Management of Heterotopic Pregnancy

Abstract

The objective of this study is to summarize the experiences of our department in the management of heterotopic pregnancy (HP) and to analyze the influence of different treatment modality on the viable intrauterine pregnancy.There were 64 patients diagnosed as HP in the Department of Gynecology and Obstetrics in our hospital between January 2003 and June 2014, 52 HP patients with viable intrauterine pregnancy were included and analyzed in our study. Interventions included expectant management, surgical management and transabdominal sonographic guided transvaginal aspiration of ectopic gestational embryo (embryo aspiration) management.Main outcome measures are maternal outcome and pregnancy outcome.In expectant management group, 4 patients suffered rupture of ectopic pregnancy, 6 patients transferred to surgical management, 1 patient suffered a fever of 40.4°C, the abortion rate was 5% (1/20). In surgical management group, emergency surgery was performed in 9 patients with unstable hemodynamics and 3 patients with stable hemodynamics, 1 patient suffered uterine rupture 5 weeks later and dead fetus was demonstrated, 1 patient suffered urinary retention postoperative, the abortion rate was 14.8% (4/27). In embryo aspiration management group, 1 patient needed another embryo aspiration, all patients were eventful and no abortion was observed.In our retrospective study, transabdominal sonographic guided aspiration of ectopic gestational embryo has the best maternal outcome and the lowest abortion rate, surgical management group shows the highest abortion rate, and expectant management presents the worst maternal outcome.

Advanced Heterotopic Pregnancy: A Case Report

“…It allows to clearly determine the size of the uterus, view the EP, assess the state of the trunk, quantify the hemoperitoneum, and achieve therapeutic procedure [3,12,13,15,18].…”

“…Pelvic ultrasound is the main paraclinical examination method for the diagnosis of heterotopic pregnancy [10,11,13,14,15]. This method determines the precise term of the pregnancy, the quality of the IUP, the position of the ectopic pregnancy and the existence of a possible effusion.…”

“…Subsequent fertility may be compromised permanently or significantly reduced if a hysterectomy must be performed before an uncontrolled bleeding during pregnancy uterine horn, or oophorectomy is necessitated by a very hemorrhagic ovarian pregnancy [11,12,15,16,19].…”

“…The scheduled 34 SA laparotomy will be carried forward in case of stagnant growth, alteration or Doppler with maternal complication [15,16,19].…”

“…In cases of radical treatment, salpingectomy should be performed without resection of the interstitial portion to not weaken the uterus. If a wedge resection of the uterine horn is made, prophylactic cesarean section should be considered [12,14,15,18,20].…”