Heterotopic Pregnancy in a Natural Conception

Abstract

Heterotopic pregnancy is rare in natural conception and most often presents as life threatening emergency like acute abdomen and hemorrhagic shock. In early unruptured stages, it presents nonspecifically, mimicking normal or abnormal pregnancy manifestations. A high index of suspicion and a definitive search for it even after confirming normal intrauterine gestation is needed. This little effort ensures a timely diagnosis and management thus preventing catastrophe. We hereby report a primigravida with unruptured heterotopic pregnancy following a natural conception, who presented as nonspecific abdominal pain. Transvaginal ultrasound was inconclusive. Emergency laparoscopy clinched the diagnosis and allowed conservative salpingostomy and continuation of intrauterine pregnancy.

Persistent increase of β‐hCG level after salpingectomy in tubal pregnancy: Good or bad news?

“…Methotrexate, mifepristone, and prostaglandins cannot be used as a result of their putative harmful effects on the viable IUP. 10,11 Considering all treatment possibilities, we recommend to correlate development of serum β-hCG level with clinical findings: reaching zero if the putative IUP did not develop adequately and resulting in abortion or increasing in a remaining intact IUP. 12 Luckily, if diagnosed early, HP has a favorable prognosis.…”

“…They are safe agents with no risk of systemic toxicity to the remaining gestation. Methotrexate, mifepristone, and prostaglandins cannot be used as a result of their putative harmful effects on the viable IUP 10,11 …”

Sonographic Detection of a Heterotopic Pregnancy in Natural Conception

“…Historically, the prevalence is estimated at 1 in 30,000; however, more recent studies have demonstrated that with pregnancies involving ovulation induction and in vitro fertilization, the incidence has increased to 1 in 100. 1,3 Other investigators estimate the risk of heterotopic pregnancy at 1 in 119, and this number rises to 1 in 45 with embryo transfer. 4 With embryo transfer, the excessive number of embryos causes multiple pregnancies, ectopic pregnancies, and heterotopic pregnancies.…”