Abstract
Case of heterotopic quadruplet pregnancy with coexistence of tubal and intrauterine twins. Objective (s): To present the case heterotopic quadruplet pregnancy with coexistence of tubal and intrauterine twins and its successful surgical management with brief literature review. Design: A case report supplemented with brief literature review and discussion. Setting: City clinical university hospital. Patient (s): Heterotopic quadruplet pregnancy with tubal and intrauterine twins in a 31-year-old woman after natural conception. Intervention (s): Laparoscopy, adhesiolisys, aspiration of tubal embryos through tubotomy and cervical dilatation and vacuum aspiration of intrauterine embryos as well as vaginal and intraoperative laparoscopic ultrasound examination. Main outcome measure (s): Physical examination, laparoscopy and postsurgical hCG serum assay, as well as preintra- and postoperative vaginal ultrasound and intraoperative laparoscopic sonography. Result (s): Successful diagnosis and treatment of a case of heterotopic quadruplet pregnancy with coexistence of tubal and intrauterine twins in a 31-year-old woman with 6 artificial abortions, pelvic inflammatory diseases and periadnexal adhesions, after natural conception was described. An intraoperative laparoscopic sonography was applied to complete diagnosis of heterotopic pregnancy with coexistence of tubal and intrauterine twins after control of bleeding and stabilization of patient condition due to necessity to perform an emergency surgery. The case was supplemented with a brief review of literature and discussion. Conclusion (s): A unique case of heterotopic quadruplet pregnancy with coexistence of tubal and intrauterine twins after natural conception was presented in the first time.
Highlights
An increasing prevalence of Ectopic Pregnancies (EPs) is a rise concern, due to widespread application of the state-of-the art Assisted Reproductive Technologies (ARTs)
There are other risk factors of EP development, including sexually transmitted and pelvic inflammatory diseases (PIDs), specially adnexitis and salpingitis with formation of hydrosalpings, intraperitoneal and periadnexal adhesions and partial occlusion of Fallopian Tubes (FTs), as well as gynaecological surgical procedures, which may lead to tubal dysfunction and ectopic embryo implantation [1]
Heterotopic Pregnancy (HP) were removed by salpingotomy in the right FT and by salpingectomy in left FT, whereas multiple intrauterine pregnancies were terminated with two fetuses after selective embryo reduction [3]
Summary
An increasing prevalence of Ectopic Pregnancies (EPs) is a rise concern, due to widespread application of the state-of-the art Assisted Reproductive Technologies (ARTs). An increased prevalence of multiple pregnancies during conception after stimulated ovulation is multiplying risk of Heterotopic Pregnancy (HP), when ectopic and intrauterine pregnancies are simultaneously coexisted. A case of combined tubal and intrauterine pregnancies was reported by Varras et al [2] in a 28-year-old woman after Natural Conception (NC), when an emergency Laparotomy (LT) with tubectomy was performed due to 1.5 liter haemoperitoneum. Bettocchi et al [3] described a case report of simultaneous bilateral tubal pregnancies and intrauterine pregnancy with five embryos in 28-year-old women after stimulation of ovulation with gonadotropins and NC. A case of combined triplet HP with twin tubal and singlet intrauterine pregnancies after NC was reported by Simsek et al [4] in 37-year-old patient. Jibodu and Darne [5] presented a case of combined tubal and intrauterine singleton pregnancies in a 29-yearold woman after NC
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