A rare case of heterotopic pregnancy managed by laparoscopic salpingectomy

Abstract

Heterotopic pregnancy is the existence of 2 or more simultaneous pregnancies with separate implantation sites, one of which is tubes or ovaries or other ectopic site. The estimated incidence in the general population is estimated at 1:35,000 (for a naturally conceived pregnancy). With increasing trend in assisted reproductive technique, the frequency of heterotopic pregnancies was increased to be between 1:100 to 1:7,000. A 36 yrs third gravida (P1, L1, A1) presented with 2 month amenorrhoea In Doppler usg there was evidence of irregular solid component at periphery with echogenic tissue around showing ring vascularity and burning ring fire sign present. There is evidence of mild free fluid collection in the pouch of Doughlas pre operative and post operative injection 17 –oh progesterone acetate (proleutone) used and post operative tidilan injection. Left sided laparoscopic salpingectomy was done. The material was collect in endobag and afterward sent it for histopathological examination which confirms trophoblastic tissue and presence of ectopic pregnancy. There is no proven role of medical management in this because of high Bhcg titer which helps to continue it afterwards. Like other cases if there was no facility for laparoscopy, laparotomy for salpingectomy is another option. Diagnosis of heterotopic rare and challenging but proper ultrasonography skills and broad mind set helps in diagnosis.