Unusual case of recurrent heterotopic pregnancy after bilateral salpingectomy and literature review

Shavit, Tal; Paz-Shalom, Einat; Lachman, E; Fainaru, Ofer; Ellenbogen, A.

doi:10.1016/j.rbmo.2012.10.006

Cited by 29 publications

(23 citation statements)

References 5 publications

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“…The results of this study showed that multiple-embryo transfer was a risk factor associated with increased incidence of HP ( OR 0.300,95% CI 0.092-0.983; P = 0.037). This nding con rms and expands that of a previous study which believed that the diagnosis of HP must be considered in patients with two or more embryos transferred in a cycle [13]. Therefore, selective singleembryo transfer probably is a preferred choice for a decreased risk of HP.…”

Section: Discussionsupporting

confidence: 85%

Risk factors and pregnancy outcomes of heterotopic pregnancy secondary to in vitro fertilization-embryo transfer: A case series study

Zhu

Zhang

Song

2020

Preprint

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Background: The early diagnosis and treatment of heterotopic pregnancy (HP) remain one of the biggest challenges in the field of gynecology. A coexisting intrauterine gestation makes the ectopic pregnancy in HP more difficult to diagnose. This case series analysis is designed to explore factors affecting the incidence of HP secondary to in vitro fertilization-embryo transfer (IVF-ET) and that affecting pregnancy outcomes after surgical treatment of HP.Methods: From the IVF registry system, the clinical data of 29 patients with HP and 92 with an intrauterine-only pregnancy (IUP) following embryo transfer from January 2009 to December 2017 were retrospectively analyzed.Results HP had a higher proportion of previous ectopic pregnancies, multiple abortion history ( ≧ 2 times) and tubal indication for IVF than IUP. In patients with HP, 31.03% had spontaneous abortion, 25.00% had preterm delivery and 58.62% resulted in a live birth. According to the results from logistic regression, history of multiple abortions (odds ratio (OR) 3.031, 95% confidence intervals (CI) 1.087-8.453; P=0.034), tubal infertility (OR 3.844, 95% CI 1.268-11.656; P=0.017), previous ectopic pregnancies (OR 2.303, 95% CI 0.625-8.490; P=0.021) and multiple embryo transfer ( OR 0.300, 95% CI 0.092-0.983; P=0.037) resulted in an elevated proportion of HP in IVF cycles. Incidence of HP was comparable between patients transferred with blastocyst and cleavage embryos. Shorter operative duration, smaller size of the ectopic mass and location in the ampulla of the fallopian tube were associated with higher chance of survival in the coexistent intrauterine pregnancy after surgical treatment with HP.Conclusions:The early diagnosis of HP remains a challenge. Previous history of ectopic pregnancy, multiple abortions, tubal infertility and multiple embryo transfer may be considered as meaningful risk factors of subsequent HP following IVF-ET. In patients with HP treated by surgery, shorter operative duration, smaller size of the ectopic mass and location in the ampulla of the fallopian tube means better reproductive prognosis.

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Section: Discussionsupporting

confidence: 85%

Risk factors and pregnancy outcomes of heterotopic pregnancy secondary to in vitro fertilization-embryo transfer: A case series study

Zhu

Zhang

Song

2020

Preprint

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“…In our present study, a total of twenty patients had ipsilateral salpingectomy or even bilateral salpingectomy but this time five had cornual, four had interstitial, and two had tubal stump pregnancy. Moreover, abdominal EP may even be happened on the condition of bilateral salpingectomy which has been reported only four cases with two of ours [ 11 – 13 ]. All together suggested that the risk factors may alter the transport mechanisms and molecules expression systemically.…”

Section: Discussionmentioning

confidence: 79%

Clinical analysis of 50 patients with heterotopic pregnancy after ovulation induction or embryo transfer

Zhang

et al. 2018

Eur J Med Res

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ObjectivesThe purpose of this study was to evaluate the clinical characteristics, prenatal diagnosis, and management of patients with heterotopic pregnancy after ovulation induction or embryo transfer.MethodsThis was a retrospective study of fifty cases with heterotopic pregnancy, in which the fertilization way, type and number of embryo transferred, gestational age, clinical presentation and outcome of intrauterine, ultrasound presentation and site of ectopic pregnancy, bilateral fallopian tube and treatment were evaluated.ResultsSix patients had spontaneous pregnancy and two had artificial insemination after ovulation induction. Sixteen had fresh and nineteen had frozen embryo transfer with seven patients unrecorded its embryo type and number. The average days from transplantation (or intercourse/insemination) to diagnosing heterotopic pregnancy was thirty-seven with the earliest eighteen and the latest more than 70 days. Although the most common presentation was vaginal bleeding or abdominal pain, more than 21% was found by ultrasound and rare individuals even presented with gastrointestinal symptom which may imply ruptured EP and hemorrhagic shock. Giving proper treatment (surgery or local drug injection), the majority of them had a successful intrauterine pregnancy with only seven miscarried.ConclusionsOvulation induction or embryo transfer increased the risk of HP greatly and clinician should raise high suspicious during the whole first trimester. Although the most ectopic site was ampullary, other sites such as cornual, cervical, abdominal especially interstitial or tubal stumps should also be assessed by ultrasound even in patients with bilateral salpingectomy or tubal obstructed. Repeated ultrasound tests 2 weeks after the diagnosis of intrauterine pregnancy with heart beating was very necessary to find the missed ones in suspicious patients. Compared with surgery, embryo suction with or without proper local drug injection would be more advisable for patients with cervical, cornual, or interstitial pregnancy in order to reserve the intrauterine pregnancy.

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“…We further examined the remaining 64 records for eligibility. We excluded 29 studies (from 32 records) for the following reasons: one study (from one record) was still ongoing; six studies (from six records) were not written in a Western language; 14 studies (from 15 records) evaluated fewer than 10 women; six studies (from six records) had insufficient data to evaluate eligibility and the authors did not respond to our electronic attempt to contact them; and two studies (from four records) did not provide IVF results. Therefore, 26 studies (from 32 records) were considered eligible.…”

Section: Resultsmentioning

confidence: 99%

High miscarriage rate in women treated with Essure® for hydrosalpinx before embryo transfer: a systematic review and meta‐analysis

Barbosa

Sotiriadis

Papatheodorou

et al. 2016

Ultrasound in Obstet & Gyne

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The available evidence suggests that, although Essure prior to ET in women with hydrosalpinx improves the chance of achieving a clinical pregnancy compared with no intervention, it is associated with a higher rate of miscarriage when compared with the other interventions. Although this evidence is based on observational studies, we believe that salpingectomy should be the first option for women who are eligible for videolaparoscopy. However, it is still premature to make recommendations for women who are not eligible for surgery, and randomized controlled trials are needed to clarify which is the best treatment alternative in such a scenario. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.

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Unusual case of recurrent heterotopic pregnancy after bilateral salpingectomy and literature review

Cited by 29 publications

References 5 publications

Risk factors and pregnancy outcomes of heterotopic pregnancy secondary to in vitro fertilization-embryo transfer: A case series study

Risk factors and pregnancy outcomes of heterotopic pregnancy secondary to in vitro fertilization-embryo transfer: A case series study

Clinical analysis of 50 patients with heterotopic pregnancy after ovulation induction or embryo transfer

High miscarriage rate in women treated with Essure® for hydrosalpinx before embryo transfer: a systematic review and meta‐analysis

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