Heterotopic Pregnancy in a Natural Conception

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.

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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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SPONTANEOUS HETEROTOPIC PREGNANCY WITH UNSTABLE VITALS: A CASE REPORT

10.36106/gjra/7401260 ◽

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!

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

BMJ Case Reports ◽

10.1136/bcr-2020-239178 ◽

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.

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Spontaneously conceived 17-week heterotopic pregnancy: a challenging and unusual diagnosis

BMJ Case Reports ◽

10.1136/bcr-2016-215489 ◽

2021 ◽

Vol 14 (3) ◽

pp. e215489

Author(s):

Sara de Oliveira ◽

Michal Yaron ◽

Patrick Dällenbach

Keyword(s):

Urinary Tract Infection ◽

Abdominal Pain ◽

Abdominal Ultrasound ◽

Heterotopic Pregnancy ◽

Emergency Unit ◽

Oral Antibiotics ◽

Adnexal Torsion ◽

Blood Tests ◽

Emergency Laparoscopy ◽

Life Threatening

A 37-year-old woman, gravida 2 para 1, arrived in our emergency clinic at 16 2/7 weeks of a spontaneously conceived pregnancy for abdominal pain. She was on oral antibiotics for 2 days to treat a suspected urinary tract infection with no improvement. Blood tests, abdominal ultrasound and intrauterine fetus were all normal. She left our emergency unit with laxatives. Four days later, she returned to our clinic with severe abdominal pain. We repeated abdominal and foetal ultrasonography and identified a left para-uterine 7×5 cm mass. As adnexal torsion was suspected, we performed an emergency laparoscopy. At laparoscopy, we found a left haematosalpinx and realised a left salpingectomy. Histology confirmed the presence of a heterotopic pregnancy (HP). This case illustrates the importance of exploring the adnexa in a gravid woman presenting with abdominal pain in the first and early second trimesters. Although rare, excluding a HP may prevent a life-threatening haemorrhage.

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

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh1208511s ◽

2012 ◽

Vol 140 (7-8) ◽

pp. 511-514 ◽

Cited By ~ 3

Author(s):

Radmila Sparic ◽

Snezana Buzadzic ◽

Rajka Argirovic ◽

Danijela Bratic ◽

Darko Plecas

Keyword(s):

Abdominal Pain ◽

In Vitro Fertilization ◽

Ectopic Pregnancy ◽

Transvaginal Ultrasound ◽

Reproductive Age ◽

Heterotopic Pregnancy ◽

Vitro Fertilization ◽

Life Threatening ◽

In Pregnancy

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; case report

National Journal of Research in Ayurved Science ◽

10.52482/ayurlog.v7i05.425 ◽

2019 ◽

Vol 7 (05) ◽

Author(s):

Vipul R. Khandagale

Keyword(s):

Risk Factors ◽

Ectopic Pregnancy ◽

Adnexal Mass ◽

Heterotopic Pregnancy ◽

Free Fluid ◽

Threatening Condition ◽

Life Threatening ◽

Ectopic Pregnancies ◽

High Index Of Suspicion ◽

Low Risk Women

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.

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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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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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A rare case report: heterotopic pregnancy with ovarian ectopic pregnancy

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20180928 ◽

2018 ◽

Vol 7 (3) ◽

pp. 1243

Author(s):

Manuja N. ◽

Ashok Devoor ◽

Umashankar .

Keyword(s):

Ectopic Pregnancy ◽

Rare Case ◽

Heterotopic Pregnancy ◽

Missed Abortion ◽

Extrauterine Pregnancy ◽

Pain Abdomen ◽

Rare Case Report ◽

Reproductive Techniques ◽

Natural Conception ◽

High Index Of Suspicion

Heterotopic Pregnancy(HP) is defined as the occurrence of intrauterine and extrauterine pregnancy simultaneously. Incidence varies from 1 in 8000 to 30,000 natural conceptions. HP is common with artificial reproductive techniques and is very rare in natural conception. A high index of suspicion is helpful in diagnosis and appropriate management. We report a case of HP in a 28-year-old woman presented with 2 and half months amenorrhoea, pain abdomen and bleeding per vagina with TAS showing intra uterine single missed abortion and ovarian ectopic pregnancy.

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