A rare case of spontaneous heterotopic pregnancy with successful pregnancy outcome following laparoscopic management of coexisting ruptured tubal pregnancy in Non-ART set up

Abstract

Heterotopic pregnancy is a rare clinical condition where both intrauterine (IU) and extra uterine pregnancy coexists. In a non-ART set up diagnosis of tubal ectopic pregnancy becomes challenging and difficult with coexisting intrauterine viable pregnancy, even when presents with ruptured form. Author is presenting one of his challenging experience in managing successfully such type of heterotopic ruptured tubal pregnancy in first trimester where extra uterine ruptured tubal pregnancy was addressed by laparoscopic salpingectomy under spinal anaesthesia with minimal uterine manipulation to continue intrauterine pregnancy till term and thus had a successful pregnancy outcome.

Heterotopic pregnancy in a natural conception presenting as an acute abdomen: Management and delivery of a live baby at term

“…sonographic examination in the diagnosis of early HP is reported to be between 26.3% and 92.4% [14]. This missed diagnosis of heterotopic gestation is also more worrisome and common in developing countries where the ultrasound may not have high resolution to identify an early ectopic gestation and also where early ultrasound is not routinely done due to late booking for antenatal care by pregnant women [4,14]. Mrs CU did not present to the hospital for assessment after she missed her period which preclude early diagnosis of heterotopic pregnancy until she presented with tubal rupture.…”

“…Heterotopic pregnancy (HP) refers to the simultaneous presence of intrauterine pregnancy and ectopic pregnancy, which is very rare but a potentially life-threatening condition [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15].…”

“…It can result from natural conception cycle or following assisted reproductive technology (ART) [4][5][6][7][8]. The incidence of heterotopic pregnancy was previously quoted to be 1 in 30,000 pregnancies; but recent publications have revised this to 1 in 3,889 pregnancies [2][3][4][5][6][7]. The incidence of heterotopic pregnancy may increase to as high as 1 in 100 pregnancies if assisted reproductive technologies (ART) are used [8,9].…”

“…The incidence of heterotopic pregnancy may increase to as high as 1 in 100 pregnancies if assisted reproductive technologies (ART) are used [8,9]. The actual etiology of HP is still unknown, although studies have shown that pelvic inflammatory disease, previous ectopic pregnancy, previous tubal surgery, pelvic adhesions, and ART are high risk factors of HP; however, some patients may not have obvious risk factors [1][2][3][4][5][6][7][8][9][10]. The most common site of ectopic gestation is the fallopian tube (95% to 97%).…”

“…Clinical presentations of HP are non-specific and may include abdominal pain, an adnexal mass, peritoneal irritation, and vaginal bleeding, as well as acute chest pain radiating to the shoulder [1][2][3][4][5][6][7][8][9]. Heterotopic pregnancy carries a considerable risk of maternal morbidity and mortality owing to the risk of rupture of the ectopic pregnancy, especially in developing countries where the diagnosis is difficult and delayed [11].…”