Heterotopic pregnancy in a woman without previous ovarian hyperstimulation: ultrasound diagnosis and management

Zullo, Fulvio; Pellicano, Massimiliano; Carlo, Costantino Di; Affinito, P.; Catizone, F.; Mastrantonio, P; Nappi, Carmine

doi:10.1016/0301-2115(96)02404-9

Cited by 6 publications

(4 citation statements)

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“…Early diagnosis of heterotopic pregnancy is difficult. Most cases of HP are diagnosed between the 5th and 34th gestational week (GW); 70% of cases are diagnosed between the 5th and the 8th GW, 20 % between the 9th and the 10th GW and the remaining 10 % after the 10th GW [10,11]. We report here on a very rare case of HP with sonographic visualisation of cardiac activity in the intrauterine Abstract !…”

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“…Insufficient beta-HCG production, which occurs with extrauterine pregnancy, is obscured by the normal values generated by the intrauterine pregnancy [4,9,10]. Nowadays, diagnostic laparoscopy together with vaginal sonography are the gold standard when heterotopic pregnancy is suspected [4,11]. Treatment can then be carried out immediately if the presence of HP is confirmed.…”

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confidence: 99%

“…However, there is currently no data available with regard to the effect of locally injected MTX on intrauterine foetal development or on the development of the child postpartum [4]. For this reason, several authors have recommended using KCl rather than MTX for selective foeticide in an ectopic pregnancy [5][6][7]11]. The disadvantage of KCl is that it may not entirely inhibit trophoblast invasion and that trophoblastic tissue will not be completely resorbed, thus necessitating an additional surgical intervention [3].…”

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Heterotopic Pregnancy after Natural Conception: A Case Report

Kratschla-Apochal

Nauer

Bolla

2012

Geburtsh Frauenheilk

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Introduction !The simultaneous occurrence of an intrauterine and an extrauterine pregnancy is referred to as heterotopic pregnancy (HP). To date, only a few cases of HP after spontaneous natural conception have been reported in the literature. The reported incidence of HP in a spontaneous cycle is between 1 : 2600 and 1 : 30 000. The morbidity and mortality associated with HP are directly correlated to the time between the first occurrence of symptoms and the final diagnosis [4]. Early diagnosis of heterotopic pregnancy is difficult. Most cases of HP are diagnosed between the 5th and 34th gestational week (GW); 70% of cases are diagnosed between the 5th and the 8th GW, 20 % between the 9th and the 10th GW and the remaining 10 % after the 10th GW [10,11]. We report here on a very rare case of HP with sonographic visualisation of cardiac activity in the intrauterine Abstract ! Heterotopic pregnancy (HP), i.e. the simultaneous development of an intrauterine and an ectopic pregnancy, is rare with a reported incidence of between 1 : 2600 and 1 : 30 000. Only a few cases have been described in the literature. We report here on an extremely rare case of HP after natural conception with cardiac activity noted on sonography in both the intrauterine and the ectopic foetus. Examination excluded appendicitis. Vaginal sonography (VS) was performed and revealed a second, extrauterine foetus with cardiac activity. The differential diagnosis included twin pregnancy in a bicornuate uterus, but HP could not be excluded. Diagnostic laparoscopy was scheduled due to progressive abdominal pain. Shortly before surgery the patient became acutely hypotensive. Laparoscopy confirmed a heterotopic pregnancy in the right tube. Due to acute rupture of the extrauterine pregnancy with intraabdominal bleeding, the procedure was converted to a laparotomy with right-sided salpingectomy. Subsequently, the intrauterine pregnancy continued without complications. The intrauterine pregnancy was uneventful with spontaneous delivery at term. Zusammenfassung

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Heterotopic Pregnancy after Natural Conception: A Case Report

Kratschla-Apochal

Nauer

Bolla

2012

Geburtsh Frauenheilk

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“…HP is a rare condition. Spontaneous incidence is 1/30,000 [2], increasing with the presence of risk factors, such as a history of pelvic inflammatory disease (PID) [2] or ovarian stimulation therapy [5,[17][18][19], and rising to approximately 1 in 100 ART pregnancies [20], since the embryos that are placed in the endometrial cavity during ART procedures may not implant immediately onto the endometrium, drifting towards the tubes and predisposing to a HP [13]. Experience about HP after spontaneous conception is very limited, consisting mostly of case reports or small case series [6].…”

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confidence: 99%