Triplet Delivery following Unilateral Twin Salpingocyesis (original) (raw)
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Case Report Triplet Delivery following Unilateral Twin Salpingocyesis
We present the case of a 36-year-old woman with primary infertility of six-year duration who had IVF/ICSI on account of male factor infertility. Transvaginal scanning done on the 30th day following embryo transfer revealed an empty uterine cavity with two gestational sacs containing active fetal echoes in the right adnexum. Patient reluctantly had right salpingectomy via open laparatomy. The patient had repeat embryo transfer eleven months afterwards that culminated in the delivery of living twins with a fetal papyraceous.
Fertility and Sterility, 2003
Objective: To report a case of combined intrauterine and interstitial twin pregnancies after bilateral salpingectomy and IVF with replacement of three embryos. Design: Case report. Setting: University hospital. Patient(s): A 31-year-old woman known to have bilateral salpingectomy for ectopic pregnancies who underwent IVF. Intervention(s): Laparotomy. Main Outcome Measure(s): Postoperation intrauterine monozygotic twins survival and birth. Result(s): After removing the interstitial monozygotic twin pregnancy, the patient had an uneventful postoperative course and delivered two healthy girls by cesarean section at 38 weeks' gestation. Conclusion(s): Heterotopic pregnancy can still occur in women treated by IVF after bilateral salpingectomy. The early sonography follow-up of IVF pregnancy would be of value because of the reported higher incidence of pathological pregnancies and especially monozygotic twinning.
Heterotopic Pregnancy After Bilateral Salpingectomy in an Ivf Patient
Serbian Journal of Experimental and Clinical Research, 2010
Purpose: To report a rare clinical case of a heterotopic pregnancy after in vitro fertilisation (IVF) was performed on a patient who had previously undergone bilateral salpingectomy. Methods: A 32-year-old woman, suff ering from mechanical infertility, underwent IVF. Th e patient had an extrauterine pregnancy a year prior to the IVF procedure and underwent a laparoscopic bilateral salpingectomy of the right fallopian tube due to the extrauterine gravidity and of the left fallopian tube due to hydrosalpinx. Th e IVF treatment resulted in a heterotopic pregnancy that involved an intrauterine and a cornual pregnancy, which were managed by performing a laparotomy and a resection of the tubal stump. Th is intrauterine pregnancy resulted in a term singleton delivery. Conclusion: Although extremely rare, every gynaecologist treating an IVF patient should consider the possibility of a cornual heterotopic pregnancy under circumstances where the patient previously underwent a bilateral salpin...
Case of progressive intrauterine twin pregnancy after surgical treatment of cornual pregnancy
Fertility and Sterility, 2007
Objective: To report on a case of heterotopic triplet pregnancy after in utero transfer of three embryos obtained by in vitro fertilization (IVF), with progression of the intrauterine twin pregnancy after resection of the cornual pregnancy. Design: Technique and instrumentation. Setting: Département de Médecine de la Reproduction, Hôpital Edouard Herriot, Lyon, France. Patients: A 32-year-old woman, nulliparous with primary infertility for the previous 12 years due to mixed causes (tubal and male infertility). Interventions: Diagnosis by ultrasound scan and per-laparoscopic confirmation, followed by resection of the cornual pregnancy by laparotomy. Main Outcome Measures: Ultrasound diagnosis and follow-up of the pregnancy. Delivery. Results: Complete ablation of the cornual pregnancy. Progression of the intrauterine twin pregnancy without difficulties until 31 weeks of gestation. Cesarean upon onset of labor. Birth of two living infants. The scar of the uterine horn, examined during the caesarean, was thick and solid. Conclusions: The early diagnosis and surgical treatment of an ectopic pregnancy permitted the development of the intrauterine pregnancy. The risk of heterotopic pregnancy is increased by medical techniques that facilitate procreation. This risk is directly related to the number of embryos transferred. In the case of heterotopic pregnancy, the rate of progressive intrauterine pregnancy after treatment of the ectopic pregnancy is encouraging.
Combined interstitial and intrauterine pregnancies after in-vitro fertilization and embryo transfer
2000
A case of combined interstitial and intrauterine pregnancies after bilateral salpingectomy and in-vitro fertilization with embryo transfer is reported. The case was incorrectly diagnosed ultrasonographically as intrauterine triplets at 7 weeks gestation. The patient suffered from intra-abdominal bleeding at 14 weeks gestation. At laparotomy, a ruptured left interstitial pregnancy with a non-viable fetus was found in the left abdominal quadrant. The uterine defect was successfully repaired and gestational contents and blood were evacuated from the abdominal cavity. The intrauterine twin pregnancy progressed without incident, and a Caesarean section was performed at 36 weeks gestation, resulting in healthy male and female infants.
