Diagnosis Of Heterotopic Pregnancy Research Articles

Ultrasound manifestations and clinical analysis of 50 cases of heterotopic pregnancy.

To investigate the value of ultrasonography in the diagnosis of heterotopic pregnancy and the follow-up. A retrospective analysis of 50 cases of clinically diagnosed heterotopic pregnancy in our hospital was performed, the clinical characteristics and ultrasonographic manifestations of the patients were summarized, the reasons for initial ultrasound missed diagnosis and misdiagnosis were analyzed, and the pregnancy outcomes were followed up. Among the 50 cases, the initial ultrasound diagnoses of intrauterine pregnancy were all gestational sac type, 32 cases of ectopic pregnancy were located in the fallopian tube, and 10 cases were located in the uterine horn, 1 case at cervix, and 1 case at caesarean section scar. Forty-one cases were consistent with surgery and/or pathology, representing initial ultrasound diagnosis coincidence rate of about 82%. Six cases were missed in the initial ultrasound examination (12%), and three cases were misdiagnosed (6%). The maximum diameter of the intrauterine gestational sac was 9-48 mm, the average was about 24.90 ± 9.56 mm, the maximum diameter of the ectopic pregnancy gestational sac or mass was 11-63 mm, and the average was about 31.45 ± 13.82 mm (p < 0.05). Intrauterine pregnancy outcomes were followed up, 45 patients with complete data and 5 patients were lost to follow-up. The follow-up rate was about 90%. Combining the patient's medical history and clinical characteristics can reduce missed diagnosis and misdiagnosis of heterotopic pregnancy. Ultrasonography has important value in the assessment of intrauterine pregnancy growth and development, and the integrity of maternal uterus.

Study on diagnosis and management strategies on heterotopic pregnancy: a retrospective study

Heterotopic pregnancy (HP) is a rare but potentially life-threatening event with a high risk of maternal death, which also jeopardise the coexisting intrauterine pregnancy (IUP), thus an early accurate diagnosis and prompt treatment can decrease adverse complications. We aimed to explore the early predictors for pregnancy outcomes of HP. We reviewed patients with HP following assisted reproductive technology in our institution between January 2013 and December 2020. The relationships between pregnancy outcomes and clinical features were analysed by logistic regression. We found that 29 patients (72.5%) of HP were accurately diagnosed by transvaginal ultrasonography (TVS). Eighteen patients in the surgery group had live births, three of whom delivered preterm. Additionally, the miscarriage rate was lower for patients with IUP cardiac activity than those without (16.7% vs. 90.0%, p < .001). Further by logistic regression analysis, an IUP with cardiac activity at HP diagnosis was identified as favourable independent predictor of live birth (p < .001). Therefore, early diagnosis and prompt surgical intervention are recommended to prevent the development of HP. Impact of statement What is already known on this subject? Heterotopic pregnancy (HP) has long been thought to be a rare but potentially life-threatening event with a high risk of complications. The early diagnosis of HP is challenging due to the co-existence of a viable intrauterine pregnancy (IUP) and the absence of typical clinical symptoms. What do the results of this study add? This stduy showed that symptoms combined with routine transvaginal ultrasonography (TVS) scans reduce the rates of misdiagnosis of HP and prompt surgical intervention after diagnosis may minimise the incidence of miscarriage of the IUP. What are the implications of these findings for clinical practice and/or further research? An IUP with cardiac activity at HP diagnosis is a predictor of a favourable prognosis of HP, and laparoscopy under general anaesthesia is effective and safe during the first trimester of pregnancy. Awareness, assessment and early interventions in view of symptoms combined with routine TVS is recommended to reduce the risk of miscarriage and ensure a favourable live birth rate.

