Should Expectant Management of Heterotopic Pregnancy be Considered?

Abstract

<h3>Study Objective</h3> To compare expectant versus interventional management of Heterotopic pregnancies. <h3>Design</h3> A retrospective cohort study, from January 2011 to December 2020. <h3>Setting</h3> Single tertiary care center. <h3>Patients or Participants</h3> All women diagnosed with heterotopic pregnancy on ultrasound examination during the study period. <h3>Interventions</h3> Data were collected from women's' medical files including demographic, laboratory and ultrasound findings, management of heterotopic pregnancy, intrauterine pregnancy, follow up and delivery characteristics. Expectant and interventional management outcomes were compared. Data are presented as median and interquartile range. <h3>Measurements and Main Results</h3> Forty-one women were diagnosed with heterotopic pregnancy during the study period, of them 73.2% (n=30) following IVF treatment. Abdominal pain was the most frequent presenting symptom (n=25.6%). Ectopic pregnancy was diagnosed in the fallopian tubes in 36 (87.8%) of the women. Management was expectant in 10 (24.4%) and interventional in 31(75.6%) of the women. Expectant management was considered when patient was stable, and ectopic pregnancy did not continue to develop. Interventions included laparoscopic salpingectomy (n=26), laparoscopic cornual resection (n=2), laparotomic cornual resection (n=1) and gestational sac aspiration (n=2). Ongoing intra-uterine pregnancy was achieved in 6 (60%) and 77%(n=17) of the women in the expectant and interventional groups, respectively. All of the women managed expectantly reached term delivery, as opposed to 22 (71.0%) in the intervention management group (p=0.60). Multivariate analysis including: Age, vaginal bleeding, BHCG and management treatment, found BHCG as the only independent parameter associated with ongoing pregnancy rate (p=0.04). <h3>Conclusion</h3> Both expectant and interventional management were found to be acceptable when heterotopic pregnancy is diagnosed with high ongoing intra-uterine pregnancy rate and term deliveries. BHCG was found as the only independent parameter associated with the ongoing rate.