Diagnosis and management of heterotopic pregnancy following embryo transfer: clinical analysis of 55 cases from a single institution

Lyu, Jiangtao; Ye, Hong; Yi, Lin; Sun, Wei; Li, Lei; Hao, Lijuan

doi:10.1007/s00404-017-4384-y

Cited by 28 publications

(28 citation statements)

References 22 publications

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“…Because most studies reported data on small sample sizes or case reports, the most common ectopic site of HP has not been well established, but tubal EP in those with an HP is considered the most frequent site, similar to those with EP alone. [ 5 , 6 ]…”

Section: Discussionmentioning

confidence: 99%

The risk factors of miscarriage and obstetrical outcomes of intrauterine normal pregnancy following heterotopic pregnancy management

Jung

Choi

et al. 2018

Medicine

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To investigate the clinical characteristics and risk factors for miscarriage of intrauterine normal pregnancy of patients with a heterotopic pregnancy (HP) after treatment.This was a retrospective study of medical records from CHA Bundang Medical Center. Sixty-four patients who were diagnosed with a HP between February 2006 and July 2017 were included in this study. All analyses were performed using SAS software, version 9.4 (SAS Institute, Inc., Cary, NC). P values < .05 were considered statistically significant.Forty-eight patients had tubal ectopic pregnancies (EP), 10 patients had cornual EPs, 1 patient had a cesarean section scar EP, 4 patients had an ovarian EP, and 1 patient had bilateral tubal EP. Among the 64 patients, 14.1% (9/64) miscarried before 10 weeks of gestation after management. Mean gestational age (GA) at treatment was 5.97 ± 0.50 weeks and 6.80 ± 1.04 weeks for miscarriage and nonmiscarriage group, respectively (P = .008). Significant differences were observed between 2 groups in terms of ultrasonographic features at the time HP was diagnosed (P = .040) Logistic regression models indicated that gestational age at treatment showed significant differences between 2 groups (OR: 0.003, 95% CI: 0.001–0.604).Immediate management after diagnosis could expect favorable prognosis of HP. GA at treatment was the only independent risk factor for miscarriage in patients with HP regardless of treatment methods.

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Section: Discussionmentioning

confidence: 99%

The risk factors of miscarriage and obstetrical outcomes of intrauterine normal pregnancy following heterotopic pregnancy management

Jung

Choi

et al. 2018

Medicine

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“…However, MRI may not always be easily accessible and the use of gadolinium contrast in HIP should be avoided in the presence of viable intrauterine pregnancy [15]. In the setting of artificial reproductive technology, only half of the heterotopic pregnancy was detected at first routine ultrasound examination [7], although higher figure of 85% has been quoted in smaller studies that proposed for routine transvaginal ultrasound at day 27 after embryo transfer [11]. In the case report, pelvic MRI was utilised to further delineate interstitial pregnancy from other potential diagnosis such as angular pregnancy or degenerating fibroid.…”

Section: Discussionmentioning

confidence: 99%

“…Serial β-hCG has roles in detecting persistent interstitial pregnancy and differentiating intrauterine pregnancy from ectopic pregnancy [11,17]. The typical doubling of serial β-hCG reading with viable intrauterine pregnancy may pose false reassurance to the clinician, resulting in missing the concomitant interstitial pregnancy in HIP [6].…”

Section: Discussionmentioning

confidence: 99%

“…11]. In the analysis of 55 cases diagnosed as heterotopic pregnancy, the symptoms of abdominal pain and/or per vaginal bleeding was observed to appear before day 27 post-embryo transfer in in-vitro fertilisation in 83% of the patient, with onset of symptoms detected the earliest at 5.8 weeks' gestation [11]. Subsequent analysis showed a gap of 0.5 weeks between the gestation at the appearance of the symptoms and the gestation at diagnosis of the heterotopic pregnancy [11].…”

