Heterotopic Pregnancy Research Articles

A rare case of heterotopic pregnancy managed by laparoscopic salpingectomy

Heterotopic pregnancy is the existence of 2 or more simultaneous pregnancies with separate implantation sites, one of which is tubes or ovaries or other ectopic site. The estimated incidence in the general population is estimated at 1:35,000 (for a naturally conceived pregnancy). With increasing trend in assisted reproductive technique, the frequency of heterotopic pregnancies was increased to be between 1:100 to 1:7,000. A 36 yrs third gravida (P1, L1, A1) presented with 2 month amenorrhoea In Doppler usg there was evidence of irregular solid component at periphery with echogenic tissue around showing ring vascularity and burning ring fire sign present. There is evidence of mild free fluid collection in the pouch of Doughlas pre operative and post operative injection 17 –oh progesterone acetate (proleutone) used and post operative tidilan injection. Left sided laparoscopic salpingectomy was done. The material was collect in endobag and afterward sent it for histopathological examination which confirms trophoblastic tissue and presence of ectopic pregnancy. There is no proven role of medical management in this because of high Bhcg titer which helps to continue it afterwards. Like other cases if there was no facility for laparoscopy, laparotomy for salpingectomy is another option. Diagnosis of heterotopic rare and challenging but proper ultrasonography skills and broad mind set helps in diagnosis.

Heterotopic Pregnancy and Septic Miscarriage: A Case Report Illustrating Risks of “Medical Shopping”, Mostly for Tricky Diagnoses

Heterotopic Pregnancy and Septic Miscarriage: A Case Report Illustrating Risks of “Medical Shopping”, Mostly for Tricky Diagnoses

Treatment of tubal heterotopic pregnancy with viable intrauterine pregnancy: Analysis of 81 cases from one tertiary care center

ObjectivesThe aim of our study was to analyze the treatment and pregnancy outcome of tubal heterotopic pregnancy (HP) patients with a viable intrauterine pregnancy (IUP) in our center. Study designThis was a retrospective analysis of 81 patients with tubal HP and a viable IUP. Patients were divided into either an expectant treatment group (29 patients) or a surgical treatment group (52 patients, 36 laparoscopy and 16 laparotomy). Data related to the basal clinical characteristic of all patients, rescue treatment and ectopic pregnancy (EP) rupture rate in the expectant treatment group, operation details in the surgical treatment group and pregnancy outcomes were collected and analyzed. Subgroup analyses were also performed. ResultsIn the expectant treatment group, the abortion rate, EP rupture rate and rescue treatment rate were 10.34 % (3/29), 21.14 % (7/29) and 34.48 % (10/29), respectively; subgroup analysis revealed that the rescue treatment rate in patients with EP mass enlargement ≥50 % was 71.43 % (5/7), which was significantly higher than that in patients with EP mass enlargement <50 % (15.00 %, 3/20), with P = 0.011. In the surgical treatment group, the abortion rate of all patients was 15.38 % (8/52); the abortion rate was 22.22 % (8/36) in the laparoscopy subgroup, which was significantly higher than that in the laparotomy subgroup (0.00 %, 0/16), with P = 0.038. ConclusionsSurgical treatment is a safe treatment option for tubal HP with a viable IUP, and laparoscopic surgery may be a potential risk factor for abortion. A high risk of failure exists for expectant management of tubal HP with a viable IUP, and EP mass enlargement ≥50 % may be a potential predictor of rescue treatment.

Ectopic pregnancies after assisted reproductive technologies

Introduction: One of the complications of assisted reproductive technologies (ART) is development of pregnancy beyond the endometrium of the uterine cavity - ectopic pregnancy (EP). There are different factors that influence the frequency of EPs after ART-. On the one hand, the characteristics of ovarian hyperstimulation, and on the other - women's age, hormonal status, history of previous pregnancy, etc. Aim: This is a retrospective study, whose purpose is to examine and evaluate different risk factors in women with EP after ART. Materials and Methods: This is a retrospective study conducted between 01.2013 and 12.2017 at the Dr. Shterev Medical Complex, Sofia. We have analyzed 5229 cycles - 3773 IVF/ICSI cycles, 875 FrET cycles, and 581 cycles with egg donation. A total of 1712 clinical, intrauterine, ectopic and heterotopic pregnancies after ART were included in our study. Results and Discussion: The rate of EPs after ART in our group was 2.4%, which corresponds to previous data, published in the scientific literature. We have also identified some rare forms of EP - cornual and cervical pregnancy. The analysis we conducted showed that probable risk factors for EP are tubal infertility and associated chronic inflammatory processes of the fallopian tubes, increased number of transferred embryos, use of additional techniques - assisted hatching, polycystic ovary syndrome (PCOS), and previous surgery in the pelvis. Conclusion: EP is a global medical emergency and its incidence increases following treatment of infertility. Early diagnosis and prompt intervention are crucial in order to diminish the morbidity and mortality, and to avoid complications thereafter.