Heterotopic pregnancy: Five case reports diagnosed in 2021

Introduction and importanceHeterotopic pregnancy is the occurrence of pregnancies in at least two different implantation sites in the same time. The diagnosis is one of the most difficult of the gynecological emergencies. In 2021 this pathology still underdiagnosed and remains unknown by physicians. Most patients are admitted in critical stage.Cases presentationsWe reported 5 cases of heterotopic pregnancies in symptomatic women admitted from January 2021 to December 2021, in maternity department, mother and child hospital abderrahim Harouchi, Ibn Rochd University Hospital of Casablanca. The frequency of this pathology in our hospital in 2021 is about 10% of ectopic pregnancies (5/52 cases of ectopic pregnancies). All the cases were received in critical phase of the pathology (vascular collapsus or hemodynamic shock). The mean diagnostic was suspected in gray scale ultrasound that show an intrauterine pregnancy associated with adnexal mass corresponding to hematosalpinx or gestational sac in the uterine tubes with medium to high abundance hemoperitoneum. All of our cases were treated by laparotomy in emergency after resuscitation measures.Clinical discussionThe existence of intrauterine pregnancy does not exclude an ectopic pregnancy and often confuses the physician who consults the patient in early stage of symptoms. The clinical symptomatology is often related to a threatened or ongoing abortion, the diagnosis of heterotopic pregnancy is usually made in the stage of hemoperitoneum secondary to a rupture of the ectopic pregnancy. The standard treatment is conservative surgery, preferably by laparoscopy. The manipulation of the uterus must be careful to preserve the intra uterine pregnancy. Laparotomy retains its indications especially in forms with hemorrhagic shock. The abortion is not rare after surgery. A progestin treatment is always indicated.ConclusionThe diagnosis of heterotopic pregnancy should not be delayed by the discovery of an intra-uterine gestational sac in symptomatic women and the adnexa must be systematically examined in the first trimester sonographic exam. The Diagnosis is often difficult and management should be initiated as soon as possible given the risk of maternal mortality.

Heterotopic Pregnancy after In Vitro Fertilisation and Embryo Transfer Post-unilateral Salpingectomy: A Case Report and Literature Review

Heterotopic pregnancy (HP) is the simultaneous occurrence of intrauterine and ectopic pregnancies (EP). The incidence of HPs occurring spontaneously ranges from 1 in 10,000 to 1 in 30,000. However, this incidence is reported to be 1 in 100 pregnancies following artificial reproductive techniques. HP is a potentially life-threatening condition that is frequently misdiagnosed, as most diagnoses for HPs are delayed, and are only made after rupture of the EP. A high index of suspicion is, therefore, required for an accurate and timely diagnosis in order to reduce maternal morbidity and mortality, which currently stands at 1 in 200,000 live births. The most common risk factors include pelvic inflammatory disease, previous EP, assisted reproduction techniques, and ovarian hyperstimulation syndrome. Transvaginal ultrasound is the gold standard for diagnosis. As detection of an intrauterine pregnancy often leads to the mistaken exclusion of a concomitant EP, a careful transvaginal scanning of the uterus and appendages should be performed in all females of reproductive age with a positive pregnancy test and red flags in anamnesis, and/or with clinical symptoms. Routine transvaginal ultrasound at Day 27 after embryo transfer could facilitate the diagnosis of HP; however, symptoms onset before or after Day 27 are clues to early diagnosis. MRI can be very helpful in diagnosing atypical cases.

The risk of miscarriage following surgical treatment of heterotopic extrauterine pregnancies.

