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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. J Clin Ultrasound 2024. [PMID: 38437597 DOI: 10.1002/jcu.23660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [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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Kassi L, Lantos E, Sheran J, Yee LM. A Spontaneous Tubal Heterotopic Triplet Pregnancy Resulting in Viable Twin Deliveries. AJP Rep 2024; 14:e7-e10. [PMID: 38269124 PMCID: PMC10805573 DOI: 10.1055/a-2201-5796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 10/20/2023] [Indexed: 01/26/2024] Open
Abstract
There are limited U.S. reports of spontaneous triplet heterotopic pregnancies discussing both maternal and fetal outcomes. A 34-year-old patient at 7 weeks of gestation presented to the emergency department with abdominal pain. She was diagnosed with a spontaneous heterotopic triplet pregnancy, consisting of a twin monochorionic-diamniotic intrauterine gestation and a ruptured left ectopic pregnancy. She underwent a laparoscopic unilateral salpingectomy. Her antepartum course was complicated by gestational diabetes mellitus and fetal growth restriction. Delivery of liveborn twins was via a cesarean delivery at 32 weeks. Timely intervention and management of a ruptured spontaneous triplet heterotopic pregnancy can result in a viable twin delivery with overall favorable maternal and newborn outcomes, although long-term implications due to prematurity and other twin sequelae exist.
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Affiliation(s)
- Luce Kassi
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Emma Lantos
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Jordan Sheran
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Lynn M. Yee
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Aldrich ZF, Ow R, Modii K, O'Leary T. Spontaneous Heterotopic Cesarean Scar Triplet Gestation Following Uterine Ablation. AJP Rep 2024; 14:e91-e95. [PMID: 38370332 PMCID: PMC10874689 DOI: 10.1055/s-0044-1779654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 10/18/2023] [Indexed: 02/20/2024] Open
Abstract
Heterotopic triplet pregnancy, cesarean scar ectopic pregnancy, and pregnancy following uterine ablation are all rare events that confer significant morbidity including spontaneous abortion, intrauterine fetal demise, preterm labor, abnormal placentation, and uterine rupture. A woman in her 30s, G6P4014, with a history of uterine ablation presented with delayed menses and vaginal spotting with imaging showing two intrauterine pregnancies (one with cardiac activity) and one live pregnancy at the cesarean scar. The patient was extensively counseled on risk to her and to the pregnancies; treatment options were discussed including expectant management and termination of pregnancy. The patient underwent an uncomplicated dilation and curettage with bilateral salpingectomy and was discharged home the day of the procedure in stable condition. This case highlights the potential compound effect of comorbid conditions that can pose difficulty in counseling and management. Key Points Patients undergoing endometrial ablation should be carefully selected and counseled extensively on highly effective contraception.Suspected cesarean scar pregnancies should be carefully evaluated early in gestation. Management should include thorough counseling and may be indivisualized.Many conditions pose a significant threat to maternal health and warrant a discussion of termination, which should be widely availaible and safe for all who need and/or desire it.
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Affiliation(s)
- Zane Frazer Aldrich
- Obstetrics and Gynecology and Maternal Fetal Medicine, Winnie Palmer Hospital for Women and Babies, Orlando, FL
| | - Rena Ow
- Obstetrics and Gynecology and Maternal Fetal Medicine, Winnie Palmer Hospital for Women and Babies, Orlando, FL
| | - Khyaati Modii
- Obstetrics and Gynecology and Maternal Fetal Medicine, Winnie Palmer Hospital for Women and Babies, Orlando, FL
| | - Timothy O'Leary
- Obstetrics and Gynecology and Maternal Fetal Medicine, Winnie Palmer Hospital for Women and Babies, Orlando, FL
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Li Y, Yu Y, Kou XH, Han ZL. Forensic Analysis of Eighteen Tubal Pregnancy-Related Medical Damage. Fa Yi Xue Za Zhi 2023; 39:571-578. [PMID: 38228476 DOI: 10.12116/j.issn.1004-5619.2022.220707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
OBJECTIVES To analyze the cases of medical damage after misdiagnosis of tubal pregnancy, to explore the causes of medical damage, the causal relationship between medical malpractice and the damage consequences, as well as the causative potency, in order to provide evaluation ideas for forensic identification of such cases. METHODS Eighteen cases of forensic identification of tubal pregnancy related medical damage were collected and retrospectively analyzed from the aspects of age, maternity history, fertility requirements, risk factors, diagnosis and treatment, medical malpractice, damage consequences, and causative potency. RESULTS All 18 cases were tubal pregnancy, of which 17 cases had medical malpractice, resulting in 14 cases of affected tubal resection, 2 cases of hemorrhagic shock death, 1 case of intrauterine fetal death and affected tubal resection. The other case had the consequence of affected tubal resection, but there was no malpractice in the treatment. CONCLUSIONS Correct diagnosis is helpful to make appropriate treatment plan, prevent disease progression and reduce serious adverse consequences and the occurrence of medical disputes. Scientific and reasonable analysis of the causal relationship between medical malpractice and damage consequences and the causative potency is of great significance to the successful settlement of medical disputes.
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Affiliation(s)
- Ying Li
- Beijing Huaxia Evidence Identification Center, Beijing 100089, China
| | - Yong Yu
- Beijing Source of Judicial Identification Center of Scientific Evidence, Beijing 100062, China
| | - Xing-Hua Kou
- Beijing Huaxia Evidence Identification Center, Beijing 100089, China
| | - Zhan-Long Han
- Beijing Huaxia Evidence Identification Center, Beijing 100089, China
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Abstract
Heterotopic pregnancy (HP) is a rare but potentially life-threatening event with a high risk of maternal death, which also jeopardise the coexisting intrauterine pregnancy (IUP), thus an early accurate diagnosis and prompt treatment can decrease adverse complications. We aimed to explore the early predictors for pregnancy outcomes of HP. We reviewed patients with HP following assisted reproductive technology in our institution between January 2013 and December 2020. The relationships between pregnancy outcomes and clinical features were analysed by logistic regression. We found that 29 patients (72.5%) of HP were accurately diagnosed by transvaginal ultrasonography (TVS). Eighteen patients in the surgery group had live births, three of whom delivered preterm. Additionally, the miscarriage rate was lower for patients with IUP cardiac activity than those without (16.7% vs. 90.0%, p < .001). Further by logistic regression analysis, an IUP with cardiac activity at HP diagnosis was identified as favourable independent predictor of live birth (p < .001). Therefore, early diagnosis and prompt surgical intervention are recommended to prevent the development of HP.Impact of statementWhat is already known on this subject? Heterotopic pregnancy (HP) has long been thought to be a rare but potentially life-threatening event with a high risk of complications. The early diagnosis of HP is challenging due to the co-existence of a viable intrauterine pregnancy (IUP) and the absence of typical clinical symptoms.What do the results of this study add? This stduy showed that symptoms combined with routine transvaginal ultrasonography (TVS) scans reduce the rates of misdiagnosis of HP and prompt surgical intervention after diagnosis may minimise the incidence of miscarriage of the IUP.What are the implications of these findings for clinical practice and/or further research? An IUP with cardiac activity at HP diagnosis is a predictor of a favourable prognosis of HP, and laparoscopy under general anaesthesia is effective and safe during the first trimester of pregnancy. Awareness, assessment and early interventions in view of symptoms combined with routine TVS is recommended to reduce the risk of miscarriage and ensure a favourable live birth rate.
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Affiliation(s)
- Yan Zhang
- Department of Obstetrics and Gynecology, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Xiujuan Chen
- Department of Obstetrics and Gynecology, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Yuan Lin
- Department of Obstetrics and Gynecology, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Chengying Lian
- Department of Obstetrics and Gynecology, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Xiumei Xiong
- Department of Obstetrics and Gynecology, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
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Valdés-Martínez OH, Sordia-Hernández LH, Sordia-Piñeyro MO, Guerra-Leal JD, García-Luna SM, Morales-Martínez FA. Intrasaccular methotrexate treatment of cervical pregnancies maintains fertility: a case series. J OBSTET GYNAECOL 2023; 43:2130207. [PMID: 36240120 DOI: 10.1080/01443615.2022.2130207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Otto Hugo Valdés-Martínez
- Centro Universitario de Medicina Reproductiva, Departamento de Ginecología y Obstetricia, Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, N.L., México
| | - Luis Humberto Sordia-Hernández
- Centro Universitario de Medicina Reproductiva, Departamento de Ginecología y Obstetricia, Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, N.L., México
| | - María Ofelia Sordia-Piñeyro
- Centro Universitario de Medicina Reproductiva, Departamento de Ginecología y Obstetricia, Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, N.L., México
| | - Jesús Dante Guerra-Leal
- Centro Universitario de Imagen Diagnostica, Departamento de Radiología e Imagen, Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González". Universidad Autónoma de Nuevo León, Monterrey, N.L., México
| | - Selene M García-Luna
- Centro Universitario de Medicina Reproductiva, Departamento de Ginecología y Obstetricia, Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, N.L., México
| | - Felipe Arturo Morales-Martínez
- Centro Universitario de Medicina Reproductiva, Departamento de Ginecología y Obstetricia, Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, N.L., México
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Chen X, Chen F, Zhu W, Mao L, Lv P, Zhu Y. Treatment effects of laparoscopy versus laparotomy on heterotopic pregnancy after in vitro fertilization and embryo transfer. Int J Gynaecol Obstet 2023; 163:689-696. [PMID: 37318117 DOI: 10.1002/ijgo.14919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 04/04/2023] [Accepted: 05/23/2023] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To compare the treatment effects of laparoscopy versus laparotomy on heterotopic pregnancy (HP) after in vitro fertilization-embryo transfer (IVF-ET). METHODS The retrospective case-control study enrolled 109 patients diagnosed with HP after IVF-ET treatment in our hospital from January 2009 to March 2020. All patients received surgical treatment by either laparoscopy or laparotomy. Data for general characteristics, diagnostic features, surgical parameters, as well as perinatal and neonatal outcomes were collected. RESULTS Sixty-two patients received laparoscopy and 47 received laparotomy. Significantly lower percentage of large hemoperitoneum (P = 0.001), shorter surgery duration (P < 0.001), less intraoperative blood loss (P = 0.001), higher rates of general anesthesia (P < 0.001), and lower cesarean section rates for singletons (P = 0.003) were found in the laparoscopy group. The perinatal and neonatal outcomes were comparable between the two groups. When interstitial pregnancy was considered alone, the surgical blood loss was significantly reduced in the laparoscopy group (P = 0.021), but there was no significant difference in hemoperitoneum, surgery duration, or perinatal and neonatal outcomes in singletons. CONCLUSION Both laparoscopy and laparotomy are effective surgical treatments for HP after IVF-ET. Laparoscopy is minimally invasive but laparotomy can be an alternative in emergency situations.
