scholarly journals Early diagnosis and surgical management of heterotopic pregnancy allows us to save the intrauterine pregnancy

2021 ◽  
Author(s):  
Gaspare Cucinella ◽  
Giuseppe Gullo ◽  
Andrea Etrusco ◽  
Erika Dolce ◽  
Silvia Culmone ◽  
...  
Keyword(s):  
Early Diagnosis ◽  
Surgical Management ◽  
Heterotopic Pregnancy ◽  
Intrauterine Pregnancy

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 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.

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

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.

Spontaneous heterotopic triplet pregnancy with intrauterine monochorionic-monoamnionic twins

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.

scholarly journals Post-traumatic bronchobiliary fistula

2019 ◽  
Vol 12 (4) ◽  
pp. e228294 ◽  
Author(s):  
Niladri Banerjee ◽  
Amulya Rattan ◽  
Pratyusha Priyadarshini ◽  
Subodh Kumar
Keyword(s):  
Early Diagnosis ◽  
Surgical Management ◽  
Gold Standard ◽  
Complete Recovery ◽  
Rare Entity ◽  
Bronchobiliary Fistula ◽  
Confirmatory Tests ◽  
Post Traumatic ◽  
Torso Trauma ◽  
Individualised Treatment

Post-traumatic bronchobiliary fistula (BBF) is a rare entity, with only a few cases reported worldwide. Bilioptysis is pathognomonic of the condition, however, bronchoscopy and bronchoalveolar lavage along with CT are used for confirmation. We describe this condition in a young woman who presented to us with bilioptysis following a laparotomy for blunt torso trauma. Diagnosis was made of BBF, followed by surgical management and complete recovery. We emphasise the signs of early diagnosis, confirmatory tests, individualised treatment and advocate surgical management as the gold standard of treatment.

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 Laparoscopic management of heterotopic pregnancy in an IVF conception

2018 ◽  
Vol 7 (3) ◽  
pp. 1255 ◽  
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.

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

Medicina ◽  
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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