Management of a Rare Case of Post IVF Triplet Ectopic Pregnancy Post Bilateral Tubal Occlusion

Poonam Mishra

doi:10.31031/igrwh.2018.02.000537

Abstract

Incidence of ectopic pregnancy after Invitro fertilization and embryo transfer (IVF-ET) in patients with prior bilateral tubal occlusion is negligible and if it occurs, it happens at unusual sites which are both difficult to diagnose as well as to treat. The possibility of early uterine rupture with life threatening haemorrhage is very high in such cases, therefore treatment of these pregnancies often require hysterectomy as a life saving measure. Our case of triplet lives ectopic pregnancy followed embryo transfer of three blastocysts. She had undergone laparoscopic bilateral proximal tubal occlusion 5 years ago. In this case, trans-abdominal ultrasound guided suction evacuation was attempted unsuccessfully. Hysteroscopy followed, which confirmed normal endometrial cavity with no gestational sac within it. Post adhesiolysis and bowel dissection, left sided cornual bulge was seen suggestive of left isthmic pregnancy. Putrescin was injected, incision made, products evacuated, and hemostatic sutures applied.

Highlights

Incidence of ectopic pregnancy after Invitro fertilization and embryo transfer (IVF-ET) in patients with prior bilateral tubal occlusion is negligible, yet it can occur at the isthmic stump, cornual or angle of uterus
The possibility of early uterine rupture with life threatening haemorrhage is very high in such cases, treatment of these pregnancies often require hysterectomy as a life saving measure
We hereby report a case of triplet live ectopic pregnancy of 6 weeks 5 days gestational age with beta human chorionic gonadotropin more than 200000 units (2sacs in right cornual and 1 in left isthmus) following embryo transfer of three blastocysts (Figure 1)

Summary

Introduction

Incidence of ectopic pregnancy after Invitro fertilization and embryo transfer (IVF-ET) in patients with prior bilateral tubal occlusion is negligible, yet it can occur at the isthmic stump, cornual or angle of uterus. We hereby report a case of triplet live ectopic pregnancy of 6 weeks 5 days gestational age with beta human chorionic gonadotropin (βhCG) more than 200000 units (2sacs in right cornual and 1 in left isthmus) following embryo transfer of three blastocysts (Figure 1). This patient had undergone laparoscopic bilateral proximal tubal occlusion 5 years ago for bilateral hydrosalpinx with frozen pelvis. While de-roofing hydrosalpinx from the angle of uterus, products of conception were seen to extrude from posterior side of the uterine musculature at the angular area, which were evacuated, and hemostatic sutures applied.

Discussion

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Conclusion