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Affiliation(s)
- Xijing Chen
- Department of Reproductive Endocrinology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Feng Chen
- Department of Reproductive Endocrinology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Wenting Zhu
- Department of Reproductive Endocrinology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Luna Mao
- Department of Reproductive Endocrinology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Pingping Lv
- Department of Reproductive Endocrinology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Yimin Zhu
- Department of Reproductive Endocrinology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
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Doyle WN, Giagni CC, Roth K, Amaducci A. Diagnosing Emergent Heterotopic Pregnancy via Point-of-Care Ultrasound: A Case Report. Cureus 2023; 15:e43663. [PMID: 37719523 PMCID: PMC10505074 DOI: 10.7759/cureus.43663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 08/17/2023] [Indexed: 09/19/2023] Open
Abstract
Patients undergoing assisted reproductive treatments are at a much higher risk for developing heterotopic pregnancy, a rare complication marked by concurrent intrauterine and ectopic pregnancies. Ruptured ectopic pregnancies are one of the leading causes of pregnancy-related mortality. We report the case of a 31-year-old woman undergoing ovulation induction that presented to the emergency department (ED) with worsening abdominal pain. Point-of-care ultrasound (POCUS) performed in the ED identified a heterotopic pregnancy in which the ectopic gestational sac had ruptured. The patient was immediately taken to the operating room for surgical management without obtaining a formal radiology-performed ultrasound. Nonspecific abdominal pain is one of the most common complaints for patients presenting to the ED. The usage of POCUS allows for rapid visualization of the abdominal cavity to diagnose the underlying cause of a patient's abdominal pain. This case demonstrates that complex etiologies can be reliably visualized and diagnosed without needing to wait for a formal radiology study.
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Affiliation(s)
- William N Doyle
- Department of Emergency and Hospital Medicine, Lehigh Valley Health Network / University of South Florida, Morsani College of Medicine, Bethlehem, USA
| | - Chelsea C Giagni
- Department of Obstetrics and Gynecology, Lehigh Valley Health Network / University of South Florida, Morsani College of Medicine, Bethlehem, USA
| | - Kevin Roth
- Department of Emergency and Hospital Medicine, Lehigh Valley Health Network / University of South Florida, Morsani College of Medicine, Bethlehem, USA
| | - Alexandra Amaducci
- Department of Emergency and Hospital Medicine, Lehigh Valley Health Network / University of South Florida, Morsani College of Medicine, Bethlehem, USA
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Kathopoulis N, Diakosavvas M, Kypriotis K, Chatzipapas I, Domali E, Protopapas A. Laparoscopic management of a second trimester ruptured spontaneous heterotopic tubal pregnancy mimicking ovarian tumour, a case report. Facts Views Vis Obgyn 2023; 15:157-160. [PMID: 37436053 PMCID: PMC10410657 DOI: 10.52054/fvvo.15.2.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND Laparoscopic surgery in the second trimester of pregnancy is a high risk and demanding operation. Especially when dealing with adnexal pathology, the surgeon should balance between the effort to establish adequate visualisation of the operating field with minimal uterine manipulation and use of energy application to avoid any potential adverse effects on the intrauterine pregnancy. OBJECTIVE The video shows laparoscopic surgery performed in the second trimester of pregnancy and highlights modifications to technique to ensure safety. Materials and Methods: We present a case report of spontaneous heterotopic tubal pregnancy that mimicked an ovarian tumour and was managed surgically with a laparoscopy in the second trimester. During surgery, a previously ruptured left tubal pregnancy (? ectopic) was the cause for a concealed hematoma in the pouch of Douglas, misdiagnosed as ovarian tumour. This is one of the few cases of heterotopic pregnancy treated by laparoscopy in the second trimester of pregnancy. RESULTS The patient was discharged the day 2 post-operatively, the intrauterine pregnancy progressed, and the patient delivered with a planned caesarean section on the 38th week. CONCLUSIONS Laparoscopic surgery, with adjustments, is a safe and effective method to manage adnexal pathology during a second trimester pregnancy.
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Ge F, Ding W, Zhao K, Qu P. Management of heterotopic pregnancy: clinical analysis of sixty-five cases from a single institution. Front Med (Lausanne) 2023; 10:1166446. [PMID: 37234242 PMCID: PMC10206220 DOI: 10.3389/fmed.2023.1166446] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 04/17/2023] [Indexed: 05/27/2023] Open
Abstract
Objective This retrospective study aims to analyze the influence of different treatment modalities on viable intrauterine pregnancy and to summarize the clinical features of heterotopic pregnancy (HP) patients. Material and methods All patients diagnosed with HP between January 2012 and December 2022 in Tianjin Central Obstetrics and Gynecology Hospital were reviewed retrospectively. Results This study diagnosed 65 patients using transvaginal ultrasound (TVS), including two cases of natural pregnancy, seven cases of ovulation induction pregnancy, and 56 cases after in vitro fertilization and embryo transfer (IVF-ET). The gestational age was 50.2 ± 13.0 days at the time of diagnosis. The most frequent manifestations were abdominal pain (61.5%) and vaginal bleeding (55.4%), while 11 patients (16.9%) had no symptoms before the diagnosis. The primary treatment was expectant and surgical management, including laparotomy and laparoscopic surgery. In the expectant management group, four patients were transferred to surgery due to rupture of ectopic pregnancy or ectopic pregnancy mass gradually enlarged. In the surgical management group, 53 patients underwent laparoscopic surgery, and six underwent laparotomy. The laparoscopic group's mean operation time was 51.3 ± 14.2 min (range: 15-140 min), and the median intraoperative blood loss was 20 mL (range 5-200 mL). In contrast, the laparotomy group's mean operation time was 80.0 ± 25.3 min (range 50-120 min), and the median intraoperative blood loss was 22.5 mL (range 20-50 mL). Four patients had postoperative abortions. Sixty-one newborns had no birth abnormalities, and no developmental malformations were discovered after a median follow-up of 32 months. Conclusion Expectant treatment has a high failure rate in HP, and laparoscopic surgery is a safe and effective treatment for removing ectopic pregnancy without increasing the risk of abortion or newborn birth defects.
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Affiliation(s)
- Feng Ge
- Clinical School of Obstetrics and Gynecology Center, Tianjin Medical University, Tianjin, China
| | - Wei Ding
- Department of Gynecological Oncology, Tianjin Central Hospital of Gynecology and Obstetrics, Tianjin, China
| | - Kun Zhao
- Department of Gynecological Oncology, Tianjin Central Hospital of Gynecology and Obstetrics, Tianjin, China
| | - Pengpeng Qu
- Clinical School of Obstetrics and Gynecology Center, Tianjin Medical University, Tianjin, China
- Department of Gynecological Oncology, Tianjin Central Hospital of Gynecology and Obstetrics, Tianjin, China
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Bhoi NR, Chandra V, Murdia K, Kawad K. Successful Management of Triplet Heterotopic Pregnancy (Interstitial) With an Intrauterine Monochorionic Diamniotic Twin Pregnancy Through Laparoscopy: A Case Report. Cureus 2023; 15:e37249. [PMID: 37162773 PMCID: PMC10164358 DOI: 10.7759/cureus.37249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2023] [Indexed: 05/11/2023] Open
Abstract
The simultaneous occurrence of intrauterine (IU) and extrauterine pregnancies is known as heterotopic pregnancy, an uncommon clinical condition that is challenging to manage. It can be a potentially fatal illness if it remains unnoticed. This is a case report of a woman who had heterotopic triplets after transferring two embryos produced through in vitro fertilization. An ultrasound scan diagnosed live interstitial heterotopic pregnancy and an intrauterine monochorionic twin pregnancy. Laparoscopic resection of interstitial heterotopic pregnancy was done. The monochorionic twin pregnancy was closely monitored by serial ultrasound, and at 36 weeks of gestation, two healthy twins were delivered by cesarean section. The fetal growth parameters were monitored, and a dopplers study was conducted to assess fetal blood flow. Even in heterotopic pregnancy, timely diagnosis and therapeutic intervention can preserve IU pregnancy with a successful outcome. Early meticulous monitoring and early detection can lead to a favorable outcome. Even in heterotropic pregnancy, a meticulous evaluation can lead to favorable outcomes by conserving IU pregnancy, and timely intervention can prevent maternal motility.
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Affiliation(s)
- Nihar R Bhoi
- Reproductive Medicine, Indira In Vitro Fertilization (IVF) Hospital Private Limited, Udaipur, IND
| | - Vipin Chandra
- Clinical Research and Operations, Indira In Vitro Fertilization (IVF) Hospital Private Limited, Udaipur, IND
| | - Kshitiz Murdia
- Reproductive Medicine, Indira In Vitro Fertilization (IVF) Hospital Private Limited, Udaipur, IND
| | - Kishor Kawad
- Reproductive Medicine, Indira In Vitro Fertilization (IVF) Hospital Private Limited, Ahmedabad, IND
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Nongrum SML, Bhandari P, Jain S. Atypical presentations of ectopic pregnancies in a rural tertiary care hospital-A case series. J Family Med Prim Care 2023; 12:590-593. [PMID: 37122663 PMCID: PMC10131951 DOI: 10.4103/jfmpc.jfmpc_623_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 08/02/2022] [Accepted: 12/02/2022] [Indexed: 05/02/2023] Open
Abstract
In spite of advances in medical sciences, diagnosis of ectopic pregnancy eludes the clinician. In this case series, we describe three variants of life-threatening pregnancies. The successful management of these cases hinged on a strong index of suspicion and early detection. Heterotopic pregnancy is the occurrence of two pregnancies in different implantation sites at the same time, which is uncommon. Heterotopic pregnancy is uncommon in natural conception, despite its prevalence in assisted reproductive technologies. A strong index of suspicion and timely laparotomy was life-saving for the woman. Caesarean scar pregnancy is a form of ectopic pregnancy in which an aberrant pregnancy is implanted at the hysterotomy site of a prior caesarean procedure. Unexplained excessive bleeding at the time of medical termination of pregnancy prompted us to explore and make a timely diagnosis of caesarean scar pregnancy. Finally, tubal choriocarcinoma is a very aggressive, extremely rare trophoblastic tumour that can be either gestational or non-gestational. High serum beta HCG raised the suspicion and timely laparotomy confirmed the diagnosis. An alert clinician who takes timely decisions can avert life-threatening complications in these pregnancies.
