Incidence Of Heterotopic Pregnancy Research Articles

Spontaneously Conceived Ruptured Heterotopic Pregnancy Presenting with Chest Pain and Dyspnea: A Case Report.

Heterotopic pregnancy, defined as simultaneous intrauterine and ectopic pregnancy, is a rare and potentially life-threatening condition. The incidence of heterotopic pregnancy has significantly increased in the modern era, primarily due to use of assisted reproductive technology. Heterotopic pregnancy in the absence of risk factors is uncommon. The symptoms of heterotopic pregnancy are similar to those of ectopic pregnancy, primarily abdominal pain and vaginal bleeding. We report a case of heterotopic pregnancy occurring in the absence of risk factors and presenting with primary symptoms of chest pain and shortness of breath. While uncommon, heterotopic pregnancy may occur in patients without risk factors and may present with atypical symptoms such as chest pain and shortness of breath.

#266 : Heterotopic Tubal Pregnancy After Frozen Embryo Transfer: A Case Report

Background: Heterotopic pregnancy is a serious complication in vitro fertilization and embryo transfer (IVF-FET). The incidence of heterotopic pregnancy in assisted reproductive technique is 1-3%. The most common site of ectopic pregnancy both in spontaneous and ART is in tubal fallopian. This case can increase morbidity and mortality both in mother and intrauterine gestation, when delayed diagnosis happened. Case report: A 31-year-old woman presented to regular control after 14 days of frozen embryo transfer. The patient was transferred one good and one moderate blastocyst, and the [Formula: see text]-human chorionic gonadotropin ([Formula: see text]-hCG) level was 1960,6 mIU/mL and progesterone level were 54.04 ng/mL. The first transvaginal ultrasound found only one fifth weeks gestational sac. Two weeks after that, we found the same seventh weeks gestational sac. The patient then came on her 11[Formula: see text] week pregnant, and ultrasound revealed another gestational sac was implanted within the right fallopian tube and one more gestational sac was within intrauterine. Both babies were alive. Emergency Laparoscopy was performed, and it was found the gestational sac indeed was being implanted in the fallopian tube and some part of the placenta was implanted within the right ovary. We then performed the right salpingectomy. The other intrauterine pregnancy was then closely monitored, and until today, the mother and other baby is in good condition. Conclusion: Heterotropic pregnancy incidence increases greatly, especially in ART. Thus, as clinicians, closely monitoring ultrasound is needed in order to prevent late diagnosis of heterotropic pregnancy.

7675 Tri-Topic Pregnancy: A Case of Spontaneous Triplets in Three Distinct Locations

<h3>Study Objective</h3> To present a case of spontaneous triplet pregnancy consisting of a single intra-uterine pregnancy and two distinct ectopic pregnancies and review the literature regarding interstitial pregnancy management. <h3>Design</h3> Case report. <h3>Setting</h3> Tertiary care hospital. <h3>Patients or Participants</h3> One patient. <h3>Interventions</h3> 29-y/o G3P2002 at approximately seven weeks gestational age by LMP with history significant for two prior full-term cesarean sections presented to the emergency department with severe, sudden onset abdominal pain. Beta-HCG was greater than 200,000. Bedside transabdominal ultrasound was limited by degree of pain; however, it revealed a fetal pole measuring eight weeks with cardiac activity surrounded by a sizable layer of myometrium, as well as an additional fetal pole with cardiac activity laterally with a thin surrounding layer of myometrium. Given severe pain in early pregnancy, ruptured ectopic pregnancy was presumed and the patient was consented for a diagnostic laparoscopy and removal of ectopic pregnancy. Intraoperatively, approximately 500cc of hemoperitoneum and both an interstitial pregnancy and an ampullary pregnancy were appreciated. Laparoscopic unilateral salpingectomy and cornuectomy were performed. Ultrasound postoperatively surprisingly demonstrated a third remaining viable intrauterine pregnancy. The patient denied any history of ART. <h3>Measurements and Main Results</h3> Pathology confirmed ectopic pregnancies in both specimens. Laparoscopic excision of two ectopic pregnancies was safely performed in this patient with maintenance of a viable, intrauterine pregnancy. Excision of the interstitial pregnancy posed greatest risk to both the patient and concurrent intrauterine pregnancy. Care was taken during cornuectomy to minimize entry depth into surrounding myometrium and blood loss. <h3>Conclusion</h3> The incidence of heterotopic pregnancy without ART is approximately 1 in 30,000. Furthermore, interstitial pregnancies make up only 1-4% of ectopic pregnancies. Laparoscopic management of interstitial pregnancies has been repeatedly demonstrated as a safe approach. We present a rare case of a ruptured triplet heterotopic pregnancy with minimal risk factors managed successfully with laparoscopic removal technique and maintenance of intrauterine pregnancy.

