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Xiao J, Zhou X, Wang S, Lai H, Yang Z, Guo Z, Luo Y. Ultrasound manifestations and clinical analysis of 50 cases of heterotopic pregnancy. JOURNAL OF CLINICAL ULTRASOUND : JCU 2024; 52:491-498. [PMID: 38437597 DOI: 10.1002/jcu.23660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Revised: 02/15/2024] [Accepted: 02/25/2024] [Indexed: 03/06/2024]
Abstract
OBJECTIVE To investigate the value of ultrasonography in the diagnosis of heterotopic pregnancy and the follow-up. METHODS A retrospective analysis of 50 cases of clinically diagnosed heterotopic pregnancy in our hospital was performed, the clinical characteristics and ultrasonographic manifestations of the patients were summarized, the reasons for initial ultrasound missed diagnosis and misdiagnosis were analyzed, and the pregnancy outcomes were followed up. RESULTS Among the 50 cases, the initial ultrasound diagnoses of intrauterine pregnancy were all gestational sac type, 32 cases of ectopic pregnancy were located in the fallopian tube, and 10 cases were located in the uterine horn, 1 case at cervix, and 1 case at caesarean section scar. Forty-one cases were consistent with surgery and/or pathology, representing initial ultrasound diagnosis coincidence rate of about 82%. Six cases were missed in the initial ultrasound examination (12%), and three cases were misdiagnosed (6%). The maximum diameter of the intrauterine gestational sac was 9-48 mm, the average was about 24.90 ± 9.56 mm, the maximum diameter of the ectopic pregnancy gestational sac or mass was 11-63 mm, and the average was about 31.45 ± 13.82 mm (p < 0.05). Intrauterine pregnancy outcomes were followed up, 45 patients with complete data and 5 patients were lost to follow-up. The follow-up rate was about 90%. CONCLUSION Combining the patient's medical history and clinical characteristics can reduce missed diagnosis and misdiagnosis of heterotopic pregnancy. Ultrasonography has important value in the assessment of intrauterine pregnancy growth and development, and the integrity of maternal uterus.
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Affiliation(s)
- Juhua Xiao
- Department of Ultrasound, Jiangxi Provincial Maternal and Child Health Hospital, Nanchang, China
| | - Xin Zhou
- Department of Ultrasound, Jiangxi Provincial Maternal and Child Health Hospital, Nanchang, China
| | - Shuang Wang
- Department of Gynecology, Jiangxi Provincial Maternal and Child Health Hospital, Nanchang, China
| | - Hua Lai
- Department of Obstetrics, Jiangxi Provincial Maternal and Child Health Hospital, Nanchang, China
| | - Zhili Yang
- Department of Ultrasound, Jiangxi Provincial Maternal and Child Health Hospital, Nanchang, China
| | - Zhen Guo
- Department of Ultrasound, Jiangxi Provincial Maternal and Child Health Hospital, Nanchang, China
| | - Ye Luo
- Department of Ultrasound, Jiangxi Provincial Maternal and Child Health Hospital, Nanchang, China
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Agrawal M, Reddy LS, Patel D, Jyotsna G, Patel A. Fetal Reduction by Potassium Chloride Infusion in Unruptured Heterotopic Pregnancy: A Comprehensive Review. Cureus 2024; 16:e53618. [PMID: 38449926 PMCID: PMC10915710 DOI: 10.7759/cureus.53618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 02/05/2024] [Indexed: 03/08/2024] Open
Abstract
This comprehensive review explores the practice of fetal reduction through potassium chloride infusion in unruptured heterotopic pregnancies. Heterotopic pregnancies, characterized by the simultaneous occurrence of intrauterine and extrauterine gestations, present unique challenges in reproductive medicine. The review defines fetal reduction and underscores its significance in mitigating risks associated with heterotopic pregnancies, including the threat of rupture, maternal morbidity, and adverse outcomes. The analysis encompasses the background, methods, efficacy, ethical considerations, and future directions related to the procedure. Findings highlight the efficacy and safety of potassium chloride infusion, emphasizing the importance of proper patient selection and counseling. Implications for clinical practice underscore the procedure's viability in specific cases where the benefits outweigh the associated risks. The review concludes with recommendations for future studies, encouraging further research on procedural techniques, alternative methods, and the psychosocial impact on patients. This work is a foundation for advancing the management of unruptured heterotopic pregnancies, providing insights for clinicians and researchers to improve clinical outcomes and patient care.