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Affiliation(s)
| | - Purnima Bhandari
- Department of Obstetrics and Gynaecology, MGIMS, Sevagram, India
| | - Shuchi Jain
- Department of Obstetrics and Gynaecology, MGIMS, Sevagram, India
- Address for correspondence: Dr. Shuchi Jain, Department of Obstetrics and Gynaecology, Kasturba Hospital, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Maharashtra, India. E-mail:
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Abstract
Heterotopic pregnancies are rare pathological pregnancy disorders in clinical practice. However, the number of cases has increased with the widespread use of ovulation induction drugs in recent years. The clinical manifestations of heterotrophic pregnancies are diverse and easy to missed or misdiagnosed. A 33-year-old married Gravida1 Para 0 + 0 patient was admitted on December 8, 2020 with intermittent abdominal pain 18 days after uterine curettage for complete hydatidiform mole of 8 weeks gestation. She had ovulation-promoting drugs prior to the index pregnancy. Hysteroscopic-directed endometrial biopsy and laparoscopic left tubal surgery were offered to her; and she is being followed up with serial pelvic ultrasounds and β-Human Chorionic Gonadotrophin (βHCG) assays. This case study presents a case of intrauterine hydatidiform mole complicated with tubal pregnancy to highlight the problems associated with its diagnosis and treatment.
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Affiliation(s)
- Jun Zhao
- Department of Obstetrics and Gynecology, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Lei Zhang
- Department of Obstetrics and Gynecology, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Jun Liang
- Department of Obstetrics and Gynecology, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Huan Zhao
- Department of Obstetrics and Gynecology, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Ziwen Wang
- Department of Obstetrics and Gynecology, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Yicun Pang
- Department of Obstetrics and Gynecology, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
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Almahloul Z, Amro B, Nagshabandi Z, Alkiumi I, Hakim Z, Wattiez A, Tahlak M, Koninckx PR. Ovarian Pregnancy: 2 Case Reports and a Systematic Review. J Clin Med 2023; 12. [PMID: 36769786 DOI: 10.3390/jcm12031138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/20/2023] [Accepted: 01/26/2023] [Indexed: 02/04/2023] Open
Abstract
Ovarian pregnancy is a rare but well-known pathology. However, pathophysiology, diagnosis and treatment are not established. Therefore, all case reports on ovarian pregnancy published in PubMed from November 2011 till November 2022 were reviewed and two case reports were added. In these 84 case reports, 8% of ovarian pregnancies occurred in women without or with blocked oviducts and 23% were localised on the other side than the corpus luteum. Since symptoms are not specific, ovarian pregnancy has to be suspected in all women with abdominal bleeding. Surgical excision is the preferred treatment. However, since an associated intra-uterine pregnancy cannot be excluded, care should be taken not to interrupt this intra-uterine pregnancy with the uterine cannula or by damaging the corpus luteum. In conclusion, in women with abdominal bleeding, an ovarian pregnancy cannot be excluded, even in women with a negative pregnancy test or an empty uterus on transvaginal ultrasonography. Therefore, a laparoscopy is indicated but the surgeon should realise that an associated intra-uterine pregnancy also cannot be excluded and that therefore care should be taken not to interrupt this intra-uterine pregnancy by the uterine cannula or by damaging the corpus luteum.
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Teka H, Yemane A, Gebremeskel M, Kinfe BA, Kiros S, Kidanu M. Heterotopic Pregnancy with Ipsilateral Adnexal Cyst Causing a Diagnostic Dilemma: A Case Report. Int Med Case Rep J 2023; 16:27-34. [PMID: 36643968 PMCID: PMC9838563 DOI: 10.2147/imcrj.s398563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 12/24/2022] [Indexed: 01/10/2023] Open
Abstract
Background Heterotopic pregnancy is the coexistence of intrauterine and extrauterine (ectopic) pregnancies. This is a relatively rare phenomenon with an incidence of 1 in 30,000 in spontaneously conceived pregnancies and 1 in 100 pregnancies achieved through assisted reproduction. Due to its relative rarity, diagnosis can be challenging. The presence of adnexal cystic masses complicating pregnancies can obscure the examination of the pelvis to rule in/out heterotopic pregnancy further adding to the complexity of the diagnosis. Case Presentation In this study, we present a 26-year-old primigravid, ethnic Tigrayan lady from the Tigray region of Ethiopia. She presented to our hospital with the complaint of progressively worsening abdominal pain of three days duration. She also had a subjective period of amenorrhea of 2 months duration. Pregnancy test was positive a few days prior to her current presentation. She reported that she had a history of treatment for pelvic inflammatory disease three months prior to her current conception. At presentation to our hospital, she was acutely ill-looking in pain, tachycardic, and hypotensive. Pelvic ultrasound showed an adnexal mass, hemoperitoneum, and an intrauterine pregnancy at 7 weeks + 5 days gestation. With the impression of ruptured ovarian cyst to rule out heterotopic pregnancy emergency, an explorative laparotomy was done which was pertinent for significant hemoperitoneum, ruptured left tubal ectopic pregnancy, and intact left ovarian cyst. Conclusion Physicians should consider a broad range of differential diagnosis in pregnant mothers who present with acute abdominal pain. Moreover, in the presence of an adnexal mass and hemoperitoneum, there is a need to maintain a low threshold for rare but life-threatening complications such as heterotopic pregnancy. The presence of an intrauterine gestation does not rule out extrauterine gestation. Thus, the presence of a viable intrauterine gestation should not stop physicians from carefully examining patients for the coexistence of an ectopic pregnancy.
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Affiliation(s)
- Hale Teka
- Department of Obstetrics and Gynecology, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia,Correspondence: Hale Teka, Department of Obstetrics and Gynecology, College of Health Sciences, Mekelle University, P.O. Box: 1871, Mekelle, Tigray, Ethiopia, Email
| | - Awol Yemane
- Department of Obstetrics and Gynecology, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Mebrihit Gebremeskel
- Department of Radiology, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Birhanu A Kinfe
- Department of Pathology, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Sara Kiros
- Department of Pathology, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Mizan Kidanu
- Department of Surgery, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
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17
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Botsyurko R, Smoligová V. Bilateral tubal ectopic pregnancy after spontaneous conception. Ceska Gynekol 2023; 88:287-290. [PMID: 37643910 DOI: 10.48095/cccg2023287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
OBJECTIVE Presentation of a case report of a rare case of bilateral tubal pregnancy in a female patient after spontaneous conception. OBSERVATION We present a case of a 26-year-old female patient first hospitalized in the Gynecology Obstetrics Clinic of the Pilsen University Hospital, where a laparoscopy was indicated for suspicion of ectopic tubal pregnancy during which a left-sided salpingectomy was performed for a macroscopically clear finding of a tubal pregnancy on the left side, this finding was also confirmed histologically. Subsequently, the patient was discharged to home care. During a follow-up examination by a district gynaecologist, the patient complained of a recurrence of pain in the lower abdomen, on collection of hCG (human chorionic gonadotropin) its increase was detected and the patient was sent for a control gynaecological examination to Mulacova Hospital in Pilsen. On the examination in the outpatient clinic, she reported significant lower abdominal pain and collapsed during transvaginal ultrasound and was hospitalized. Subsequently, diagnostic laparoscopy was indicated during hospitalization, during which tubal pregnancy on the right and hemoperitoneum were macroscopically evident. A right-sided salpingectomy was performed for this finding with subsequent hCG drop, resolution of the discomfort and histological confirmation of tubal pregnancy on the right. CONCLUSION The incidence of such cases without prior ovulation stimulation is 1 out of 200,000 pregnancies and an estimated 1 out of 725 to 1 out of 1,580 ectopic pregnancies. Even so, bilateral tubal or heterotopic ectopic pregnancy should be considered in the differential diagnosis, as both conditions can be immediately life-threatening.
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18
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Sun PP, Dong SY, Xie JL, Liu KK, Guo AP. Management of a uterine serosal heterotopic pregnancy after in vitro fertilization in a woman with bilateral salpingectomy: A case report and literature review. Medicine (Baltimore) 2022; 101:e32551. [PMID: 36595862 PMCID: PMC9794245 DOI: 10.1097/md.0000000000032551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
RATIONALE Heterotopic pregnancy (HP) is defined as the simultaneous presence of intrauterine pregnancy and ectopic pregnancy (EP). HP after bilateral salpingectomy is extremely rare and may lead to serious complications if it is misdiagnosed and untreated timely. Here, we presented the first reported case of uterine serosal HP in a woman after assisted reproductive technology with bilateral salpingectomy because of bilateral tubal ectopic pregnancy. PATIENT CONCERNS A 27-years-old pregnant woman after in vitro fertilization with bilateral salpingectomy complained of a sudden onset of unprovoked abdominal pain, which was persistent and dull. She denied vaginal bleeding. DIAGNOSES Serum beta-human chorionic gonadotropin levels are difficult to predict HP. Transvaginal ultrasonography demonstrated 1 gestational sac in the uterine cavity and 1 thick-walled cystic mass over the upper of the uterus, with a large amount of fluid in the Pouch of Douglas. Emergency laparotomy revealed a uterine serosal pregnancy combined with intrauterine pregnancy. INTERVENTIONS This patient was successfully managed via emergency laparotomy to remove residual tissue and repair the rupture of the uterine serosal pregnancy. OUTCOMES At postoperative 4 days, repeat transvaginal ultrosonography presented 1 intrauterine gestational sac with a visible fetal bud and cardiac tube pulsation. Now the patient recover well and is in an ongoing pregnancy. LESSONS It is noteworthy that HP/ectopic pregnancy is still not prevented after bilateral salpingectomy. In cases of multiple embryo transfer, even if intrauterine pregnancy has been established, it is important to rule out HP/ectopic pregnancy in time. Early diagnosis and early management can significantly improve clinical outcomes.
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Affiliation(s)
- Ping-Ping Sun
- The Reproductive Medicine Centre of Weifang People’s Hospital, Weifang, Shandong, China
| | - Shu-Yi Dong
- The Reproductive Endocrinology Department of Gaomi Maternity and Child Care Hospital, Weifang, Shandong, China
| | - Jin-Long Xie
- The Reproductive Medicine Centre of Weifang People’s Hospital, Weifang, Shandong, China
| | - Kun-Kun Liu
- The Reproductive Medicine Centre of Weifang People’s Hospital, Weifang, Shandong, China
| | - Ai-Ping Guo
- The Reproductive Endocrinology Department of Gaomi Maternity and Child Care Hospital, Weifang, Shandong, China
- * Correspondence: Ai-Ping Guo, The Reproductive Endocrinology Department of Gaomi Maternity and Child Care Hospital, No. 3188 Fenghuang Street of Gaomi, Weifang, Shandong Province 261000, China (e-mail: )
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19
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Sheng S, Zhang H, Pan Z, Li T, Wang X, Shi M, Wang F. Treatment of heterotopic cervical pregnancy by ultrasound-guided hysteroscopy: A case report and literature review. Medicine (Baltimore) 2022; 101:e32177. [PMID: 36482618 PMCID: PMC9726398 DOI: 10.1097/md.0000000000032177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Heterotopic cervical pregnancy is a rare event of ectopic pregnancy with an incidence rate of < 1%. Herein, we report a rare case of successful treatment of heterotopic pregnancy following an in vitro fertilization-embryo transfer using ultrasound-guided hysteroscopy. In order to choose the best treatment option, we reviewed the clinical treatments and discussion of heterotopic cervical pregnancy over the last 15 years. METHODS The heterotopic pregnancy was terminated using ultrasound-guided hysteroscopy; however, the intrauterine pregnancy was maintained. We searched for the keywords "cervical pregnancy combined with intrauterine pregnancy," "compound pregnancy," "assisted reproductive technology," "cervical pregnancy," and "ectopic pregnancy" on PubMed to include articles published in the last 15 years. RESULTS The patient underwent an emergency cervical cerclage at 22 weeks' gestation for cervical insufficiency and delivered a healthy newborn at 38 weeks' gestation by transvaginal compliance. Twenty-one relevant case reports were selected. After analysis and discussion, we found that assisted reproductive technology is more likely to lead to heterotopic pregnancy than unassisted reproduction. Most women requesting the preservation of intrauterine embryos opted for surgical termination of cervical pregnancy and achieved the ideal outcomes. CONCLUSION More attention should be paid to the diagnosis and treatment of heterotopic pregnancies to obtain the most optimal pregnancy outcome and long-term prognosis. Hysteroscopic surgery is a completely feasible cervical pregnancy treatment option with less postoperative impact on the mother and the intrauterine fetus.
