EP24.19: Heterotopic pregnancy in a spontaneous pregnancy

Abstract

We describe a case in a third pregnancy, 36 years old woman with history of low ovarian reserve. One spontaneous miscarriage, 1 twin pregnancy in 2016 by IVF (egg donation) March 2017 comes to A&E department because low abdominal pain. US scan reveals 8 weeks intrauterine pregnancy (spontaneous) and 6 x 3 cm left adnexal mass suspicious of tubal pregnancy, ring Doppler colour in left ovary and free fluid in the pelvis and therefore heterotopic pregnancy diagnosis. Although the lower probability of heterotopic pregnancy in this case we perform a Laparoscopy that showed mild hemoperitoneum, left ovary mass with clots inside including left fimbriae with resto of fallopian tube almost intact. Findings that could match as well with Ruptured Corpus luteum. Pathological finding revealed chorionic velli in ovary surface so we confirmed heterotopic pregnancy. Heterotopic pregnancy are a combination of intrauterine and ectopic pregnancies, rather than two ectopic pregnancies. 90% of ectopic pregnancies occur in the fallopian tube although different location as cervix, ovary, cornual, tubal segment, abdomen or previous Caesarean scar are described. The estimated incidence of heterotopic pregnancy is rare in 1 in 30,000 pregnancies. With ART (Assisted Reproductive Techniques) the incidence is supposed to be higher in 1 in 3900 pregnancies. In our case we describe the low probability of a Heterotopic pregnancy in a non ART pregnancy and the low probability within the ectopic pregnancy to be ovaric instead of tubal one.