Transvaginal aspiration for treatment of heterotopic pregnancy:a report of 4 cases

Abstract

Objective To investigate the value and application of transvaginal aspiration for treatment of heterotopic pregnancy(HP). Methods Four cases of HP managed by ultrasound-guided transvaginal aspiration were selected from all pregnancies by IVF-ET between January 2004 and December 2009 at Reproductive Center of the Third Affiliated Hospital of Guangzhou Medical College. The indications, optimal timing, treatment and pregnancy outcomes of transvaginal aspiration in these four cases were studied. Results The four cases of HP managed by transvaginal aspiration were all intrauterine pregnancy complicated with tube pregnancy. Cardiac activity was detected both in the extrauterine and intrauterine embryos of four patients. Three were treated by transvaginal aspiration of ectopic embryos. Two of them were managed on days 42 and 43 of pregnancy respectively, and both had successful full-term delivery. One was treated on day 68 but laparotomy was necessitated due to tube rupture 4 hours later. Spontaneous abortion ensued 4 days after operation. The fourth patient was managed by ultrasound-guided transvaginal aspiration and injection of 2 ml of 50% glucose solution on day 50, and she had uneventful term delivery. Conclusion Ultrasound-guided transvaginal aspiration is an option for early HP patients (less than 8 weeks) without pregnant tube rupture and intraperitoneal hemorrhage, in whom long-term follow-up can be ensured. Key words: Heterotopic pregnancy; Punctures, vaginal; Embryo transfer; Insemination, artificial; Indication