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Affiliation(s)
- Manjusha Agrawal
- Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Lucky Srivani Reddy
- Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Drashti Patel
- Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Garapati Jyotsna
- Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Archan Patel
- Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Julien A, Gremeau AS, Campagne-Loiseau S, Chauveau B, Chauvet P, Combet L, Canis M. Case Report of an exceptional spontaneous abdominal heterotopic pregnancy with superfetation: Diagnosis and treatment: Heterotopic pregnancy with superfetation (8+1 WG & 5+4 WG). J Gynecol Obstet Hum Reprod 2024; 53:102701. [PMID: 38013015 DOI: 10.1016/j.jogoh.2023.102701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 11/23/2023] [Accepted: 11/23/2023] [Indexed: 11/29/2023]
Abstract
Heterotopic pregnancy is an extremely rare condition in which an intrauterine and an extrauterine pregnancy co-exist. In spontaneous conceptions, heterotopic pregnancy occurs in only 1/30 000 pregnancies. The treatment of heterotopic pregnancy must be as minimally invasive as possible to preserve the development of the intrauterine pregnancy. Superfetation, defined as the coexistence of 2 or more foetuses of different gestational ages, remains particularly exceptional and poorly explained (second ovulation? embryonic diapause?). Here, we present an extremely rare case of a spontaneous heterotopic evolutive pregnancy with superfetation, consisting of an embryo in the pouch of Douglas estimated at 8 + 1 weeks of gestation (WG) and a progressive intrauterine pregnancy estimated at 5 + 4 WG. We treated the extrauterine pregnancy with an intra-cardiac injection of potassium chloride echo-guided via the vaginal route, and the patient then underwent exploratory laparoscopy 9 days later and lavage and aspiration of the abdominal heterotopic pregnancy due to pain and biological inflammatory syndrome probably caused by pelvic mass syndrome and peritoneal irritation from the foetal necrosis. She has not yet given birth and is currently at 36 WG.
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Affiliation(s)
- A Julien
- Department of Gynaecological Surgery, Clermont-Ferrand University Hospital, 1 Place Lucie et Raymond Aubrac, 63003 Clermont Ferrand, France; Department of Biology and Reproductive Medicine, Clermont-Ferrand University Hospital, 1 Place Lucie et Raymond Aubrac, 63003 Clermont Ferrand, France.
| | - A-S Gremeau
- Department of Gynaecological Surgery, Clermont-Ferrand University Hospital, 1 Place Lucie et Raymond Aubrac, 63003 Clermont Ferrand, France; Department of Biology and Reproductive Medicine, Clermont-Ferrand University Hospital, 1 Place Lucie et Raymond Aubrac, 63003 Clermont Ferrand, France
| | - S Campagne-Loiseau
- Department of Gynaecological Surgery, Clermont-Ferrand University Hospital, 1 Place Lucie et Raymond Aubrac, 63003 Clermont Ferrand, France
| | - B Chauveau
- Radiology Department, Clermont-Ferrand University Hospital, 1 Place Lucie et Raymond Aubrac, 63003 Clermont Ferrand, France; EnCoV, IP, UMR 6602 CNRS, Clermont Auvergne University, Clermont-Ferrand, France
| | - P Chauvet
- Department of Gynaecological Surgery, Clermont-Ferrand University Hospital, 1 Place Lucie et Raymond Aubrac, 63003 Clermont Ferrand, France; EnCoV, IP, UMR 6602 CNRS, Clermont Auvergne University, Clermont-Ferrand, France
| | - L Combet
- Department of Gynaecological Surgery, Clermont-Ferrand University Hospital, 1 Place Lucie et Raymond Aubrac, 63003 Clermont Ferrand, France
| | - M Canis
- Department of Gynaecological Surgery, Clermont-Ferrand University Hospital, 1 Place Lucie et Raymond Aubrac, 63003 Clermont Ferrand, France; EnCoV, IP, UMR 6602 CNRS, Clermont Auvergne University, Clermont-Ferrand, France
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Ruan HC, Zhang YH, Chen L, Zhou WX, Lin J, Wen H. The risk factors for miscarriage of viable intrauterine pregnancies in patients with heterotopic pregnancy after surgical intervention. Medicine (Baltimore) 2023; 102:e36753. [PMID: 38134099 PMCID: PMC10735068 DOI: 10.1097/md.0000000000036753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 12/01/2023] [Indexed: 12/24/2023] Open
Abstract
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.
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Affiliation(s)
- Heng-chao Ruan
- Department of Gynecological Oncology, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yan-hua Zhang
- Department of Gynecological Oncology, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Lu Chen
- Department of Gynecological Oncology, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Wei-xiao Zhou
- Department of Gynecological Oncology, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jun Lin
- Department of Gynecological Oncology, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hong Wen
- Department of Gynecological Oncology, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
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