Spontaneous live unilateral twin ectopic pregnancy – A case presentation

Abstract

The incidence of ectopic pregnancy has increased in recent years and now is around one in 100 pregnancies. However, the incidence of live twin ectopic pregnancy in a spontaneous conception is still quite rare. A 34-year-old gravida 3, para 0 presented in the Early Pregnancy Unit with a positive pregnancy test, lower abdominal pain and vaginal spotting. Her quantitative serum Beta hCG was high, and the transvaginal scan revealed an empty uterine cavity with a twin ectopic pregnancy in the left adnexa with cardiac activity in both embryos. The patient was taken for laparoscopic surgery and a left ampullary twin pregnancy was confirmed. She underwent a left salpingectomy and is well on a one-year follow-up. This case report discusses the incidence, diagnoses and treatment of ectopic pregnancies in general.

Management of a spontaneously conceived live unilateral twin ectopic pregnancy in Australia: A case report

“…We identified 21 cases of live twin ectopic pregnancies [ 2 , 4 , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] ]. Of these, 14 were diagnosed between six and eight weeks of gestation [ 2 , 4 , 6 , [8] , [9] , [10] , [11] , [18] , [19] , [20] , [21] , [22] ], while one pregnancy was diagnosed at just four weeks of gestation after presenting with abdominal pain and vaginal bleeding [ 14 ]. Only three pregnancies progressed beyond eight weeks of gestation [ 13 , 16 , 23 ], and the gestational age of the remaining two was not reported [ 12 , 17 ].…”

“…Ectopic pregnancies are extrauterine gestations, accounting for 1.62% of all pregnancies in Australia [ 1 ]. Risk factors include a history of ectopic pregnancies, cigarette smoke, the use of an intrauterine contraceptive device, tubal sterilisation surgery, assisted reproductive techniques (ART) and anatomy distorted by pelvic inflammatory disease or operative trauma [ 2 ].…”

“…Guidelines recommend salpingectomy in the case of ectopic pregnancy with bHCG greater than 5000 IU/L due to increased risk of treatment failure and rupture with medical management [ 3 ]. bHCG levels in twin ectopic pregnancies are higher than in singleton ectopic pregnancies, which tend to be lower than in normal intrauterine pregnancies [ 2 ]. While the morbidity and mortality associated with singleton ectopic pregnancies is declining, the risk of hypovolemic shock as a result of rupture is higher in twin ectopic pregnancies and rupture is estimated to occur in 30–50% of cases [ 4 ].…”

A spontaneous bilateral fallopian tube pregnancy with didelphic uterus

“…[ 5 ] Although in recent years, due to the development of assisted reproductive technology, the morbidity of EP has increased, spontaneous bilateral fallopian tube pregnancy cases remain rare. [ 6 ] Transvaginal ultrasound has a positive predictive value of 96.7% and a negative predictive value of 99.4% for the identification of EP. [ 6 – 8 ] However, the efficacy of preoperative ultrasound in diagnosing bilateral EPs is also poor, with only a couple of successful cases known because even the most experienced sonographers may only encounter a handful, and no previous literature has reported cases.…”

“…First, it is a spontaneous bilateral fallopian tube pregnancy; similar cases do not exist. [ 6 ] Second and more importantly, the patient had a didelphic uterus. The diagnosis of EP in this patient was further concealed by her unremarkable medical history and physical examination findings.…”