Spontaneous Heterotopic Pregnancy: Diagnosis and Management

Abstract

Background. Heterotopic pregnancies albeit rare are conceivably life-threatening if missed. With the development of assisted reproductive techniques, the incidence has increased. Confirmation of an intrauterine pregnancy (IUP) should not preclude the existence of a heterotopic pregnancy. Case. A healthy 27-year-old patient (gravida 4, term 1, preterm 0, abortion 2, living 1) at approximately 5 weeks gestation through natural conception presented to the emergency room with acute abdominal pain and vaginal bleeding. Pelvic ultrasound showed evidence of an IUP and a right adnexal mass, raising suspicion for a heterotopic pregnancy. The patient underwent an uncomplicated laparoscopic right salpingectomy. An IUP was confirmed on ultrasound postoperatively. The patient had an early pregnancy loss at 8 weeks of gestation. Conclusion. With a high index of suspicion from clinical presentation and pelvic imaging, heterotopic pregnancy, while rare, should not be ruled out.

Spontaneous Heterotopic Pregnancy with Ovarian Localization: Case Report

“…Far more frequently, surgical intervention has been described as a therapeutic modality in various studies and is the necessary intervention in the case of hemoperitoneum, as occurred in this respective case study 3 4 6 . Laparoscopy should be preferred over laparotomy in hemodynamically stable patients because of shorter recovery time, less need for antibiotics and analgesia, and fewer wound healing problems 12 13 . Furthermore, regarding the presented case, the patient received therapeutic laparoscopy with ablation of the EUG on the ovary and could be discharged on the second postoperative day with a rapid recovery and an uncomplicated postoperative course.…”

Heterotopic Pregnancy and Amniotic Embolism: a Case Report

“…The clinical presentation of AE may include hypoxemia, sudden maternal collapse, DIC, and acute fetal distress (2). The evolution of patients is typically biphasic, with pulmonary hypertension and right ventricular failure at the beginning, followed by left ventricular failure during or immediately after delivery (12).…”

“…It is estimated that the incidence of spontaneous HP is 1:30,000 pregnancies, but when associated with in vitro fertilization, it can reach 1:100 pregnancies. Furthermore, the presence of an intrauterine pregnancy often delays its diagnosis and early intervention, as the increase in β-HCG ends up being attributed to the intrauterine pregnancy (2). Amniotic embolism (AE) occurs when amniotic uid or fetal tissue fragments enter the maternal circulation, which can cause pulmonary hypertension, cardiovascular collapse, disseminated intravascular coagulation (DIC), and high mortality rates (3).…”

Fetal Reduction by Potassium Chloride Infusion in Unruptured Heterotopic Pregnancy: A Comprehensive Review

“…The occurrence of spontaneous HP is considered rare, affecting approximately one in 30,000 pregnancies [ 4 ]. However, there is a notable trend indicating a rise in incidence attributed to the widespread adoption of ART and ovulation induction.…”

“…The increased prevalence of multiple pregnancies resulting from ovulation induction and ART procedures contributes substantially to the elevated occurrence of HP. Consequently, although still infrequent, the incidence of HP may be more pronounced in the context of ART and ovulation induction [ 4 , 6 , 7 ].…”