Heterotopic Pregnancy Complicating In Vitro Fertilization (original) (raw)
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Heterotopic pregnancy is a rare but intriguing disease, which poses a high risk for pregnant women and for intrauterine pregnancy. Clinically, it is mainly characterized by pain and vaginal bleeding. b-hCG serum dosage is used to detect the pregnancy, but transvaginal ultrasound is needed to diagnose heterotopic pregnancy. From all the risk factors, the assisted reproductive treatments represent the most important, especially when multiple embryos are transferred. Patients with a heterotopic pregnancy are at risk of having a spontaneous or medically induced abortion, and for this reason appropriate and tailored treatment should be considered, pursuing the optimal risk/benefit ratio. Although conservative treatments are available in the case of only extrauterine pregnancy, such as methotrexate, often the laparoscopic approach seems unavoidable in heterotopic pregnancy. To preserve the intrauterine pregnancy, a conservative treatment is remarkable, both salpingotomy or salpingostomy. In this case report, we present a successful laparoscopic treatment of an extrauterine pregnancy with the prosecution of the intrauterine pregnancy up to the third trimester. In particular, a 25-year-old girl referred to the Villa Sofia Cervello Hospital complaining of abdominopelvic pain and vaginal bleeding for 2 days. The salpingectomy approach was performed, and every anatomical piece was sent for histopathology.
Heterotopic pregnancy: two cases and a comparative review
Fertility and Sterility, 2007
Objective: To analyze the incidence, diagnostic, and therapeutic management of heterotopic pregnancy by comparing a review for the 1971-1993 period with the one carried out in the present study (1994-2004). Design: Review of the literature. Setting: University teaching assisted reproductive technology (ART) center. Patient(s): Two case reports included in a comparative review of the literature on heterotopic pregnancy. Intervention(s): Review of the published literature from January 1994 to December 2004 was performed by means of MEDLINE database. Medical subject heading words used were: heterotopic pregnancy, assisted reproductive technology, and ectopic pregnancy. A comparison with a previously reported review, including cases from 1971 to 1993. Main Outcome Measure(s): Comparative study of the diagnosis and treatment of ectopic pregnancy. Result(s): During the 1971-1993 period the definitive diagnosis of heterotopic pregnancy was performed by laparoscopy or laparotomy in 59% of cases. This proportion increased to 74% from 1994 to 2004. Likewise, the percentage of cases in which an early diagnosis was possible (performed before the ninth week of pregnancy) did not vary in any of the time periods evaluated (71% vs. 74%). Conclusion(s): Despite the increased medical knowledge and use of improved reproductive technologies, heterotopic pregnancy still remains a diagnostic and therapeutic challenge to practitioners.
Diagnosis and Treatment of Heterotopic Pregnancy Compared with Ectopic Pregnancy
The Journal of the American Association of Gynecologic Laparoscopists, 2002
Heterotopic pregnancy (HP) is defined as coexistence of an intrauterine and an extrauterine pregnancy. It is no longer considered a rarity after assisted reproductive technology (ART). Its occurrence may be as high as 0.75% to 1.3% of pregnancies conceived after ART 1-4 or even higher in women with preexisting tubal disease. 5 Heterotopic pregnancy is associated with major diagnostic pitfalls, as clinical features vary widely. Early sonographic examination is commonly performed in cases of ART pregnancy; however, 353
Long-term Outcome After Laparoscopic Treatment of Heterotopic Pregnancy: 19 Cases
Journal of Minimally Invasive Gynecology, 2010
Study Objective: To determine the long-term outcome of intrauterine pregnancies after treatment of heterotopic pregnancies. Design: Retrospective cohort study (Canadian Task Force classification II-3). Setting: Tertiary center university hospital. Patients: All women who underwent surgery because of heterotopic pregnancy over 12 years. Intervention: Laparoscopic surgery. Measurements and Main Results: Infant development and future pregnancy. Extrauterine pregnancies were located in the tube (n 5 13), uterine cornua (n 5 3), ovary (n 5 1), and tubal stump (n 5 2). During laparoscopy, a ruptured tube was found in 6 tubal pregnancies (46%), blood transfusion was needed in 7 heterotopic pregnancies (37%), and salpingectomy was performed in 12 women with tubal pregnancies (91.7%). The pregnancy outcome consisted of 13 babies (term and preterm) taken home and 5 miscarriages. Long-term follow up demonstrated that 10 of 13 infants (76.9%) exhibited normal development. Three infants, all from 1 triplet pregnancy, exhibited borderline to normal development. Ten of 15 women achieved additional pregnancies, with 10 deliveries and only 1 extrauterine pregnancy in the tubal stump. Conclusions: Women with a heterotopic pregnancy are at high risk for late diagnosis and at risk for hypovolemic shock at diagnosis, and may require blood transfusion. The outcome of intrauterine pregnancy in association with heterotopic pregnancy requiring surgical intervention is good, and most complications were associated with multifetal pregnancy and preterm delivery.
