Heterotopic Interstitial Pregnancy Research Articles

Diagnosis and management of heterotopic intramural pregnancy after in vitro fertilization: an eight-case series.

To analyze the ultrasound characteristics, clinical management, and pregnancy outcomes of heterotopic intramural pregnancies (HIMPs) after embryo transfer. This was a retrospective observational study of women who were diagnosed with HIMPs. The ultrasound characteristics, clinical treatment, and pregnancy outcomes of patients with HIMPs were evaluated. Eight women with HIMPs were included. Among them, 6 patients were diagnosed by transvaginal sonography, and 2 patients were misdiagnosed with heterotopic interstitial pregnancy. The diagnostic accuracy was 75% (6/8). Five patients with HIMPs were diagnosed at the time of the initial scan (5+6-6+3 weeks). An intramural gestational sac was observed in all 6 patients, and an embryo with cardiac activity was detected in one patient on the follow-up scans. Intrauterine pregnancies (IUPs) were revealed in all 6 patients, and embryo(s) with cardiac activity were observed in 5 patients at the time of the initial diagnosis or later. The patients receiving expectant treatment all presented with bagel signs, while patients with embryos with cardiac activity all underwent surgery. Among the 6 diagnosed women, 1 patient was initially treated medically, 4 were treated expectantly, and 1 was treated surgically. Among the 6 diagnosed patients, the IUPs of 5 patients resulted in live infants. Single ET should be recommended to decrease the possibility of HIMP. An accurate diagnosis of HIMP was reached in most cases by detailed ultrasound early in the first trimester. Most IUPs of HIMPs seem to have good outcomes with timely and proper management. Expectant management might be a possible choice for nonviable intramural pregnancies.

Interstitial heterotopic pregnancy after bilateral total salpingectomy in IVF patients: a case report and literature review.

Heterotopic pregnancy of an intrauterine pregnancy and an interstitial or stump pregnancy after bilateral salpingectomy is a rare complication of in vitro fertilization (IVF) that can lead to severe hemorrhage; prompt identification and management are important. The aim of this paper was to present a case report and an updated literature review of women who had had combined interstitial/stump and intrauterine pregnancies during an in an IVF cycle after total bilateral salpingectomy. We conducted a search in PubMed for reported heterotopic pregnancy, of a combined intrauterine pregnancy with an interstitial or stump pregnancy, in women who underwent IVF after bilateral salpingectomy. Our search yielded 13 heterotopic pregnancies in women who underwent IVF after bilateral salpingectomy. Forty-six percent of the women had more than two embryos transferred, and all the women had a history of ectopic pregnancies or tubal infertility. Most of the women presented at 6-7 weeks of pregnancy with vaginal bleeding and/or abdominal pain. A ruptured ectopic pregnancy was presented in 42%. Ultrasound was the main diagnostic tool in most cases. Only two women had been medically treated with local KCL or methotrexate, while 83% underwent surgical treatment. Five women had uncomplicated cesarean sections near or at term. Women with bilateral total salpingectomy remain at risk of heterotopic pregnancy, which poses a diagnostic and treatment challenge. This risk may be reduced by the reduction in the number of transferred embryos in IVF. For those who wish to preserve intrauterine pregnancy, cornual resection can be performed with good prognosis.

The risk factors for miscarriage of viable intrauterine pregnancies in patients with heterotopic pregnancy after surgical intervention.

