A Case of Heterotopic Pregnancy in a Spontaneous Cycle

Abstract

Objective: Heterotopic pregnancy is a condition in which extrauterine and intrauterine pregnancy coincides. It is encountered very rarely especially in the absence of risk factors. The incidence of heterotopic pregnancy has increased in recent years due to the developments in assisted reproductive technologies (ART). In this case report, we aimed to emphasize the early diagnosis and proper management of heterotopic pregnancies with its mortality and morbidity rates and importance for future fertility. Case: Seven-weeks pregnant women by the date of her last menstrual period had undergone dilatation and curettage (D&C) in another medical center upon the diagnosis of a missed abortus. She applied to the same center after the procedure with the complaint of groin pain and was referred to our tertiary center because of the plateaud β-hCG levels during her follow-up. Her gynecologic and ultrasonographic examination in our clinic suggested an extrauterine pregnancy and the patient underwent a laparoscopy. A tubal ectopic pregnancy was detected at the right tube and a linear salpingotomy was performed. Heterotopic pregnancy diagnosis was confirmed with the pathological examination reports of the samples obtained in D&C and laparoscopy. Conclusion: The heterotopic pregnancy diagnosis should be kept in mind in the differential diagnosis of women who applied with the complaint of abdominal pain in the first trimester of pregnancy especially in pregnancies occurring after ART and should be managed appropriately on time.

Therapeutic Approaches in Cases with Heterotopic Pregnancy: A Retrospective Analysis of Six Patients

“…It has been suggested that a delay in diagnosis can cause maternal mortality of 1% and foetal mortality of 45-65% [2]. It is important to perform a meticulous pelvic sonography evaluation to detect HP even in cases with a positive pregnancy test and an intrauterine gestational sac on sonography after infertility treatment [1].…”

“…Diagnosis of a HP can be challenging and a high index of suspicion is mandatory for early diagnosis and appropriate treatment. High-resolution TVUS is the primary diagnostic method in HP [2]. The findings of a complex cyst in the adnexal area, a haematosalpinx, a tubal ring and a foetal heart rate and free fluid in the Douglas space should raise the suspicion of a HP [7].…”

“…Ectopic pregnancy is generally observed at tubes, but it may also occur at a caesarean scar or have a cervical, ovarian or abdominal localisation in rare instances [2]. Although it is rarely seen during natural conception cycles, the incidence has raised to 1:100 due to the increasing use of assisted reproduction techniques in infertile patients [2,3].…”

“…The most frequent symptoms of HP are abdominal pain and vaginal bleeding, but patients can occasionally present with acute abdomen resulting from a haemoperitoneum [1]. High-resolution transvaginal sonography (TVUS) is the primary diagnostic method, and management may vary depending on the patient's haemodynamic status, localisation of the ectopic pregnancy and desire of the family for a child [2]. Here, we discuss the presenting complaints, diagnostic and therapeutic approaches and pregnancy outcomes of 6 patients with HP managed in our clinic.…”

“…It has been suggested that tubal injury is the most important risk factor for the development of HP. Other potential reasons include tubal surgery, pelvic inflammatory disease, a history of ectopic pregnancy, endometriosis and in vitro fertilisation [2][3][4]. The most frequent symptoms of HP are abdominal pain and vaginal bleeding, but patients can occasionally present with acute abdomen resulting from a haemoperitoneum [1].…”