First trimester heterotopic pregnancy with shock treated laparoscopically, followed by uneventful term pregnancy and normal birth

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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Involvement of nephrin in human placental trophoblast syncytialization

Reproduction ◽

10.1530/rep-14-0424 ◽

2015 ◽

Vol 149 (4) ◽

pp. 339-346 ◽

Cited By ~ 4

Author(s):

Yue Li ◽

Ru Zheng ◽

Rui Wang ◽

Xiaoyin Lu ◽

Cheng Zhu ◽

...

Keyword(s):

Cell Fusion ◽

Connexin 43 ◽

Transmembrane Protein ◽

First Trimester ◽

Trophoblast Cell ◽

Term Pregnancy ◽

Fusion Model ◽

Placental Development ◽

Functional Conservation ◽

Ig Superfamily

The placenta has numerous functions, such as transporting oxygen and nutrients and building the immune tolerance of the fetus. Cell fusion is an essential process for placental development and maturation. In human placental development, mononucleated cytotrophoblast (CTB) cells can fuse to form a multinucleated syncytiotrophoblast (STB), which is the outermost layer of the placenta. Nephrin is a transmembrane protein that belongs to the Ig superfamily. Previous studies have shown that nephrin contributes to the fusion of myoblasts into myotubes in zebrafish and mice, presenting a functional conservation with its Drosophila ortholog sticks and stones. However, whether nephrin is involved in trophoblast syncytialization remains unclear. In this study, we report that nephrin was localized predominantly in the CTB cells and STB of human placenta villi from first trimester to term pregnancy. Using a spontaneous fusion model of primary CTB cells, the expression of nephrin was found to be increased during trophoblast cell fusion. Moreover, the spontaneous syncytialization and the expression of syncytin 2, connexin 43, and human chorionic gonadotropin beta were significantly inhibited by nephrin-specific siRNAs. The above results demonstrate that nephrin plays an important role in trophoblast syncytialization.

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Heterotopic Pregnancy: Successful Management by Laparoscopic Salpingectomy in First Trimester and Continuation of Intrauterine Pregnancy until Term.

World Journal of Laparoscopic Surgery with DVD ◽

10.5005/jp-journals-10033-1323 ◽

2017 ◽

Vol 10 (3) ◽

pp. 139-141

Author(s):

Rajendra Shitole ◽

Sharankumar Kavalgi ◽

Hemant Deshpande

Keyword(s):

First Trimester ◽

Heterotopic Pregnancy ◽

Successful Management ◽

Intrauterine Pregnancy ◽

Laparoscopic Salpingectomy

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Diagnosis of Heterotopic Pregnancy Using Ultrasound and Magnetic Resonance Imaging in the First Trimester of Pregnancy: A Case Report

Case Reports in Radiology ◽

10.1155/2012/317592 ◽

2012 ◽

Vol 2012 ◽

pp. 1-3 ◽

Cited By ~ 2

Author(s):

Sue Yazaki Sun ◽

Edward Araujo Júnior ◽

Julio Elito Júnior ◽

Liliam Cristine Rolo ◽

Felipe Favorette Campanharo ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Power Doppler ◽

Uterine Cavity ◽

Lower Abdominal Pain ◽

First Trimester ◽

Heterotopic Pregnancy ◽

Resonance Imaging ◽

Good Continuation ◽

Intrauterine Pregnancy

Heterotopic pregnancy is a condition characterized by implantation of one or more viable embryos into the uterine cavity while another one is implanted ectopically, particularly into the uterine tube. Its occurrence has increased drastically over the last few years due to assisted reproduction procedures. In general, the diagnosis is made during the first trimester by using endovaginal two-dimensional ultrasound (2DUS), through observing a complex para- or retrouterine mass in association with a viable uterine pregnancy. However, under some conditions such as atypical ultrasonographic presentations, 2DUS does not clarify the situation whereas magnetic resonance imaging (MRI) of the pelvis is able to do so. We present the case of a pregnant woman in her fifth pregnancy, with a clinical condition of lower abdominal pain and pallor. Endovaginal 2DUS showed a complex voluminous mass in the left pelvic region in association with a viable intrauterine pregnancy. 2DUS in power Doppler mode showed “ring” vascularization, compatible with an ectopic gestational sac. MRI was of great importance in that it suggested that the mass had hematic content, which together with the clinical features, indicated that laparotomy should be performed. This surgical choice was essential for the woman to achieve a clinical improvement and for good continuation of the intrauterine pregnancy.

