Heterotopic Triplet Pregnancy after In Vitro Fertilization with Favorable Outcome of the Intrauterine Twin Pregnancy Subsequent to Surgical Treatment of the Tubal Pregnancy

Abstract

Heterotopic triplet pregnancy is an exceptionally rare medical condition. The broad use of assisted reproductive technologies has contributed to the increase of ectopic and subsequently heterotopic pregnancy rate, masking a life-threatening condition for the gravid and the intrauterine pregnancy. We describe a case of a woman with heterotopic triplets at 9+4 gestational week following transfer of three embryos obtained by in vitro fertilization techniques. The ectopic tubal pregnancy was ruptured and salpingectomy was performed by laparotomy. The intrauterine pregnancy progressed to the delivery by cesarean section of two healthy twins at 36+2 gestational age. Heterotopic triplets with tubal ectopic are a special diagnostic and therapeutic challenge for the obstetrician. High index of suspicion and timely treatment by laparotomy or laparoscopy can preserve the intrauterine gestation with a successful outcome of the pregnancy.

Cornual Heterotopic Pregnancy after Bilateral Salpingectomy and Uterine Septum Resection Resulting in Term Delivery of a Healthy Infant

“…However, after the extensive use of parenteral gonadotropin therapy in assisted reproduction techniques (ART), the incidence of HP is approximately between 1 : 7963 and 1 : 30.000 in the general population [ 2 ]. In pregnancies resulting from assisted reproduction techniques, the incidence ranges from 1/100 to 1/3,600 [ 3 ]. A cornual ectopic pregnancy is one of the most life-threatening types of ectopic gestations, which accounts for 2–4% of all the ectopic pregnancies, and it has a mortality rate which is 6-7 times higher than that of the ectopic pregnancies in general [ 4 ].…”

A case of spontaneous heterotopic pregnancy in natural conception complicated with hemoperitoneum

“…It should be noted that a higher abortion rate of the intrauterine pregnancy was documented in patient undergoing medical versus surgical management in proportions of 50%-13% [8,9]. Although the incidence of heterotopic pregnancy has increased tremendously over the last decade due to the use of ART, other possible causes of heterotopic pregnancy should not be ignored in clinical practice [8,10]. According to US statistics, about two-thirds of the increase in the twin birth rate in the last three decades is likely associated with ART and non-ART infertility treatments while the remaining one third is related to other factors including family history of multiple gestation, exogenous hormones, diet, and race [5,9,11].…”

Risk factors and pregnancy outcomes of heterotopic pregnancy secondary to in vitro fertilization-embryo transfer: A case series study

“…Heterotopic pregnancies are extremely rare forms of ectopic pregnancy in gynecology. However, in recent years the incidence rate has increased to 1% with widespread use of ART [6]. HP is a life-threatening condition which have a maternal mortality rate eight times greater than tubal ectopic pregnancies [7].…”