To summarize the clinical characteristics and explore the risk factors for miscarriage of a viable intrauterine pregnancy following surgical intervention in patients with heterotopic pregnancy (HP). A total of 106 women diagnosed with HP that underwent surgical intervention in the Women's Hospital School of Medicine Zhejiang University between January 2014 and December 2021 were included in this retrospective study. They were divided into a miscarriage group (n = 13) and an ongoing pregnancy group (n = 93) according to the outcomes of the HP within 2 weeks after surgery. Data regarding clinical characteristics, surgical conditions, postoperative recovery, and complications were collected and compared between the groups. Logistic multivariate analysis was performed to explore the risk factors for miscarriage in patients with HP within 2 weeks of surgical intervention. Among the 106 women with HP, 80 had tubal HP, 8 had cornual HP, and 18 had interstitial HP. Eighty-seven (82.1%) patients developed clinical symptoms that manifested primarily as abnormal vaginal bleeding and/or abdominal pain, whereas 19 (17.9%) patients had no clinical symptoms. The mean gestational age on the day of surgery was 7.2 weeks (inter-quartile range, 6.4-8.3). The miscarriage rate within 2 weeks of surgical intervention was 12.3% in patients with HP. Compared to the ongoing pregnancy group, the miscarriage group had a higher body mass index, earlier gestational age at treatment, and higher volume of hemoperitoneum (P < .05 for all). Logistic multivariate analysis indicated that the women with a hemoperitoneum volume > 200 mL had significantly higher risk of miscarriage after adjusting covariates [OR (odds ratio) = 5.285, 95% CI (confidence interval) (1.152-24.238), P < .05]. Hemoperitoneum volume was independently associated with miscarriage of viable intrauterine pregnancies in patients with HP within 2 weeks of surgical intervention.

EP27.10: Successful management of interstitial heterotopic pregnancy by selective fetal reduction using ultrasound guidance

EP27.10: Successful management of interstitial heterotopic pregnancy by selective fetal reduction using ultrasound guidance

Successful Management of Interstitial Heterotopic Pregnancy by Fetal Reduction Using Ultrasound-guided Laparoscopy

Successful Management of Interstitial Heterotopic Pregnancy by Fetal Reduction Using Ultrasound-guided Laparoscopy

Successful Ultrasound-Guided Methotrexate Intervention in the Treatment of Heterotopic Interstitial Pregnancy: A Case Report and Literature Review

This study aims to share the experience of minimally invasive ultrasound-guided methotrexate intervention in the treatment of heterotopic interstitial pregnancy (HIP) with good pregnancy outcomes, and to review the treatment, pregnancy outcomes, and impact on the future fertility of HIP patients. The paper describes the medical history, clinical manifestations, treatment history, and clinical prognosis of a 31-year-old woman with HIP, and reviews cases of HIP from 1992 to 2021 published in the PubMed database. The patient was diagnosed with HIP by transvaginal ultrasound (TVUS) at 8 weeks after assisted reproductive technology. The interstitial gestational sac was inactivated by ultrasound-guided methotrexate injection. The intrauterine pregnancy was successfully delivered at 38 weeks of gestation. Twenty-five HIP cases in 24 studies published on PubMed from 1992 to 2021 were reviewed. Combined with our case, there were 26 cases in total. According to these studies, 84.6% (22/26) of these cases were conceived by in vitro fertilization embryo transfer, 57.7% (15/26) had tubal disorders, and 23.1% (6/26) had a history of ectopic pregnancy; 53.8% (14/26) of the patients presented with abdominal pain and 19.2% (5/26) had vaginal bleeding. All cases were confirmed by TVUS. In total, 76.9% (20/26) of intrauterine pregnancies had a good prognosis (surgery vs. ultrasound interventional therapy 1:1). All fetuses were born without abnormalities. The diagnosis and treatment of HIP remain challenging. Diagnosis mainly relies on TVUS. Interventional ultrasound therapy and surgery are equally safe and effective. Early treatment of concomitant heterotopic pregnancy is associated with high survival of the intrauterine pregnancy.