Heterotopic Pregnancy Secondary to in vitro Fertilization-Embryo Transfer: Risk Factors and Pregnancy Outcomes.

BackgroundWith the widespread application of assisted reproduction technology (ART) and increased pelvic inflammatory disease, the incidence of heterotopic pregnancy (HP) has risen. However, the risk factors and treatment of HP remain indefinite.ObjectivesTo explore risk factors affecting the incidence of HP secondary to in vitro fertilization-embryo transfer (IVF-ET) and pregnancy outcomes after surgical treatment of HP.Methods29 patients with HP and 116 with an intrauterine-only pregnancy (IUP) after IVF-ET during the same period were included retrospectively from January 2015 to September 2020.ResultsPatients with HP had a higher proportion of previous ectopic pregnancies, multiple abortion history (≧2 times) and tubal indication for IVF than IUP. Besides, they had a greater possibility to end in spontaneous abortion (31.03 vs.13.79%, P = 0.028) and preterm delivery (25.00 vs. 7.00%, P = 0.035), less possibility to result in a live birth (58.62 vs. 78.45%, P = 0.028). History of multiple abortions (≥2 times) [odds ratio (OR) 3.031, 95% confidence intervals (CI) 1.087–8.453; P = 0.034], tubal infertility (OR 3.844, 95% CI 1.268–11.656; P = 0.017), previous ectopic pregnancies (OR 2.303, 95% CI 0.625–8.490; P = 0.021) and number of embryo transfer (OR 0.300, 95% CI 0.092–0.983; P = 0.037) resulted in an elevated proportion of HP in IVF treatment. Shorter operative duration, smaller size of the ectopic mass and location in the ampulla of the fallopian tube were associated with higher chance of survival in the coexistent intrauterine pregnancy after surgical treatment.ConclusionsPrevious history of ectopic pregnancy, multiple abortions, tubal infertility and multiple-embryo transfer may be considered as meaningful risk factors of subsequent HP following IVF-ET. In patients with HP treated by surgery, shorter operative duration, smaller size of the ectopic mass and location in the ampulla of the fallopian tube means better reproductive prognosis.

Heterotopic pregnancy

Heterotopic pregnancy is defined as a condition when intrauterine and extra uterine pregnancy occur simultaneously. It is a life-threatening condition that requires immediate and accurate diagnostics and treatment. It is difficult to diagnose and easily missed. The incidence in the general population is estimated to be 1 in 30,000. With the advent of Assisted Reproduction Techniques (ART) and ovulation induction, the overall incidence of heterotopic pregnancy has risen to approximately 1 in 3,900 pregnancies. Other risk factors include a history of pelvic inflammatory disease (PID), tubal damage, pelvic surgery, uterine Mullerian abnormalities, and prior tubal surgery. Heterotopic pregnancy is a potentially fatal condition, rarely occurring in natural conception cycles. Most commonly, heterotopic pregnancy is diagnosed at the time of rupture when surgical management is required. We present a case of a 30-year-old secondi gravida with history of one spontaneous abortion and pelvic inflammatory disease, who conceived spontaneously and at her fifth week of amenorrhea, was presented to the emergency department with acute pain in lower abdomen, moderate vaginal bleeding and weakness. Laboratory tests and transvaginal ultrasonography revealed the diagnosis of heterotopic pregnancy.

Minimally invasive surgical management of a cornual ectopic pregnancy, with and without a concurrent intrauterine pregnancy

To describe techniques for resection of a cornual heterotopic pregnancy. This video demonstrates a surgical technique for excision of a cornual heterotopic pregnancy with narrative video footage using two case examples. The incidence of cornual heterotopic pregnancy is unknown; however, the incidence of heterotopic pregnancy itself has increased through the use of assisted reproductive technologies and the majority of cornual heterotopic pregnancies occur after assisted reproductive technologies use. These cases have been treated traditionally using exploratory laparotomy and cornual wedge resection with good outcomes. With advancements in minimally-invasive surgical techniques, laparoscopic resection of cornual heterotopic pregnancies has been demonstrated to be safe and feasible. A patient with an 8-week cornual heterotopic pregnancy and a patient with a 10-week cornual ectopic pregnancy. Laparoscopic resection of the cornual ectopic pregnancy. Feasibility of a "purse-string" technique for the resection of a heterotopic cornual pregnancy. Robotic-assisted laparoscopic resection of a cornual heterotopic pregnancy can be performed with minimal blood loss with the use of the "purse-string" technique in settings where vasopressin cannot be used for hemostasis. This technique includes the use of a 2-0 V-Loc suture in a circumferential fashion around the ectopic pregnancy, which allows for faster suturing and immediate tension at the myometrium. The same suture is then used to close the defect, which allows for a simpler and efficient closure with minimal entry into the myometrium. In this video, we demonstrate the successful resection of cornual heterotopic pregnancy using a "purse-string" surgical technique. This technique allows for minimal blood loss in cases where additional techniques for hemostasis cannot be used, such as injection of vasopressin and uterine artery ligation.