STUDY QUESTIONWhat is the risk of loss of a live normally sited (eutopic) pregnancy following surgical treatment of the concomitant extrauterine ectopic pregnancy?SUMMARY ANSWERIn women diagnosed with heterotopic pregnancies, minimally invasive surgery to treat the extrauterine ectopic pregnancy does not increase the risk of miscarriage of the concomitant live eutopic pregnancy.WHAT IS KNOWN ALREADYPrevious studies have indicated that surgical treatment of the concomitant ectopic pregnancy in women with live eutopic pregnancies could be associated with an increased risk of miscarriage. The findings of our study did not confirm that.STUDY DESIGN, SIZE, DURATIONA retrospective observational case–control study of 52 women diagnosed with live eutopic and concomitant extrauterine pregnancies matched to 156 women with live normally sited singleton pregnancies. The study was carried out in three London early pregnancy units (EPUs) covering a 20-year period between April 2000 and November 2019.PARTICIPANTS/MATERIALS, SETTING, METHODSAll women attended EPUs because of suspected early pregnancy complications. The diagnosis of heterotopic pregnancy was made on ultrasound scan and women were subsequently offered surgical or expectant management.There were three controls per each case who were randomly selected from our clinical database and were matched for maternal age, mode of conception and gestational age at presentation.MAIN RESULTS AND THE ROLE OF CHANCEIn the study group 49/52 (94%) women had surgery and 3/52 (6%) were managed expectantly. There were 9/52 (17%, 95% CI 8.2–30.3) miscarriages <12 weeks’ gestation and 9/49 (18%, 95% CI 8.7–32) miscarriages in those treated surgically. In the control group, there were 28/156 (18%, 95% CI 12.2–24.8) miscarriages <12 weeks’ gestation, which was not significantly different from heterotopic pregnancies who were treated surgically [odds ratio (OR) 1.03 95% CI 0.44–2.36]. There was a further second trimester miscarriage in the study group and one in the control group. The live birth rate in the study group was 41/51 (80%, 95% CI 66.9–90.2) and 38/48 (79%, 95% CI 65–89.5) for those who were treated surgically. These results were similar to 127/156 (81%, 95% CI 74.4–87.2) live births in the control group (OR 0.87, 95% CI 0.39–1.94).LIMITATIONS, REASONS FOR CAUTIONThis study is retrospective, and the number of patients is relatively small, which reflects the rarity of heterotopic pregnancies. Heterotopic pregnancies without a known outcome were excluded from analysis.WIDER IMPLICATIONS OF THE FINDINGSThis study demonstrates that in women diagnosed with heterotopic pregnancies, minimally invasive surgery to treat the extrauterine pregnancy does not increase the risk of miscarriage of the concomitant live eutopic pregnancy. This finding will be helpful to women and their clinicians when discussing the options for treating heterotopic pregnancies.STUDY FUNDING/COMPETING INTEREST(S)This work did not receive any funding. None of the authors has any conflict of interest to declare.TRIAL REGISTRATION NUMBERResearch Registry: researchregistry6430.

LA GROSSESSE HETEROTOPIQUE: A PROPOS DUN CASET REVUE DE LA LITTERATURE

Heterotopic pregnancy is defined by the simultaneous presence of an intrauterine pregnancy (GIU) and an ectopic pregnancy (GEU) in the same patient regardless of the location of the ectopic pregnancy. It is a pathological form of bi-ovular dizygotic twin pregnancy which implanted in the uterine cavity and the other in an ectopic situation. It is rare but exceptional, of ultrasound its diagnostic difficulties remain. This frequency has sharply increased in recent years due to the development of MAP techniques and the high frequency of upper genital infections. We report a case of a 37-year-old parturient who consulted for acute pelvic pain and bleeding in a context of amenorrhea and hemodynamic instability, a heterotopic pregnancy was diagnosed by ultrasound and an urgent mini laparotomy was performed. Through this case we want to retrospectively underline the great interest of the early diagnosis of heterotopic pregnancy in order to preserve the patients subsequent fertility as well as the GIU.

Vaginal birth after laparoscopic management of heterotopic pregnancy at the Douala general hospital, Cameroon: A case report

Heterotopic pregnancy is the simultaneous presence of an intrauterine and ectopic pregnancy. The prevalence of the condition is unknown in Cameroon. We report a case of heterotopic pregnancy managed by laparoscopy. MS a 33-year-old G2P0010 woman was admitted to our department because of 7 2/7 weeks' amenorrhea, mild vaginal bleeding, and severe lower abdominal pain. She has a 6 years' history of secondary infertility, one induced abortion, and chlamydia infection treated with doxycycline. Furthermore, she has a history of left laparoscopic salpingotomy for tubo-ovarian abscess. She became pregnant after receiving clomiphene citrate and timed intercourse. Her beta hCG assay was 97000 mIU/mL and transvaginal sonography confirmed ruptured heterotopic pregnancy. She underwent laparoscopic left salpingectomy and the intrauterine pregnancy evolved normally and she gave birth to a healthy female that weighed 3050 g at 38 5/7 weeks gestation. The diagnosis of heterotopic pregnancy needs a high index of suspicion. Laparoscopic treatment of heterotopic pregnancy needs to become widespread in Cameroon.

Heterotopic pregnancy - how easily you can go wrong in diagnosing? A case study.

