1
|
Oyeh E, Ofori S, Hiadzi EK, Sefogah PE. Challenges in the diagnosis and management of a ruptured heterotopic gestation following ultrasound-guided embryo transfer in low resource settings: a case report. J Med Case Rep 2024; 18:28. [PMID: 38263261 PMCID: PMC10807105 DOI: 10.1186/s13256-023-04317-x] [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] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 12/12/2023] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Heterotopic pregnancies are increasing in incidence with the advent of rising prevalence of in vitro fertilization and embryo transfer (IVF-ET) globally. Although rare, this condition is a serious potentially life-threatening gynaecological complication. CASE PRESENTATION We present the case of a 36-year-old Ghanaian woman who conceived following IVF and presented two weeks after confirmation of intrauterine gestation with sudden onset lower abdominal pain. A diagnosis of ruptured heterotopic pregnancy was made, laparotomy and salpingectomy was done followed with further management of the intrauterine gestation. CONCLUSION To the best of our knowledge, this is the first reported case of heterotopic pregnancy in Ghana. A high index of suspicion for heterotopic pregnancy is required even in the presence of a confirmed intrauterine gestation following IVF-ET.
Collapse
Affiliation(s)
- Ernest Oyeh
- Akai House Clinic, 1 Sixth Circular Rd, Accra, Ghana
| | - Samuel Ofori
- Lister Hospital and Fertility Centre, Airport Hills, Accra, Ghana
| | - Edem K Hiadzi
- Lister Hospital and Fertility Centre, Airport Hills, Accra, Ghana
| | - Promise E Sefogah
- Department of Obstetrics and Gynaecology, University of Ghana Medical School, Accra, Ghana.
| |
Collapse
|
2
|
Wilson P, Durant A, Degen K. Mature Cystic Teratoma Mimics Heterotopic Pregnancy on Sonograph. S D Med 2023; 76:167-169. [PMID: 37566672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 08/13/2023]
Abstract
INTRODUCTION Mature cystic teratomas (MCTs) present clinically with a wide host of different symptomatic manifestations. Because they are often comprised of multiple tissue types, imaging can also take on many different forms making the diagnosis of MCT difficult in certain situations. In this case, we present a patient who had a MCT that mimicked a heterotopic pregnancy on sonograph. CASE PRESENTATION A 21-year-old female G1P0 at approximately six weeks gestation by last menstrual period presented to the emergency department with a chief complaint of vaginal bleeding that began the previous day. A transvaginal ultrasound demonstrated a viable intrauterine pregnancy with fetal cardiac activity and an additional structure in the left adnexa resembling a gestational sac and fetal pole absent of cardiac activity. Obstetrics was consulted, and a preliminary diagnosis of heterotopic pregnancy was made. Diagnostic laparoscopy with intraoperative ultrasound revealed a 3 cm cyst in the left ovary that appeared to contain serous fluid. Aspiration and subsequent dissection of the cyst revealed material consistent with a mature cystic teratoma confirmed by pathologic analysis. DISCUSSION This case highlights the importance of ultrasound in detecting adnexal masses while also exposing some of its limitations. Due to their variable presentation and potential to mimic other insidious pathologies, MCTs must always be considered when identifying adnexal structures on ultrasound.
Collapse
Affiliation(s)
- Peter Wilson
- University of South Dakota Sanford School of Medicine
| | - Ashley Durant
- University of South Dakota Sanford School of Medicine
| | - Katherine Degen
- Monument Health Rapid City Hospital, Rapid City, South Dakota
- University of South Dakota Sanford School of Medicine
| |
Collapse
|
3
|
Cimpoca B, Moldoveanu A, Gică N, Gică C, Ciobanu AM, Panaitescu AM, Oprescu D. Heterotopic Quadruplet Pregnancy. Literature Review and Case Report. ACTA ACUST UNITED AC 2021; 57:medicina57050483. [PMID: 34065925 PMCID: PMC8151375 DOI: 10.3390/medicina57050483] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 05/05/2021] [Accepted: 05/08/2021] [Indexed: 11/23/2022]
Abstract
Heterotopic pregnancy is the condition where both intrauterine and ectopic pregnancy are present. It rarely occurs after natural conception, but is more common with assisted reproductive techniques, when more than one embryo is transferred. Quadruplet heterotopic pregnancy is exceedingly rare. Methods: A literature review was conducted aiming to highlight the diagnosis difficulties and the management options in heterotopic quadruplet pregnancies. Results: Nine relevant studies were identified by researching PubMed up to 2021 for “heterotopic quadruplet pregnancy”, “quadruplet intrauterine and ectopic pregnancy”, “synchronous intrauterine and ectopic pregnancy”. Conclusions: In this paper, we present a case of heterotopic quadruplet pregnancy and address the difficulty in diagnosing this condition and make formal recommendations.