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.

Heterotopic pregnancy in natural conception: About two cases

Introduction: Heterotopic gestation is defined as the coexistence of an intrauterine (IUP) and extra uterine pregnancy (EUP) regardless of its location. The incidence of heterotopic pregnancy is very low but it is difficult to diagnose clinically.

Cornual heterotopic pregnancy after in vitro fertilization: management by laparoscopic repair

The incidence of heterotopic pregnancy has risen dramatically with the widespread use of assisted reproductive technology. The risk factors for this pathology include tubal infertility, cleavage stage embryo transfer and frozen embryo transfer. Herein we report two cases with cornual heterotopic pregnancy after in vitro fertilization/embryo transfer. They managed by laparoscopic cornual repair or salpingectomy. Early diagnosis and appropriate management of heterotopic pregnancy may lead to a favorable prognosis.

Spontaneous Heterotopic Pregnancy: Dual Case Report and Review of Literature.

Introduction. Heterotopic pregnancy is a rare complication usually seen in populations at risk for ectopic pregnancy or those undergoing fertility treatments. It is a potentially dangerous condition occurring in only 1 in 30,000 spontaneous pregnancies. With the advent of Assisted Reproduction Techniques (ART) and ovulation induction, the overall incidence of heterotopic pregnancy has risen to approximately 1 in 3,900 pregnancies. Other risk factors include a history of pelvic inflammatory disease (PID), tubal damage, pelvic surgery, uterine Mullerian abnormalities, and prior tubal surgery. Heterotopic pregnancy is a potentially fatal condition, rarely occurring in natural conception cycles. Most commonly, heterotopic pregnancy is diagnosed at the time of rupture when surgical management is required. Case. This paper represents two cases of heterotopic pregnancies as well as a literature review. Conclusion. Heterotopic pregnancy should be suspected in patients with an adnexal mass, even in the absence of risk factors. Clinicians must be alert to the fact that confirming an intrauterine pregnancy clinically or by ultrasound does not exclude the coexistence of an ectopic pregnancy. A high index of suspicion in women is needed for early and timely diagnosis, and management with laparotomy or laparoscopy can result in a favorable and successful obstetrical outcome.

Single Incision Laparoscopic management of a ruptured Heterotopic pregnancy presenting as an acute appendicitis: A case report

Heterotopic pregnancy, defined as the coexistence of an intrauterine pregnancy and an extrauterine pregnancy. It is a rare entity and theoretically occurs at an incidence of 1 in 30 000 pregnancies (2,3,12). The rise in the incidence of tubal and pelvic diseases has contributed to an increasing rate of heterotopic pregnancies. This rise can also be attributed to the increasing use of assisted reproductive technology such as In Vitro Fertilization (IVF) and Gamete intra-fallopian transfer (GIFT) (2,3,11,12). After assisted reproductive technology procedures, the incidence of heterotopic pregnancy is at a concerning 1 in 100 pregnancies (2,12).The treatment of heterotopic pregnancy aims to maintain the intrauterine pregnancy while removing the extrauterine pregnancy using a minimally invasive method (1). The treatment modalities for heterotopic pregnancy can be divided into surgical and non-surgical treatments. Non-surgical treatments involve the direct administration of drugs, such as potassium chloride, methotrexate, and hyperosmolar glucose to the extrauterine gestational sac under ultrasonographic or laparoscopic guidance (10,11). Systemic management of these agents is difficult because these treatments can result in termination of both the desirable intrauterine and unwanted extrauterine pregnancy (7). Surgical management, particularly laparoscopic surgery, has a shorter operating time, faster recovery, and less postoperative pain compared with those of laparotomy.As seen in our patient, heterotopic pregnancy is a difficult entity to diagnose, often leading to the late detection of an extrauterine sac (2). Our patient is a 36-year-old who has been trying to get pregnant for 2 years. Because of the information available a diagnosis of acute appendicitis in pregnancy was made. There were no clear signs of a ruptured ectopic pregnancy despite ultrasonography been done. An emergency laparoscopic procedure was done highlighting the underlining pathology.