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Affiliation(s)
- Shuman Sheng
- Department of Obstetrics and Gynecology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, People’s Republic of China
| | - Haomeng Zhang
- Department of Obstetrics and Gynecology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, People’s Republic of China
| | - Zhengwu Pan
- Department of Obstetrics and Gynecology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, People’s Republic of China
| | - Tao Li
- Department of Obstetrics and Gynecology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, People’s Republic of China
| | - Xin Wang
- Department of Ultrasound Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, People’s Republic of China
| | - Min Shi
- Department of Obstetrics and Gynecology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, People’s Republic of China
| | - Fei Wang
- Department of Obstetrics and Gynecology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, People’s Republic of China
- Department of Obstetrics and Gynecology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, People’s Republic of China
- * Correspondence: Fei Wang, Department of Obstetrics and Gynecology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 324 Jingwu Road, Jinan, Shandong 250021, People’s Republic of China (e-mail: )
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20
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Chen S, Zhu Y, Xie M. Comparison of laparoscopic and open approach in the treatment of heterotopic pregnancy following embryo transfer. Front Surg 2022; 9:1006194. [PMID: 36386500 PMCID: PMC9663481 DOI: 10.3389/fsurg.2022.1006194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 10/06/2022] [Indexed: 01/25/2023] Open
Abstract
PURPOSE Heterotopic pregnancy (HP) is a rare disease with the coexistence of an intrauterine and ectopic embryos. There is no consensus on the optimal treatment of HP at present. This research aimed to compare the perioperative and pregnancy outcomes of laparoscopic (LA) and open approach (OA) in patients with HP after embryo transfer. METHODS Women with HP receiving surgical treatment (LA or OA) were retrospectively recruited in this study between October 2006 and December 2020. The demographic, perioperative and obstetric data were collected and compared between LA and OA group. RESULTS Totally, 86 patients were included in this study. Among these patients, 62 underwent LA and 24 underwent OA. There was an increase in the adoption of LA between the 2006-2012 period and the 2013-2020 period [25% (6/24) vs. 90% (56/62), p < 0.001]. Compared with OA, patients treated by LA had much less blood loss [20 (10-50) vs. 30 (20-50) ml, p = 0.036] and fewer days of hospital stay [5.0 (4.0-7.3) vs. 9.5 (7-15.3) days, p < 0.001], but a relatively higher cost (15,580 ± 3196¥ vs. 11,717 ± 3820¥, p < 0.001). During the laparoscopic procedure, no one needed to be converted to open surgery. However, the rates of first trimester miscarriage, preterm, cesarean section, birth weight, 1- and 5-min Apgar were similar between LA and OA group (all p > 0.05). CONCLUSIONS Compared with open approach, laparoscopy was shown to provide a comparable pregnancy outcomes and a better performance on perioperative outcomes in the treatment of HP patients with embryo transfer.
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Affiliation(s)
- Shengfu Chen
- Department of Obstetrics and Gynecology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yingying Zhu
- Clinical Research Design Division, Clinical Research Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China,Correspondence: Meiqing Xie Yingying Zhu
| | - Meiqing Xie
- Department of Obstetrics and Gynecology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China,Correspondence: Meiqing Xie Yingying Zhu
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21
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Fan Y, Du A, Zhang Y, Xiao N, Zhang Y, Ma J, Meng W, Luo H. Heterotopic cervical pregnancy: Case report and literature review. J Obstet Gynaecol Res 2022; 48:1271-1278. [PMID: 35191138 PMCID: PMC9303410 DOI: 10.1111/jog.15193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 01/14/2022] [Accepted: 02/06/2022] [Indexed: 11/29/2022]
Abstract
Cervical pregnancy (CP) is a rare form of ectopic pregnancy (EP) in which the embryo implants and grows inside the endocervical canal. Heterotopic cervical pregnancy is an even rare form of EP, in which at least two embryos are simultaneously implanted in different sites and only one in the uterine cavity. Although many treatment approaches are available, the ideal management remains unclear. Here, we describe two cases of CP caused by assisted reproductive technologies (ART). One case underwent fertilization with intracytoplasmic sperm injection (ICSI) for male factor infertility, and the other was frozen–thawed embryo transfer (FET) following conventional in vitro fertilization (IVF). Both cases were successfully treated with ultrasound‐guided cervical pregnancy aspiration, and intrauterine pregnancies were effectively protected. To the best of our knowledge, these two were rare case reports use aspiration without additional methods and intrauterine pregnancy achieved live birth.
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Affiliation(s)
- Yazhen Fan
- Center for Reproductive Medicine, Tianjin Central Hospital of Gynecology Obstetrics, Tianjin, China
| | - Aijun Du
- Center for Reproductive Medicine, Tianjin Central Hospital of Gynecology Obstetrics, Tianjin, China
| | - Yinfeng Zhang
- Center for Reproductive Medicine, Tianjin Central Hospital of Gynecology Obstetrics, Tianjin, China
| | - Nan Xiao
- Center for Reproductive Medicine, Tianjin Central Hospital of Gynecology Obstetrics, Tianjin, China
| | - Yunshan Zhang
- Center for Reproductive Medicine, Tianjin Central Hospital of Gynecology Obstetrics, Tianjin, China
| | - Junfang Ma
- Center for Reproductive Medicine, Tianjin Central Hospital of Gynecology Obstetrics, Tianjin, China
| | - Wenjia Meng
- Center for Reproductive Medicine, Tianjin Central Hospital of Gynecology Obstetrics, Tianjin, China
| | - Haining Luo
- Center for Reproductive Medicine, Tianjin Central Hospital of Gynecology Obstetrics, Tianjin, China
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22
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Krishnamoorthy K, Greenberg P, Perlman BE, Morelli SS, Jindal SK, McGovern PG. The incidence of ectopic/heterotopic pregnancies after blastocyst-stage frozen-thawed embryo transfers compared with that after cleavage-stage: a Society for Assisted Reproductive Technologies Clinical Outcomes Reporting System study. F S Rep 2021; 2:421-427. [PMID: 34934982 PMCID: PMC8655396 DOI: 10.1016/j.xfre.2021.06.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 06/05/2021] [Accepted: 06/29/2021] [Indexed: 11/15/2022] Open
Abstract
Objective To investigate whether there is a difference in the ectopic/heterotopic pregnancy rate of blastocyst-stage frozen-thawed embryo transfers (FETs) compared with that of cleavage-stage FETs. Design A retrospective cohort study. Setting Not applicable. Patient(s) Women undergoing autologous FETs at either the blastocyst stage (n = 118,572) or the cleavage stage (n = 117,619), as reported to the Society for Assisted Reproductive Technology from 2004 to 2013. Intervention(s) None. Main Outcome Measure(s) Pregnancy outcomes, specifically ectopic pregnancy rates and heterotopic pregnancy rates. Result(s) Among those who became pregnant, there was a significantly lower incidence of ectopic/heterotopic pregnancies in blastocyst-stage FETs versus that in cleavage-stage FETs (0.8% vs. 1.1%). The differences in ectopic/heterotopic pregnancy rates remained statistically significant after controlling for confounders such as tubal factor infertility and number of embryos transferred. Conclusion(s) Blastocyst-stage FET was associated with a lower ectopic/heterotopic pregnancy rate compared with cleavage-stage FET.
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Affiliation(s)
- Kavitha Krishnamoorthy
- Obstetrics, Gynecology and Reproductive Health, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Patricia Greenberg
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey
| | - Barry E Perlman
- Obstetrics, Gynecology and Reproductive Health, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Sara S Morelli
- Obstetrics, Gynecology and Reproductive Health, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Sangita K Jindal
- Montefiore's Institute for Reproductive Medicine and Health, Hartsdale, New York
| | - Peter G McGovern
- University Reproductive Associates, Hasbrouck Heights, New Jersey
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Nomura S, Kyozuka H, Jin T, Fujimori M, Suzuki D, Sato K, Imamura T, Nomura Y. First trimester heterotopic pregnancy with shock treated laparoscopically, followed by uneventful term pregnancy and normal birth. Fukushima J Med Sci 2021; 67:168-171. [PMID: 34707040 PMCID: PMC8784197 DOI: 10.5387/fms.2021-14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Heterotopic pregnancy (HP), a coexistence of intrauterine and ectopic pregnancies, is extremely rare. Although there have been many reports of maternal outcomes in pregnant women with HP, they have not described fetal neurodevelopmental outcomes and survival. A 30-year-old Japanese woman in early gestation who had undergone two previous cesarean deliveries was transferred to our hospital with vital signs of shock. HP was confirmed by ultrasonography and laparoscopic surgery, and right salpingectomy was performed. At term, a 2,875 g neonate was delivered via cesarean section without any complications.