Introduction: Heterotopic pregnancy is a rare, but potentially life-threatening pathology. The diagnosis of heterotopic pregnancy is still one of the biggest challenges in modern gynecology. The incidence of those pregnancies in natural conception is about 1:30000. Case presentation: We present an unusual case of a heterotopic pregnancy which was misdiagnosed in the first trimester as a dichorionic twin pregnancy. At 13 weeks of gestation, the patient presented with an acute abdomen, she was diagnosed with a heterotopic pregnancy, and therefore was operated on, with the excision of the ruptured fallopian tube and the ectopic pregnancy performed. Discussion: The presence of an intrauterine pregnancy does not rule out the presence of a coexisting ectopic pregnancy. Clinicians should always keep in mind that a heterotopic pregnancy may occur in a woman of reproductive age. Careful ultrasound scan of the uterus and appendages is a must in all women of reproductive age with clinical symptoms.

Diagnosis and management of heterotopic pregnancy following embryo transfer: clinical analysis of 55 cases from a single institution.

The aims of this study were to summarize the clinical features of patients with heterotopic pregnancy (HP) following embryo transfer (ET) and explore the risk factors for miscarriage after surgery. All patients with HP following ET treated by surgery between August 2014 and August 2015 in Chongqing Health Center for Women and Children were retrospectively reviewed. Fifty-five patients were identified, including 40 with tubal HP, 9 interstitial HP and 6 cornual HP. The most frequent manifestations before diagnosis was abdominal pain (29.1%), while 19 patients (34.5%) had no symptoms before diagnosis. The sensitivity of symptoms for HP was 65.5%. Gestational age atsymptomonset of these patients with symptoms (n=36) was 5.8weeks (range 4.7-8.1). Forty-seven patients (85.5%) were suspected of HP when they received first transvaginal ultrasonography (TVS). The mean gestational age at diagnosis was 6.3weeks (range 4.7-8.3, 16-41days after ET). First TVS suggesting HP (P=0.000) and first TVS performed before day 27 (P=0.000) were two independent predictors for gestational age at diagnosis. Gestational age at surgery day was 6.7weeks (range 5.3-10.7). Fifty-one patients (92.7%) resulted in a live birth. Gestational age at surgery day was the only independent risk factor for miscarriage in patients with HP treated by laparotomy (OR 0.003, 95%CI 0.001-0.604). Routine TVS at day 27 after ET could facilitate the diagnosis of HP, symptoms onset before or after day 27 are clues to early diagnosis. Prompt surgery after diagnosis may improve the prognosis of HP following ET.

Clinical Outcomes of Patients With Heterotopic Pregnancy After Surgical Treatment

Study ObjectiveTo review the surgical management and clinical outcomes of patients with heterotopic pregnancy (HP) who underwent in vitro fertilization and embryo transfer (IVF-ET) and surgical treatment between January 2010 and December 2015. DesignRetrospective clinical analysis (Canadian Task Force classification II). SettingAssisted Reproductive Technology Center of Peking University Third Hospital. PatientsFifty-six patients with HP who underwent IVF-ET and surgical treatment between January 2010 and December 2015. InterventionsIn 56 patients, we retrospectively analyzed general characteristics, diagnostic features, surgical management, and clinical outcomes based on medical records and follow-up telephone interviews. All 56 patients had undergone transvaginal sonography on the day of admission. Fifty-four 54 patients had undergone laparoscopic surgery. Two patients with suspected heterotopic cervical pregnancy had undergone extraction with forceps and curettage under abdominal ultrasound guidance. Measurements and Main ResultsThe incidence of HP was significantly lower in frozen-thawed embryo transfer cycles compared with fresh embryo transfer cycles (29 of 13 128 [0.22%] vs 124 of 22 327 [0.56%]; p = .000). The live birth rate was 75.0% without congenital abnormalities, and the miscarriage rate was 17.86%. There were no significant differences in the rates of miscarriage (p = .08) and preterm delivery (p = .39) among different positions of heterotopic tubal pregnancy. There were no significant differences in general characteristics, diagnostic features, and intraoperative findings between the miscarriage and non-miscarriage groups, or between the preterm and term delivery groups. ConclusionThe incidence of HP has risen dramatically with the widespread application of assisted reproductive technology, and the diagnosis and management of HP remain challenging. With increased awareness of HP in patients who have undergone IVF-ET, early diagnosis and appropriate surgical treatment may lead to a favorable prognosis.