Heterotopic pregnancy: A case Report.

Heterotopic pregnancy (HP) is a rare phenomenon. It is defined as simultaneous presence of intrauterine and extrauterine pregnancy. A case of HP is discussed. A young patient presented initially with two months amenorrhea and lower abdominal pain. Initial ultrasound showed only 6 weeks intrauterine pregnancy. But, due to increasing severity of pain ultrasound was repeated showing heterotopic pregnancy, which was later confirmed by histopathology.&#x0D; Keywords: Tubal pregnancy, Ectopic pregnancy, Heterotopic pregnancy . &#x0D;

Early intervention for heterotopic caesarean scar pregnancy to preserve intrauterine pregnancy may improve outcomes: a retrospective cohort study.

What is the best intervention time and method for patients who are diagnosed with heterotopic caesarean scar pregnancy (HCSP) wishing to preserve intrauterine pregnancy. Four patients diagnosed with HCSP from January 2014 to May 2019 were enrolled. Because HCSP is rare, data on 27 published cases were extracted to augment the analysis. Clinical characteristics and medical documents related to fetal reduction and subsequent maternal-neonate outcomes were analysed. The intervention time was significantly earlier in the full-term birth group (6.76 ± 1.05 weeks) compared with pre-term birth group (8.02 ± 1.55 weeks; P = 0.042). The cumulative full-term delivery rate was 91.48% when the intervention was at 6 weeks' gestation and decreased to 42.02% at 8 weeks. The maternal-neonate outcome was similar among the selective fetal reduction and surgical removal groups as was delivery time (34.68 ± 3.12 versus 34.80 ± 6.64 weeks; P = 0.955). In the four cases undergoing selective fetal reduction, the residual mass grew by 1.16-7.07 times compared with the area before reduction. The maximum size of the residual mass was observed at 12-13 weeks and 22-25 weeks. Most patients with HCSP who choose to keep intrauterine pregnancy will be able to carry the fetus to term. Selective fetal reduction would be the first intervention of choice and should take place immediately after diagnosis. The residual mass after reduction could continue to grow throughout the whole pregnancy, although this should not be considered as an indication for termination. With good supervision and careful management, the pregnancy could be maintained and carried to term.

A case report of heterotopic pregnancy

Heterotopic pregnancy (HP) refers to the simultaneous presence of intrauterine pregnancy (IUP) and ectopic pregnancy (EP), which is very rare but a potentially life-threatening condition. HP can be spontaneous or the subsequence of assisted reproductive technology (ART). A 23 years old patient, primigravida who came to the emergency department presenting lower abdominal pains for four days accompanied by moderate dark vaginal bleeding. The sonar reported Heterotopic Pregnancy. Laparotomy was performed and a clinically 13 week's fetus was found in the Pouch of Douglas. The other embryo that showed fetal activity and no other complication was left inside the uterus. The patient was seen in the hospital every month till delivered by cesarean section an alive baby. Heterotopic pregnancy is now more frequent because of reproductive assisted techniques. Doctors should keep a high index of suspicion in patients with intrauterine pregnancies accompanied by abdominal pains.

