Treatment of tubal heterotopic pregnancy with viable intrauterine pregnancy: Analysis of 81 cases from one tertiary care center

Li, JinBo; Luo, XiaoChan; Yang, Jian‐Bo; Chen, Shuqin

doi:10.1016/j.ejogrb.2020.06.005

Cited by 10 publications

(14 citation statements)

References 25 publications

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“… Shang et al (2019) reported the pregnancy loss rate as 26%, but after excluding women with miscarriages, the live normally sited pregnancy loss rate was only 12%. Other studies on HPs report a miscarriage rate between 12% and 17% ( Yu et al , 2014 ; Jeon et al , 2016 ; Na et al , 2018 ; Wu et al , 2018 ; Li et al , 2020 ; Lv et al , 2020 ) which was similar to our findings.…”

Section: Discussionsupporting

confidence: 92%

The risk of miscarriage following surgical treatment of heterotopic extrauterine pregnancies

Solangon

Otify

Gaughran

et al. 2022

Human Reproduction Open

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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.

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Section: Discussionsupporting

confidence: 92%

The risk of miscarriage following surgical treatment of heterotopic extrauterine pregnancies

Solangon

Otify

Gaughran

et al. 2022

Human Reproduction Open

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“…[17][18][19][20] Our study showed that the average pregnancy loss rate for HP within 2 weeks of surgery was 12.3% (13/106), which was similar to the 12% to 17% miscarriage rate reported in previous studies. [1,11,13,21,22] Moreover, considering that spontaneous abortion occurs in 11% to 65% of viable IUPs, surgical intervention for HP is considered safe and does not augment the risk factors for miscarriage of viable IUPs in patients with HP. [23] Our study has some limitations.…”

Section: Discussionmentioning

confidence: 99%

“…Evidence suggests that earlier symptoms such as vaginal bleeding, and abdominal pain, along with a younger gestational age on the day of surgery are independent predictors of intrauterine pregnancy loss. [1,4,11–13] However, we found that the signs or symptoms had no effect on the prognosis of viable IUP in patients with HP within 2 weeks of surgery. Additionally, we identified the hemoperitoneum volume as an independent predictor of miscarriage of viable IUP in patients with HP treated surgically.…”

Section: Discussionmentioning

confidence: 99%

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

Ruan,

Zhang,

Chen

et al. 2023

Medicine

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To summarize the clinical characteristics and explore the risk factors for miscarriage of a viable intrauterine pregnancy following surgical intervention in patients with heterotopic pregnancy (HP). A total of 106 women diagnosed with HP that underwent surgical intervention in the Women’s Hospital School of Medicine Zhejiang University between January 2014 and December 2021 were included in this retrospective study. They were divided into a miscarriage group (n = 13) and an ongoing pregnancy group (n = 93) according to the outcomes of the HP within 2 weeks after surgery. Data regarding clinical characteristics, surgical conditions, postoperative recovery, and complications were collected and compared between the groups. Logistic multivariate analysis was performed to explore the risk factors for miscarriage in patients with HP within 2 weeks of surgical intervention. Among the 106 women with HP, 80 had tubal HP, 8 had cornual HP, and 18 had interstitial HP. Eighty-seven (82.1%) patients developed clinical symptoms that manifested primarily as abnormal vaginal bleeding and/or abdominal pain, whereas 19 (17.9%) patients had no clinical symptoms. The mean gestational age on the day of surgery was 7.2 weeks (inter-quartile range, 6.4–8.3). The miscarriage rate within 2 weeks of surgical intervention was 12.3% in patients with HP. Compared to the ongoing pregnancy group, the miscarriage group had a higher body mass index, earlier gestational age at treatment, and higher volume of hemoperitoneum (P < .05 for all). Logistic multivariate analysis indicated that the women with a hemoperitoneum volume > 200 mL had significantly higher risk of miscarriage after adjusting covariates [OR (odds ratio) = 5.285, 95% CI (confidence interval) (1.152–24.238), P < .05]. Hemoperitoneum volume was independently associated with miscarriage of viable intrauterine pregnancies in patients with HP within 2 weeks of surgical intervention.

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“…con laparoscopia fueron significativamente mayores (22,22 %) con las de las dieciséis pacientes tratadas mediante laparotomía (0 %), p < 0,038. Estos abordajes se determinaron en pacientes inestables hemodinámicamente, con sospecha de ruptura, o actividad cardiaca en el eh (23). Si el tratamiento quirúrgico es el abordaje de elección, son pocas las publicaciones respecto al método anestésico para el manejo del eh.…”

Section: • Embarazo Cornualunclassified

Embarazo heterotópico espontáneo con resultado perinatal favorable, reporte de un caso y revisión de la literatura

Moreno

Ortiz

2021

Rev. Med.

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el embarazo heterotópico (EH) es una gestación múltiple en la que un embrión se implanta dentro de la cavidad uterina, y otro en cualquier otra parte como un embarazo ectópico (EE). Espontáneo, tiene una incidencia de uno en 30.000 embarazos, y con técnicas de reproducción asistida (TRA) hasta uno en cien. Su diagnóstico temprano permite reducir la morbimortalidad y mejorar el pronóstico para el embarazo intrauterino. El objetivo del artículo es realizar una revisión de la literatura sobre eh y presentar un caso clínico. Se realizó una búsqueda en bases de datos Pubmed y Medline, utilizando combinaciones con operadores booleanos de los términos MESH: heterotopic pregnancy, ectopic pregnancy, therapy, risk factors y prognosis. Los límites de la búsqueda fueron: artículos en texto completo, idiomas español e inglés, publicados en los últimos diez años. Se obtuvieron 275 títulos; luego de eliminar los duplicados y la evaluación del resumen, se utilizaron veintisiete referencias. Se presenta un caso de una paciente gesta 2, antecedente de ee roto, con EH espontáneo y ruptura de gestación tubárica; se describe su manejo y resultado perinatal. El EH puede tener implantación tubárica (más frecuente) o en cualquier otra localización. El diagnóstico debe estar centrado en los factores de riesgo y los criterios de ultrasonido. El manejo puede ser expectante, médico o quirúrgico, teniendo con el primero el peor pronóstico materno, con el segundo, menores tasas de pérdida gestacional y mejores resultados maternos, y con el último mayores tasas de aborto. El diagnóstico del EH se realiza por ultrasonido transvaginal; de acuerdo con cada caso se orienta el tratamiento. El abordaje quirúrgico es la primera línea en la presentación aguda. El manejo expectante o la aspiración guiada por ultrasonido son opciones razonables en la paciente estable. Son necesarias más cohortes de pacientes para evaluar los resultados del manejo en nuestro medio.

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Treatment of tubal heterotopic pregnancy with viable intrauterine pregnancy: Analysis of 81 cases from one tertiary care center

Cited by 10 publications

References 25 publications

The risk of miscarriage following surgical treatment of heterotopic extrauterine pregnancies

The risk of miscarriage following surgical treatment of heterotopic extrauterine pregnancies

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

Embarazo heterotópico espontáneo con resultado perinatal favorable, reporte de un caso y revisión de la literatura

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