HETEROTOPIC PREGNANCY – CASE REPORT

Heterotopic pregnancy is the simultaneous occurrence of intrauterine and ectopic pregnancy. This situation is very rare (1:30 000 pregnancies), while recently, with the development of assisted reproductive techniques, the incidence has increased to 1:100 – 1:500 pregnancies. The aim of the study is to present the situation of coexistence of intrauterine pregnancy and ruptured tubal pregnancy. The case concerns a 32-year-old patient in the 12th week of the second pregnancy in whom the only risk factor was the state after Caesarean section and thus possible intraperitoneal adhesions. The ultrasound revealed normal intrauterine pregnancy and a very large amount of free fluid in the smaller pelvis. After immediate surgical intervention, a ruptured right tubal pregnancy was found. Right fallopian tube was removed. After the operation, the patient with the preserved intrauterine pregnancy was discharged from the ward. Further intrauterine pregnancy was normal. Delivery by Caesarean section. Conclusions: The described case indicates that the existence of intrauterine pregnancy does not exclude the existence of ectopic pregnancy and emphasizes the great importance of correctly and accurately carried out ultrasound examination in the first trimester of pregnancy along with appendicitis assessment. Early diagnosis of heterotopic pregnancy reduces the risk of complications.

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Heterotopic Pregnancy: A Clinical Case Report

Bangladesh Medical Journal ◽

10.3329/bmj.v39i3.9950 ◽

1970 ◽

Vol 39 (3) ◽

Author(s):

S Chowdhury ◽

T Chowdhury

Keyword(s):

Abdominal Pain ◽

Case Report ◽

Ectopic Pregnancy ◽

Clinical Examination ◽

Clinical Case ◽

Lower Abdominal Pain ◽

Tubal Pregnancy ◽

Heterotopic Pregnancy ◽

Intrauterine Pregnancy ◽

Ectopic Pregnancies

Heterotopic pregnancy is coexistence of intrauterine and extrauterine pregnancies that is ectopic pregnancies. It is said to be rare. Here we report a case of 27 years old woman with heterotopic pregnancy. Patient had a typical presentation of severe lower abdominal pain following amenorrhoea for 2½ months. On clinical examination, there was suspicion of ectopic pregnancy but ultrasonography revealed early intrauterine pregnancy along with right tubal pregnancy with huge collection in abdomen . Immediate laparotomy was done and diagnosis was confirmed as a case of heterotopic pregnancy.DOI: http://dx.doi.org/10.3329/bmj.v39i3.9950 BMJ 2010; 39(3)

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Cornual Heterotopic Pregnancy after Bilateral Salpingectomy and Uterine Septum Resection Resulting in Term Delivery of a Healthy Infant

Case Reports in Obstetrics and Gynecology ◽

10.1155/2014/157030 ◽

2014 ◽

Vol 2014 ◽

pp. 1-3 ◽

Cited By ~ 2

Author(s):

Serkan Oral ◽

Yaşam Kemal Akpak ◽

Nilay Karaca ◽

Ali Babacan ◽

Kadir Savan

Keyword(s):

Ectopic Pregnancy ◽

Transvaginal Ultrasound ◽

Uterine Cavity ◽

Heterotopic Pregnancy ◽

Simultaneous Occurrence ◽

Free Fluid ◽

Uterine Septum ◽

Bilateral Salpingectomy ◽

Live Fetus

Heterotopic pregnancy is the simultaneous occurrence of two or more implantation sites. A 25-year-old infertile patient with a history of bilateral salpingectomy, uterine septum resection, and left cornual resection was diagnosed with heterotopic pregnancy in her secondin vitrofertilization trial. She attended our clinic when she was 7-week pregnant, complaining initially of severe abdominal pain. Findings associated with peritoneal irritation were positive during the physical examination. Transvaginal ultrasound revealed right cornual ectopic pregnancy with a live fetus in the middle of the uterine cavity. Also free fluid was noted in the pelvis. A diagnosis of heterotopic pregnancy with rupture of the cornual pregnancy was made. She underwent emergency laparoscopy with aspiration of the ruptured ectopic pregnancy, suturing to the entire visible cornual margins, and assurance of good haemostasis. Her recovery was uneventful and she continued receiving care in our obstetric unit. She delivered a healthy newborn by cesarean section at term.

