Abstract
Heterotopic pregnancy (HP) is defined as the simultaneous development of an intra- and an extra uterine gestation. The occurrence of a spontaneous triplet HP is an exceptionally rare medical condition. We report the case of a young woman with spontaneous heterotopic triplets at 8 weeks of gestation, with a misdiagnosis of topic twins and acute appendicitis. The ectopic tubal pregnancy was ruptured and a salpingectomy was performed by laparotomy. The intrauterine pregnancy progressed uneventfully. The two healthy babies were delivery by cesarean section at 36 ± 2 weeks of gestation. Heterotopic triplets with ruptured tubal ectopic pregnancy represent a special diagnostic and therapeutic challenge for the obstetrician. A high rate of clinical suspicion and timely treatment by laparotomy or laparoscopy can preserve the intrauterine gestation with a successful outcome of the pregnancy.
Highlights
Heterotopic pregnancy (HP) is a rare medical condition in obstetrics
We report the case of a young woman with spontaneous heterotopic triplets at 8 weeks of gestation, with a misdiagnosis of topic twins and acute appendicitis
The incidence of HP nowadays is estimated around 1:7,0002 to 1:15,000 live births (0/8% calculated risk) in contrast with the lower incidence of 1:30,000 in 1948.4 The higher incidence of HP in patients under assisted reproduction techniques (ART) programs is attributed to multiple ovulation, higher incidence of pelvic inflammatory disease (PID) observed currently, and tubal damage related or not to transfer of many embryos.[1,5]
Summary
Heterotopic pregnancy (HP) is a rare medical condition in obstetrics. It is characterized by the presence of coexistent intrauterine and ectopic pregnancies. Heterotopic triplets are even more uncommon, and cases with tubal ectopic and coexisting twin intrauterine pregnancy are limited. This medical condition can be hazardous to the intrauterine pregnancy as well as to the life of the mother. We present the case of a ruptured right tubal pregnancy, referred as acute abdomen in a patient pregnant with intrauterine twins and suspected acute appendicitis. The aim of this paper is to emphasize the need for high clinical suspicion of this clinical entity during the routine first trimester ultrasound examination, even in the presence of an intrauterine multiple gestation and especially when predisposing factors such as in vitro fertilization (IVF) are present
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