A case report of heterotopic pregnancy

A case report of heterotopic pregnancy

A rare cause of surgical abdomen: Heterotopic pregnancy rupture

Heterotopic pregnancy is simultaneous extrauterine and intrauterine localization of the fertilized ovum. In this article, we aimed to present the case of a ruptured heterotopic pregnancy patient who had abortion a week ago. A 28-year-old female patient was referred to the Emergency Department due to vaginal bleeding and abdominal pain. Physical examination revealed that the patient, who had an abortion a week ago because of unwanted pregnancy at the 7th gestational week, had widespread sensitivity in the abdomen. Active bleeding was observed in vaginal examination. Her serum β-human chorionic gonadotropin level was 14562 mIU/mL. A fetus surrounded by hematoma with an 8 mm crown-rump length and heartbeat was observed in the right adnexal area during pelvic ultrasonography. The patient was diagnosed with ruptured heterotopic pregnancy and underwent surgery. In female patients who are in reproductive age and who refer to Emergency Department with acute abdominal pain and vaginal bleeding, it must not be ignored that there might be extrauterine pregnancy along with intrauterine pregnancy and/or rupture. Ectopic pregnancy is a disease, which might occur in sexually active women in reproductive period and develops as a result of abnormal implantation of blastocyst. It can be localized in the ovaries, and less commonly, in the fallopian tubes. Ovarian pregnancy is characterized with the blastocyst being implanted in the ovary. It constitutes 0.15-3% of ectopic pregnancies and is observed in approximately one in every 7000 pregnancies. In our case, the blastocyst was localized in the right ovarian area, which is exceedingly rare.

A Case of Heterotopic Pregnancy- Right Cornual Ruptured Ectopic with Non Viable Intrauterine Pregnancy

A Case of Heterotopic Pregnancy- Right Cornual Ruptured Ectopic with Non Viable Intrauterine Pregnancy

Anaesthesia considerations and management in case of first trimester heterotopic pregnancy undergoing a laparoscopic ectopic excision

Heterotopic pregnancy is a presence of intrauterine and extra-uterine gestation concurrently. It might be rare but possess great challenge for an anaesthetist as both maternal and foetal safety are at risk. We report a case of 28 years primigravida diagnosed as heterotopic pregnancy and shifted for an emergency laparoscopic ectopic excision under General anaesthesia. Our primary concern for maternal and foetal safety for undergoing surgery in first trimester pregnancy was achieved by Meticulous attention to preoperative counselling, airway management, aspiration prophylaxis, haemodynamic stability, choice of anaesthesia and anaesthetic drugs which have minimal impact on utero-placental perfusion and uterine relaxation. On follow up the patient delivered a healthy full term live female child weighing 2.7 kg by elective cesarean section.

Unusual Presentation of Heterotopic Pregnancy

Heterotopic pregnancy is a rare occurrence in naturally conceived pregnancy and is difficult to assess as pain and bleeding may be due to abortion. We report a case of spontaneous heterotopic pregnancy which was missed in initial transabdominal scan and was reported to be intrauterine pregnancy and was later identified as heterotopic pregnancy with serial beta-human chorionic gonadotropin levels and clinical features. If assisted reproductive treatment procedures are not involved, it is likely to be missed and may lead to serious and delayed consequences.

Heterotopic pregnancy: Simultaneous viable and nonviable pregnancies.

Heterotopic pregnancy occurs when a patient has simultaneous intrauterine and ectopic pregnancies. Rates of heterotopic pregnancy have been rising with increased availability and access to in vitro fertilization and other advanced fertility technologies. Symptoms of heterotopic pregnancy are nonspecific, such as vague abdominal pain, so transvaginal ultrasound is a crucial part of the diagnostic process. Laparoscopy is the most commonly performed treatment of the ectopic pregnancy; other options include localized injections of methotrexate and/or potassium chloride. Following definitive termination of the ectopic pregnancy, many patients will successfully deliver the intrauterine pregnancy at term. Early identification of heterotopic pregnancy can reduce maternal morbidity and mortality.

Pregnancy-preserving Laparoendoscopic Single-site Surgery for Gynecologic Disease: A Case Series