Heterotopic pregnancy: a case series
International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2022
Heterotopic pregnancy once considered a rare phenomenon is now thought to be more common as the overall incidence of ectopic pregnancy continues to increase. We report a series of six cases of heterotopic pregnancies seen in our department over a period of seven years. Two of these occurred after assisted reproductive techniques; while the other cases were spontaneous heterotopic pregnancies. The clinical presentation of these cases was varied with late diagnosis occurring in two cases. Preservation of the intrauterine pregnancy was obtained in four cases. Unfortunately, the other cases were aborted spontaneously on the postoperative period. Only with an early diagnosis and adequate management the intrauterine pregnancies will reach viability, with a great chance of a favorable obstetric outcome.
Double Trouble: Heterotopic Pregnancy
Journal of SAFOG, 2014
A heterotopic pregnancy is defined as the presence of a combined intrauterine and ectopic pregnancy. Its estimated incidence is as between 1/7000 and 1/30,000 pregnancies. It is also reported to be as high as 1% after the use of assisted reproductive technology. Heterotopic pregnancies are diagnostic and therapeutic challenges for obstetricians. If they continue without diagnosis, a life-threatening situation may occur even when timely surgical intervention with laparotomy is performed. Here, we report a case series of three patients having three different scenarios, who were diagnosed with heterotopic pregnancies in the first trimester and managed successfully.
Gynecology and Obstetrics Research - Open Journal, 2015
• Heterotopic pregnancy is a rare but life-threatening condition • Very few clinicians will come across this very serious gynaecological condition during their careers • It is very difficult to diagnose and the patient may collapse and die during investigations • Life-saving emergency laparotomy is essential in seriously sick patients LEARNING OBJECTIVES • To increase awareness amongst clinicians about this rare condition • To help in the diagnosis and management of this serious pregnancy complication • To help save lives ETHICAL ISSUES • The safety of the mother and the intrauterine fetus • The removal of the extrauterine fetus to save the mother and the intrauterine fetus
Heterotopic Pregnancy – A Case Report
Journal of Minimally Invasive Gynecology, 2011
Incidence and risk factors for ectopic pregnancy [3] Heterotopic pregnancy after ovulation induction and assisted reproductive technologies: A literature review from 1971 to 1993 [4] Heterotopic interstitial pregnancy: A case report [5] Management and obstetric outcomes of 17 heterotopic interstitial pregnancies [6] Delayed detection of spontaneous bilateral tubal ectopic pregnancies after methotrexate treatment [7] Unforeseen consequences of the increasing rate of cesarean deliveries: Early placenta accreta and cesarean scar pregnancy, a review [8] Obstetric and neonatal outcome of multifetal pregnancy reduction [9] Obstetric outcomes in reduced and non-reduced twin pregnancies, a single hospital experience [10] Normal vaginal delivery at term after expectant management of heterotopic caesarean scar pregnancy: A case report [11] Naturally occurring heterotopic pregnancy in a multiparous patient: A case report
Heterotopic pregnancy and assisted reproduction—an update
Journal of Assisted Reproduction and Genetics, 1996
Purpose: Heterotopic pregnancy, an extremely rare event #~ the past. has become a common conwlication of assisted reproduction techniques. Methods and Results: This serious sequetla of IVF/ET or GIFT is probably the result of ovarian hyperstimulation and the transfer of several emb~. os into the uterus or tubes of a preselected population suffering from mechanical infertili~'. The techniques and medium used for embryo transfer may also be involved. Delayed diagnosis resulting in rupture, hemorrhage, and emergency intera,ention with its serious consequences is being reported in nearly half of the cases. Conclusions: The prognosis Jbr a viable intrauterine pregnancy, however, is good, and these combined pregnancies have produced a living child in about 70% of cases. A High index of suspicion, repeated ultrasounds, and early intetwention are mandator?; to salvage the viable intrauterine pregnancy and avoid maternal mortali~.
Heterotopic pregnancy: A diagnosis we should suspect more often
Journal of Emergencies, Trauma, and Shock, 2010
Heterotopic pregnancy is rare. Heterotopic Pregnancy occurs in< 1/ 30,000 pregnancies in natural conception and about 0.08% of all pregnancies. With artificial reproductive techniques, this incidence increases to between1/100 to 1/500. Pregnancy test should be performed on all women of reproductive age who present with abdominopelvic pain and or vaginal bleeding. It's important to perform ultrasonography before termination of early pregnancy. A high index of suspicion should be raised in instances of acute pelvic pain in the face of documented intra uterine pregnancy. Conservative treatment can be done inunruptured Heterotopic pregnancies whereas operative management is the main stay in women with ruptured ectopic in the presence of intrauterine pregnancy. We report two cases of Heterotopic pregnancy in a rural medical college in one year duration.