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Affiliation(s)
- Shinji Nomura
- Department of Obstetrics and Gynecology, Ohta Nishinouchi Hospitale
| | - Hyo Kyozuka
- Department of Obstetrics and Gynecology, Ohta Nishinouchi Hospitale
| | - Toki Jin
- Department of Obstetrics and Gynecology, Ohta Nishinouchi Hospitale
| | - Mimori Fujimori
- Department of Obstetrics and Gynecology, Ohta Nishinouchi Hospitale
| | - Daisuke Suzuki
- Department of Obstetrics and Gynecology, Ohta Nishinouchi Hospitale
| | - Kenichi Sato
- Department of Pediatrics, Ohta Nishinouchi Hospital
| | | | - Yasuhisa Nomura
- Department of Obstetrics and Gynecology, Ohta Nishinouchi Hospitale
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Koutras A, Fasoulakis Z, Diakosavvas M, Syllaios A, Pagkalos A, Samara AA, Tsatsaris G, Ntounis T, Theodora M, Sindos M, Kontomanolis EN. Cervical Twin Heterotopic Pregnancy: Overview of Ectopic Pregnancies and Scanning Detection Algorithm. Medicina (Kaunas) 2021; 57:969. [PMID: 34577892 DOI: 10.3390/medicina57090969] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 09/09/2021] [Accepted: 09/14/2021] [Indexed: 11/17/2022]
Abstract
Background: Ectopic pregnancy is the leading cause of gestation-related deaths during the first trimester. Cervical twin heterotopic pregnancies, when ectopic, constitute a small and rare part of gynecological surgery. Case Presentation: A 30-year-old pregnant woman (gravida 3, para 2) presented with mild pain in the lower abdomen and traces of bleeding per vaginum for three days. Transvaginal ultrasonography revealed a balloon-shaped cervical canal with a visible gestational sac measuring 3.5 × 3.9 cm. A second gestational sac was seen in the uterine cavity. The measurements of the gestational sacs corresponded to 7 + 4 weeks' pregnancy. A decision for medical abortion with mifepristone and misoprostol was made. However, due to an incomplete abortion and continuous bleeding, a curettage was performed. Conclusions: Spontaneous heterotopic pregnancy with the ectopic pregnancy located in the cervix is an extremely rare clinical condition requiring urgent treatment in order to reduce maternal mortality and morbidity and preserve fertility.
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25
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Ozawa N, Shibata M, Mitsui M, Umehara N, Samura O, Sago H. Spontaneously conceived heterotopic pregnancy with abdominal pregnancy implanted on the vesicouterine pouch: A case report and literature review. J Obstet Gynaecol Res 2021; 47:3720-3726. [PMID: 34342369 DOI: 10.1111/jog.14967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 07/10/2021] [Accepted: 07/23/2021] [Indexed: 11/28/2022]
Abstract
We report the case of a 36-year-old woman with spontaneously conceived heterotopic pregnancy with abdominal pregnancy. She visited the hospital at 5 weeks and 4 days of gestation and transvaginal ultrasonography revealed a normal intrauterine pregnancy. Two days later, she was urgently transported to the hospital due to extreme abdominal pain. Emergent laparotomy was performed to investigate the cause of massive intraperitoneal bleeding, which was confirmed to have been due to an abdominal pregnancy that implanted on the vesicouterine pouch. The hematic mass, including chorionic villi, was successfully removed from the peritoneum. The subsequent course of the intrauterine pregnancy was uneventful and a healthy baby was born at term. To the best of our knowledge, this is an extremely rare case report of a spontaneously conceived heterotopic abdominal pregnancy, in which the intrauterine pregnancy showed a successful outcome despite the collapse of the abdominal pregnancy at a very early stage.
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Affiliation(s)
- Nobuaki Ozawa
- Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Megumi Shibata
- Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Mari Mitsui
- Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Nagayoshi Umehara
- Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Osamu Samura
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo, Japan
| | - Haruhiko Sago
- Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
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Abdelmonem AH, Sayed G, Abugazia AE, Kohla S, Youssef R. Heterotopic pregnancy after a spontaneous conception a case report with a review of clinical, laboratory and imaging findings. Clin Case Rep 2021; 9:e04649. [PMID: 34430013 PMCID: PMC8365543 DOI: 10.1002/ccr3.4649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 06/24/2021] [Accepted: 07/12/2021] [Indexed: 11/10/2022] Open
Abstract
Heterotopic pregnancy (HP) describes the simultaneous presence of two pregnancies at different implantation sites. Usually, one pregnancy is intrauterine and the other one is ectopic. The incidence of HP after assisted reproductive technologies reaches 1:3900, but is very rare after a spontaneous pregnancy, with a reported incidence of 1 to 30,000 pregnancies. Due to its rarity, complex clinical picture, and laboratory findings, it is challenging to diagnose HP. We present a case of spontaneous HP diagnosed in the first trimester by ultrasound (US) and magnetic resonance imaging (MRI) and subsequently managed successfully. We present an analysis of the clinical and laboratory findings as well as imaging, including MRI that we used to diagnose the condition. Additionally, we performed a literature review. CONCLUSIONS HP is a very rare condition frequently faced in obstetrics, gynecology, and emergency departments that requires a high index of clinical suspicion. US remains the imaging modality of choice in diagnosing a HP, however, in some cases, an MRI with a reported safety in the first trimester, can be used to provide additional information over US.
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Affiliation(s)
- Ahmed H. Abdelmonem
- Department of RadiologyHamad General HospitalDohaQatar
- Weill Cornell Medicine QatarDohaQatar
| | - Gamal Sayed
- Weill Cornell Medicine QatarDohaQatar
- Department of Obstetrics & GynecologyWomen’s Wellness and Research CenterDohaQatar
- Clinical DepartmentCollege of MedicineQU HealthQatar UniversityDohaQatar
- University of DundeeDundeeUK
| | | | - Samah Kohla
- Weill Cornell Medicine QatarDohaQatar
- Department of Laboratory Medicine and PathologyHematology DivisionHamad Medical CorporationDohaQatar
| | - Reda Youssef
- Weill Cornell Medicine QatarDohaQatar
- Department of RadiologyWomen’s Wellness and Research CenterDohaQatar
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Dhillon S, Yim G, Vandse R. Anesthetic Management of a Patient With a Ruptured Heterotopic Pregnancy for Emergency Exploratory Laparotomy. Cureus 2021; 13:e16850. [PMID: 34513431 PMCID: PMC8412343 DOI: 10.7759/cureus.16850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2021] [Indexed: 11/24/2022] Open
Abstract
Heterotopic pregnancy (HP) is an uncommon clinical condition characterized by the coexistence of intrauterine and extra-uterine pregnancies. HP is a diagnostic challenge as the typical methods for the early diagnosis of ectopic pregnancy are confounded by the simultaneous presence of intrauterine pregnancy (IUP). Ruptured HP is a potentially life-threatening obstetric emergency and can result in significant morbidity and mortality. Early diagnosis is the key to a favorable outcome. With the increasing number of patients undergoing artificial reproductive technology (ART), which is an important risk factor for HP, the odds of encountering HP patients are also growing. Anesthesiologists are challenged by the need to manage a bleeding obstetric patient while simultaneously ensuring the safety of the IUP. We present perioperative management of a patient with bleeding ruptured HP for emergency laparotomy who went on to have a successful twin delivery 37w3d via cesarean section.
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Affiliation(s)
- Sameep Dhillon
- Anesthesiology, Loma Linda University School of Medicine, Loma Linda, USA
| | - Gibbs Yim
- Anesthesiology, Loma Linda University School of Medicine, Loma Linda, USA
| | - Rashmi Vandse
- Anesthesiology, Loma Linda University Medical Center, Loma Linda, USA
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28
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Hosoya S, Kasahara Y, Komazaki H, Kishi H, Takano H, Okamoto A. A rare case of heterotopic pregnancy after a single embryo transfer: A case report and literature review. J Obstet Gynaecol Res 2021; 47:3707-3711. [PMID: 34254398 DOI: 10.1111/jog.14923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/29/2021] [Accepted: 06/26/2021] [Indexed: 11/30/2022]
Abstract
Heterotopic pregnancy (HP) is a rare but life-threatening disease. We report a rare case of HP that occurred after single embryo transfer (SET) with spontaneous natural pregnancy possibly due to sexual intercourse (SI) during assisted reproductive technology treatment and reviewed previous reports. A 39-year-old woman at 7 weeks 5 days' gestation with anti-sperm antibody who underwent a single frozen-thawed embryo transfer in her natural cycle presented with lower abdominal pain and vaginal bleeding. She had several SIs before the day of SET. A viable intrauterine fetus and an extrauterine mass at the right adnexa were detected on transvaginal ultrasonography. An emergent laparoscopic surgery showed a swollen right fallopian tube, and right salpingectomy was performed. Unfortunately, intrauterine fetal death was diagnosed at 19 weeks' gestation. In conclusion, the possibility of HP should be considered in patients with SIs around the day of SET.
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Affiliation(s)
- Satoshi Hosoya
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo, Japan.,Department of Obstetrics and Gynecology, The Jikei University Kashiwa Hospital, Chiba, Japan
| | - Yuta Kasahara
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo, Japan
| | - Hiromi Komazaki
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo, Japan.,Department of Obstetrics and Gynecology, The Jikei University Kashiwa Hospital, Chiba, Japan
| | - Hiroshi Kishi
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo, Japan
| | - Hirokuni Takano
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo, Japan.,Department of Obstetrics and Gynecology, The Jikei University Kashiwa Hospital, Chiba, Japan
| | - Aikou Okamoto
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo, Japan
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29
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Kluckman ML, Schwope RB, Provagna AJ, Yauger BJ, Ramirez CI. The double corpus luteum: A novel sonographic sign of heterotopic pregnancy. J Clin Ultrasound 2021; 49:617-621. [PMID: 33761132 DOI: 10.1002/jcu.23006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 02/26/2021] [Accepted: 03/11/2021] [Indexed: 06/12/2023]
Abstract
Heterotopic pregnancy is a rare and highly morbid condition with simultaneous intrauterine and extra-uterine pregnancies. The early diagnosis of heterotopic pregnancy is difficult, owing to rarity of the condition and nonspecific clinical and laboratory findings. This case report introduces the "double corpus luteum" sign, a new sonographic and magnetic resonance imaging sign which is easily detectable and should raise the index of suspicion for heterotopic pregnancy. We present a surgically confirmed spontaneous heterotopic and angular pregnancy in a young woman without risk factors or assisted reproductive therapy to illustrate the utility of this novel sign.
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Affiliation(s)
- Matthew L Kluckman
- Department of Radiology, Brooke Army Medical Center, San Antonio, Texas, USA
| | - Ryan B Schwope
- Department of Radiology, Brooke Army Medical Center, San Antonio, Texas, USA
- Uniformed Services, University of the Health Sciences, Bethesda, Maryland, USA
| | - Alyssa J Provagna
- Department of Obstetrics and Gynecology, Brooke Army Medical Center, San Antonio, Texas, USA
| | - Belinda J Yauger
- Department of Obstetrics and Gynecology, Brooke Army Medical Center, San Antonio, Texas, USA
| | - Christina I Ramirez
- Department of Obstetrics and Gynecology, Brooke Army Medical Center, San Antonio, Texas, USA
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30
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Mu Q, Liu Y, Wang S, Luan S, Li J, Fan J. Cervical heterotopic pregnancy: A case report. Zhong Nan Da Xue Xue Bao Yi Xue Ban 2021; 46:212-216. [PMID: 33678661 PMCID: PMC10929780 DOI: 10.11817/j.issn.1672-7347.2021.190712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Indexed: 11/03/2022]
Abstract
Heterotopic pregnancies are rare and difficult to be diagnosed early. A patient with combined intrauterine pregnancy and cervical pregnancy was admitted in Qingdao Municipal Hospital in 2019. The patient complained of abnormal vaginal bleeding after menopause and was misdiagnosed as simple intrauterine pregnancy. She underwent artificial abortion and suffered intraoperative hemorrhage. To stop bleeding, she received the treatment of uterine artery embolization immediately. Afterwards, cervical residual pregnancy tissues started necrosis, blood β-human chorionic gonadotropin level and the cervix appearance gradually returned to normal. This report suggests that cervical heterotopic pregnancy inclines to be mis diagnosed. Correct diagnosis should be made as soon as possible. Selective uterine artery embolization is an effective measure to prevent and treat massive bleeding.
