Heterotopic pregnancy with suspicion of superfetation after the intrauterine insemination cycle with ovulation induction using clomiphene citrate: A case report.

Ayumu Ito,Rika Hayashi,Kazuko Shimai,Kentaro Nakaoka,Kenji Takahashi,Masahito Nakakuma,Takamasa Furukawa,Tadashi Namihira,Sadanori Kasai

doi:10.4081/cp.2019.1129

Ayumu Ito, Rika Hayashi + Show 7 more

Open Access

https://doi.org/10.4081/cp.2019.1129

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Abstract

At 22 days after intrauterine insemination with ovulation induction using clomiphene citrate at a previous hospital, a 30-year-old woman was admitted to our hospital owing to right lower quadrant abdominal pain. We diagnosed threatened abortion because of a gestational sac in the uterus on transvaginal ultrasonography. The next day, she complained of increased abdominal pain. Transvaginal ultrasonography revealed a gestational sac-like structure in the echo free space. She was diagnosed with heterotopic pregnancy due to a ruptured right tubal pregnancy, underwent laparoscopic right salpingectomy. Rupture of a gestational age of 5 weeks is extremely rare. If this was a case of a heterotopic pregnancy due to superfetation, it could be explained as this clinical course. When a pregnant woman develops abdominal pain, heterotopic pregnancies should not be excluded from the differential diagnosis, and the possibility of superfetation should be taken into consideration.

Highlights

Superfetation refers to the simultaneous pregnancy of two fetuses of different gestational ages due to the occurrence of ovulation, fertilization, and implantation during a pre-existing pregnancy
Clomiphene citrate wad administered to the patient for ovulation induction prior to intrauterine insemination (IUI)
The patient was diagnosed with heterotopic pregnancy due to a ruptured right tubal pregnancy, which was surgically managed by laparoscopic right salpingectomy on the same day

Summary

Introduction

Superfetation refers to the simultaneous pregnancy of two fetuses of different gestational ages due to the occurrence of ovulation, fertilization, and implantation during a pre-existing pregnancy. The heterotopic pregnancy was likely due to superfetation, occurring after the establishment of an ectopic tubal pregnancy during the preceding untreated self-timing cycle This case report includes a review of the literature. At 22 days after this treatment, the patient was admitted to the emergency unit at our hospital owing to abdominal pain at the right lower quadrant Because of her positive pregnancy test result, she was referred to our department for medical consultaion. The serum hCG level was 6447.55 mIU/mL Based on these findings, the patient was diagnosed with heterotopic pregnancy due to a ruptured right tubal pregnancy, which was surgically managed by laparoscopic right salpingectomy on the same day. The intrauterine gestational sac corresponded to a gestational age of 5 weeks and 2 days, suggesting that intrauterine pregnancy very likely resulted from the IUI that we performed. Known to occur in various animals, superfetation has been rarely reported in humans.[1,2,3] Altough heterotopic pregnancies

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