Heterotopic Pregnancy

Abstract

Review the clinical presentation, diagnosis, and minimally invasive management of heterotopic pregnancy. Case Report and Clinical Review. University-affiliated Non-Profit Physician Organization. Second trimester IVF patient presenting with an acute abdomen. Laparoscopic treatment of ruptured second trimester ectopic pregnancy as a component of heterotopic pregnancy. Heterotopic pregnancy, in which two gestations coexist at two different locations- usually an ectopic tubal pregnancy with a simultaneous intrauterine pregnancy, occurs naturally in one out of every 30,000 pregnancies. The incidence is considerably higher in pregnancies conceived with Assisted Reproductive Technology, estimated at 1.5 of every 1000 ART pregnancies. In recent years the overall incidence of heterotopic pregnancy in the United States has risen to 1:3900. A case report of a second trimester heterotopic IVF pregnancy with tubal rupture is herein described, managed laparoscopically with maternal preservation but an ultimate adverse outcome for the surviving intrauterine twin. The diagnosis of heterotopic pregnancy is reviewed and management options discussed. Heterotopic pregnancy presents a diagnostic challenge for clinicians and consequently is often diagnosed at a more advanced gestational age, not infrequently with tubal rupture and maternal hemodynamic instability. Because of the serious potential consequences for maternal and neonatal health, the possibility of heterotopic pregnancy should be considered with high risk pregnancies. The ART pregnancy should be identified as such when requesting ultrasound studies, and the ultrasonographer should carefully screen the pelvis for a concomitant ectopic gestation. Once the diagnosis of heterotopic pregnancy is made or strongly suspected, intervention should be as timely and minimally invasive as possible, to protect the coexisting intrauterine pregnancy and prevent serious maternal morbidity.