Analysis on the Outcome of Tubal Interstitial Pregnancy after Partial Cornual Resection

Objective: To investigate the safety of re-pregnancy after partial cornual resection for tubal interstitial pregnancy. Methods: The clinical data of 22 cases of re-pregnancy after partial cornual resection from November 20J 3 to June 20J 9 were retrospectively analyzed, the operation condition, re-pregnancy outcome and neonatal outcome were analyzed. Results: 18 of the 21 cases were tubal interstitial pregnancy, the re-pregnancy interval was 6-36 months, the median delivery time was 17.4 moths, the median delivery time was 36 weeks (28-41+2W), there was 2 cases of birth weight &lt;2500 g. The remaining 4 cases were interstitial heterotopic pregnancy, the median delivery time was 36 weeks (32+4-38+2W), there was 1 case of birth weight &lt;2500g. Of the 22 patients, 21 were delivered by cesarean section and 1 was vaginal delivery, all the newborns survived. There were no cases of rupture of uterus, adhesion or implantation of placenta at uterine horn. Conclusion: The patients with tubal interstitial pregnancy after standard partial cornual resection have a good outcome of re-pregnancy.

Laparoscopic Management of Heterotopic Interstitial Pregnancy (after Spontaneous Conception) with Hemoperitonium with Preservation of the Intrauterine Pregnancy: A Case

Laparoscopic Management of Heterotopic Interstitial Pregnancy (after Spontaneous Conception) with Hemoperitonium with Preservation of the Intrauterine Pregnancy: A Case

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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.

Analysis of the pregnancy outcomes of heterotopic fallopian tubal pregnancy and heterotopic interstitial pregnancy after in vitro fertilization - embryo transfer

Analysis of the pregnancy outcomes of heterotopic fallopian tubal pregnancy and heterotopic interstitial pregnancy after in vitro fertilization - embryo transfer

Selective medical treatment of heterotopic interstitial pregnancy

A new case of interstitial pregnancy after embryos transfer is reported. The interstitial pregnancy was one of twin pregnancy who was diagnosed sonographically and selectively interrupted at the 15th week. The residual pregnancy ended in an elective cesarean section early term.

Management and pregnancy outcomes of heterotopic pregnancy

Objective: To investigate the clinical features, diagnosis and treatments of heterotopic pregnancy (HP) and demonstrate the outcomes of HP after the surgical treatment of ectopic pregnancies. Methods: A retrospective analysis was performed on 144 cases of HP in Women's Hospital, School of Medicine, Zhejiang University from January 2003 to December 2016. Results: (1) Clinical features of HP:the average age of patients was (30.8±3.8) years old, body mass index (BMI) was (21.9±2.9) kg/m(2), and was diagnosed at (6.5±1.3) weeks gestational age. Four patients (2.8%) were naturally pregnant, 10 patients (6.9%) received ovulation induction, and 130 patients (90.3%) had received infertility treatments. Fifty-one patients (35.4%) had no clinical symptoms, and 93 patients (64.6%) had clinical symptoms included vaginal hemorrhage,abdominal pain and hemorrhagic shock caused by intraperitoneal hemorrhage. The location of ectopic pregnancy was most common in the fallopian tubes (59.0%, 85/144) and the interstitial part (33.3%,48/144) . (2) Ectopic pregnancy treatment of HP:thirteen patients underwent expectation treatment, and the remaining 131 cases underwent surgical treatment, including laparoscopy (n=56) , laprotomy (n=52) , and fetal reduction (n=23) . Among the 131 patients underwent surgery, intrauterine pregnancy were found inevitable abortion in 6 cases preoperatively. The total early abortion rate after surgery was 14.4% (18/125) ; the second operation rate was 3.1% (4/131) . (3) Intrauterine pregnancy outcome of HP: 120 intrauterine fetal were survival, the total live birth rate was 83.3% (120/144) .One hundred and seven intrauterine fetal were survival after operation and the live birth rate after operation was 85.6% (107/125) . Twenty-nine cases were premature delivery and the premature delivery rate was 24.2% (29/120) . There was no significant differences between tubal HP and interstitial HP group in the preterm birth rate [25.8% (16/62) vs 26.3% (10/38) ; χ(2)=0.003, P>0.05]. Cesarean section rate of delivery in interstitial HP group was significantly higher than that in tubal HP group [97.4% (37/38) vs 59.7% (37/62) ], and the difference was statistically significant (χ(2)=17.400, P<0.05) . Conclusions: The clinical manifestations of HP are diversified, combining of high risk factors, clinical symptoms and ultrasonography could improve the accuracy of diagnosis. Different method has been used to treat HP, such as laparoscopic or laparotomy and fetal reduction, and there are varying degrees of failure rate and postoperative abortion rate. We should consider carefully to adopt expectant management. Through individualized treatment, most HP could get good perinatal outcomes.

