Angular Heterotopic Pregnancy: Successful Differential Diagnosis, Expectant Management and Postpartum Care

Abstract

Heterotopic pregnancy is a rare, difficult to diagnose and life-threatening pathology, which requires timely decisions made by an experienced multidisciplinary team. In this type of multiple pregnancy there are both intrauterine and ectopic pregnancies present. Its incidence increases in pregnancies conceived by assisted reproductive technology or in pregnancies with ovulation induction. This article presents an angular heterotopic pregnancy case in a 34-year-old multigravida. The patient was admitted on the 14th week of gestation due to abdominal pain on the left side with suspicion of heterotopic pregnancy. Transabdominal ultrasound and magnetic resonance imaging (MRI) were performed to confirm the diagnosis of heterotopic angular pregnancy in the left cornu of the uterus. Multidisciplinary team made a decision to keep monitoring the growth of both pregnancies by ultrasound while maternal vitals were stable. Due to intensifying abdominal pain, diagnostic laparoscopy was performed. No signs of uterine rupture were observed, and no additional surgical procedures were performed. Maternal status and ultrasonographic findings were closely monitored. The mass in the left cornu of the uterus did not change significantly and the fetal growth of the intrauterine pregnancy matched its gestational age throughout pregnancy. At the 41st week of gestation, a healthy female neonate was born via spontaneous vaginal delivery. The incidence rate of heterotopic pregnancy tends to grow due to an increased number of pregnancies after assisted reproductive technology and ovulation induction. It is important to always assess the risk factors. The main methods for diagnosing heterotopic pregnancies are ultrasonography and MRI. The main management tactics for heterotopic pregnancy include expectant management as well as surgical or medical termination of the ectopic pregnancy. Expectant management may be chosen as an option only in a limited number of cases, if the clinical situation meets the specific criteria. When applicable, expectant management may reduce the frequency of unnecessary interventions and help to prevent patients from its complications.

Ultrasound manifestations and clinical analysis of 50 cases of heterotopic pregnancy

“…A HP is a rare, difficult-to-diagnose, and life-threatening pathological condition [7][8][9] that occurs mostly in women conceived using ART such as in vitro fertilization, ovulation induction, and intrauterine insemination. 10,11 The incidence has been reported to be as high as 1:100 in ART-conceived pregnancies.…”

The risk factors for miscarriage of viable intrauterine pregnancies in patients with heterotopic pregnancy after surgical intervention

“…[17][18][19][20] Our study showed that the average pregnancy loss rate for HP within 2 weeks of surgery was 12.3% (13/106), which was similar to the 12% to 17% miscarriage rate reported in previous studies. [1,11,13,21,22] Moreover, considering that spontaneous abortion occurs in 11% to 65% of viable IUPs, surgical intervention for HP is considered safe and does not augment the risk factors for miscarriage of viable IUPs in patients with HP. [23] Our study has some limitations.…”

Heterotopic pregnancy: a case report of intrauterine hydatidiform mole with tubal pregnancy

“…High levels of serum human chorionic gonadotropin (hCG) in these patients can lead to atypical clinical symptoms. 4 Thus, early diagnosis and early treatment are challenging in these patients. We herein report a case involving a woman with an intrauterine hydatidiform mole and tubal pregnancy who was admitted to our hospital.…”