Heterotopic Pregnancy Research Articles

A pitfall in ultrasonographic diagnosis–heterotopic cornual pregnancy initially misdiagnosed as leiomyoma

A pitfall in ultrasonographic diagnosis–heterotopic cornual pregnancy initially misdiagnosed as leiomyoma

Heterotopic caesarean section scar pregnancy after embryo transfer: a case report successfully treated with aspiration

Heterotopic caesarean section scar pregnancy after embryo transfer: a case report successfully treated with aspiration

Heterotopic pregnancy: A rare entity

Heterotopic gestation is a very rare entity in natural conception, occurring in only 1 in 30,000 spontaneous pregnancies. A high index of suspicion is necessary for the timely diagnosis and appropriate intervention. We report the case of heterotopic pregnancy in a 32-year-old female presented with hemoperitoneum from ruptured tubal pregnancy with live intrauterine gestation at 6 weeks' period of gestation, diagnosed on ultrasound examination.

Ruptured Heterotopic Pregnancy Following Spontaneous Conception

Ruptured Heterotopic Pregnancy Following Spontaneous Conception

Spontaneous heterotopic pregnancy associated with the threat of abortion: diagnostic difficulties

Defined as the association of intrauterine and ectopic pregnancies in an individual, spontaneous heterotopic pregnancy occurred rarely with an incidence of 1/30,000. We report a case of a spontaneous heterotopic pregnancy associating a ruptured right ampullar pregnancy with a progressive intra uterine pregnancy and trophoblastic detachment managed in our department of Gynecology-Obstetrics II of the Hassan II Teaching Hospital of Fez.

Four cases of heterotopic pregnancy treated at our institution

Four cases of heterotopic pregnancy treated at our institution

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

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.

Laparoscopic surgery for non-obstetric acute abdomen in pregnancy: A retrospective case series review.

Background:Laparoscopic techniques have been used during pregnancy by obstetricians since the 1970's, primarily to diagnose and treat ectopic and heterotopic pregnancies. Pregnancy was considered as an absolute contraindication to laparoscopy by surgeons as recently as 1991, and a few still doubt the safety of minimal access in gravid patients. When an emergent operation is indicated, the surgery should not be withheld on the sole basis of patient's gravid state. On the contrary, the alleviation of maternal disease is thought to take priority because the health of the foetus is dependant on the mother.Materials and Methods:This is a retrospective study of a case series of 18 obstetric patients who presented with non-obstetric causes of acute abdomen requiring surgical intervention. Ultrasonography and magnetic resonance imaging (MRI) along with other laboratory investigations were carried out to reach the diagnosis. Laparoscopic surgery was considered as the modality of treatment. All the patients were given the necessary care post-surgery and were followed up till parturition to look for any complications.Results:The data were analysed considering the presentation, diagnostic variations and the surgical modifications statistically.Conclusion:The decision of surgery should be prompt and should be weighed against complications of conserving the patient. Due to the diagnostic limitations of ultrasonography, MRI should be coupled to confirm the diagnosis. Laparoscopy offers less analgesic requirements and shorter hospital stay. The operative time is highly subjective to the experience and training of the surgeon and the laparoscopic set-up itself.

Heterotopic triplet pregnancy after in vitro fertilization and intracytoplasmatic sperm injection complicated with ovarian hyperstimulation syndrome single twin fetal demise and cervical incompetence: a successful obstetrical outcome

Spontaneous heterotopic triplet pregnancy (HTP) was formerly considered to be extremely rare. Recently, the broad use of assisted reproductive techniques to assist infertile couples, has contributed to the constant rise of non-spontaneous heterotopic triplets. A case of 38-year-old woman who underwent in vitro fertilization (IVF) and intracytoplasmatic sperm injection (ICSI) is presented. A series of complications appeared and were treated successfully. Although this situation could be life threatening and should alert the medical community, misdiagnosis is still present. The clinicians need to be aware that after IVF procedures, one or more complications might occur. In those cases, early diagnosis and surgical or conservative intervention is of paramount importance.

Successful Management of Heterotopic Cervical Pregnancy with Ultrasonographic-guided Laser Ablation

Heterotopic pregnancy refers to the simultaneous presence of ectopic pregnancy and intrauterine pregnancy. With the advent of assisted reproductive technology, the overall incidence of heterotopic pregnancies has risen. We report a case of a 36-year-old woman with type 2 diabetes mellitus and 1-year of primary infertility. Following oral ovulation induction cycles and intrauterine insemination, diagnosis of heterotopic cervical pregnancy was made by ultrasonography at 7.4 weeks of gestation. Laser ablation of the cervical pregnancy was performed achieving adequate homeostasis at the implantation site and preserving the intrauterine pregnancy. A healthy infant was delivered at 36 0/7 weeks by cesarean section. Laser ablation is a minimally invasive procedure that appears to lead to successful outcomes in the treatment of heterotopic cervical pregnancy.