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Cervical Twin Heterotopic Pregnancy: Overview of Ectopic Pregnancies and Scanning Detection Algorithm

Medicina ◽

10.3390/medicina57090969 ◽

2021 ◽

Vol 57 (9) ◽

pp. 969

Author(s):

Antonios Koutras ◽

Zacharias Fasoulakis ◽

Michail Diakosavvas ◽

Athanasios Syllaios ◽

Athanasios Pagkalos ◽

...

Keyword(s):

Ectopic Pregnancy ◽

Uterine Cavity ◽

Medical Abortion ◽

First Trimester ◽

Detection Algorithm ◽

Heterotopic Pregnancy ◽

Cervical Canal ◽

Mortality And Morbidity ◽

Gestational Sac ◽

Ectopic Pregnancies

Background: Ectopic pregnancy is the leading cause of gestation-related deaths during the first trimester. Cervical twin heterotopic pregnancies, when ectopic, constitute a small and rare part of gynecological surgery. Case Presentation: A 30-year-old pregnant woman (gravida 3, para 2) presented with mild pain in the lower abdomen and traces of bleeding per vaginum for three days. Transvaginal ultrasonography revealed a balloon-shaped cervical canal with a visible gestational sac measuring 3.5 × 3.9 cm. A second gestational sac was seen in the uterine cavity. The measurements of the gestational sacs corresponded to 7 + 4 weeks’ pregnancy. A decision for medical abortion with mifepristone and misoprostol was made. However, due to an incomplete abortion and continuous bleeding, a curettage was performed. Conclusions: Spontaneous heterotopic pregnancy with the ectopic pregnancy located in the cervix is an extremely rare clinical condition requiring urgent treatment in order to reduce maternal mortality and morbidity and preserve fertility.

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TO STUDY THE CONSEQUENCES OF TEENAGE PREGNANCY- MATERNAL AND PERINATAL OUTCOME IN TERTIARY CARE CENTER

10.36106/5100956 ◽

2021 ◽

pp. 22-25

Author(s):

Yogesh Thawal ◽

Meenal M. Patvekar ◽

Prashant Suryarao ◽

Dipak Suresh Kolate ◽

Shayari Jain ◽

...

Keyword(s):

Birth Weight ◽

Teenage Pregnancy ◽

Post Partum ◽

Care Center ◽

Tertiary Care ◽

First Trimester ◽

Tertiary Care Center ◽

College Hospital ◽

Live Births ◽

Normal Birth

Background: Teenage pregnancies are associated with high degree of maternal and neonatal complications. As many adolescents are neither physically nor psychologically ready for pregnancy or childbirth, this reproductive event makes them more vulnerable to complications resulting in devastating health sequences for them. Objectives: Our objective is to study feto-maternal outcomes in teenage pregnancy for betterment of society & for abetting economic burden on country. This observational Materials & Methods: study was done over 2 years at our tertiary care center - Dr DY Patil Medical College, Hospital and Research Institute, Pimpri, Pune. A total of 205 participants were included in the study after obtaining informed consent from the patients who satised the inclusion of age more than or equal to 18 years and lesser than 20 years. Operative interventions like D&E Results : , LSCS were increased in teenage pregnancies with emergency LSCS in 36.58% of the participants. First trimester & Antepartum complications were common in teenage pregnancies. Even Intrapartum & Post partum complications were contributed signicantly to feto-maternal morbidity & mortality . 54.04% had low birth weight and only 40.91% had normal birth weight. A total 64 NICU admissions were needed from 193 live births. Of these 12 expired in early neonatal period (<7 days) whereas 7 expired between 7 to 28 days. Among those who survived, almost 40 % had perinatal hypoxia. There were 96.98% live births whereas 3.01% IUD. Conclusion : Teenage pregnancy is a condition which gives rise to further complications and affects both the maternal as well as the neonatal health. Hence it is important that at every level of the society there is awareness regarding sexual education, use of contraceptives and the ill effects of teenage pregnancy.