Laparoscopic Salpingectomy for Heterotopic Pregnancy: A Case Report from Ile-Ife, Nigeria

Abstract Background: Heterotopic pregnancy in a spontaneous conception is a rare and life-threatening condition. With its high rate of twin gestation and ectopic pregnancy, a country such as Nigeria might be expected to have a higher incidence of heterotopic pregnancy. The use of laparoscopic surgery in the management of heterotopic pregnancy has been widely reported, but none has been documented in Nigeria. Case: This report presents a 24-year-old G3, P1011 admitted with severe right iliac fossa pain in pregnancy at 13 weeks' gestation, with stable vital signs. An ultrasound scan revealed a normal intrauterine pregnancy with a heterogeneous right adnexal mass; hence, a right ovarian cyst accident in pregnancy was suspected. Emergency laparoscopy, however, revealed a slow leaking right ampullary tubal pregnancy coexisting with a normal intrauterine gestation. The patient underwent a laparoscopic right salpingectomy with continuation of the intrauterine pregnancy. Results: The pregnancy had progressed to 2...

Gestación heterotópica espontánea

Heterotopic pregnancy is a rare clinical condition in which several pregnancies can coexist inside and outside the uterus. In recent years, the incidence of heterotopic pregnancy has increased due to assisted reproductive techniques. A high index of suspicion may help in the early diagnosis and appropriate treatment of this entity. We report a case of spontaneous heterotopic gestation in a 35-year-old woman who developed both an extra- and an intrauterine pregnancy diagnosed by ultrasound 10 weeks after the onset of amenorrhea.

Heterotopic Pregnancy

Review the clinical presentation, diagnosis, and minimally invasive management of heterotopic pregnancy. Case Report and Clinical Review. University-affiliated Non-Profit Physician Organization. Second trimester IVF patient presenting with an acute abdomen. Laparoscopic treatment of ruptured second trimester ectopic pregnancy as a component of heterotopic pregnancy. Heterotopic pregnancy, in which two gestations coexist at two different locations- usually an ectopic tubal pregnancy with a simultaneous intrauterine pregnancy, occurs naturally in one out of every 30,000 pregnancies. The incidence is considerably higher in pregnancies conceived with Assisted Reproductive Technology, estimated at 1.5 of every 1000 ART pregnancies. In recent years the overall incidence of heterotopic pregnancy in the United States has risen to 1:3900. A case report of a second trimester heterotopic IVF pregnancy with tubal rupture is herein described, managed laparoscopically with maternal preservation but an ultimate adverse outcome for the surviving intrauterine twin. The diagnosis of heterotopic pregnancy is reviewed and management options discussed. Heterotopic pregnancy presents a diagnostic challenge for clinicians and consequently is often diagnosed at a more advanced gestational age, not infrequently with tubal rupture and maternal hemodynamic instability. Because of the serious potential consequences for maternal and neonatal health, the possibility of heterotopic pregnancy should be considered with high risk pregnancies. The ART pregnancy should be identified as such when requesting ultrasound studies, and the ultrasonographer should carefully screen the pelvis for a concomitant ectopic gestation. Once the diagnosis of heterotopic pregnancy is made or strongly suspected, intervention should be as timely and minimally invasive as possible, to protect the coexisting intrauterine pregnancy and prevent serious maternal morbidity.

Embarazo heterotópico diagnosticado en una cesárea a término

The incidence of heterotopic pregnancy is increasing as a result of the greater use of assisted reproduction techniques. Early diagnosis is important because a ruptured ectopic pregnancy can be life threatening. We present an atypical case of extrauterine pregnancy diagnosed during the course of an elective cesarean section at term.

Gestación heterotópica en inseminación artificial

We report a case of heterotopic pregnancy, which is of interest due to its low incidence and the serious complications that can ensue when diagnosis is delayed. Most of the heterotopic pregnancies described occurred after in vitro fertilization techniques. These pregnancies are less frequent after artificial insemination and are exceptional in spontaneous pregnancies. Our objective is to emphasize the increase in this type of pregnancy in the last few years due to assisted reproduction techniques and to highlight the importance of early diagnosis.The incidence of heterotopic pregnancy is increasing due to the use of assisted reproduction techniques. This entity frequently presents after rupture of the ectopic pregnancy, leading to a gynecological emergency due to maternal bleeding, and requires prompt treatment. Consequently, we stress the importance of diagnosis, which is difficult, in the asymptomatic phase. Furthermore, a high index of suspicion should be maintained in abdominal pain associated with hemoperitoneum in an intrauterine pregnancy obtained after assisted reproduction techniques.