Laparoscopic Management of 42 Cases of Tubal Stump Pregnancy and Postoperative Reproductive Outcomes

Tubal stump pregnancy is a rare variant of ectopic pregnancy. The aim of this study was to evaluate laparoscopic surgery for tubal stump pregnancy and to investigate postoperative pregnancy outcomes. Retrospective study. University-affiliated hospital. Patients (n = 42) diagnosed with tubal stump pregnancy. Data were extracted from the electronic medical records system of the hospital. Patients diagnosed with tubal stump pregnancy between June 2010 and July 2018 were included. Data included demographic characteristics, gravidity and parity, history of pelvic surgery, clinical features, and treatment. All procedures were laparoscopic. Postoperative pregnancy outcomes were identified from electronic medical records or by telephone. Patients' mean age was 30 (range, 21-39) years. Twelve of 42 tubal stump pregnancies (28.6%) had ruptured ectopic pregnancy at the time of operation. The remaining 30 cases had intact stump pregnancy during surgery. Patients were followed for a mean of 31 (range, 10-60) months. Follow-up data were available for 33 of 39 patients (3 with heterotopic tubal stump pregnancy were not included in follow-up data because all resulted in a live births and had no desire for future pregnancy). Eighteen of 28 patients (64.3%) who attempted conception had intrauterine pregnancies (IUPs) during the follow-up period; of these 18 IUPs, 14 (77.8%) resulted in live births. There was 1 case of uterine rupture in a singleton pregnancy at 20+5 weeks that resulted in fetal death. Three of 18 IUPs (16.7%) ended in the first trimester with spontaneous abortions. Laparoscopic surgery is a feasible option for tubal stump pregnancy and is associated with favorable pregnancy outcomes.

Effect of endometrial thickness on ectopic pregnancy in frozen embryo transfer cycles: an analysis including 17,244 pregnancy cycles

To investigate whether endometrial thickness (EMT) influences the incidence of ectopic pregnancy (EP) in frozen embryo transfer (FET) cycles. Retrospective cohort study. Academic tertiary-care medical center. A total of 16,556 patients were enrolled between January 2010 and December 2017, comprising 16,701 intrauterine, 488 ectopic, and 45 heterotopic pregnancy cycles after FET. None. EP was the primary outcome. EMT was the main measured variable. Data were analyzed with the binary logistic general estimating equations model to calculate the adjusted odds ratio (aOR) for EP. After adjusting for confounders, EMT remained statistically significant as an independent risk factor for EP. Compared with women with an EMT of ≥14 mm, the aORs for women with EMT in the ranges 7-7.9, 8-9.9, and 10-11.9 mm were 2.70 (95% confidence interval [CI], 1.65-4.40), 2.06 (95% CI, 1.33-3.20), and 1.66 (95% CI, 1.07-2.58), respectively. Hormone replacement treatment for endometrial preparation during FET increased the risk of EP after adjustment for confounding variables. EMT is inversely proportional to EP rate in FET cycles and is therefore a potential quantitative marker of endometrial receptivity and uterine contractibility in an FET cycle. The predictive validity of EMT value must be evaluated in further studies.

The indicator of clinical outcomes for patients with heterotopic pregnancy following in-vitro fertilization with embryo transfer

ObjectiveTo explore the early predictors for pregnancy outcomes in patients with heterotopic pregnancy (HP) following in-vitro fertilization with embryo transfer (IVF-ET). Material and methodsThis retrospective study reviewed 81 patients with HP following IVF-ET in our institution between January 2003 and September 2017. The relationships between clinical outcomes and general characteristics, sonographic features and different management options were analyzed by logistic regression analysis. ResultsThe gestational age at the time of diagnosis was 50.9 ± 12.3 days. Among these cases, 76 were accurately diagnosed by TVS, 1 was misdiagnosed as adnexal torsion by TVS, and 4 were confirmed to have IUPs after the surgical treatment. Hence, the sensitivity of TVS for detecting HP was 93.8% (76/81). However, forty-seven patients (58.0%) had suspected HP when they underwent the initial TVS. Among these patients, live births occurred for 60 patients, 11 of whom delivered preterm. The miscarriage rate was 58.3% (14/24) for patients without IUP cardiac activity at HP diagnosis, and 12.3% (7/57) for patients with IUP cardiac activity; a significant correlation was identified (χ2 = 18.651, P < 0.001). Additionally, the abortion rate of patients following fresh non-donor embryo was higher than patients after frozen-thawed embryo (χ2 = 10.437, P = 0.001). Further by logistic regression analysis, patients following frozen-thawed embryo and an IUP with cardiac activity at HP diagnosis were identified as two independent factors of pregnancy outcome. (OR = 0.060, 95%CI = 0.008–0.471, P = 0.007; OR = 0.010, 95%CI = 0.001–0.124, P<0.001). ConclusionsPatients following frozen-thawed embryo and an IUP with cardiac activity at HP diagnosis could be the independent predictors for a favorable prognosis.