Collapse
Affiliation(s)
- Brîndușa Cimpoca
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (B.C.); (A.M.P.); (D.O.)
| | | | - Nicolae Gică
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (B.C.); (A.M.P.); (D.O.)
- Department of Obstetrics and Gynecology, Filantropia Clinical Hospital, 011171 Bucharest, Romania; (C.G.); (A.M.C.)
- Correspondence: ; Tel.: +40-727827815
| | - Corina Gică
- Department of Obstetrics and Gynecology, Filantropia Clinical Hospital, 011171 Bucharest, Romania; (C.G.); (A.M.C.)
| | - Anca Marina Ciobanu
- Department of Obstetrics and Gynecology, Filantropia Clinical Hospital, 011171 Bucharest, Romania; (C.G.); (A.M.C.)
| | - Anca Maria Panaitescu
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (B.C.); (A.M.P.); (D.O.)
- Department of Obstetrics and Gynecology, Filantropia Clinical Hospital, 011171 Bucharest, Romania; (C.G.); (A.M.C.)
| | - Dana Oprescu
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (B.C.); (A.M.P.); (D.O.)
- INSMC “Alessandrescu Rusescu”, 011062 Bucharest, Romania;
| |
Collapse
|
4
|
Swiniarski M, Sadkowska M, Roman G, Szeszko L, Sipak-Szmigiel O. Heterotopic pregnancy - case report. Wiad Lek 2020; 73:828-830. [PMID: 32731726] [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: 06/11/2023]
Abstract
OBJECTIVE Heterotopic pregnancy is the simultaneous occurrence of intrauterine and ectopic pregnancy. This situation is very rare (1:30 000 pregnancies), while recently, with the development of assisted reproductive techniques, the incidence has increased to 1:100 - 1:500 pregnancies. The aim of the study is to present the situation of coexistence of intrauterine pregnancy and ruptured tubal pregnancy. PATIENTS AND METHODS The case concerns a 32-year-old patient in the 12th week of the second pregnancy in whom the only risk factor was the state after Caesarean section and thus possible intraperitoneal adhesions. The ultrasound revealed normal intrauterine pregnancy and a very large amount of free fluid in the smaller pelvis. After immediate surgical intervention, a ruptured right tubal pregnancy was found. Right fallopian tube was removed. After the operation, the patient with the preserved intrauterine pregnancy was discharged from the ward. Further intrauterine pregnancy was normal. Delivery by Caesarean section. CONCLUSION Conclusions: The described case indicates that the existence of intrauterine pregnancy does not exclude the existence of ectopic pregnancy and emphasizes the great importance of correctly and accurately carried out ultrasound examination in the first trimester of pregnancy along with appendicitis assessment. Early diagnosis of heterotopic pregnancy reduces the risk of complications.
Collapse
Affiliation(s)
- Michal Swiniarski
- Gynecology And Obstetrics Ward, The District Hospital In Dzialdowo, Dzialdowo, Poland
| | - Monika Sadkowska
- Gynecology And Obstetrics Ward, The District Hospital In Dzialdowo, Dzialdowo, Poland
| | - Grzegorz Roman
- Gynecology And Obstetrics Ward, The District Hospital In Dzialdowo, Dzialdowo, Poland
| | - Lukasz Szeszko
- Gynecology And Obstetrics Ward, The Provincial Specialist Hospital In Biala Podlaska, Biala Podlaska, Poland
| | - Olimpia Sipak-Szmigiel
- Department Of Obstetrics And Pregnancy Pathology, Pomeranian Medical University In Szczecin, Szczecin, Poland
| |
Collapse
|
5
|
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.
Collapse
|
6
|
Goldman KN, Keltz J, Berg RE, Noyes NL. Heterotopic Gestation with Twin Intrauterine Implantation Following Transfer of Three Developmentally-delayed Embryos from Cryopreserved Oocytes: A Case Report. J Reprod Med 2015; 60:436-440. [PMID: 26592072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND In vitro fertilization (IVF) data suggest improved live birth rates for embryos transferred at the blastocyst versus the cleavage stage. Embryos that have not reached the blastocyst stage by day 5 postthaw have diminished potential for implantation and live birth. Few data exist regarding embryogenesis and optimal timing of transfer for embryos derived from previously cryopreserved oocytes, but we report the case of 100% implantation following transfer of 3 developmentally-delayed embryos derived from cryopreserved oocytes. CASE A 38-year-old woman cryopreserved 20 oocytes for the purpose of future childbearing. At age 42 she returned to thaw and fertilize 8 oocytes using donor sperm. Embryos were cultured to day 5 postthaw, at which time 1 morula and 2 cleavage-stage embryos were available for transfer. Three-embryo transfer resulted in a heterotopic tubal pregnancy and twin intrauterine gestation. Laparoscopic salpingectomy was performed for the ectopic gestation. The twin intrauterine pregnancy spontaneously reduced to singleton, and the patient delivered a live-born infant. CONCLUSION While heterotopic and multifetal pregnancy are known risks of multiembryo transfer, 3 lesser-quality embryos derived from cryopreserved oocytes would be unlikely to have high implantation potential. Future studies are needed to delineate timing of embryogenesis events in previously cryopreserved oocytes.