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Affiliation(s)
- Qingling Mu
- Department of Gynecology and Obstetrics, Qingdao Municipal Hospital, Qingdao Shandong 266000.
| | - Ying Liu
- Department of Gynecology and Obstetrics, Qingdao Municipal Hospital, Qingdao Shandong 266000
| | - Shuping Wang
- Department of Gynecology and Obstetrics, Qingdao West Coast New District People's Hospital, Qingdao Shandong 266400, China
| | - Shaohong Luan
- Department of Gynecology and Obstetrics, Qingdao Municipal Hospital, Qingdao Shandong 266000
| | - Jing Li
- Department of Gynecology and Obstetrics, Qingdao Municipal Hospital, Qingdao Shandong 266000
| | - Jun Fan
- Department of Gynecology and Obstetrics, Qingdao Municipal Hospital, Qingdao Shandong 266000.
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Abstract
Heterotopic pregnancy is a rare, life-threatening clinical entity with an overall incidence of about 1:30,000 in spontaneous natural conception cases, especially in cases of delayed diagnosis or conflicting clinical features. Here, we present an unusual case of heterotopic pregnancy in a 22-year-old multigravida presented to the emergency department (ED) with a clinical picture of the acute abdomen following recent abdominal trauma. Abdominal ultrasound revealed hemoperitoneum and a single viable intrauterine pregnancy at seven weeks' gestation. Following surgical exploration, the patient underwent removal of the ectopic pregnancy tissue with right salpingectomy. Since the presence of a conflicting history or equivocal physical signs and symptoms makes it difficult to diagnose heterotopic pregnancy, ED physicians and surgeons must consider the diagnosis even when dealing with viable intrauterine pregnancies. Besides, acute abdominal pain associated with shock should be regarded as suggestive of heterotopic pregnancy. Thus, prompt evaluation and a high index of suspicion are of paramount importance to prevent unwanted sequelae.
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32
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Pi R, Liu Y, Zhao X, Liu P, Qi X. Tubal infertility and pelvic adhesion increase risk of heterotopic pregnancy after in vitro fertilization: A retrospective study. Medicine (Baltimore) 2020; 99:e23250. [PMID: 33181716 PMCID: PMC7668441 DOI: 10.1097/md.0000000000023250] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
To analyze risk factors associated with heterotopic pregnancy and the uterine pregnant outcome of those patients after surgery.We retrospectively analyzed 22 patients diagnosed as HP after in vitro fertilization (IVF) between January 2015 and December 2018.HP was diagnosed at gestation age of 55.4 ± 11.8 days. HP were presented as irregular vaginal bleeding, abdominal pain, and sometimes no symptoms. 81.8% of ectopic lesion in HP occurred at fallopian tubes, especially ampullary; cornual pregnancy takes up 13.6%. Compared with clinical intrauterine pregnancy (IUP), IVF with tubal infertility factors had higher risks of HP (OR 4.185, 95% CI 1.080- 16.217); IVF with pelvic adhesion also had higher risks of HP (OR 5.552 95% CI 1.677-18.382); IVF with more than 2 embryos transferred increased risks of HP (OR 23.253, 95% CI 1.804-299.767). The abortion rates of surgery-treated HP and IUP after IVF were 27.8% versus 10.3% (P = .042).These results demonstrate IVF with tubal infertility, pelvic adhesion or multiembryos transfer are risk factors of HP. Furthermore, surgery could induce abortion.
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33
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Murewanhema G, Madombi S, Hlathswayo L, Simango N. Concurrent ruptured spontaneous heterotopic pregnancy and ruptured appendix with delayed presentation in the first trimester: a case report. Pan Afr Med J 2020; 37:222. [PMID: 33520061 PMCID: PMC7821793 DOI: 10.11604/pamj.2020.37.222.26182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 10/30/2020] [Indexed: 11/18/2022] Open
Abstract
Acute appendicitis is the commonest non-gynaecological surgical emergency in pregnancy. However, the concurrent occurrence of acute appendicitis with a heterotopic pregnancy is a rare event and presents diagnostic challenges to unsuspecting clinicians and sonographers. We present a case of a woman who had a heterotopic pregnancy and was noted to have a gangrenous appendicitis at laparotomy, illustrating how a diagnosis of acute appendicitis could easily be missed in pregnancy. We report the case of a 34-year-old woman in the first trimester of pregnancy who had a missed diagnosis of acute appendicitis after she had complained of vague abdominal symptoms for three weeks. She presented to a gynaecologist with vaginal bleeding for three days and was noted to have a heterotopic pregnancy on ultrasound scan. At laparotomy, she was noted to have a gangrenous appendicitis with pyoperitoneum concurrent with a ruptured left fimbrial ectopic pregnancy. Left salpingectomy and saline lavage were done and she had uneventful post-operative recovery. Unsuspecting clinicians, in patients without risk factors, can miss both heterotopic pregnancy and acute appendicitis. As assisted reproductive techniques become widespread, the possibility of heterotopic pregnancies must always be considered and any patient who presents with vague abdominal symptoms must be suspected to have the possibility of acute appendicitis. Because of the unreliability of laboratory investigations and clinical predictive scores in pregnancy, sonographers must be specifically asked to scan for heterotopic pregnancy and appendicitis in suspected cases.
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Affiliation(s)
- Grant Murewanhema
- Department of Obstetrics and Gynaecology, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Simbarashe Madombi
- Department of Obstetrics and Gynaecology, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Lynette Hlathswayo
- Department of Obstetrics and Gynaecology, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Ndabaningi Simango
- Department of Obstetrics and Gynaecology, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
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34
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Černiauskaitė M, Vaigauskaitė B, Ramašauskaitė D, Šilkūnas M. Spontaneous Heterotopic Pregnancy: Case Report and Literature Review. ACTA ACUST UNITED AC 2020; 56:medicina56080365. [PMID: 32707853 PMCID: PMC7466362 DOI: 10.3390/medicina56080365] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 07/17/2020] [Accepted: 07/17/2020] [Indexed: 11/16/2022]
Abstract
Heterotopic pregnancy is defined as a condition when intrauterine and extrauterine pregnancy occur simultaneously. It is a life-threatening condition that requires immediate and accurate diagnostics and treatment. We present a case of a 28-year-old primigravida female who conceived spontaneously and at her seventh week of gestation and was presented to the emergency department with weakness and acute pain in lower abdomen. Laboratory tests and transvaginal ultrasonography revealed the diagnosis of heterotopic pregnancy. Urgent laparoscopic salpingotomy was chosen as a treatment option. The ectopic pregnancy was successfully removed with the preservation of the intrauterine embryo and fallopian tubes. The course of pregnancy after the surgery was without complications, and a healthy baby was delivered at the 39th week of gestation. When treated properly and on time, a heterotopic pregnancy can result in live childbirth with favorable outcomes for both the child and the mother.
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Affiliation(s)
- Miglė Černiauskaitė
- Faculty of Medicine, Vilnius University, M. K. Čiurlionio g. 21, 03101 Vilnius, Lithuania
- Correspondence: ; Tel.: +370-622-36-570
| | - Brigita Vaigauskaitė
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University Clinic of Obstetrics and Gynaecology, Vilnius University Hospital Santaros Clinics, Santariškių g. 2, 08661 Vilnius, Lithuania; (B.V.); (D.R.); (M.Š.)
| | - Diana Ramašauskaitė
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University Clinic of Obstetrics and Gynaecology, Vilnius University Hospital Santaros Clinics, Santariškių g. 2, 08661 Vilnius, Lithuania; (B.V.); (D.R.); (M.Š.)
| | - Mindaugas Šilkūnas
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University Clinic of Obstetrics and Gynaecology, Vilnius University Hospital Santaros Clinics, Santariškių g. 2, 08661 Vilnius, Lithuania; (B.V.); (D.R.); (M.Š.)
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Lee KN, Ham HJ, Whang EJ, Eun-Ji J, Seung-Hye C, Lee KY. Successful heterotopic pregnancy with prior radical trachelectomy after transabdominal cervico isthimic cerclage with methotrexate treatment. J Obstet Gynaecol Res 2020; 46:663-667. [PMID: 32028544 DOI: 10.1111/jog.14196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 12/30/2019] [Indexed: 11/30/2022]
Abstract
Heterotopic pregnancy with cervical incompetence is very uncommon. And yet there is no definite treatment for cervical incompetence occurring after radical trachelectomy. We are reporting a rare and novel case of a following in vitro fertilization combined intrauterine pregnancy and interstitial pregnancy which was successfully treated with maintenance of the pregnancy to term.
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Affiliation(s)
- Kyong-No Lee
- Department of Obstetrics and Gynecology, Kangnam Sacred Heart Hospital of Hallym University, Seoul, Korea
| | - Hee-Jin Ham
- Department of Obstetrics and Gynecology, Kangnam Sacred Heart Hospital of Hallym University, Seoul, Korea
| | - Eun-Jee Whang
- Department of Obstetrics and Gynecology, Kangnam Sacred Heart Hospital of Hallym University, Seoul, Korea
| | - Jo Eun-Ji
- Department of Obstetrics and Gynecology, Kangnam Sacred Heart Hospital of Hallym University, Seoul, Korea
| | - Choi Seung-Hye
- Department of Obstetrics and Gynecology, Kangnam Sacred Heart Hospital of Hallym University, Seoul, Korea
| | - Keun-Young Lee
- Department of Obstetrics and Gynecology, Kangnam Sacred Heart Hospital of Hallym University, Seoul, Korea
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36
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Xi Q, Yu Y, Zhang X, Zhang H, Jiang Y, Liu R, Zhang H. Two cases of intrauterine pregnancy with tubal stump pregnancy after in vitro fertilization and embryo transfer following ipsilateral salpingectomy: A case report. Medicine (Baltimore) 2019; 98:e18183. [PMID: 31804336 PMCID: PMC6919399 DOI: 10.1097/md.0000000000018183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE The recently increased rate of heterotopic pregnancies (HPs) has been largely attributed to the increased use of assisted reproduction technologies (ARTs). HP is a rare and potentially life-threatening condition. It is unusual in natural conception cycles, occurring in 1:10,000 to 1:50,000 pregnancies. However, with the increased use of ART such as in vitro fertilization and embryo transfer (IVF-ET), the incidence has risen to 0.5-1%. PATIENT CONCERNS Case 1 was a 28-year-old woman who presented to our center complaining of a sudden onset of right-side lower abdominal pain with a small amount of vaginal bleeding. She had undergone IVF-ET and received a thawed embryo transfer with two embryos 23 days previously. She had a history of right salpingectomy for an ectopic pregnancy during the downregulation of her ovulatory cycle 1 year ago. Case 2 was a 25-year-old woman who presented to our center complaining of a sudden onset of right-side lower abdominal pain. She had also undergone thawed embryo transfer following IVF-ET with two embryos 35 days previously. She had a history of right salpingectomy for an ectopic pregnancy 1.5 years previously. DIAGNOSES Both patients were diagnosed as having a heterotopic pregnancy. INTERVENTIONS Patient 1 underwent emergency laparoscopy; patient 2 underwent emergency laparotomy and both were treated medically to prevent abortion of the intrauterine pregnancies. OUTCOMES Patient 1 had an incomplete abortion and underwent uterine curettage on the day 10 after the operation. Patient 2 experienced no further complications during pregnancy and a healthy baby girl was born at the 38th gestational week. LESSONS Reproductive physicians need to pay more attention to patients who have received more than one embryo at transfer, especially those with a history of salpingectomy.
