Study On Diagnosis And Management Strategies On Heterotopic Pregnancy

Abstract

Objective The aims of this study were to analysis the clinical characteristics of women with heterotopic pregnancy (HP) following embryo transfer (ET) and explore the early predictors for pregnancy outcomes.Methods This retrospective study reviewed patients with HP following assisted reproductive technology (ART) in our institution between January 2013 and December 2020. The relationships between pregnancy outcomes and general features, ultrasonic characteristics and different treatment modality were analyzed by logistic regression analysis.Results Fourty patients were identified, including 27 with tubal HP, 7 interstitial HP and 6 cornual HP. The most frequent manifestations before diagnosis was vaginal bleeding (30.0%), while 7 patients (17.5%) had no symptoms before diagnosis. The mean gestational age at symptom onset was 44.8 ± 8.6 days (range 27–68). Gestational age at diagnosis was 49.4 ± 7.6 days (range 29–68). Among these cases, twenty-nine patients of HP were accurately diagnosed by transvaginal ultrasonography (TVS). Hence, the sensitivity of TVS for detecting HP was 72.5% (29/40). Eleven patients received expectant management, while 29 patients underwent laparotomy (13/29) or laparoscopy (16/29) surgery. Gestational age at surgery day was 51.0±8.6 days (range 33–67). Live births occurred for 18 patients in the surgery group, 3 of whom delivered preterm. Additionally, the miscarriage rate was lower for patients with IUP cardiac activity (16.7% vs. 90.0%) than patients without IUP cardiac activity at HP diagnosis (P < 0.001). Further by logistic regression analysis, an IUP with cardiac activity at HP diagnosis was identified as an independent factors of pregnancy outcome (P<0.001).Conclusions Symptoms combined with routine TVS scans could reduce misdiagnosis and facilitate the diagnosis of HP. An IUP with cardiac activity at HP diagnosis as predictors for a favorable prognosis of HP. Prompt surgical intervention after diagnosis may minimize the incidence of abortion of IUP.