Section: Introductionmentioning

confidence: 99%

“…The diagnosis of HIP is established between six to 14 weeks of gestation [11,12]. Late diagnosis of HIP at 26 weeks' gestation has been reported in which the pregnancy was mistakenly labelled as dichorionic diamniotic twin at 12 weeks of gestation, only to be diagnosed as HIP as the concomitant interstitial pregnancy spontaneously ruptured [13].…”

Section: Introductionmentioning

confidence: 99%

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The Challenge in Diagnosing and Managing Heterotopic Interstitial Pregnancy in Natural Conception

Mohamad¹,

Daud²,

Thow³

et al. 2019

JCHS

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Heterotopic interstitial pregnancy in natural conception is very rare. Definitive diagnosis is made by systematic pelvic ultrasound. Simultaneous viable conception observed in both intra- and extra-uterine is pathognomonic of heterotopic interstitial pregnancy. We report a 34-year-old woman primigravida at 10 weeks’ amenorrhoea who underwent evacuation of retained product of conception for missed miscarriage. Intraoperatively, minimal product of conception was retrieved. Bedside pelvic ultrasound showed cystic mass at right superolateral part of uterine fundus suspicious of interstitial pregnancy. Cornual resection was performed via laparotomy. Histopathological examination showed presence of product of conception and interstitial pregnancy. Serum β-human chorionic gonadotropin dropped from 10,027 IU/l on day one post-ERPC to 210 IU/l at day three post-cornual resection. This case report highlighted the challenge in diagnosing heterotopic interstitial pregnancy conceived naturally. Timely diagnosis may avert dire consequences of massive haemorrhage from ruptured uterine cornua.

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Treatment effects of laparoscopy versus laparotomy on heterotopic pregnancy after in vitro fertilization and embryo transfer

Chen

Zhu

et al. 2023

Intl J Gynecology & Obste

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ObjectiveTo compare the treatment effects of laparoscopy versus laparotomy on heterotopic pregnancy (HP) after in vitro fertilization‐embryo transfer (IVF‐ET).MethodsThe retrospective case–control study enrolled 109 patients diagnosed with HP after IVF‐ET treatment in our hospital from January 2009 to March 2020. All patients received surgical treatment by either laparoscopy or laparotomy. Data for general characteristics, diagnostic features, surgical parameters, as well as perinatal and neonatal outcomes were collected.ResultsSixty‐two patients received laparoscopy and 47 received laparotomy. Significantly lower percentage of large hemoperitoneum (P = 0.001), shorter surgery duration (P < 0.001), less intraoperative blood loss (P = 0.001), higher rates of general anesthesia (P < 0.001), and lower cesarean section rates for singletons (P = 0.003) were found in the laparoscopy group. The perinatal and neonatal outcomes were comparable between the two groups. When interstitial pregnancy was considered alone, the surgical blood loss was significantly reduced in the laparoscopy group (P = 0.021), but there was no significant difference in hemoperitoneum, surgery duration, or perinatal and neonatal outcomes in singletons.ConclusionBoth laparoscopy and laparotomy are effective surgical treatments for HP after IVF‐ET. Laparoscopy is minimally invasive but laparotomy can be an alternative in emergency situations.

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Diagnosis and management of heterotopic pregnancy following embryo transfer: clinical analysis of 55 cases from a single institution

Abstract: Routine TVS at day 27 after ET could facilitate the diagnosis of HP, symptoms onset before or after day 27 are clues to early diagnosis. Prompt surgery after diagnosis may improve the prognosis of HP following ET.

Cited by 28 publications

References 22 publications

The risk factors of miscarriage and obstetrical outcomes of intrauterine normal pregnancy following heterotopic pregnancy management

The risk factors of miscarriage and obstetrical outcomes of intrauterine normal pregnancy following heterotopic pregnancy management

The Challenge in Diagnosing and Managing Heterotopic Interstitial Pregnancy in Natural Conception

Treatment effects of laparoscopy versus laparotomy on heterotopic pregnancy after in vitro fertilization and embryo transfer

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