Triplet Heterotopic Pregnancy After Gonadotropin Stimulation and Intrauterine Insemination Diagnosed at Laparoscopy: A Case Report

Heterotopic pregnancy has been traditionally considered a rare event; however, with the use of assisted reproductive technology, the incidence of heterotopic pregnancies is increasing. Diagnosing a heterotopic pregnancy can be challenging. This report describes a 30-year-old female at 11 weeks' gestation with an intrauterine twin pregnancy after gonadotropin stimulation and intrauterine insemination who presented complaining of left lower quadrant abdominal pain with constipation and cramps. The patient was empirically treated for diverticulitis but failed to respond to therapy. A heterotopic triplet pregnancy was ultimately diagnosed at laparoscopy. Heterotopic pregnancy must be considered in the differential diagnosis of abdominal pain in the first trimester, especially in patients who conceived by means of assisted reproductive technology. Surgical treatment is the most frequently used method of treatment.

A case report describing a heterotopic cervical pregnancy successfully treated using a combination of transvaginal ultrasound-guided aspiration and hemostatic cervical stay sutures.

Objective: The incidence of heterotopic pregnancies has increased as the use of in vitro fertilization (IVF) has become more widespread. Heterotopic cervical pregnancies, while still extremely rare, would be expected to increase in frequency with the expanding use of assisted reproductive technologies (ART). The main cause of the increased incidence of cervical pregnancy in ART is unclear. It may be as a result of infertility factors or secondary to the IVF procedure itself. The attractiveness of conservative management of heterotopic cervical pregnancies is understandably high, especially in cases involving ART. A procedure which completely evacuates the cervical pregnancy without undue risk of trauma to the intrauterine pregnancy, hemorrhage, or infection would be ideal. Several case reports document different conservative techniques with varying degrees of success. Our objective was to review these case reports, and to present a case of a heterotopic cervical pregnancy successfully treated with transvaginal ultrasound-guided aspiration and cervical stay sutures.

Heterotopic pregnancy complicating in vitro fertilization.

A review was undertaken of the cases of heterotopic pregnancy resulting from in vitro fertilization/embryo transfer (IVF/ET) and frozen embryo replacement (FER) in a 6-year cohort of women at National Women's Hospital in Auckland. The incidence of heterotopic pregnancy was 2.9% (5 cases) in 173 clinical pregnancies resulting from 901 embryo replacements. Of the 5 women with heterotopic pregnancy, 1 had unilateral tubal patency and 4 had bilateral tubal blockage; 3 had 'high responder' peak serum oestradiol levels (greater than 9,000 pmol/L) prior to oocyte pick-up (OPU); 3 had a serum human chorionic gonadotrophin beta subunit (beta-HCG) level greater than 600 IU/L on Day 14 following embryo transfer (ET) in the absence of a multiple intrauterine gestation on subsequent ultrasound scan. In the 4 women in whom unequivocal diagnosis of heterotopic pregnancy was not made on the initial ultrasound scan, there was delay in appropriate management, in 1 for more than 5 months. In conclusion, early IVF pregnancies require a transvaginal ultrasound scan performed by a sonographer experienced in the diagnosis of ectopic pregnancy and management of early pregnancy complications by clinicians in close consultation with the IVF centre itself. No single risk factor, laboratory test or combination of these is sensitive or specific enough to predict the occurrence of heterotopic pregnancy. The first-line surgical treatment of heterotopic pregnancy should be laparoscopic salpingectomy with excision of all except the intramural portion of the affected Fallopian tube.

Simultaneous intra- and extra-uterine pregnancy with ovarian hyperstimulation syndrome after induction of ovulation: a case report.

We present a case of polycystic ovary syndrome (PCOS) that developed simultaneous intra- and extra-uterine pregnancy with ovarian hyperstimulation syndrome (OHSS) after induction of ovulation with pure FSH-HCG. At 9 weeks of pregnancy, the bilateral tubal pregnancy caused an imminent spontaneous abortion, and both Fallopian tubes were resected. After the laparotomy, the pregnancy progressed without problems until 31 weeks and 5 days of pregnancy, when signs of spontaneous abortion appeared, and healthy twin female babies were delivered by cesarean section. The incidence of heterotopic pregnancy is increasing in cases in which inducers of ovulation or ART, such as IVF-ET and GIFT, have been employed. One must be well aware that the danger of heterotopic pregnancy following induction of ovulation is imminent, particularly in cases with risk factors of multiple and/or extra-uterine pregnancy, such as PCOS, a history of tubal restoration, and sexually transmitted disease(s).