DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20215118

A case report of heterotopic pregnancy

Keerathana R., Sundar Narayanan S.

Abstract


Heterotopic pregnancy is the presence of both intrauterine and extrauterine (ectopic) implantation as described by Reece in 1983 and is extremely rare. It accounts for 1 per 30000, in natural cycles and 9 per 10000, in assisted reproduction cycles. The aim of this report is to introduce this case as it poses a challenge to diagnosis due to its complex clinical and laboratory findings. A primigravida aged 30 at 6 weeks period of gestation, reported with minimal bleeding per vaginum. On performing a physical examination her vitals were stable and no significant findings were noted except for an enlarged uterus corresponding to 6 weeks with posterior forniceal fullness. Her beta-hCG was 23765 IU/ml and ultrasound showed a live intrauterine gestation with left adnexal mass- likely ectopic gestational sac. Laparoscopy showed a left tubal pregnancy and salpingectomy was done. The postoperative period was uneventful and she was discharged with a single live intrauterine gestation of 6-7 weeks. She carried on with her pregnancy and delivered a healthy baby at term. The diagnosis is possible only in cases when there is a high index of suspicion by the treating clinician. The adnexa must be inspected carefully in the confirmatory ultrasound. The early timely diagnosis gives a good maternal outcome and hence crucial in the management.


Keywords


Ectopic, Heterotopic, Infertility, Laparoscopy, Salpingectomy, Pregnancy

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References


Elnahry AG, Elnahry GA. Management of Idiopathic Intracranial Hypertension During the COVID-19 Pandemic. Rev Recent Clin Trials. 2021;16(2):122-5.

Walker DJ, Clarke TC, Kennedy CR. Heterotopic ectopic and intrauterine pregnancy after embryo replacement. Br J Obstet Gynaecol. 1993;100(11):1048-9.

Tal J, Haddad S, Gordon N, Tritsch I. Heterotopic pregnancy after ovulation induction and assisted reproductive technologies: a literature review from 1971 to 1993. Fertil Steril. 1996;66(1):1-12.

Wygledowski J, Sawicki W, Cendrowski K. Case of co existent intra and extra uterine pregnancy. Med sci Monit. 1998;4:522-5.

Dundar O, Tutuncu L, Mungen E, Muhcu M, Yergok YZ. Heterotopic pregnancy: tubal ectopic pregnancy and monochorionic monoamniotic twin pregnancy: a case report. Perinatal J. 2006;14:96-100.

Wright A, Kowalczyk CL, Quintero R, Leach RE. Selective embryo reduction in a heterotopic pregnancy using potassium chloride injection resulting in a hematosalpinx. Fertil Steril. 1996;66(6):1028-30.

Yu Y, Xu W, Xie Z, Huang Q, Li S. Management and outcome of 25 heterotopic pregnancies in Zhejiang, China. Eur J Obstet Gynecol Reprod Biol. 2014;180:157-61.

Tingi E, Rowland J, Hanna L. A case of heterotopic pregnancy following spontaneous conception. J Obstet Gynaecol. 2015;35(4):430-1.

Varras M, Akrivis C, Hadjopoulos G, Antoniou N. Heterotopic pregnancy in a natural conception cycle presenting with tubal rupture: a case report and review of the literature. Eur J Obstet Gynecol Reprod Biol. 2003;106(1):79-82.

Jan F, Naikoo GM, Rather MH, Sheikh TA, Rather YH. Ruptured heterotopic pregnancy: a rare cause for hemoperitoneum; report of three cases from Kashmir, India. Indian J Surg. 2010;72(5):404-6.