Ruptured heterotopic pregnancy in a natural conception cycle: a case report at the Yaounde central Hospital (Cameroon) (original) (raw)
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International Journal of Case Reports and Images, 2019
Introduction: Heterotopic pregnancy is a rare clinical condition where both intrauterine and extra uterine pregnancy coexists. In a spontaneous conception, the diagnosis is difficult to make, but an important one to consider in the presence of acute abdominal pain, hemorrhagic shock, and intrauterine pregnancy. Case Report: A 28-year-old G4P0+4 with a family history of multiple gestation who presented with acute abdomen and haemorrhagic shock at a gestational age of nine weeks and five days. The diagnosis of ruptured ectopic pregnancy coexisting with viable intrauterine gestation was made with ultrasound findings as well as clinical features necessitating emergency exploratory laparotomy. Ethical approval was obtained from the ethics and research committee of Federal Teaching Hospital Abakaliki. Successful treatment of ectopic pregnancy with uneventful convalescence and viable intrauterine pregnancy delivered at term. Conclusion: Obstetricians should keep a high index of suspicion of heterotopic pregnancy among women of reproductive age, especially
Ruptured Heterotopic Pregnancy: Case Report
Journal of Surgery and Medicine
Ectopic pregnancy is defined as a condition in which the gestational sac is located outside the uterine cavity. And also Heterotopic pregnancy is the addition of at least one extra-uterine pregnancy to normal pregnancy. This is more common in patients with assisted reproductive techniques and ovulation induction. Today, with the increasing use of assisted reproductive techniques, the importance of primary care services has become increasingly important and must be kept in mind. We report a case of intrauterine normal pregnancy was accompanied by ruptured tubal pregnancy.
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.
Diagnosis and management of a spontaneous heterotopic pregnancy: Rare case report
International Journal of Surgery Case Reports, 2021
Introduction and importance: Heterotopic pregnancy is the occurrence of pregnancies in at least two different implantation sites in the same time. The diagnosis of heterotopic pregnancy remains one of the greatest challenges of the gynecological-obstetrical emergencies. Case presentation: We report a rare case of spontaneous heterotopic pregnancy of a 32-year-old woman, diagnosed with a heterotopic pregnancy by ultrasound and treated by laparotomy in emergency obstetrical department of Ibn Rochd University Hospital of Casablanca. Clinical discussion: The existence of intrauterine pregnancy does not exclude an ectopic pregnancy. The occurrence of a spontaneous heterotopic pregnancy without risk factors is a rare event, the clinical symptomatology is often related to a threatened or ongoing abortion, the diagnosis of heterotopic pregnancy is not made until the appearance of signs of hemoperitoneum secondary to a ruptured EP, hence the importance of a systematic ultrasound examination of the adnexa during first trimester ultrasound. The standard treatment is conservative surgery, preferably by laparoscopy. Laparotomy retains its indications especially in forms with hemorrhagic shock. With the aim of preserving intrauterine pregnancy while removing ectopic pregnancy. Conclusion: The diagnosis of heterotopic pregnancy should not be excluded by the discovery of a UGI in a spontaneous cycle. Diagnosis is often difficult and management should be initiated as soon as possible given the risk of maternal mortality.
Heterotopic in spontaneous ruptured pregnancy with a living birth term: a case report in Madagascar
International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2018
We report a case of heterotopic pregnancy with a history of left oophorectomy, seen at the obstetrics and gynaecology Department of the Soavinandriana Hospital Center with a favourable outcome of pregnancy in utero. CASE REPORT This is about a 35-year-old woman, G3P1, with a history of cesarean section in January 2015 and early spontaneous miscarriage referred for treatment of acute pelvic pain associated with food-induced vomiting. From 5 days to 7 weeks of amenorrhea. The physical examination at the entrance showed a painful abdomen especially at the pelvic level but of low intensity, the plasma b-hCG level was positive and the abdominalpelvic echography revealed a single evolutionary intrauterine pregnancy. In front of this clinical and Para clinical picture, an analgesic treatment was carried out. On the 3rd day of hospitalization, sudden pelvic pain, dagger type, lateralized on the right and examination noted a painful abdomen with defense in the hypo gastric
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.
A rare case of spontaneous heterotopic pregnancy presented as ruptured ectopic pregnancy
International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2016
Heterotopic gestation, although common with assisted reproductive techniques, is very rare in natural conception. A high index of suspicion can help in timely diagnosis and appropriate intervention. We report a case of 30 year old patient who was treated for a heterotopic pregnancy. She had taken treatment for genital tuberculosis in the past. The patient presented acutely with a ruptured tubal pregnancy in shock and this was managed by emergency laparotomy. A high index of suspicion is needed in women with risk factors for an ectopic pregnancy and in low risk women who have free fluid with or without an adnexal mass with an intrauterine gestation.
Spontaneous heterotopic pregnancy: a case report
International Journal of Reproduction, Contraception, Obstetrics and Gynecology
Heterotopic pregnancy is defined as multiple gestation in which intrauterine and extrauterine gestational sacs co-exist. The extra uterine gestational sac is most commonly tubal ectopic pregnancy. We presented case of a 26 years old multigravida who presented to emergency with complaints of pain abdomen and giddiness for 2-3 days. She was at period of gestation (POG) 7 weeks and on clinical examination patient was anxious with mild pallor, mildly tachycardiac and blood pressure (BP) was 90/60 mm of Hg. After thorough clinical examination and sonography diagnosis of heterotopic pregnancy with ruptured tubal ectopic was made. She was taken up for Emergency laparotomy after investigations and consent. Left salpingectomy was done and she was discharged with a single intrauterine live pregnancy on 6th post op day. For early detection of cases of heterotopic pregnancy careful evaluation of adnexa is mandatory in early gestation scan.
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.