A case report of bilateral tubal ectopic pregnancy following day 5 embryo transfer

Tubal pregnancy after clomiphene treatment: are you sure is not bilateral?

The estimated prevalence of ectopic pregnancy (EP) is 1-2% worldwide. Bilateral tubal pregnancies represent the rarest form of heterotopic pregnancy, and spontaneously conceived are extremely unusual, as many cases are derived from assisted reproductive techniques. We describe a case of bilateral tubal pregnancy after clomiphene therapy and sexual intercourse in which the second EP was not contemporarily revealed.

Spontaneous Bilateral Tubal Ectopic Pregnancy: Incidental Finding During Laparoscopy - Brief Report and Review of Literature

Objective: Bilateral tubal ectopic pregnancies are rare; the reported incidence is only 1 in 200 000 pregnancies. Detecting bilateral tubal ectopic pregnancy is urgent because of the associated morbidity and mortality. The appropriate fertility-preserving surgery must also be considered, as preservation of both tubes is presumed to offer better fertility prospects. Case Report: A 39-year-old gravida 2, para 1 presented with vaginal bleeding at 8 + 4 weeks of gestation. An approximately 18 mm adnexal mass in the right fallopian tube was detected on ultrasound. Laparoscopy was performed because ectopic pregnancy was suspected. This suspicion was confirmed during laparoscopy; the right fallopian tube was found to contain a mass measuring 20 mm in the isthmic part. Ultrasound of the left fallopian tube also showed a mass in the ampullary region (diameter: 10 mm), also suspicious for ectopic pregnancy. Bilateral salpingotomy was performed laparoscopically. Pathological examination confirmed the diagnosis. Conclusions for Practice: Although ectopic tubal pregnancy is seen more often after assisted reproductive techniques, bilateral spontaneous ectopic pregnancies must also be considered in other cases. Laparoscopic surgery is effective to confirm the diagnosis and treat heterotopic pregnancies. Further studies will be needed to confirm whether unilateral or bilateral conservative fertility-preserving surgery is more appropriate.

Tubal pregnancy associated with additional conception in a contralateral tube

Pregnancy of unknown location is defined as empty endometrial cavity despite positive pregnancy test, and often develops as overt intrauterine or ectopic pregnancy. The pathophysiology of persistent pregnancy of unknown location, however, which involves continuous low serum human chorionic gonadotropin without any visible implantation site, is unknown. We report a case of left tubal pregnancy associated with additional conception in the contralateral tube. Left tubal pregnancy was suspected in a 40-year-old nulligravid woman after two embryo transfers following in vitro fertilization. Laparoscopic bilateral salpingectomy was performed for bilateral hydrosalpinx. Products from an additional conception were identified in the right tube. Short tandem repeat analysis using genomic DNA from resected specimens indicated two conceptions of different origin. The extra conception identified on microscopy may indicate one pathogenesis of persistent pregnancy of unknown location. Salpingectomy of the contralateral tube with hydrosalpinx is an option to prevent persistent occult pregnancy.

A rare case of bilateral ectopic pregnancy and differential diagnosis of gestational trophoblastic disease

BACKGROUND

Bilateral ectopic pregnancy is a rare condition and is divided in two subgroups, primary and secondary, based on history of assisted reproductive technology.

CASE PRESENTATION

A 30 year old primigravid woman with history of infertility and ovulation induction presented to a hospital in Kashan in year 2013. She had vaginal bleeding, abdominal pain and ultrasound findings suggested early pregnancy. Due to high titer of β-HCG, gestational trophoblastic disease was proposed and D8C was done in referral and admission to gyneco-oncology ward in Tehran. Repeat sonography suggested ectopic pregnancy in left side and repeat β-HCG level showed an increase of 19435 mIU/ml. Laparotomy findings revealed bilateral ampullary ectopic pregnancy. Bilateral salpingostomy followed by one course of methotrexate was prescribed.

CONCLUSION

Bilateral ectopic gestation should be considered as a rare differential diagnosis for ectopic pregnancy. In this study, bigger size and rupture in left side was observed.

Misdiagnosis of bilateral tubal pregnancy: a case report

Introduction

The incidence of bilateral tubal pregnancy is rising due to the increase of pelvic inflammatory disease and assisted reproductive techniques. Because the clinical manifestations of bilateral tubal pregnancy are not specific, we often ignore inspection of the other fallopian tube when focusing on the lesions, which may cause misdiagnosis.

Case presentation

A 33-year-old Chinese woman presented with vaginal bleeding after menopause and with an abnormality found by transvaginal ultrasound scan for which she underwent laparoscopy and salpingectomy. Unfortunately, she had to undergo a repetitive laparoscopic salpingotomy for the other tubal pregnancy due to misdiagnosis of her bilateral tubal pregnancy.

Conclusions

The incidence of unusual presentations of ectopic pregnancies has risen. Surgeons should always keep in mind the possibility of bilateral tubal pregnancy. An attentive examination of the pelvis, especially the two fallopian tubes, is necessary to avoid missing bilateral tubal pregnancy.

Heterochronic bilateral ectopic pregnancy after ovulation induction

Ectopic pregnancy is identified with the widely-applied assisted reproductive technology (ART). Bilateral ectopic pregnancy is a rare form of ectopic pregnancy which is difficult to be diagnosed at the pre-operation stage. In this paper, we presented an unusual case of heterochronic bilateral ectopic pregnancy after stimulated intrauterine insemination (IUI), where there has been a delay of 22 d between the diagnoses of the two ectopic pregnancies. Literature was reviewed on the occurrence of bilateral ectopic pregnancy during the past four years in the MEDLINE database. We found 16 cases of bilateral ectopic pregnancy reported since 2008, and analyzed the characteristics of those cases of bilateral ectopic pregnancy. We emphasize that ovulation induction and other ARTs may increase the risk of bilateral ectopic pregnancy. Because of the difficulty in identification of bilateral ectopic pregnancy by ultrasonography, the clinician should be aware that the treatment of one ectopic pregnancy does not preclude the occurrence of a second ectopic pregnancy in the same patient and should pay attention to the intra-operation inspection of both side fallopian tubes in any ectopic pregnancy case.

Bilateral tubal ectopic pregnancy following intra uterine insemination (IUI): A case report

BACKGROUND

The incidence of ectopic pregnancy varies between 1.5-2% of all pregnancies. Bilateral tubal ectopic pregnancy is rare. It may occur in 1 per 200 000 pregnancies.

CASE

This is a case report of 25 year-old woman who underwent intra uterine insemination (IUI), because of tubal factor infertility (unilateral). On the 30(th) day after the IUI she complained from pelvic pain and vaginal bleeding. Pelvic ultrasound showed bilateral tubal ectopic pregnancy with fluid in Douglas Pouch and empty uterine cavity. Exploratory laparotomy, left salpingectomy, and right salpingostomy were performed on the same day of admission.

CONCLUSION

The above case suggests that cases presenting with infertility and ectopic pregnancy should be followed very closely with β-hCG and or Trans Vaginal Sonography (TVS) to exclude double ectopic. So, as in this case, early diagnosis is essential for prevention of maternal morbidity and mortality.