[Heterotopic pregnancy: a case report with a rare symptomatology]

Diagnosis and management of a spontaneous heterotopic pregnancy: Rare case report

Introduction and importance

Heterotopic pregnancy is the occurrence of pregnancies in at least two different implantation sites in the same time. The diagnosis of heterotopic pregnancy remains one of the greatest challenges of the gynecological-obstetrical emergencies.

Case presentation

We report a rare case of spontaneous heterotopic pregnancy of a 32-year-old woman, diagnosed with a heterotopic pregnancy by ultrasound and treated by laparotomy in emergency obstetrical department of Ibn Rochd University Hospital of Casablanca.

Clinical discussion

The existence of intrauterine pregnancy does not exclude an ectopic pregnancy. The occurrence of a spontaneous heterotopic pregnancy without risk factors is a rare event, the clinical symptomatology is often related to a threatened or ongoing abortion, the diagnosis of heterotopic pregnancy is not made until the appearance of signs of hemoperitoneum secondary to a ruptured EP, hence the importance of a systematic ultrasound examination of the adnexa during first trimester ultrasound. The standard treatment is conservative surgery, preferably by laparoscopy. Laparotomy retains its indications especially in forms with hemorrhagic shock. With the aim of preserving intrauterine pregnancy while removing ectopic pregnancy.

Conclusion

The diagnosis of heterotopic pregnancy should not be excluded by the discovery of a UGI in a spontaneous cycle. Diagnosis is often difficult and management should be initiated as soon as possible given the risk of maternal mortality.

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Heterotopic pregnancy is rare when at least two pregnancies are present simultaneously in different implantation sites.

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The diagnostic of heterotopic pregnancy is often delayed due to the visualization of the intrauterine sac.

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Treatment of heterotopic pregnancy aims to preserve the intrauterine pregnancy while removing the ectopic pregnancy.

Successful expectant management of tubal heterotopic pregnancy

Expectant management for tubal heterotopic pregnancy could be considered as a successful option in a symptom-free patient where the ectopic embryo has a limited craniocaudal length with no cardiac activity. We report the obstetric outcome after expectant management for a right tubal heterotopic pregnancy. Heterotopic pregnancy was first recognized at 6 weeks gestation in a 32-year-old salpingectomized woman with an 8-year history of subfertility who conceived after in utero transfer of three embryos obtained by in vitro fertilization. Expectant management and close ultrasonographic and clinical monitoring were done. The intrauterine pregnancy proceeded unremarkably. A cesarean section was performed for breech presentation, and it allowed the delivery of a healthy 2260-g male infant. The examination of the adnexa showed a pre-rupture of the right fallopian tube.