Clinical Outcomes of Tubal Heterotopic Pregnancy: Assisted vs. Spontaneous Conceptions

Heterotopic Cesarean Scar Pregnancy: A Case Report

Heterotopic pregnancy is a rare condition with an intrauterine pregnancy coexisting with extrauterine pregnancy. It is considered a rare condition, with an incidence of one in 30,000 spontaneous pregnancies. Because of its rarity, there are no international management guidelines. It is associated with increased maternal morbidity and mortality. Heterotopic pregnancy is a challenging condition to diagnose because it can be missed due to the intrauterine pregnancy. The most common signs and symptoms to support and help us reach a diagnosis would be adnexal mass, abdominal pain, and enlarged uterus. In this case report, we aim to compare the clinical course and the outcome of intrauterine gestation while coexisting with scar pregnancy and the management options. This case report concerns a 34-year-old pregnant woman with a heterotopic pregnancy managed in Bahrain Defence Force Hospital.

Value of transvaginal sonography in diagnosing heterotopic pregnancy after in-vitro fertilization with embryo transfer

OBJECTIVES

To assess the value of transvaginal sonography (TVS) in the diagnosis of heterotopic pregnancy (HP) in the first trimester after in-vitro fertilization with embryo transfer (IVF-ET).

METHODS

This was a retrospective review of women undergoing IVF-ET between January 2005 and December 2011. Women were diagnosed with an HP using TVS if a visible intrauterine gestational sac was observed with any of the following: (i) an inhomogeneous adnexal mass; (ii) an empty extrauterine gestational sac seen as a hyperechoic ring; or (iii) a yolk sac and/or fetal pole with or without cardiac activity in an extrauterine sac.

RESULTS

Overall, 16 483 consecutive women who underwent IVF had TVS during the study. Of these, 174 cases were diagnosed on TVS as having an HP, and 10 cases were missed. Fifty-two cases were treated expectantly and were excluded from the analysis. Three types of ultrasonographic presentation of ectopic pregnancy (EP) were seen in HP patients, with a gestational sac found in 70 cases, a ring sign in 21 and an adnexal mass in 31. The sensitivity and specificity of TVS for the detection of HP were 92.4 and 100%, respectively, with positive and negative predictive values of 100 and 99.9%. The HP cases comprised 103 tubal EPs and 29 non-tubal EPs. In 93 patients (70.5%), their intrauterine pregnancy resulted in a live birth, 37 patients (28.0%) suffered an early miscarriage and two patients (1.5%) had a late miscarriage.

CONCLUSION

Early TVS performed by an experienced sonographer has a high sensitivity for making the correct diagnosis of HP after IVF-ET.