The study objective was to assess the feasibility of laparoendoscopic single-site surgery (LESS) for the management of nonobstetric, gynecologic disease processes in pregnant patients. A retrospective case series of 13 pregnant women aged 21 to 42 years who underwent LESS for various gynecologic pathology. If able to be contacted, the patients were followed up until the delivery of the fetus. The surgeries were performed in a single institution between January 2015 and June 2019. The patients were selected if a laparoscopic intervention was indicated. The cases included 6 ovarian cystectomies and 2 salpingo-oophorectomies for adnexal masses; 1 myomectomy for a degenerated myoma; 1 salpingectomy for a heterotopic pregnancy; 2 cerclage placements for recurrent pregnancy loss and cervical insufficiency; and 1 paratubal cystectomy. The patients underwent LESS through a 2.5-cm umbilical incision. The masses were exteriorized using a laparoscopic specimen retrieval bag, with the exception of 2 large adnexal masses, which were aspirated at the incision site, exteriorized after content drainage, and cystectomies performed extracorporeally. The fascial incision wasrepaired with a permanent suture. Various data were collected from patients, including age, surgical and obstetric history, gestational age at surgery, and ultrasonic imaging results. The outcomes measured were operative duration, intraoperative bleeding, postoperative symptoms, fetal monitoring before andafter surgery, pathologic findings, conversions, intraoperative complications, and pregnancy outcomes. Eight cases were performed in the first trimester, 4 in the second trimester, and 1 in the third trimester, with the surgeries lasting between 45 minutes and 298 minutes. The blood loss ranged from 5 mL to 300 mL, and postoperative symptoms of mild pelvic or abdominal pain were reported. There were 2 conversions to traditional multiport laparoscopic surgery for the 2 cerclage cases, and there were no open surgery conversions or intraoperative complications. The fetal heart rate ranged between 130 beats per minute and 167 beats per minute postoperatively. Of the 9 patients who were able to be contacted for follow-up, all had successful deliveries. One patient was healthy at 31 weeks and 5 days without complication at the time of her last follow-up. LESS may be performed by experienced surgeons on gravid patients in any trimester for adnexal masses, myomas, heterotopic pregnancy, and cervical incompetence. Future multiple-center studies may provide further evidence that LESS is a feasible and safe option for gynecologic surgery during pregnancy.

Ruptured ectopic in a spontaneous heterotopic gestation; management and spontaneous vertex delivery of a live baby at term

Heterotopic pregnancy is the simultaneous co-existence of an intrauterine and extrauterine pregnancy. It is uncommon and potentially dangerous occurring in 1:30,000 of natural conceptions. It carries a significant maternal morbidity and mortality including foetal wastage due to the risk of ectopic gestation. To report a case of ruptured ectopic in a spontaneous heterotopic gestation at 8 weeks of amenorrhoea. The case note of the patient was retrieved and the management reviewed. Relevant review of literature on the subject was also done. She was a 25 year old nullipara who presented at the accident and emergency unit of Rivers State University Teaching Hospital at 8 weeks gestation with two weeks history of lower abdominal pain with no associated bleeding per vaginam. There was haemoperitoneum from a ruptured tubal pregnancy co-existing with live intrauterine pregnancy diagnosed on ultrasound scan. She had emergency exploratory laparotomy and right partial salpingectomy. Intraoperative findings were haemoperitoneum of 1.5 litres, bulky uterus and right ruptured isthmic ectopic gestation. She did well post operatively and was discharged home to continue with antenatal care. She subsequently delivered a live male baby that weighed 3.4kg at term. Mother and baby were discharged in good clinical state. Clinicians must be alert to the fact that confirming an intrauterine pregnancy clinically or by ultrasound scan does not exclude the co-existence of an ectopic gestation. A high index of suspicion is needed for early diagnosis of heterotopic pregnancy even in the absence of risk factors; to prevent maternal mortality and have a favourable obstetric outcome.

Spontaneous Heterotopic Pregnancy: A Case Report

ABSTRACT INTRODUCTION: Heterotopic pregnancy refers to the presence of simultaneous pregnancies at two or more different implantation sites; commonly both intrauterine and extrauterine gestation. It is a rare and life-threatening condition which is difficult to diagnose and easily missed. We report an extremely rare case of heterotopic pregnancy after natural conception with cardiac activity noted on sonography in both the intrauterine and the ectopic pregnancy. CASE PRESENTATION A 38 years old gravida 2 para 1 mother diagnosed with heterotopic pregnancy despite lack of any notable risk factors at a gestational age of 11weeks and 6 days. Trans-vaginal ultrasound showed alive intrauterine pregnancy and right adnexal ectopic pregnancy with a heartbeat. She underwent exploratory laparotomy and right salpingectomy was done and discharged home with a stable clinical condition; and had uneventful antenatal visits. She delivered by emergency C- section at 39 weeks &amp; 3 days gestation for an indication of non-reassuring fetal heart rate pattern. CONCLUSION: This un-common case demonstrates the possibility of occurrence of natural heterotopic pregnancy and clinical detection helped for a good maternal and fetal outcome. Keywords: Ectopic pregnancy; Heterotopic pregnancy, Spontaneous

Management strategies of heterotopic pregnancy following in vitro fertilization-embryo transfer