Successful Outcome of Spontaneously Conceived Heterotopic Pregnancy masquerading Ovarian Torsion

ABSTRACT Aim To sensitize clinicians regarding possibility of heterotopic pregnancy even in spontaneous conceptions. Background Though heterotopic pregnancy is a rare condition, its incidence is rising, which varies from one in 8,000 to 30,000, more in assisted reproductive technique conceptions. It is being commonly misdiagnosed. Here, we present a case of heterotopic pregnancy after spontaneous conception, diagnosis of which was confused with ovarian torsion. Case Report A 31-year-old second gravid para one with one living issue at 12 week 6 day period of gestation presented to emergency with acute-onset pain in right lower abdomen for 3 days. On examination, an ovarian tumor with ascitis with probable torsion was suspected along with intrauterine pregnancy. These findings were further supported by similar ultrasound picture. Patient was taken up for laparotomy. Intraoperative finding was suggestive of heterotopic pregnancy with ruptured left tubal ectopic pregnancy. Left salpingectomy was done with minimal uterine manipulation. Histopathology showed blood clots, hyalinized villi, and acute inflammatory cell infiltrate suggestive of ectopic pregnancy. Ultrasonography (USG) done in the postoperative period showed viable intrauterine pregnancy. The patient is currently following with us and is in her second trimester of pregnancy. Conclusion Heterotopic pregnancy is a diagnostic and therapeutic challenge; a high index of suspicion is required. It is important for clinicians to see adnexal in detail even if intrauterine pregnancy has been seen clearly during USG, especially in high-risk cases. Clinical significance Heterotopic pregnancies can occur even in the absence of high-risk factors. In patients with intrauterine pregnancy, who present with adnexal mass with free fluid in abdomen, clinicians should keep their mind open for possible diagnosis of heterotopic pregnancy. Early diagnosis and surgical management will decrease maternal morbidity and increase chances of survival of intrauterine pregnancy. How to cite this article Vatsa R, Meena J, Kumar S, Zangmo R, Bharti J, Roy KK. Successful Outcome of Spontaneously Conceived Heterotopic Pregnancy masquerading Ovarian Torsion. J South Asian Feder Obst Gynae 2017;9(1):60-62.

Successful treatment algorithm for evaluation of early pregnancy after in vitro fertilization

To evaluate a prospectively implemented clinical algorithm for early identification of ectopic pregnancy (EP) and heterotopic pregnancy (HP) after assisted reproductive technology (ART). Analysis of prospectively collected data. Academic medical center. All ART-conceived pregnancies between January 1995 and June 2013. Early pregnancy monitoring via clinical algorithm with all pregnancies screened using human chorionic gonadotropin (hCG) levels and reported symptoms, with subsequent early ultrasound evaluation if hCG levels were abnormal or if the patient reported pain or vaginal bleeding. Algorithmic efficiency for diagnosis of EP and HP and their subsequent clinical outcomes using a binary forward stepwise logistic regression model built to determine predictors of early pregnancy failure. Of the 3,904 pregnancies included, the incidence of EP and HP was 0.77% and 0.46%, respectively. The algorithm selected 96.7% and 83.3% of pregnancies diagnosed with EP and HP, respectively, for early ultrasound evaluation, leading to earlier treatment and resolution. Logistic regression revealed that first hCG, second hCG, hCG slope, age, pain, and vaginal bleeding were all independent predictors of early pregnancy failure after ART. Our clinical algorithm for early pregnancy evaluation after ART is effective for identification and prompt intervention of EP and HP without significant over- or misdiagnosis, and avoids the potential catastrophic morbidity associated with delayed diagnosis.

