The Challenge in Diagnosing and Managing Heterotopic Interstitial Pregnancy in Natural Conception

Bahiyah Abdullah,Darminder Singh Chopra,Noor Azura Noor Mohamad,Sun Ta Thow,Suzanna Daud

doi:10.24191/jchs.v4i2.7514

Abstract

Heterotopic interstitial pregnancy in natural conception is very rare. Definitive diagnosis is made by systematic pelvic ultrasound. Simultaneous viable conception observed in both intra- and extra-uterine is pathognomonic of heterotopic interstitial pregnancy. We report a 34-year-old woman primigravida at 10 weeks’ amenorrhoea who underwent evacuation of retained product of conception for missed miscarriage. Intraoperatively, minimal product of conception was retrieved. Bedside pelvic ultrasound showed cystic mass at right superolateral part of uterine fundus suspicious of interstitial pregnancy. Cornual resection was performed via laparotomy. Histopathological examination showed presence of product of conception and interstitial pregnancy. Serum β-human chorionic gonadotropin dropped from 10,027 IU/l on day one post-ERPC to 210 IU/l at day three post-cornual resection. This case report highlighted the challenge in diagnosing heterotopic interstitial pregnancy conceived naturally. Timely diagnosis may avert dire consequences of massive haemorrhage from ruptured uterine cornua.

Highlights

Heterotopic interstitial pregnancy (HIP) is a diagnosis made when both intrauterine and extrauterine interstitial pregnancy coexist [1]
The maternal death occurs as a result of massive haemorrhage due to ruptured intramyometrial arcuate vasculature that supply the cornua of uterus occupied by the late diagnosed interstitial pregnancy [4, 9]
In the analysis of 55 cases diagnosed as heterotopic pregnancy, the symptoms of abdominal pain and/or per vaginal bleeding was observed to appear before day 27 post-embryo transfer in in-vitro fertilisation in 83% of the patient, with onset of symptoms detected the earliest at 5.8 weeks’ gestation [11]

Summary

INTRODUCTION

Heterotopic interstitial pregnancy (HIP) is a diagnosis made when both intrauterine and extrauterine interstitial pregnancy coexist [1]. In the analysis of 55 cases diagnosed as heterotopic pregnancy, the symptoms of abdominal pain and/or per vaginal bleeding was observed to appear before day 27 post-embryo transfer in in-vitro fertilisation in 83% of the patient, with onset of symptoms detected the earliest at 5.8 weeks’ gestation [11]. Crown-rump length measurement in consistent with 7 weeks of gestation and no fetal cardiac activity (Figure 1) She agreed for conservative management given the miscarriage process had started. The crown-rump length miscarriage at early pregnancy assessment unit with measurement was of 7 weeks’ gestation with no visible fetal cardiac activity. The patient made good recovery at six weeks follow-up

DISCUSSION

CONCLUSION

Findings

Conflict of Interest Authors declare none