ObjectiveThe purpose of this study was to evaluate the efficiency and safety of different treatment modalities for heterotopic pregnancy (HP) in vitro fertilization-embryo transfer (IVF-ET) cycles to avoid influence on intrauterine pregnancy (IUP). Materials and methodsCases of HP (n = 90) were from the IVF/ICSI registry database at the Reproductive Hospital Affiliated to Shandong University. An additional 360 women were randomly selected as controls. The primary outcome to examine the risk factors, diagnostic modalities and the impact of different treatment modalities for HP. ResultsOur results showed that surgical treatment had a certain effect on improving the live-birth rate, although the effect was not statistically significant (87.9% vs. 70.8%, P = 0.055). The risk factors for HP included previous tubal surgery and hydrosalpinx. Fourteen days after embryo transfer, the serum levels of β-human chorionic gonadotropin (β-hCG) and estradiol (E2) were lower in the HP group than in the IUP group (P < 0.05). Furthermore, age and endometrial thickness showed a significant difference between the early abortion and the live-birth groups of HP. ConclusionsIn our retrospective study, we supported early surgical laparoscopic intervention to minimize the incidence of abortion of IUP, which resulted in a better live-birth rate. A history of ectopic pregnancy and previous tubal surgery may increase the risk of HP. Low levels of serum β-hCG and E2 on the 14th day after embryo transfer could indicate the incidence of HP.

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.

Use of Laparoscopic Slip Knot with Purse-String Suture in Surgical Management of Unruptured Heterotopic Interstitial Pregnancies.

BackgroundThe aim of this study was to investigate the advantages and disadvantages of using laparoscopic slip knot with purse-string suture technique in the surgical management of unruptured heterotopic interstitial pregnancies compared with other surgical strategies.Material/MethodsWe retrospectively analyzed data on 13 patients with unruptured heterotopic interstitial pregnancies who underwent laparoscopy in our hospital between May 2012 and August 2018. The control group consisted of 10 patients who underwent cornual resection or cornuostomy with conventional sutures and knots. The study group consisted of 3 patients whose surgical plans involved use of the slip knot with purse-string suture technique followed by cornuostomy. We evaluated the surgical records and video to comparatively analyze their operation duration, intraoperative blood loss, and pregnancy outcomes.ResultsThe average volume of intraoperative blood loss was 76.67±25 ml in the study group and 215.00±110 ml in the control group. On average, the intraoperative blood loss volume in the study group was 138 ml less than in the control group and the difference was statistically significant (P<0.05). There was no statistically significant difference in the live birth rate and operation time between the 2 groups (P>0.05). The duration of hemostasis in the study group was 11 min shorter than in the control group, while the duration of cornual electrocoagulation in the study group was 18.5 s shorter. Both groups achieved thorough hemostasis without the help of vasopressin and avoided use of embryo-killing drugs such as methotrexate. Neither group required second surgery or developed postoperative complications such as uterus rupture or persistent ectopic pregnancy.ConclusionsThis strategy is safe and reliable for gestational sac clearance while simultaneously preventing any potential harm to the intrauterine embryo. It is particularly suitable for unruptured HIP patients who have a strong desire to preserve their intrauterine embryos.

HETEROTOPIC PREGNANCY – CASE REPORT

Heterotopic pregnancy is the simultaneous occurrence of intrauterine and ectopic pregnancy. This situation is very rare (1:30 000 pregnancies), while recently, with the development of assisted reproductive techniques, the incidence has increased to 1:100 - 1:500 pregnancies. The aim of the study is to present the situation of coexistence of intrauterine pregnancy and ruptured tubal pregnancy. The case concerns a 32-year-old patient in the 12th week of the second pregnancy in whom the only risk factor was the state after Caesarean section and thus possible intraperitoneal adhesions. The ultrasound revealed normal intrauterine pregnancy and a very large amount of free fluid in the smaller pelvis. After immediate surgical intervention, a ruptured right tubal pregnancy was found. Right fallopian tube was removed. After the operation, the patient with the preserved intrauterine pregnancy was discharged from the ward. Further intrauterine pregnancy was normal. Delivery by Caesarean section. Conclusions: The described case indicates that the existence of intrauterine pregnancy does not exclude the existence of ectopic pregnancy and emphasizes the great importance of correctly and accurately carried out ultrasound examination in the first trimester of pregnancy along with appendicitis assessment. Early diagnosis of heterotopic pregnancy reduces the risk of complications.