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A Case of Heterotopic Pregnancy

Chattagram Maa-O-Shishu Hospital Medical College Journal ◽

10.3329/cmoshmcj.v14i1.22888 ◽

2015 ◽

Vol 14 (1) ◽

pp. 64-66 ◽

Cited By ~ 1

Author(s):

Kaberi Majumder ◽

Anisul Moula

Keyword(s):

Ectopic Pregnancy ◽

Ultrasound Examination ◽

Clinical Suspicion ◽

Heterotopic Pregnancy ◽

Free Fluid ◽

Intrauterine Pregnancy ◽

Sense Of Security ◽

Risk Of Rupture ◽

False Sense ◽

Gestational Sac

We are presenting a case report of heterotopic pregnancy, which is diagnosed during ultrasound examination of a gravid woman, 23 year old, referred from outpatient department. Heterotopic pregnancy is a rare obstetrics phenomenon and carries a significant natural morbidity and mortality due to risk of rupture of the ectopic pregnancy. Clinicians and sonographers may fall into a false sense of security when an intrauterine gestational sac is identified. This results in inadequate inspection of the adnexae and remaining structures during ultrasonography despite a strong initial clinical suspicion of ectopic pregnancy. Hence, a thorough ultrasonographic examination is needed in managing these patients, especially when there is a high suspicion of ectopic pregnancy or in the presence of pelvic free fluid even when an intrauterine pregnancy is identified. DOI: http://dx.doi.org/10.3329/cmoshmcj.v14i1.22888 Chatt Maa Shi Hosp Med Coll J; Vol.14 (1); Jan 2015; Page 64-66

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A unique case of diagnosis of a heterotopic pregnancy at 26 weeks – case report and literature review

BMC Pregnancy and Childbirth ◽

10.1186/s12884-020-03465-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Anna Kajdy ◽

Katarzyna Muzyka-Placzyńska ◽

Dagmara Filipecka-Tyczka ◽

Jan Modzelewski ◽

Marek Stańczyk ◽

...

Keyword(s):

Gestational Age ◽

Abdominal Cavity ◽

Uterine Cavity ◽

Rare Condition ◽

Exploratory Laparotomy ◽

First Trimester ◽

Heterotopic Pregnancy ◽

Free Fluid ◽

Intrauterine Pregnancy ◽

Unique Case

Abstract Background Heterotopic pregnancy (HP) is a rare condition when at least two pregnancies are present simultaneously at different implantation sites and only one located in the uterine cavity. The majority of cases are diagnosed in the first trimester. Case presentation We present a unique case of HP diagnosed at 26 weeks of spontaneous pregnancy in a patient without any relevant risk factors. We performed an extensive review of HP cases from MEDLINE (PUBMED) published in English between 2005-2019 to prove this case's uniqueness. A 24-year-old woman presented because of threatened preterm birth. Despite treatment, pain aggravated, without progression of labor. An emergency ultrasound exam revealed free fluid in the abdominal cavity. Suspicion of active bleeding prompted the medical team to perform an exploratory laparotomy. The surgery team found a ruptured heterotopic pregnancy. This was an unexpected cause of nontraumatic hemoperitoneum at such advanced gestational age. The postoperative period was uneventful, and the intrauterine pregnancy continued to term. The final review included 86 out of 124 records. A total number of 509 cases were identified, but not all of them had complete data. The maximum reported gestational age at the time of diagnosis was 16 weeks of pregnancy, while our case became symptomatic and was diagnosed at 26 weeks of pregnancy. Conclusions Regardless of pregnancy age, HP can be a cause of hemoperitoneum, and it should be included in the differential diagnosis of acute abdomen in the second trimester.

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

EMJ Reproductive Health ◽

10.33590/emjreprohealth/21-00145 ◽

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.