International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2016
Congenital uterine anomalies result from an abnormal formation, fusion or reabsorption of Müllerian ducts during fetal life. A 26 year-old healthy woman with history of 5 years of primary infertility. Her physical exam was completely normal, while a transvaginal ultrasound revealed a left unicornuate uterus and normal left ovary and fallopian tube, but the right ovary and tube could not be visualized and right sided ectopic kidney at the level of umbilicus was noted. Left kidney was in normal position. A diagnostic laparoscopy for her confirmed left unicorunate uterus with normal left ovary and tube along with rudimentary right horn and only about 2 cm proximal stump of the right fallopian tube. The couple underwent two cycles of ICSI because of male factor. First βHCG report was 349mIu/ml followed by second which was 2432.1mIu/ml. First ultra sound revealed biamniotic bichorionic twin live intrauterine pregnancies. A fetal reduction was planned at 11 weeks for fetus A due to increases NT>5mm which was completed uneventfully. Cervical length was measured at 18-20 weeks which were merely 1.4cms. Hence McDonald's cervical encirclage was performed. Cervical knot was cut and emergency cesarean section was performed at 35weeks gestation, and a 2.6 kg male baby was delivered uneventfully.
2013
A successful pregnancy is the greatest goal for reproductive medicine. The probability that pregnancy occurs during a cycle of assisted reproduction is a function of multiple factors, of which embryo transfer is one of the most critical steps in these treatments. This article reports a case of successful pregnancy and twin delivery by transmyometrial embryo transfer after IVF in a woman with a neocavity parallel to the uterine cavity, which prevented the transfer of embryos to the correct place. The patient first went to another fertility centre where embryo transfer was impossible to perform because the cervix could not be canalized. Subsequently in this study clinic, after considering the difficulty of inserting a catheter into the endometrial cavity, a trial transfer was performed, which discovered a false route parallel to endometrial cavity. Following a first cycle in which conventional transcervical embryo transfer was performed, a transmyometrial embryo transfer was carried out and the patient became pregnant with twins. In cases where transcervical embryo transfer is very difficult or impossible to perform, the value of transmyometrial transfer is self-evident. RBMOnline
Unruptured unilateral twin ectopic pregnancy: a rare case report
International Journal of Reproduction, Contraception, Obstetrics and Gynecology
Unilateral twin ectopic pregnancy is a rare entity with an incidence of 1 in 125,000 pregnancies. This is a case of a 26-year-old primigravida with a spontaneous unilateral twin ectopic gestation, diagnosed on transvaginal ultrasound, treated laparoscopically by doing unilateral salpingectomy and confirmed with histopathology. The doubt for ectopic pregnancy was raised when the serum β-HCG level was constantly >1500 mIU/ml and serum progesterone level was <5 pg/ml and no intrauterine pregnancy was seen. On a follow-up scan, twin gestational sac was noted in right adnexa along with a large haemorrhagic cyst in the right ovary. On post-surgery follow-up, patient was found to have had complete recovery. This case report discusses the incidence and rarity, yet possibility of twin ectopic gestations, the need for early diagnosis and its management.
The Australian and New Zealand Journal of Obstetrics and Gynaecology, 2004
To bring the success rate of in vitro fertilisation (IVF) procedures to an acceptable level, multiple embryos have historically been replaced. This has resulted in an &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;epidemic&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; of multiple births. The pendulum has now swung full circle and the number of embryos transferred is now being limited. Such high numbers of IVF twins will not be produced in the future. To review retrospectively the outcome of a series of pregnancies achieved by IVF where the 6 week ultrasound showed the presence of two sacs. Retrospective study in a university IVF programme that produced 746 IVF pregnancies with twins at 6 weeks of gestation (1991-1999). The main outcome measures were perinatal mortality, pregnancy outcome, gestation at delivery and obstetrics complications reported. Interestingly, by 20 weeks gestation, 184 (24.7%) of pregnancies spontaneously reduced to a singleton, whereas 49 (6.6%) lost both twins. Of the 513 (68.8%) viable twin pregnancies (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;20 weeks), 154 (20.6%) went on to term (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;37 weeks), whereas 250 (33.5%) delivered between 33 and 36 weeks gestation. The perinatal mortality per 1000 births was 6.5 over 37 weeks, 8.0 for 33-36 weeks, 41.7 for 29-32 weeks and 500 for under 28 weeks.