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Liu C, Jiang H, Ni F, Liu Y, Zhang W, Feng C. The Management of Heterotopic Pregnancy with Transvaginal Ultrasound-Guided Local Injection of Absolute Ethanol. Gynecol Minim Invasive Ther 2019; 8:149-154. [PMID: 31741839 PMCID: PMC6849102 DOI: 10.4103/gmit.gmit_4_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 04/17/2019] [Accepted: 04/29/2019] [Indexed: 12/03/2022] Open
Abstract
Aims: The aim of the study is to present five cases of heterotopic pregnancy (HP) patients who received transvaginal ultrasound-guided local injection of absolute ethanol (AE). Settings and Design: This was a case series and literature review in Reproductive Medicine Center of the 105th Hospital of the People's Liberation Army. Materials and Methods: Five primary infertile women who underwent assisted reproductive technology were diagnosed with HP and treated with local injection of AE (1.0–2.5 ml) under transvaginal ultrasound guidance. The size of intrauterine (IU) and ectopic sacs and the level of serum beta-human chorionic gonadotropin as well as pregnancy outcomes were monitored after treatment. Statistical Analysis Used: Not applicable. Results: Four of five cases presented with lack of Doppler flow in the injected area after AE injection. Meanwhile, IU pregnancy proceeded well after treatment and delivered a normal newborn. One case received emergency surgery 3 h after local injection of 2.5 ml AE because of the rupture of ectopic gestational sac (GS). An early abortion was identified 7 days after the surgery. Conclusions: Transvaginal ultrasound-guided local injection of AE is an alternative nonsurgical treatment for HP, yet overdose injection of AE will increase the risk of ectopic GS rupture.
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Affiliation(s)
- Conghui Liu
- Reproductive Medicine Center, 105 Hospital of the People's Liberation Army, Hefei, China
| | - Hong Jiang
- Reproductive Medicine Center, 105 Hospital of the People's Liberation Army, Hefei, China
| | - Feng Ni
- Reproductive Medicine Center, 105 Hospital of the People's Liberation Army, Hefei, China
| | - Ying Liu
- Reproductive Medicine Center, 105 Hospital of the People's Liberation Army, Hefei, China
| | - Wenxiang Zhang
- Reproductive Medicine Center, 105 Hospital of the People's Liberation Army, Hefei, China
| | - Cuie Feng
- Reproductive Medicine Center, 105 Hospital of the People's Liberation Army, Hefei, China
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Abstract
Heterotopic pregnancy is defined as the simultaneous presence of intrauterine and ectopic pregnancies. It is a rare condition, but due to the increasing use of artificial reproductive techniques, the incidence of heterotopic pregnancy is increasing. Most of the patients with heterotopic pregnancy have a previous history of infertility or tubal diseases. In this case series, we are presenting six cases of heterotopic pregnancy. Three of them had a history of assisted reproductive technique: one patient had in vitro fertilization with three embryos transferred, and two patients received follicular stimulating hormone therapy. In one of the cases, heterotopic pregnancy was missed on an initial transabdominal scan, and in the following weeks, it was diagnosed on transvaginal ultrasound. Five patients underwent laparoscopic salpingectomy, and one patient had laparotomy and then a salpingectomy was done. Follow-up ultrasound scans for intrauterine pregnancy (IUP) showed abortion of the IUP, except in one patient who delivered a healthy full-term baby via spontaneous vaginal delivery. Therefore, there is a need to develop diagnostic criteria to rule out heterotopic pregnancy if the patient underwent any type of assisted reproductive techniques. We are emphasizing the need for more careful scanning of the adnexa via transvaginal ultrasound, especially in high-risk patients, even if the intrauterine gestation is confirmed.
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Affiliation(s)
- Usman Nabi
- Radiology, Hamad Medical Corporation, Doha, QAT
| | | | - Fariha Ghaffar
- Internal Medicine, Allama Iqbal Medical College, Lahore, PAK
| | - Sadia Sajid
- Radiology, Hamad Medical Corporation, Doha, QAT
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Bhairavi S, Dash S, Dash S. Heterotopic Cervical Pregnancy: A Rare Case Treated by Transvaginal Aspiration. J Hum Reprod Sci 2019; 12:355-357. [PMID: 32038090 PMCID: PMC6937772 DOI: 10.4103/jhrs.jhrs_147_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 02/05/2019] [Accepted: 04/15/2019] [Indexed: 12/03/2022] Open
Abstract
Cervical pregnancy is a rare form of ectopic pregnancy. Heterotopic cervical pregnancy is much more rare scenario. This is a case of Heterotopic cervical pregnancy treated successfully by transvaginal ultrasound guided aspiration.
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Affiliation(s)
- Sindhu Bhairavi
- Department of Reproductive Medicine, Srishti Hospital, Puducherry, India
| | - Soumyaroop Dash
- Department of Reproductive Medicine, Srishti Hospital, Puducherry, India
| | - Sebanti Dash
- Department of Reproductive Medicine, Srishti Hospital, Puducherry, India
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40
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Abstract
Heterotopic pregnancy is a rare condition in which both intrauterine and extrauterine pregnancies occur simultaneously. It was reported to be very rare in normal conceived pregnancy. However, with the considerable progress of the assisted reproductive techniques, the incidence of heterotopic pregnancy increased. Furthermore, the incidence also increases in previous abortions. In this case report, we will present and discuss a patient who had heterotopic pregnancy after clomiphene-induced ovulation as well as a history of previous abortion where the extrauterine fallopian tube ruptured and was managed surgically while the intrauterine pregnancy was preserved.
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Affiliation(s)
- Hanoof Ali Alqahtani
- Department of Obstetrics and Gynecology, Abha Maternity and Children Hospital, Abha, Saudi Arabia
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41
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Palasová H, Fabian M. Heterotopic pregnancy Vital intrauterine pregnancy 12+4, vital ectopic pregnancy 11+4. Ceska Gynekol 2019; 84:351-354. [PMID: 31826632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE We present a case of a 32-year-old female patient, tertigravid after spontaneous conception with acute pain in the abdomen. It was a heterotopic pregnancy at 12 weeks of gestation, with late manifestation of clinical symptoms. DESIGN Case report. SETTING Department of Obstetrics and Gynecology, Silesian Hospital in Opava. CONCLUSION Heterotopic pregnancy is a rare, but potentially fatal complication of early pregnancy. The aim should be to remove the ectopic pregnancy while maintaining the vital intrauterine pregnancy. 76% of pregnancies in utero at the time of intervention for heterotopic pregnancy end in childbirth.
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42
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Sanogo M, Ouédraogo I, Sib SR, Zamane H, Kiemtore S, Ouattara A, Sawadogo YA, Kain DP, Kabore YS, Millogo TFDT, Bonane BT. [A 36 weeks heterotopic pregnancy discovered incidentally at the Regional University Hospital of Ouahigouya]. Mali Med 2019; 34:47-48. [PMID: 35897218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Heterotopic pregnancy is a rare entity, its development up to term is exceptional. We report a case of heterotopic pregnancy of fortuitous discovery during a caesarean section performed in a 26-year-old female patient received for abdomino-pelvic pain on suspected twin pregnancy of 33 SA. No obstetric ultrasound had been performed before admission. Two ultrasound ultrasounds have objectified an intrauterine twin pregnancy with hydramnios. A caesarean section at 36 weeks indicated for twin pregnancy with hydramnios and severe anemia was performed during which we discovered an intrauterine pregnancy and an abdominal pregnancy with insertion of the placenta at the level of the broad left ligament with adhesion on the left annex, Omentum and small handles. Newborns did not require any special care outside the classical essential care. The first intrauterine had a weight of 2650 g and the second abdominal of 2000 g. The postoperative sequences were simple.
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Affiliation(s)
- Moussa Sanogo
- Gynécologue-obstétricien au Centre Hospitalier Universitaire Régional (CHUR) de Ouahigouya
| | - Issa Ouédraogo
- Gynécologue-obstétricien au Centre Hospitalier Universitaire Régional (CHUR) de Ouahigouya
| | - Sansan Rodrigue Sib
- Gynécologue-obstétricien au Centre Hospitalier Universitaire Régional (CHUR) de Ouahigouya
| | - Hyacinthe Zamane
- Gynécologie-obstétrique au Centre Hospitalier Universitaire de Ouagadougou
| | - Sibraogo Kiemtore
- Gynécologie-obstétrique au Centre Hospitalier Universitaire de Ouagadougou
| | - Adama Ouattara
- Gynécologie-obstétrique au Centre Hospitalier Universitaire de Ouagadougou
| | | | - Dantola Paul Kain
- Gynécologie-obstétrique au Centre Hospitalier Universitaire de Ouagadougou
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43
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Onoh RC, Ejikeme BN, Onwe AB, Asiegbu OU. Ruptured ectopic in heterotopic pregnancy: Management and spontaneous vertex delivery of a live baby at term. Niger J Clin Pract 2018; 21:672-677. [PMID: 29735871 DOI: 10.4103/njcp.njcp_67_16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Spontaneous heterotopic pregnancy is an uncommon clinical condition in which there is a simultaneous development of intrauterine and extrauterine pregnancies. It is a life-threatening emergency when the ectopic ruptures. We present Mrs. EC, a 27-year-old G1P0 + 0 with a family history of multiple gestations who had a heterotopic pregnancy at a gestational age of 7 weeks. She presented with features of threatened miscarriage at early pregnancy with an ultrasound confirmation of intrauterine pregnancy. The diagnosis of ruptured ectopic pregnancy coexisting with intrauterine gestation was made with ultrasound findings as well as clinical features necessitating emergency exploratory laparotomy. Thereafter, pregnancy was carried to term, and she delivered a live male baby that weighed 3.0 kg. Heterotopic pregnancy should be sort for in all pregnancies during the early scan, especially in those with predisposing factors for multiple gestations and risk factors for ectopic gestation. A high index of suspicion is necessary for making a diagnosis in women with intrauterine pregnancy, with or without symptoms of ectopic gestation, and irrespective of the existence of risk factors for ectopic pregnancy.
