Laparoendoscopic Single-Site Surgery for Management of Heterotopic Pregnancy: A Case Report and Review of Literature (original) (raw)
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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.
Laparoscopic Management of Tubal Ectopic of Heterotopic Pregnancy
Journal of Bangladesh College of Physicians and Surgeons, 2017
A heterotopic pregnancy is a rare complication of pregnancy in which both extra-uterine (ectopic pregnancy) and intrauterine pregnancy occur simultaneously. The prevalence of heterotopic pregnancy is estimated at 0.6- 2.5: 10,000 pregnancy. It is a challenge for obstetrician to manage the tubal pregnancy without interruption of intrauterine pregnancy. Here we describe a case who had left tubal alive ectopic pregnancy & also intrauterine alive pregnancy simultaneously after a natural conception. This patient was managed successfully with laparoscopic left salpingectomy, and intrauterine pregnancy has been continuing. There are some precautions during laparoscopic procedure & post operative period which can help for continuation of intrauterine pregnancy. In our clinical experience, this is an extreme rare disorder and we feel interest to report this case. A heterotopic pregnancy can result from a natural conception; it requires a high index of suspicious for early and timely diagnosi...
Menopausal Review
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.
Case Reports in Obstetrics and Gynecology
Background. The coexistence of an intrauterine pregnancy and an ectopic pregnancy (heterotopic pregnancy) is an extremely rare, yet major, complication during pregnancy. The early diagnosis of a heterotopic pregnancy is of great importance for fetal viability, maternal safety, and the progression of an uncomplicated intrauterine pregnancy. Case Presentation. We report a case of a naturally conceived heterotopic tubal pregnancy in a 37-year-old primigravida. The patient presented with continuous, dull, lower abdominal pain and a positive urine pregnancy test which was conducted a week prior to the start of the pain. The patient was hospitalized, and based on the clinical image and after strict monitoring, she was diagnosed with a heterotopic pregnancy. She was treated with laparoscopic salpingectomy after the rupture of the ectopic pregnancy while the desired intrauterine gestation continued without any complications. The pregnancy resulted in the birth of a healthy infant through va...
Journal of Minimally Invasive Gynecology, 2011
This prospective cohort study reports our initial experience with laparoscopic surgery in ectopic pregnancy performed exclusively through an umbilical incision using a single 3-channel port. Since September 2009, we have performed single-port laparoscopic surgery in 11 patients with ectopic pregnancy. In all 11 patients, laparoendoscopic single-site salpingectomy was completed successfully without conversion to a standard laparoscopic approach or to laparotomy. The median (range) operative time was 35 (25-65) minutes, operative blood loss was 30 (5-50) mL, and duration of hospital stay was 8 (5-18) hour. No patient required a blood transfusion, and no intraoperative complications occurred. Laparoendoscopic single-site surgery is a feasible surgical approach for treatment of ectopic pregnancy. Additional studies are needed to compare this approach with conventional laparoscopic treatment.
Laparoscopic Management of Lately Diagnosed Triplet Heterotopic Pregnancy
Open Journal of Obstetrics and Gynecology
Ruptured ectopic pregnancy is one of the outcomes of mis or delayed diagnosis and the massive hemorrhage resulting is responsible for more than three quarters of the first trimester maternal death. Simultaneous presence of intrauterine pregnancy adds obstacles for the correct diagnosis to take place. The management of this condition is a real dilemma as life threatening condition could be the only presentation which needs immediate intervention. The high index of suspicion is mandatory to ensure timely diagnosis and management to prevent stormy outcome.
A Successful Pregnancy Outcome in a Heterotopic Abdominal Pregnancy: A Case Report
2019
Introduction: Heterotopic pregnancy is the existence of both intrauterine pregnancy and ectopic pregnancy simultaneously. Het-erotopic pregnancy (HP) has been a rare type of multifetal pregnancy. Heterotopic abdominal pregnancy (HAP) is a very rare diagnosis with very few reported cases. Case Presentation: We reported a rare case of HAP in a 32-year-old woman (G2L1) with a history of 13 weak amenorrhea and mild pelvic pain presenting with two live fetuses in the 13th week. The patient also did not mention any risk factor of ectopic pregnancy such as pelvic inflammatory disease, assisted reproductive techniques, endometriosis, and multiparity. Diagnosis of HAP was performed with the use of sonography and magnetic resonance imaging. We managed the patient with emergency laparotomy due to acute abdominal pain a few hours after admission. Laparotomy revealed the rupture of the left fimbria with 500 cc hemoperi-toneum. The excision of the ectopic gestational sac in the cul-de-sac and left salpingectomy with preserving the intrauterine fetus was performed. The patient finally gave birth to one live term birth. Conclusions: Physicians should consider the possibility of HP in women with spontaneous pregnancy and abdominal pain. Both sonography and MRI should be performed to help timely diagnosis.
Live twin birth after successful treatment of a ruptured heterotopic pregnancy by laparoscopy
Gynecological Surgery, 2009
We report a case of a live twin birth after laparoscopic treatment of a ruptured heterotopic pregnancy. A 29-year-old woman, with a history of right salpingectomy for ectopic pregnancy, became pregnant after transfer of three embryos at in vitro fertilization treatment. At the ninth week of gestation, she was admitted to our clinic with abdominal pain. Ultrasonographic examination revealed a triplet heterotopic pregnancy consisting of an intrauterine twin pregnancy and an ectopic pregnancy in the left fallopian tube. An immediate laparoscopy was planned and left salpingectomy was performed. In the postoperative period, intrauterine twin pregnancy continued uneventfully; at the 35th week of gestation, two healthy infants with birth weights of 2,206 and 2,426 g were delivered. Heterotopic pregnancies must be kept in mind after assisted reproductive techniques. Early diagnosis allows successful laparoscopic treatment without sequel. Laparoscopic surgery is an appropriate method to manage selected patients with heterotopic tubal pregnancy.