Collapse
|
7
|
Barker VE, Barker RE, Parry-Smith W, Panikkar J, Macdonald RR. From heterotopic twins to medical school. BJOG 2015; 122:652. [PMID: 25800386 DOI: 10.1111/1471-0528.13336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
8
|
Bedaiwy MA, Volsky J, Lazebnik N, Liu J. Laparoscopic single-site linear salpingostomy for the management of heterotopic pregnancy: a case report. J Reprod Med 2014; 59:522-524. [PMID: 25330700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND The laparoscopic management of tubal pregnancy component of a heterotopic pregnancy was conducted via multiport approach. In this report we describe a new technique using a single port approach with long-term follow-up. CASE A 27-year-old woman, G4P1031, presented with a heterotopic pregnancy after 2 years of infertility treatment. She underwent multiple surgeries to excise left ovarian cysts, lysis of adhesions, and recanalization of the right fallopian tube. During this time she also experienced a left-sided ectopic pregnancy and was treated with a traditional operative laparoscopy. Upon diagnosis of a heterotopic pregnancy, the decision was made to perform a laparoendoscopic single-site (LESS) procedure for treatment of a right ectopic pregnancy via a salpingostomy to preserve her potential for future spontaneous conception. A linear salpingostomy procedure was performed without complications, and the patient was able to carry her intrauterine pregnancy to term. CONCLUSION The LESS procedure is effective in resolving an ectopic pregnancy without affecting a coexisting intrauterine pregnancy, and preserving the potential for future spontaneous pregnancies. This approach should be considered for eligible patients with a heterotopic pregnancy who desire preservation of tubal function. (J Reprod Med 2014;
Collapse
|
9
|
ETCHEGORRYCOLOMBO PA, BLOJ A, WEIMBERG S. [HETEROTOPIC PREGNANCY]. Prensa Med Argent 1964; 51:244. [PMID: 14190193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
|
10
|
COHN S, GROSSBARD P. HETEROTOPIC PREGNANCY. J Med Soc N J 1963; 60:244-5. [PMID: 14082083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
|
11
|
|
12
|
FLEISHER AA, SEAMAN I. Heterotopic pregnancy: the effect of shock on the first-trimester fetus. Obstet Gynecol 1961; 18:763-6. [PMID: 13893512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/24/2023]
|
13
|
HATHAWAY HR, VASQUEZ EC. Combined pregnancies with survival of both babies, report of a case. Obstet Gynecol 1961; 18:352-4. [PMID: 13712241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2023]
|
14
|
SKULJ V, DRAZANCIC A. [Eutopic, ectopic, and heterotopic pregnancy. An attempt at the classification of the various possibilities of the nidation, placentation, and later development of the fertilized egg]. Zentralbl Gynakol 1961; 83:1312-20. [PMID: 13913738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/24/2023]
|
15
|
VISHNIAVSKY S, ISRAELI S. [Heterotopic pregnancies]. Harefuah 1958; 55:154-6. [PMID: 13586687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/23/2023]
|
16
|
CAVANAGH D, MACLURE JG. Heterotopic pregnancy possibly involving primary peritoneal nidation; report of a case. Obstet Gynecol 1958; 12:341-3. [PMID: 13578305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2023]
|
17
|
SHELL FM. Heterotopic pregnancy: a report of three cases. South Med J 1958; 51:760-2. [PMID: 13556185 DOI: 10.1097/00007611-195806000-00014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
18
|
BALINT G, KOVACS L. [Interesting case of heterotopic pregnancy observed in connection with appendectomy]. Magy Noorv Lapja 1956; 19:184-9. [PMID: 13368652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
|
19
|
DERBY CJ, MILLER RC. Heterotopic pregnancy--(combined intra-uterine and extra-uterine pregnancy). Ohio State Med J 1951; 47:433-4. [PMID: 14833725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
|
20
|
PUTZ TK. [Diagnosis of heterotopic pregnancy]. Zentralbl Gynakol 1951; 73:1522-9. [PMID: 14893935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
|
21
|
DRUMEL G. [Combined extra-intrauterine pregnancy with successful outcome]. Ann Soc Belg Med Trop (1920) 1950; 30:109-11. [PMID: 15413864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
|
22
|
LEE GQ. Ruptured heterotopic pregnancy. West J Surg Obstet Gynecol 1950; 58:130. [PMID: 15410529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
|
23
|
CRON RS, STOUFFER JG. Coexisting intrauterine and extrauterine pregnancy. Wis Med J 1949; 48:923. [PMID: 18143846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
|
24
|
COLLIER MA. Combined pregnancy; report of a case. J Fla Med Assoc 1947; 33:446. [PMID: 20285333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
|