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Affiliation(s)
- R C Onoh
- Reproductive Endocrinology and Infertility Unit, Department of Obstetrics and Gynaecology, Federal Teaching Hospital, Abakaliki, Ebonyi, Ebonyi State, Nigeria
| | - B N Ejikeme
- Department of Obstetrics and Gynaecology, Federal Teaching Hospital, Ebonyi State, Nigeria
| | - A B Onwe
- Department of Obstetrics and Gynaecology, Federal Teaching Hospital, Ebonyi State, Nigeria
| | - O U Asiegbu
- Department of Obstetrics and Gynaecology, Federal Teaching Hospital, Ebonyi State, Nigeria
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44
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Na ED, Jung I, Choi DH, Kwon H, Heo SJ, Kim HC, Kang SH, Cho H. The risk factors of miscarriage and obstetrical outcomes of intrauterine normal pregnancy following heterotopic pregnancy management. Medicine (Baltimore) 2018; 97:e12233. [PMID: 30212954 PMCID: PMC6156031 DOI: 10.1097/md.0000000000012233] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
To investigate the clinical characteristics and risk factors for miscarriage of intrauterine normal pregnancy of patients with a heterotopic pregnancy (HP) after treatment.This was a retrospective study of medical records from CHA Bundang Medical Center. Sixty-four patients who were diagnosed with a HP between February 2006 and July 2017 were included in this study. All analyses were performed using SAS software, version 9.4 (SAS Institute, Inc., Cary, NC). P values < .05 were considered statistically significant.Forty-eight patients had tubal ectopic pregnancies (EP), 10 patients had cornual EPs, 1 patient had a cesarean section scar EP, 4 patients had an ovarian EP, and 1 patient had bilateral tubal EP. Among the 64 patients, 14.1% (9/64) miscarried before 10 weeks of gestation after management. Mean gestational age (GA) at treatment was 5.97 ± 0.50 weeks and 6.80 ± 1.04 weeks for miscarriage and nonmiscarriage group, respectively (P = .008). Significant differences were observed between 2 groups in terms of ultrasonographic features at the time HP was diagnosed (P = .040) Logistic regression models indicated that gestational age at treatment showed significant differences between 2 groups (OR: 0.003, 95% CI: 0.001-0.604).Immediate management after diagnosis could expect favorable prognosis of HP. GA at treatment was the only independent risk factor for miscarriage in patients with HP regardless of treatment methods.
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Affiliation(s)
- Eun Duc Na
- Department of Obstetrics and Gynecology, CHA Bundang Medical Center, CHA University, Seongnam
| | - Inkyung Jung
- Division of Biostatistics, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul
| | - Dong Hee Choi
- Fertility Center of CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Hwang Kwon
- Fertility Center of CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Seok Jae Heo
- Division of Biostatistics, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul
| | - Hyeon Chul Kim
- Department of Obstetrics and Gynecology, CHA Bundang Medical Center, CHA University, Seongnam
| | - Suk Ho Kang
- Department of Obstetrics and Gynecology, CHA Bundang Medical Center, CHA University, Seongnam
| | - HeeYoung Cho
- Department of Obstetrics and Gynecology, CHA Bundang Medical Center, CHA University, Seongnam
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45
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Miyague AH, Chrisostomo AP, Costa SL, Nakatani ET, Kondo W, Gomes CC. Treatment of heterotopic caesarean scar pregnancy complicated with post termination increase in size of residual mass and morbidly adherent placenta. J Clin Ultrasound 2018; 46:227-230. [PMID: 28590029 DOI: 10.1002/jcu.22507] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 04/20/2017] [Accepted: 05/05/2017] [Indexed: 06/07/2023]
Abstract
We report a case of a secundipara with heterotopic cesarean scar pregnancy (HCSP) treated with potassium chloride injection into the ectopic embryo followed by sac aspiration. The remaining "mass" increased in size threefold and was surrounded by a rich vascular network. An arteriovenous malformation was suspected; however, appropriate treatment was precluded because of the viability of the ectopic gestation. Sonographic examination revealed a morbidly adherent placenta, and attempt to resect the mass laparoscopically was complicated by bleeding that required hysterectomy. This case illustrates a complication of the intervention performed to preserve the intrauterine gestation in case of HCSP. © 2017 Wiley Periodicals, Inc. J Clin Ultrasound 46:227-230, 2018.
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Affiliation(s)
- Andre Hadyme Miyague
- Department of Gynecology and Obstetrics, Clinical Hospital of Federal University of Paraná-UFPR, Curitiba, Brazil
- Woman and Fetal Medicine Institute-IMMEF, Curitiba, Brazil
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46
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Abstract
Heterotopic pregnancy occurs when intrauterine and ectopic pregnancy are concomitant; overall rate rises from 1/30.000 to 1.5/1000 in assisted reproductive technology pregnancies. HIV (human immunodeficiency virus) patients are at increased risk of heterotopic pregnancies due to the greater frequency of assisted reproductive technology and pelvic inflammatory disease. We report the first case of heterotopic pregnancy in HIV woman.
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Affiliation(s)
- Valeria Savasi
- Unit of Obstetrics and Gynecology, Department of Biomedical and Clinical Sciences, ASST Fatebenefratelli Sacco - Hospital 'L. Sacco', University of Milan, Milan, Italy
| | - Patrizio Antonazzo
- Unit of Obstetrics and Gynecology, Department of Biomedical and Clinical Sciences, ASST Fatebenefratelli Sacco - Hospital 'L. Sacco', University of Milan, Milan, Italy
| | - Carlo Personeni
- Unit of Obstetrics and Gynecology, Department of Biomedical and Clinical Sciences, ASST Fatebenefratelli Sacco - Hospital 'L. Sacco', University of Milan, Milan, Italy
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47
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Paradise C, Carlan SJ, Holloman C. Spontaneous uterine cornual rupture at 26 weeks' gestation in an interstitial heterotopic pregnancy following in vitro fertilization. J Clin Ultrasound 2016; 44:322-325. [PMID: 26677169 DOI: 10.1002/jcu.22322] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 11/06/2015] [Indexed: 06/05/2023]
Abstract
Interstitial implantation in a heterotopic pregnancy is extremely rare, and despite currently available diagnostic modalities, early identification of an interstitial ectopic pregnancy remains difficult. This report describes a case of spontaneous cornual rupture at 26 weeks' gestation in a woman with diamniotic dichorionic twins that resulted in live births. The patient had previously undergone laparoscopic bilateral salpingectomy, and the pregnancy was conceived with in vitro fertilization. Interstitial implantation in a heterotopic pregnancy can go unrecognized, resulting in increased maternal and infant morbidity and mortality. © 2015 Wiley Periodicals, Inc. J Clin Ultrasound 44:322-325, 2016.
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Affiliation(s)
- Courtney Paradise
- Department of Obstetrics and Gynecology, Orlando Health, Orlando, FL
| | - S J Carlan
- Department of Obstetrics and Gynecology, Orlando Health, Orlando, FL
| | - Conisha Holloman
- Department of Obstetrics and Gynecology, Orlando Health, Orlando, FL
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48
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Fatema N, Al Badi MM, Rahman M, Elawdy MM. Heterotopic pregnancy with natural conception; a rare event that is still being misdiagnosed: a case report. Clin Case Rep 2016; 4:272-5. [PMID: 27014450 PMCID: PMC4771864 DOI: 10.1002/ccr3.502] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Revised: 11/16/2015] [Accepted: 12/25/2015] [Indexed: 11/06/2022] Open
Abstract
Simultaneous presence of intra- and extra-uterine pregnancies have been known as heterotopic pregnancy (HP); the condition which is extremely rare with natural conception. Our aim is to increase the obstetrician's awareness to increase the level of positive outcome in such rare events.
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Affiliation(s)
- Nishat Fatema
- Department Gynaecology & Obstetric Ibri Regional Hospital Ministry of Health Ibri Sultanate of Oman
| | - Muna Mubarak Al Badi
- Department Gynaecology & Obstetric Ibri Regional Hospital Ministry of Health Ibri Sultanate of Oman
| | - Mahin Rahman
- Department Gynaecology & Obstetric Ibri Regional Hospital Ministry of Health Ibri Sultanate of Oman
| | - Mohamed M Elawdy
- Department of Surgery Ibri Regional Hospital Ministry of Health Ibri Sultanate of Oman
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49
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Abstract
Spontaneous heterotopic pregnancy is a rare clinical condition in which intrauterine and extrauterine pregnancies occur at the same time. It is rare, estimated to occur in 1 in 30,000 pregnancies. The case was a 38-year-old woman with spontaneously conceived heterotopic pregnancy. She was admitted to our center with hypovolemic shock. Focused assessment sonography for trauma examination in emergency department showed large amount of free fluid in peritoneal cavity. She was managed surgical laparotomy. Considering spontaneous pregnancies, physician should be aware of the possibility of heterotopic pregnancy in all reproductive age women, especially those with history of recent abortion. It can occur without any predisposing risk factors. Patients should be informed about possible side effects of nonprescription medicines, and also the health care centers must be safe peaceful environment for them without severe legal consequences.
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Affiliation(s)
- Abdolghader Pakniyat
- Department of Emergency Medicine, Arak University of Medical Sciences, Arak, Iran
| | - Arash Yazdanbakhsh
- Department of Emergency Medicine, Arak University of Medical Sciences, Arak, Iran
| | | | - Fatimah Talebi
- Department of Emergency Medicine, Arak University of Medical Sciences, Arak, Iran
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50
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Elena HE, Elena AF, Miola A, Glujovsky D, Sueldo CE. [Successful treatment of a cervical heterotopic pregnancy following an in vitro fertilization procedure]. Medicina (B Aires) 2016; 76:30-32. [PMID: 26826990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Abstract
A 37-year-old nulligravida infertile female had a cervical heterotopic pregnancy following an in vitro fertilization procedure. Early intervention on the 6th week of gestation with a manual vacuum aspirator reached to remove the cervical pregnancy. Ligation of the descending cervical branches of the uterine arteries and a cervical cerclage, were placed before the aspiration, for prevention of possible hemorrhage. Successful removal of the cervical pregnancy was achieved with only mild bleeding. An intrauterine pregnancy progressed to viability without complications, resulting in a vaginal delivery of a preterm live-birth at 35.4 weeks, of a male that weighted 2740 g.
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Affiliation(s)
- Hernán E Elena
- Servicio de Ginecología y Obstetricia, Clínica 25 de Mayo, Mar del Plata, Argentina. E-mail:
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