Clinical analysis of 50 patients with heterotopic pregnancy after ovulation induction or embryo transfer

Abstract

ObjectivesThe purpose of this study was to evaluate the clinical characteristics, prenatal diagnosis, and management of patients with heterotopic pregnancy after ovulation induction or embryo transfer.MethodsThis was a retrospective study of fifty cases with heterotopic pregnancy, in which the fertilization way, type and number of embryo transferred, gestational age, clinical presentation and outcome of intrauterine, ultrasound presentation and site of ectopic pregnancy, bilateral fallopian tube and treatment were evaluated.ResultsSix patients had spontaneous pregnancy and two had artificial insemination after ovulation induction. Sixteen had fresh and nineteen had frozen embryo transfer with seven patients unrecorded its embryo type and number. The average days from transplantation (or intercourse/insemination) to diagnosing heterotopic pregnancy was thirty-seven with the earliest eighteen and the latest more than 70 days. Although the most common presentation was vaginal bleeding or abdominal pain, more than 21% was found by ultrasound and rare individuals even presented with gastrointestinal symptom which may imply ruptured EP and hemorrhagic shock. Giving proper treatment (surgery or local drug injection), the majority of them had a successful intrauterine pregnancy with only seven miscarried.ConclusionsOvulation induction or embryo transfer increased the risk of HP greatly and clinician should raise high suspicious during the whole first trimester. Although the most ectopic site was ampullary, other sites such as cornual, cervical, abdominal especially interstitial or tubal stumps should also be assessed by ultrasound even in patients with bilateral salpingectomy or tubal obstructed. Repeated ultrasound tests 2 weeks after the diagnosis of intrauterine pregnancy with heart beating was very necessary to find the missed ones in suspicious patients. Compared with surgery, embryo suction with or without proper local drug injection would be more advisable for patients with cervical, cornual, or interstitial pregnancy in order to reserve the intrauterine pregnancy.

Successfully Managing Cornual Heterotopic Pregnancy:A Case Report and Literature Review

“…[32] In addition, the latest findings by Chinese researchers at Zhejiang University show that, compared with surgery, embryo suction with or without proper local drug injection is advisable for patients with cervical, cornual or interstitial pregnancy, as this can preserve the intrauterine pregnancy. [42] In our case, the embryo in the lateral angle of the uterine cavity close to the internal ostium of the fallopian tube was a rare form of ectopic pregnancy. Since it was close to the normal embryo, we could not completely remove the pregnancy tissue in the left horn during operation.…”

“…Wu et al [42] 5 (IVF-ET) Bilateral salpingectomy 2 (Abdominal pain and viginal bleeding), 3 (Free of symptoms) (7-9)…”

Spontaneously conceived heterotopic pregnancy with abdominal pregnancy implanted on the vesicouterine pouch: A case report and literature review

“…The incidence of HP in spontaneous pregnancies is estimated to be one in 30 000, 1 while infertility treatments such as ovulation induction or multiple embryo transfer (ET) could dramatically increase the incidence to 1.0% 1,2 . Similar to a general ectopic pregnancy, ectopic pregnancy in HP occurs anywhere in the abdominal cavity other than the endometrial lining of the uterus, with the fallopian tubes being the most frequent location 1–3 . Abdominal pregnancy (AP), defined as an implantation in the peritoneal cavity exclusive of tubal, ovarian, or intraligamentary implantation, is a rare form of ectopic pregnancy 4–6 .…”

Treatment of tubal heterotopic pregnancy with viable intrauterine pregnancy: a retrospective study

“…An early and correct diagnosis of tubal HP is difficult. Symptoms of tubal HP include abdominal pain, vaginal bleeding or hypovolemic shock resulting from tubal EP rupture; however, some patients can be asymptomatic [5,6]. Due to its nontypical clinical presentations, a diagnosis of tubal HP may be delayed, missed or misdiagnosed as threatened abortion [7,8].…”

“…According to the literature, treatment modalities of tubal HP with viable IUP include surgical removal of EP tissues, expectant management, medical treatment with local or systemic methotrexate and sonographically-guided transvaginal aspiration of ectopic gestational embryos with or without embryo-killing drug treatment (embryo aspiration treatment) [5][6][7][9][10][11][12]. Medical treatment with methotrexate should not be considered due to its indicated teratogenic effects on viable IUP [13].…”