Acute pelvic pain following miscarriage heterotopic pregnancy must be excluded: case report

BackgroundHeterotopic pregnancies are increasing in prevalence and this case highlights the importance of excluding the diagnosis in patients with pelvic pain following miscarriage. A known pre-existing intrauterine pregnancy can be falsely reassuring and delay the diagnosis of a potentially life-threatening concurrent ectopic pregnancy.Case presentationIn this report, we describe a case of spontaneous heterotopic pregnancy in a woman who had initially presented with pelvic pain and vaginal bleeding, and was diagnosed on pelvic ultrasound with a missed miscarriage; a non-viable intrauterine pregnancy. She re-presented 7 days later with worsening pelvic pain and bleeding, and a repeat pelvic ultrasound identified a ruptured tubal ectopic pregnancy in addition to an incomplete miscarriage of the previously identified intrauterine pregnancy. She underwent an emergency laparoscopy where a ruptured tubal ectopic pregnancy was confirmed.ConclusionBeing a time critical diagnosis with the potential for an adverse outcome, it is important that the emergency physician considers heterotopic pregnancy as a differential diagnosis in patients presenting with pelvic pain following a recent miscarriage. The same principle should apply to pelvic pain in the context of a known viable intrauterine pregnancy or recent termination of pregnancy. A combination of clinical assessment, beta human chorionic gonadotropin levels, point of care ultrasound and formal transvaginal ultrasound must be utilized together in these situations to explicitly exclude heterotopic pregnancy.

2363 Laparoscopic Management of Heterotopic Cornual Pregnancy - Tips & Tricks

Video Objective To provide practical tips and tricks on laparoscopic management of a heterotopic cornual pregnancy. Setting This video presents a 38-year-old nulliparous female patient who received bilateral salpingectomy and then underwent in vitro fertilization. Heterotopic pregnancy was found at 8 weeks of gestation. We arranged fetal reduction by ultrasound-guided potassium chloride injection. Two weeks after the procedure, severe lower abdominal pain developed. Due to massive hemoperitoneum with suspected left cornual rupture, she was admitted for laparoscopic intervention. Interventions Laparoscopic surgery was arranged. Left cornual pregnancy with necrosis and oozing were seen upon entry into the abdominal cavity. Estimated internal bleeding was about 3000 ml. Laparoscopic management was carried out in five steps: identification of the cornual protruding mass; control of bleeding via a loop ligation; incision of the cornus precisely with complete removal of the ectopic gestational tissue; closure of the defect of the cornus; and hemostasis using Floseal matrix. Conclusion The surgery was done smoothly and the patient recovered well with ongoing pregnancy. However, the patient underwent termination of pregnancy at 23 weeks of gestation due to fetal hydrocephalus.

1450 Laparoscopic Cornual Resection of Heterotopic Cornual Pregnancy

Video Objective Laparoscopic heterotopic cornual pregnancy resection. Setting A 41 y/o woman, with history of G3P0E1(status post right salpingectomy)SA1 got pregnancy via IVF with frozen embryo transferred. Four embryos were transferred. However, at about gestational age 6 weeks, two intrauterine gestational sac and one right cornual gestational sac were found. All the fetus had heart beats. Thin uterine wall at right cornus about 0.53cm in size was also noticed. To preserve normal intrauterine pregnancy, surgical intervention was suggested, and the patient received laparoscopic cornual resection surgery. Interventions During operation, to prevent fetus injury, we didn't use uterine manipulator or pitressin injection. We also avoided electrical energy device to decrease thermal effect to fetus. Because of the rich blood flow of uterus, we hoped to decreased the surgical time, and barbed suture was used. Multiple suture layers for uterus was applied. We also used vaginal ultrasound during operation to check the uterine condition. After checking bleeders, adhesion barrier was used. For postoperative medication, progesterone was prescribed for tocolysis. We checked ultrasound after the surgery, and only one fetus with fetal heart beat was noticed. Conclusion Laparoscopic heterotypic cornual pregnancy resection is feasible with the advantages of decreased hospital stay, less wound pain, and less use of analgesics. Further obstetrics outcome is reassuring in current studies.

A spontaneous heterotopic pregnancy presented with acute abdomen treated with NOTES procedure: Case report

A spontaneous heterotopic pregnancy presented with acute abdomen treated with NOTES procedure: Case report

EP28.25: Spontaneous heterotopic early pregnancy: intracavitary and tubal, followed by laparoscopic salpingectomy and legal artificial abortion

EP28.25: Spontaneous heterotopic early pregnancy: intracavitary and tubal, followed by laparoscopic salpingectomy and legal artificial abortion

EP22.09: Expectant management of heterotopic Caesarean scar pregnancy: two case reports and review of clinical courses

EP22.09: Expectant management of heterotopic Caesarean scar pregnancy: two case reports and review of clinical courses

EP28.18: Successful management of heterotopic cervical and triplet trichorionic intrauterine pregnancy: case report and brief review of literature

EP28.18: Successful management of heterotopic cervical and triplet trichorionic intrauterine pregnancy: case report and brief review of literature