Management and obstetric outcomes of 17 heterotopic interstitial pregnancies

BackgroundHeterotopic interstitial pregnancy is a rare variant of heterotopic pregnancies, and it poses challenges in treating the heterotopic pregnancy and preserving the intrauterine pregnancy. However, there is no clear consensus regarding the optimal management. The aim of this study was to investigate the pregnancy outcomes of women diagnosed with heterotopic interstitial pregnancy.MethodsA total of 17 women diagnosed with heterotopic interstitial pregnancy between July 2010 and December 2015 were included. General characteristics of each patient, including age, gravidity and parity, history of pelvic inflammatory disease or surgery, and especially the corresponding therapeutic interventions, were retrospectively analyzed. Moreover, pregnancy outcomes were further followed by face-to-face interview.ResultsOf the 17 patients, 10 (58.5%) underwent surgical treatment (7 laparoscopic cornual resection, and 3 laparotomy); and 3 cases simultaneously terminated the intrauterine pregnancy by suction evacuation. Compared with laparotomy, laparoscopic cornual section showed shorter operative time (median 40 vs. 70 min), less blood loss (150 vs. 400 ml) and shorter hospital stay (2 vs. 4 days). In addition, 4 (23.5%) patients underwent selective embryo reduction under transvaginal ultrasound guidance. Expectant management was chosen in the remaining 3 patients. In the follow-up study, other than a case of missed miscarriage, the other 13 women who remained committed to their pregnancies all delivered healthy babies either by caesarean section or vaginal birth. No congenital anomalies were reported, and all the infants were in good growth and development.ConclusionsLaparoscopic cornual resection is a feasible approach with favorable surgical and long-term pregnancy outcomes. Additionally, medical or expectant management may be a viable treatment option for selected symptom-free patient. Although the survival of the intrauterine pregnancy could not always be assured, the prognosis for a woman with heterotopic interstitial pregnancy is generally good.

Laparoscopic Management of a Spontaneous Interstitial Heterotopic Pregnancy with Preservation of the Intrauterine Pregnancy: Case Report from Middle East

Heterotopic pregnancy is defined as multiple gestation in which one gestational sac is intrauterine while the other is extra uterine- most commonly tubal ectopic pregnancy. An interstitial ectopic pregnancy is one of the most lifethreatening types of ectopic gestations, with a mortality rate that can reach 6-7 times higher than that of the ectopic pregnancies in general. In our case report, heterotopic pregnancy occurs after a spontaneous conception cycle. A 34-year-old Gravid 3 Para 1 + Abortion 1 woman with a gestational age of 8 weeks + 3 days by LMP. She was diagnosed and managed laparoscopicaly by right salpingectomy with preservation of intrauterine pregnancy. She was discharged on the second postoperative day and followed-up regularly at the obstetrics clinic with uneventful antenatal follow up. This might be the first case to be presented from Middle east with such scenario. Careful evaluation of the adnexa is mandatory not only in women undergoing assisted reproduction, but also with spontaneous pregnancy to avoid delayed diagnosis in such cases.

