A case of spontaneous heterotopic pregnancy in natural conception complicated with hemoperitoneum

Abstract

A B S T R A C THeterotopic pregnancy, defined as simultaneous intrauterine and ectopic gestations, is an uncommon occurrence in women who conceive without assisted reproduction techniques. We present the case of 28 years old female with strong family history of multiple gestations, who presented with acute severe abdominal pain and diagnosed with spontaneous heterotopic pregnancy in natural conception. Ectopic pregnancy was successfully removed surgically to conserve the uterine pregnancy. After one week, patient presented with vaginal bleeding and diagnosed with missed abortion and lost her desired uterine pregnancy. This case report discusses the significance of early diagnosis and treatment of heterotopic pregnancy to avoid both fetal and maternal morbidity and mortality. Practitioners should carry a high index of suspicion for heterotopic pregnancy in patients presenting with common symptoms and carry a family history of multiple gestation pregnancies.

Spontaneous Heterotopic Pregnancy with Unaffected Intrauterine Pregnancy: Systematic Review of Clinical Outcomes

“…Our review revealed improved outcomes for intrauterine pregnancies when the extrauterine ones were located in the fallopian tubes, as compared to the interstitial ectopic sack [26]. Almost all articles included in our study reported an unaffected intrauterine pregnancy, with the exception of one article that reported a spontaneous abortion [38]. However, the literature describes an unaffected intrauterine pregnancy in two thirds of cases and spontaneous abortion in one third [32].…”

“…Although the presence of extrauterine pregnancy is usually associated with risk factors, we found a number of case reports that presented patients with heterotopic pregnancies in the absence of known risk factors [4,19,26,27,29,33,34,36]. Five articles mentioned the existence of risk factors for the patients, such as a history of pelvic inflammatory disease, history of repeated miscarriages and intrauterine interventions, history of abdominal surgery [18,23,30,38,39], thus emphasizing the importance of identifying patients with risk factors and performing differential diagnosis on individuals with clinical signs of SHP.…”

“…Despite division across surgical techniques, minimal intraoperative manipulation of the uterus is advised in order to prevent ruptures and damage to the intrauterine pregnancy [40]. Emergency surgical treatment is advised in the presence of hemoperitoneum [4,18,19,21,23,[26][27][28]31,33,36,38,40].…”

Diagnosis and management of a spontaneous heterotopic pregnancy: Rare case report

“…The incidence of heterotopic pregnancy is estimated at 1/30.00, above 1/100 when associated with in vitro fertilization, and 1/900 when using clomiphene citrate [4] . The important risk factors for the development of a heterotopic pregnancy include family history, endometriosis, tubal disease, history of pelvic inflammation, high hormone levels, embryo transfer technique [5] .…”

Heterotropic pregnancy: a common masquerade than ever thought?

“…Heterotropic pregnancy is relatively uncommon in spontaneous conception with 1 in 30,000 cases reported, the incidence of heterotopic pregnancy increases to 1 in 3900 when conception is enhanced with various assisted reproduction techniques (ART) including in vitro fertilization, super ovulation, and intrauterine insemination. 2 The incidence of heterotropic pregnancy could be rising, especially with advent of ART and use of clomiphene citrate for ovulation induction. 4,8 Also reported is effect of pelvic inflammatory disease on ectopic pregnancy.…”