Clinical analysis of 50 patients with heterotopic pregnancy after ovulation induction or embryo transfer

Zaigui Wu,Ping Xu,Xinmei Zhang,Xiufeng Huang

doi:10.1186/s40001-018-0316-y

Abstract

ObjectivesThe purpose of this study was to evaluate the clinical characteristics, prenatal diagnosis, and management of patients with heterotopic pregnancy after ovulation induction or embryo transfer.MethodsThis was a retrospective study of fifty cases with heterotopic pregnancy, in which the fertilization way, type and number of embryo transferred, gestational age, clinical presentation and outcome of intrauterine, ultrasound presentation and site of ectopic pregnancy, bilateral fallopian tube and treatment were evaluated.ResultsSix patients had spontaneous pregnancy and two had artificial insemination after ovulation induction. Sixteen had fresh and nineteen had frozen embryo transfer with seven patients unrecorded its embryo type and number. The average days from transplantation (or intercourse/insemination) to diagnosing heterotopic pregnancy was thirty-seven with the earliest eighteen and the latest more than 70 days. Although the most common presentation was vaginal bleeding or abdominal pain, more than 21% was found by ultrasound and rare individuals even presented with gastrointestinal symptom which may imply ruptured EP and hemorrhagic shock. Giving proper treatment (surgery or local drug injection), the majority of them had a successful intrauterine pregnancy with only seven miscarried.ConclusionsOvulation induction or embryo transfer increased the risk of HP greatly and clinician should raise high suspicious during the whole first trimester. Although the most ectopic site was ampullary, other sites such as cornual, cervical, abdominal especially interstitial or tubal stumps should also be assessed by ultrasound even in patients with bilateral salpingectomy or tubal obstructed. Repeated ultrasound tests 2 weeks after the diagnosis of intrauterine pregnancy with heart beating was very necessary to find the missed ones in suspicious patients. Compared with surgery, embryo suction with or without proper local drug injection would be more advisable for patients with cervical, cornual, or interstitial pregnancy in order to reserve the intrauterine pregnancy.

Highlights

Heterotopic pregnancy (HP), first reported in 1708, was defined as the co-incidence of intrauterine and ectopic pregnancy
Fertilization way, gestational age at diagnosis, the ultrasound characteristics of IUP and EP, clinical symptoms, bilateral fallopian tubes, EP site, and treatments were recorded and analyzed; the results are described in Tables 1, 2, 3, 4, and 5
Coexisting with the IUP, forty-two patients had conceived with IVF-ET, two with intrauterine insemination (IUI) and the other six conceived naturally after ovulation induction

Summary

Introduction

Heterotopic pregnancy (HP), first reported in 1708, was defined as the co-incidence of intrauterine and ectopic pregnancy. It was often difficult to diagnose the HP as early as possible because large amount of them were asymptomatic or just masked by enlarged ovaries after ovulation induction [3, 4]. The clinician and sonographer should raise high suspicious of HP with patients transplanting multiple embryos or having ovulation induction. The traditional salpingectomy may be still practicable to HP patients with tubal pregnancy, but for special types such as cornual and interstitial pregnancy the conventional management with salpingectomy and cornual resection should no longer be the first choice. To a certain extent, could relieve the risk of uterine rupture during the subsequent pregnancy

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