HETEROTOPIC PREGNANCY MISDIAGNOSED AS ACUTE APPENDICITIS

The diagnosis of heterotopic pregnancy is usually more difficult than the other obstetric emergencies, necessitating a thorough anamnesis and a high diagnostic suspicion, followed by the utilization of ultrasonography as the most valuable diagnostic tool. In this report the intraoperative finding of a heterotopic pregnancy in an adult female patient was presented while being operated by the general surgeon with the working diagnosis of acute appendicitis under emergency conditions. Key words: heterotopic pregnancy; appendicitis

Spontaneous Second Trimester Heterotopic Pregnancy

Background: A heterotopic pregnancy means the presence of an intrauterine and extrauterine pregnancy at the same time. Its incidence is ∼1/7000–1/30,000 pregnancies; however, it may reach 1% because of the use of assisted reproductive technology. The diagnosis of heterotopic pregnancy is always difficult for obstetricians. Heterotopic pregnancy could be life threatening if diagnosis is delayed. Surgical treatment through laparotomy is usually needed. Case: The case of a 24-year-old woman who had a spontaneous extra- and intrauterine pregnancy is presented. In this case, there was a delay in the diagnosis of the ectopic pregnancy, leading to emergency laparotomy. Results: The intrauterine pregnancy was not affected by the laparotomy. The patient was kept on analgesics and intravenous tocolysis for 48 hours postoperatively, and was kept in the hospital up to the 7th postoperative day. She was discharged on the 8th postoperative day. Conclusions: Heterotopic pregnancy must be considered in every patient complaining of acute abdomen, even if intrauterine pregnancy is present. Every obstetrician examining women by ultrasound in early pregnancy should examine the adnexa. Early diagnosis is highly recommended in order to save the tube and the intrauterine pregnancy. (J GYNECOL SURG 30:301)

Management and outcome of 25 heterotopic pregnancies in Zhejiang, China

ObjectiveTo characterize general attributes of women with heterotopic pregnancy (HP) in order to establish an optimal management regimen. Study designA retrospective analysis was conducted on 25 HPs recorded at the Women’s Hospital of Zhejiang University between 2007 and 2011. Data on patients’ symptoms, risk factors, diagnostic features, treatment and outcome were collected and analysed. ResultsAll patients had conceived via assisted reproductive technology (ART), 72% had a history of pelvic inflammatory disease and 68% of patients were symptomatic. Fifty-six percent of patients were diagnosed with HP via routine transvaginal ultrasound examination at approximately 6–7 weeks of gestation. Eighty percent of patients underwent surgical treatment (35% laparoscopic salpingectomy, 65% laparotomy), and 20% of patients underwent medical treatment with local injection of methotrexate (MTX) or MTX in combination with potassium chloride (KCl) into ectopic sites such as the cervix or interstitium. Eighty-eight percent of patients delivered live infants without congenital anomalies, and three patients (all of whom underwent surgical treatment) miscarried. ConclusionsRoutine transvaginal ultrasound examination at approximately 6–7 weeks of gestation could facilitate the diagnosis of HP, although repeat ultrasound is necessary to avoid misdiagnosis. Prompt diagnosis and correct treatment, including local injection of MTX or MTX in combination with KCl into various ectopic sites, led to favourable prognoses.

Cornual heterotopic pregnancy after bilateral salpingectomy and uterine septum resection resulting in term delivery of a healthy infant.

Heterotopic pregnancy is the simultaneous occurrence of two or more implantation sites. A 25-year-old infertile patient with a history of bilateral salpingectomy, uterine septum resection, and left cornual resection was diagnosed with heterotopic pregnancy in her second in vitro fertilization trial. She attended our clinic when she was 7-week pregnant, complaining initially of severe abdominal pain. Findings associated with peritoneal irritation were positive during the physical examination. Transvaginal ultrasound revealed right cornual ectopic pregnancy with a live fetus in the middle of the uterine cavity. Also free fluid was noted in the pelvis. A diagnosis of heterotopic pregnancy with rupture of the cornual pregnancy was made. She underwent emergency laparoscopy with aspiration of the ruptured ectopic pregnancy, suturing to the entire visible cornual margins, and assurance of good haemostasis. Her recovery was uneventful and she continued receiving care in our obstetric unit. She delivered a healthy newborn by cesarean section at term.

Heterotopic pregnancy after spontaneous conception

The diagnosis of heterotopic pregnancy (co-existing intrauterine and extrauterine pregnancy) remains one of the most important challenges in early pregnancy care.The incidence with natural concepti...