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A rare case of spontaneous heterotopic pregnancy with successful pregnancy outcome following laparoscopic management of coexisting ruptured tubal pregnancy in Non-ART set up

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20182381 ◽

2018 ◽

Vol 7 (6) ◽

pp. 2515

Author(s):

G. D. Maiti ◽

Tony Jose ◽

Shilpa Gupta ◽

Vibhu Chatterjee

Keyword(s):

Pregnancy Outcome ◽

Rare Case ◽

First Trimester ◽

Tubal Pregnancy ◽

Heterotopic Pregnancy ◽

Intrauterine Pregnancy ◽

Successful Pregnancy ◽

Tubal Ectopic Pregnancy ◽

Set Up ◽

Laparoscopic Salpingectomy

Heterotopic pregnancy is a rare clinical condition where both intrauterine (IU) and extra uterine pregnancy coexists. In a non-ART set up diagnosis of tubal ectopic pregnancy becomes challenging and difficult with coexisting intrauterine viable pregnancy, even when presents with ruptured form. Author is presenting one of his challenging experience in managing successfully such type of heterotopic ruptured tubal pregnancy in first trimester where extra uterine ruptured tubal pregnancy was addressed by laparoscopic salpingectomy under spinal anaesthesia with minimal uterine manipulation to continue intrauterine pregnancy till term and thus had a successful pregnancy outcome.

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A Ruptured Spontaneous Heterotopic Tubal Pregnancy With a Viable Intrauterine Pregnancy

International Journal of Women’s Health Care ◽

10.33140/ijwhc.02.02.07 ◽

2017 ◽

Vol 2 (2) ◽

Keyword(s):

United States ◽

Cesarean Section ◽

Ectopic Pregnancy ◽

Fallopian Tube ◽

Peritoneal Cavity ◽

First Trimester ◽

The United States ◽

Tubal Pregnancy ◽

Intrauterine Pregnancy ◽

Ectopic Pregnancies

An ectopic pregnancy is a pregnancy located outside of the intrauterine cavity.They comprise 1-2% of all first trimester pregnancies and 6% of pregnancy related deaths in the United States [1]. Ectopic pregnancies most commonly occur in the fallopian tube but can also implant in other locations, including the ovaries, peritoneal cavity, cesarean section scars and the cervix [2].

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A Ruptured Spontaneous Heterotopic Tubal Pregnancy With a Viable Intrauterine Pregnancy

International Journal of Women’s Health Care ◽

10.33140/ijwhc/02.02.09 ◽

2017 ◽

Vol 2 (2) ◽

Keyword(s):

United States ◽

Cesarean Section ◽

Ectopic Pregnancy ◽

Fallopian Tube ◽

Peritoneal Cavity ◽

First Trimester ◽

The United States ◽

Tubal Pregnancy ◽

Intrauterine Pregnancy ◽

Ectopic Pregnancies

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Successful Outcome of Spontaneously Conceived Heterotopic Pregnancy masquerading Ovarian Torsion

Journal of SAFOG with DVD ◽

10.5005/jp-journals-10006-1459 ◽

2017 ◽

Vol 9 (1) ◽

pp. 60-62

Author(s):

Sunesh Kumar ◽

Kallol K Roy ◽

Juhi Bharti ◽

Richa Vatsa ◽

Jyoti Meena ◽

...

Keyword(s):