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Double Trouble: Heterotopic Pregnancy

Journal of SAFOG with DVD ◽

10.5005/jp-journals-10006-1298 ◽

2014 ◽

Vol 6 (3) ◽

pp. 167-170

Author(s):

Shruthi Krishnamoorthy ◽

G Usha Rani ◽

O Syamala ◽

Rukshana LNU ◽

Naveen Alexander

Keyword(s):

Ectopic Pregnancy ◽

Assisted Reproductive Technology ◽

South Asian ◽

Surgical Intervention ◽

Case Series ◽

First Trimester ◽

Reproductive Technology ◽

Heterotopic Pregnancy ◽

Life Threatening ◽

Threatening Situation

ABSTRACT A heterotopic pregnancy is defined as the presence of a combined intrauterine and ectopic pregnancy. Its estimated incidence is as between 1/7000 and 1/30,000 pregnancies. It is also reported to be as high as 1% after the use of assisted reproductive technology. Heterotopic pregnancies are diagnostic and therapeutic challenges for obstetricians. If they continue without diagnosis, a life-threatening situation may occur even when timely surgical intervention with laparotomy is performed. Here, we report a case series of three patients having three different scenarios, who were diagnosed with heterotopic pregnancies in the first trimester and managed successfully. How to cite this article Krishnamoorthy S, Rani GU, Syamala O, Rukshana, Alexander N. Double Trouble: Heterotopic Pregnancy J South Asian Feder Obst Gynae 2014;6(3):167-170.

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Heterotopic pregnancy: a case report

Egyptian Journal of Radiology and Nuclear Medicine ◽

10.1186/s43055-020-00325-9 ◽

2020 ◽

Vol 51 (1) ◽

Author(s):

Tamer Ali ◽

Mohamed A. Tawab ◽

Mona Abdel Ghaffar ElHariri ◽

Alaa A. Ayad

Keyword(s):

Abdominal Pain ◽

Adnexal Mass ◽

Stable Condition ◽

Lower Abdominal Pain ◽

Rare Condition ◽

First Trimester ◽

Heterotopic Pregnancy ◽

Intrauterine Pregnancy ◽

Laboratory Findings ◽

The Right

Abstract Background Heterotopic pregnancy describes the occurrence of two pregnancies in different implantation sites simultaneously, which is rare, yet it is a challenge to diagnose such a problem due to complex clinical and laboratory findings. In the current study, we present a case of first trimester heterotopic pregnancy diagnosed by ultrasound (US) and magnetic resonance imaging (MRI) and was managed successfully. Case presentation A 22-year-old primigravida lady with spontaneous pregnancy was presented by increasing lower abdominal pain for 5 days with brownish vaginal discharge, nausea, and vomiting episodes. Trans-abdominal and endovaginal ultrasound was performed and revealed a viable intrauterine pregnancy of 8 weeks and 1 day, associated with a heterogeneous complex right adnexal mass. MR imaging revealed a right adnexal mass intimately anterior to the normal right ovary. Laparascopy was done; it revealed a distended right fallopian tube with pregnancy while the right ovary was not seen (impeded in the pouch of Douglas), and right salpingectomy was done. The specimen was sent for histopathology. The patient tolerated the procedure well and was then taken to the recovery room in stable condition. The histopathological report confirmed the diagnosis of ectopic pregnancy. Conclusion However, heterotopic is a rare condition, any pregnant woman presenting with alarming abdominal pain and adnexal abnormality; heterotopic pregnancy should be among the differential diagnosis possibilities. The patient should be thoroughly investigated using ultrasound and MRI if needed, to exclude this rare diagnosis and allow on-time proper management.

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