Value of transvaginal sonography in diagnosing heterotopic pregnancy after in‐vitro fertilization with embryo transfer

To assess the value of transvaginal sonography (TVS) in the diagnosis of heterotopic pregnancy (HP) in the first trimester after in-vitro fertilization with embryo transfer (IVF-ET). This was a retrospective review of women undergoing IVF-ET between January 2005 and December 2011. Women were diagnosed with an HP using TVS if a visible intrauterine gestational sac was observed with any of the following: (i) an inhomogeneous adnexal mass; (ii) an empty extrauterine gestational sac seen as a hyperechoic ring; or (iii) a yolk sac and/or fetal pole with or without cardiac activity in an extrauterine sac. Overall, 16 483 consecutive women who underwent IVF had TVS during the study. Of these, 174 cases were diagnosed on TVS as having an HP, and 10 cases were missed. Fifty-two cases were treated expectantly and were excluded from the analysis. Three types of ultrasonographic presentation of ectopic pregnancy (EP) were seen in HP patients, with a gestational sac found in 70 cases, a ring sign in 21 and an adnexal mass in 31. The sensitivity and specificity of TVS for the detection of HP were 92.4 and 100%, respectively, with positive and negative predictive values of 100 and 99.9%. The HP cases comprised 103 tubal EPs and 29 non-tubal EPs. In 93 patients (70.5%), their intrauterine pregnancy resulted in a live birth, 37 patients (28.0%) suffered an early miscarriage and two patients (1.5%) had a late miscarriage. Early TVS performed by an experienced sonographer has a high sensitivity for making the correct diagnosis of HP after IVF-ET.

Spontaneous Heterotopic Pregnancy Successfully Treated via Laproscopic Surgery With Subsequent Viable Intrauterine Pregnancy: A Case Report

Heterotopic pregnancy (HP) refers to the presence of simultaneous pregnancies at two different sites of implantation, one intrauterine and the other extrauterine. The incidence of HP has increased in recent years secondary to a rise in the use of assisted reproductive technologies (ART). A 34-year-old woman, without risk factors for multiple pregnancies, presented with a spontaneous hypertopic pregnancy to a military facility. The ectopic pregnancy was successfully treated via laparoscopic surgery. She maintained a viable intrauterine pregnancy and was 32 weeks gestation with no complications at the time of submission. This case highlights the importance of maintaining a wide differential in a patient who presents with elevated Beta-human Chorionic Gonadotropin Hormone (B-HCG) levels, which continue to rise, as well as signs and symptoms consistent with ectopic pregnancy. Currently the rate of ART is rising; therefore, the expected cases of HP will likely continue to rise. At this time, there are no standard protocols for treatment and diagnosis of HP; this is an area that should be further researched in order to provide the best medical care for these women, the intrauterine pregnancy and future fertility.

Diagnosis of Heterotopic Pregnancy Using Ultrasound and Magnetic Resonance Imaging in the First Trimester of Pregnancy: A Case Report

Heterotopic pregnancy is a condition characterized by implantation of one or more viable embryos into the uterine cavity while another one is implanted ectopically, particularly into the uterine tube. Its occurrence has increased drastically over the last few years due to assisted reproduction procedures. In general, the diagnosis is made during the first trimester by using endovaginal two-dimensional ultrasound (2DUS), through observing a complex para- or retrouterine mass in association with a viable uterine pregnancy. However, under some conditions such as atypical ultrasonographic presentations, 2DUS does not clarify the situation whereas magnetic resonance imaging (MRI) of the pelvis is able to do so. We present the case of a pregnant woman in her fifth pregnancy, with a clinical condition of lower abdominal pain and pallor. Endovaginal 2DUS showed a complex voluminous mass in the left pelvic region in association with a viable intrauterine pregnancy. 2DUS in power Doppler mode showed “ring” vascularization, compatible with an ectopic gestational sac. MRI was of great importance in that it suggested that the mass had hematic content, which together with the clinical features, indicated that laparotomy should be performed. This surgical choice was essential for the woman to achieve a clinical improvement and for good continuation of the intrauterine pregnancy.