High Risk ◽

Ectopic Pregnancy ◽

Rare Condition ◽

Ovarian Torsion ◽

Heterotopic Pregnancy ◽

Successful Outcome ◽

Inflammatory Cell Infiltrate ◽

Free Fluid ◽

Intrauterine Pregnancy ◽

Assisted Reproductive Technique

ABSTRACT Aim To sensitize clinicians regarding possibility of heterotopic pregnancy even in spontaneous conceptions. Background Though heterotopic pregnancy is a rare condition, its incidence is rising, which varies from one in 8,000 to 30,000, more in assisted reproductive technique conceptions. It is being commonly misdiagnosed. Here, we present a case of heterotopic pregnancy after spontaneous conception, diagnosis of which was confused with ovarian torsion. Case Report A 31-year-old second gravid para one with one living issue at 12 week 6 day period of gestation presented to emergency with acute-onset pain in right lower abdomen for 3 days. On examination, an ovarian tumor with ascitis with probable torsion was suspected along with intrauterine pregnancy. These findings were further supported by similar ultrasound picture. Patient was taken up for laparotomy. Intraoperative finding was suggestive of heterotopic pregnancy with ruptured left tubal ectopic pregnancy. Left salpingectomy was done with minimal uterine manipulation. Histopathology showed blood clots, hyalinized villi, and acute inflammatory cell infiltrate suggestive of ectopic pregnancy. Ultrasonography (USG) done in the postoperative period showed viable intrauterine pregnancy. The patient is currently following with us and is in her second trimester of pregnancy. Conclusion Heterotopic pregnancy is a diagnostic and therapeutic challenge; a high index of suspicion is required. It is important for clinicians to see adnexal in detail even if intrauterine pregnancy has been seen clearly during USG, especially in high-risk cases. Clinical significance Heterotopic pregnancies can occur even in the absence of high-risk factors. In patients with intrauterine pregnancy, who present with adnexal mass with free fluid in abdomen, clinicians should keep their mind open for possible diagnosis of heterotopic pregnancy. Early diagnosis and surgical management will decrease maternal morbidity and increase chances of survival of intrauterine pregnancy. How to cite this article Vatsa R, Meena J, Kumar S, Zangmo R, Bharti J, Roy KK. Successful Outcome of Spontaneously Conceived Heterotopic Pregnancy masquerading Ovarian Torsion. J South Asian Feder Obst Gynae 2017;9(1):60-62.

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Role of Serum β-HCG doubling in Diagnosis of Early Pregnancy and its Management Strategy

Current Women s Health Reviews ◽

10.2174/1573404816999200905140919 ◽

2020 ◽

Vol 16 ◽

Author(s):

Divya Mirji ◽

Shubha Rao ◽

Akhila Vasudeva ◽

Roopa P.S

Keyword(s):

Ectopic Pregnancy ◽

Early Pregnancy ◽

Management Strategy ◽

Transvaginal Ultrasound ◽

Expectant Management ◽

First Trimester ◽

Intrauterine Pregnancy ◽

Β Hcg ◽

Pregnancy Of Unknown Location

Background: Pregnancy of unknown location (PUL) is defined as the absence of intrauterine or extrauterine sac and Beta Human Chorionic Gonadotropin levels (β-HCG) above the discriminatory zone of 1500 mIU/ml. It should be noted that PUL is not always an ectopic; however, by measuring the trends of serum β-HCG, we can determine the outcome of a PUL. Objective: This study aims to identify the various trends β-HCG levels in early pregnancy and evaluate the role of β-HCG in the management strategy. Methods: We conducted a prospective observational study of pregnant women suspected with early pregnancy. Cases were classified as having a pregnancy of unknown location (PUL) by transvaginal ultrasound and ß-HCG greater than 1000 mIU/ml. Expectant management was done until there was a definite outcome. All the collected data were analyzed by employing the chi-square test using SPSS version 20. Results: Among 1200 women who had early first trimester scans, 70 women who fulfilled our criteria of PUL and ß-HCG > 1000 mIU/ml were recruited in this study. In our study, the mean age of the participants was 30±5.6yrs, and the overall mean serum ß-HCG was 3030±522 mIU/ml. The most common outcome observed was an ectopic pregnancy, 47% in our study. We also found the rate of failing pregnancy was 27%, and that of intrauterine pregnancy (IUP) was 25%. Overall, in PUL patients diagnosed with ectopic pregnancy, 9% behaved like IUP, and 4% had an atypical trend in their ß-HCG. Those who had an IUP, 11% had a suboptimal increase in ß-HCG. Conclusion: PUL rate in our unit was 6%. Majority of the outcome of PUL was ectopic in our study. Every case of PUL should be managed based on the initial ß-HCG values, clinical assessments and upon the consent of the patient.

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