EP24.18: Heterotopic pregnancy and interstitial ectopic pregnancy: 6 cases series

EP24.18: Heterotopic pregnancy and interstitial ectopic pregnancy: 6 cases series

Should sexual intercourse be avoided during the embryo transfer cycle? Life-threatening ruptured heterotopic pregnancy after single thawed embryo transfer: case report and review of the literature

To report the life-threatening complication of a raptured heterotopic pregnancy occurring from thawed single embryo transfer. A 33-year-old woman underwent in vitro fertilization (IVF) under a step-up regimen. After oocyte collection, blastocysts were frozen, and a single frozen-thawed blastocyst was then transferred according to the natural cycle. On day 17 after embryo transfer, an intrauterine pregnancy was confirmed. On day 28, she complained of sudden abdominal pain and ultrasonography revealed marked fluid retention in the peritoneal cavity. Emergency laparoscopy was performed, revealing hemoperitoneum and a ruptured interstitial heterotopic pregnancy (HP), which was then resected laparoscopically. Because sexual intercourse had occurred shortly before the transfer, a HP comprising a spontaneous pregnancy and a pregnancy achieved by assisted reproductive technology was assumed. The fetus in the uterus survived and was delivered. In this case, however, despite the single embryo transfer during the natural-cycle frozen-thawed embryo transfer process, the risk of life-threatening complication as a HP as a consequence of spontaneous pregnancy after sexual intercourse remained.

Management and outcome of heterotopic interstitial pregnancy: Case report and review of literature.

To report a case of heterotopic interstitial pregnancy after invitro fertilization-embryo transfer (IVF-ET), presenting with a second trimester uterine rupture. To review the clinical presentations, risk factors, treatment options, and outcome of heterotopic interstitial pregnancies. We describe the clinical presentation, management, and outcome of a patient with a heterotopic interstitial pregnancy, diagnosed following second trimester rupture of the interstitial pregnancy. We reviewed all published cases of heterotopic interstitial pregnancies. A 35-year-old pregnant woman with a past history of right adnexectomy and 16 weeks pregnant with dichorionic diamniotic twins following IVF-ET, was admitted to our department with unexplained recurrent abdominal pain and anemia. Further investigation showed a hemoperitoneum and because of hypovolemic shock an emergency laparotomy was performed, with diagnosis of a ruptured heterotopic interstitial pregnancy. The uterine defect was sutured using simple interrupted sutures. The intrauterine pregnancy progressed uneventful afterwards.We found 86 cases in the published literature, reporting on heterotopic interstitial pregnancies. 80.2% (69/86) occurred after IVF-ET. History of uni- or bilateral salpingectomy is a major risk factor, present in 39.5% (34/86). 37.2% (32/86) presented with cornual rupture. Surgery was performed in 53.5% (46/86) of cases. Medical management was possible in case of unruptured, early diagnosed heterotopic interstitial pregnancy (32.6% (28/86)). Watchful waiting was only possible when the interstitial pregnancy miscarried (5.8% (5/86)). The live birth rate of the intrauterine pregnancy, when viable at presentation, was 70.0% (56/80). The live birth rate of the interstitial pregnancy was only 4.7% (4/86). The majority of cases are diagnosed by detailed ultrasound in the setting of early follow-up after IVF-ET and are asymptomatic at diagnosis. Yet, a substantial number of patients present with cornual rupture. Risk factors are IVF-ET and a history of salpingectomy. Depending on clinical presentation, treatment options include watchful waiting, medical treatment, or surgery. Unfortunately, the interstitial pregnancy is generally lost, and only has a chance of survival in case of presentation at a viable gestational age. The outcome of the coexisting intrauterine pregnancy is generally good.

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.

Laparoscopic Management of Heterotopic Interstitial Pregnancy with Subsequent Term Delivery.

A 35 year-old woman at 7-week gestational age was referred to our hospital. The patient was diagnosed with the heterotopic interstitial pregnancy by transvaginal ultrasonogra- phy after receiving in vitro fertilization (IVF) and embryo transfer. Laparoscopic excision and curettage was successfully performed at 8.4-gestational age under general anesthesia and the patient was discharged 2 days after operation without any post-operative complications. The woman had normal antenatal follow-up and deliv- ered a healthy baby at term by cesarean section.