The risk of miscarriage following surgical treatment of heterotopic extrauterine pregnancies

Abstract

Study Question What is the risk of loss of a live normally sited (eutopic) pregnancy following surgical treatment of the concomitant extrauterine ectopic pregnancy? Summary Answer In women diagnosed with heterotopic pregnancies, minimally invasive surgery to treat the extrauterine ectopic pregnancy does not increase the risk of miscarriage of the concomitant live eutopic pregnancy. What Is Known Already Previous studies have indicated that surgical treatment of the concomitant ectopic pregnancy in women with live eutopic pregnancies could be associated with an increased risk of miscarriage. The findings of our study did not confirm that. Study Design, Size, Duration A retrospective observational case-control study of 52 women diagnosed with live eutopic and concomitant extrauterine pregnancies matched to 156 women with live normally sited singleton pregnancies. The study was carried out in three London Early Pregnancy Units covering a twenty-year period between November 2019 and April 2000. Participants/Materials, Setting, Methods All women attended early pregnancy units because of suspected early pregnancy complications. The diagnosis of heterotopic pregnancy was made on ultrasound scan and women were subsequently offered surgical or expectant management. There were three controls per each case who were randomly selected from our clinical database and were matched for maternal age, mode of conception and gestational age at presentation. Main Results And The Role Of Chance In the study group 49/52 (94%) women had surgery and 3/52 (6%) were managed expectantly. There were 9/52 (17%, 95% CI 8.2-30.3) miscarriages <12 weeks’ gestation and 9/49 (18%, 95% CI 8.7-32) miscarriages in those treated surgically. In the control group there were 28/156 (18%, 95% CI 12.2-24.8) miscarriages <12 weeks’ gestation, which was not significantly different from heterotopic pregnancies who were treated surgically (OR 1.03 95% CI 0.44-2.36). There was a further second trimester miscarriage in the study group and one in the control group. The live birth rate in the study group was 41/51 (80%, 95% CI 66.9-90.2) and 38/48 (79%, 95% CI 65-89.5) for those who were treated surgically. These results were similar to 127/156 (81%, 95% CI 74.4-87.2) live-births in the control group (OR 0.87, 95% CI 0.39-1.94). Limitations, Reasons For Caution This study is retrospective, and the number of patients is relatively small, which reflects the rarity of heterotopic pregnancies. Heterotopic pregnancies without a known outcome were excluded from analysis. Wider Implications Of The Findings This study demonstrates that in women diagnosed with heterotopic pregnancies, minimally invasive surgery to treat the extrauterine pregnancy does not increase the risk of miscarriage of the concomitant live eutopic pregnancy. This finding will be helpful to women and their clinicians when discussing the options for treating heterotopic pregnancies. Study Funding/Competing Interest(s) This work did not receive any funding. None of the authors has any conflict of interest to declare. Trial Registration Number Research Registry: researchregistry6430.

Comparison of laparoscopic and open approach in the treatment of heterotopic pregnancy following embryo transfer

“…The standard management for HP remains unknown due to the rarity of this disease. Surgical treatment is the most frequently choice for HP ( 8 – 11 ). With the development of equipment and techonology, clinicians have put more and more attention to laparoscopy, rather than open surgery ( 21 – 23 ).…”

“…Currently, there are no clinical guidelines or expert consensus to provide the standard management recommendation for HP due to its rarity. Surgery has been the most common treatment of choice in patients with HP, especially for those with unstable clinical sign or EP ruptures (8)(9)(10)(11). Open approach (OA) is the traditional surgical method for HP.…”

“…However, the question about the preferred surgical approach for HP patients remains unsolved. Only few case-series and case-report studies have demonstrated that LA could be safely performed in HP patients ( 10 , 11 , 14 ), even for heterotopic interstitial or cornual pregnancies ( 15 – 18 ). In contrast, several studies have found that LA would increase the risk of fetal loss in HP patients ( 7 , 19 ).…”

Abdominal heterotopic pregnancy after in vitro fertilization and embryo transfer following bilateral salpingectomy: A case report and literature review

“…Miscarriage rates reached up to 26% in women who had surgical treatment ( 24 ). Others demonstrated that surgical treatment of heterotopic extrauterine pregnancies did not increase the risk of miscarriage of the concomitant live eutopic pregnancy ( 25 ). In our report, among 14 patients who received surgery with pregnancy outcomes, 10 patients resulted in the delivery of full-term neonates, while 2 patients had spontaneous abortion or fetal arrest.…”

The risk factors for miscarriage of viable intrauterine pregnancies in patients with heterotopic pregnancy after surgical intervention

“…[1,2] However, with the increased application of assisted reproductive techniques (ART) such as in vitro fertilization and artificial insemination (AI), the incidence of HP in a woman with ART treatment has raised to approximately 1%. [3][4][5] It is essential to diagnose and treat HP as soon as possible to avoid severe complications, such as hypovolemic shock, emergency blood transfusions, maternal mortality, and fetal loss. The early and accurate diagnosis of HP remains challenging due to the presence of IUP.…”