uterus and appendages should be performed in all females of reproductive age with a positive pregnancy test and red flags in anamnesis, and/or with clinical symptoms. Routine transvaginal ultrasound at Day 27 after embryo transfer could facilitate the diagnosis of HP; however, symptoms onset before or after Day 27 are clues to early diagnosis. MRI can be very helpful in diagnosing atypical cases.

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.

Uterine Arterio-Venous Malformation: A Rare Post Mortem Finding in a Young Female

2021 ◽  
Vol 11 (11) ◽  
pp. 130-133
Author(s):  
Sumiti Gupta ◽  
Renuka Verma ◽  
Rajnish Kalra
Keyword(s):  
Vaginal Bleeding ◽  
Venous Malformation ◽  
Young Female ◽  
Uterine Bleeding ◽  
Post Mortem ◽  
Dysfunctional Uterine Bleeding ◽  
Maternal Morbidity And Mortality ◽  
Life Threatening ◽  
Arterio Venous Malformation ◽  
High Index Of Suspicion

Uterine arterio-venous malformation is one of the differentials of dysfunctional uterine bleeding that can result in life-threatening emergency with sudden, unexpected massive vaginal bleeding. We describe a case of 20-year old female, who presented with sudden heavy vaginal bleeding and was diagnosed with uterine arterio-venous malformation on post-mortem examination. High index of suspicion is required to make a timely diagnosis for appropriate management and to avoid maternal morbidity and mortality. Key words: Uterine arterio-venous malformations, embolization, dysfunctional uterine bleeding.

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

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.

scholarly journals Comparative study of neuroimaging features and clinical symptoms in patients with eclampsia

2021 ◽  
Vol 10 (11) ◽  
pp. 4171
Author(s):  
Neha Meena ◽  
Suman Meena ◽  
Khushbu Meena ◽  
Savitri Verma
Keyword(s):  
Ct Scan ◽  
Maternal Morbidity ◽  
Clinical Symptoms ◽  
Occipital Lobe ◽  
Study Data ◽  
Morbidity And Mortality ◽  
Computed Tomographic ◽  
High Risk Factors ◽  
Maternal Morbidity And Mortality ◽  
Life Threatening

Background: Eclampsia is a life-threatening emergency that remains a major cause for feto-maternal morbidity and mortality. The purpose of our study was to access various computed tomographic scan (CT) findings in eclampsia patients and compare neurological symptoms with radiological findings. Methods: A prospective analytical study was undertaken in department of obstetrics and gynecology, J. K. Lon hospital, Kota during the period of 2019-2020. Women who presented as eclampsia and admitted in indoor wards were included in the study. Data analyzed included various maternal and fetal parameters, CT scan findings and outcome of pregnancy. Results: The incidence of eclampsia was 1.1% of total deliveries. High risk factors associated with eclampsia were primigravida (70%), maternal age (70% in 21-25 years age group), illiteracy (64%), inadequate antenatal care (96%), early gestation (68%). On CT scan findings 52% patients had abnormal CT scan findings of which most common was cerebral edema (57.7%). Parieto-occipital lobe was most common region to be affected. Altered sensorium was found to be significantly associated with abnormal CT scan findings.Conclusions: Eclampsia is a major cause of fetal and maternal morbidity and mortality.  CT scan in eclampsia have significant role in early diagnosis of patients with cerebral pathologies and these CT scan findings were associated with the level of consciousness and number of convulsive episodes.  Thus, CT scan helps in further management of these patients by multidisciplinary approach.

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