A case of spontaneous heterotopic pregnancy in natural conception complicated with hemoperitoneum (original) (raw)
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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.
Acute presentation of a heterotopic pregnancy following spontaneous conception: a case report
Cases Journal, 2009
Spontaneous heterotopic pregnancy is a rare clinical condition in which intrauterine and extra uterine pregnancies occur at the same time. It can be a life threatening condition and can be easily missed with the diagnosis being overlooked. We present the case of a 40 year old patient who was treated for a heterotopic pregnancy. She had a transvaginal ultrasound because of a previous ectopic pregnancy and an intrauterine gestational sac was seen with false reassurances. The patient presented acutely with a ruptured tubal pregnancy and this was managed laparoscopically. The ectopic pregnancy was not suspected at her initial presentation. 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.
Live birth after treatment of a spontaneous ovarian heterotopic pregnancy: A case report
Case Reports in Women's Health, 2019
Spontaneous heterotopic pregnancies occur in about 1/30000 pregnancies, with the ovarian subtype comprising 2.3% of the total. We report the case of a healthy 32-year-old woman, gravida 4, para 3, who presented to the emergency room with severe abdominal pain. Two weeks earlier, pelvic ultrasound had revealed a 6-week intrauterine pregnancy. She was hemodynamically stable, but had rebound tenderness on the right iliac fossa. Transvaginal ultrasound revealed an evolutive intrauterine pregnancy with a gestational age (GA) of 8 weeks, with a synchronous evolutive adnexal pregnancy of the same GA and some free fluid in the pouch of Douglas. She underwent an urgent laparoscopy which showed an intact gestational sac containing an embryo on the right ovary associated with mild hemoperitoneum. An ovarian wedge resection was performed to preserve ovarian tissue. The intrauterine pregnancy had no complications and the patient delivered vaginally at term. Heterotopic pregnancy is potentially life-threatening. Despite being extremely rare after natural conception, and even more so in the absence of major risk factors, it should be considered in any pregnant woman with abdominal pain. A high index of suspicion is important for a prompt diagnosis, selection of the appropriate surgical treatment and successful obstetric outcomes.
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
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.
Spontaneous heterotopic pregnancy (HP) is a very rare and fatal condition that could result in significant maternal morbidity and mortality if prompt diagnosis and appropriate interventions are not instituted at the right time. Unfortunately, this life-threatening condition may be easily misdiagnosed in early pregnancy due to its rarity, vague clinical presentation and the presence of an intrauterine pregnancy which may confuse an inexperienced clinician. The aim of management is to excise the ectopic gestation while preserving the intrauterine pregnancy, if alive. We present a case of spontaneous HP that had complete excision of the ectopic gestation and a live delivery of the intrauterine pregnancy at term.
Heterotopic Pregnancy in Natural Conception – A Case Report
International Journal of Women’s Health Care
Heterotopic gestation is very rare in natural conception but can be common with assisted reproductive techniques; a high index of suspicion can help in timely diagnosis and appropriate intervention. We report a case of heterotopic pregnancy in a 32-year-old woman presented with hemoperitoneum from ruptured right sided tubal pregnancy with live intrauterine gestation at 12 weeks of amenorrhea, diagnosed on clinical and ultrasound examination.
Spontaneous Heterotopic Pregnancy: Dual Case Report and Review of Literature
Case reports in obstetrics and gynecology, 2016
Introduction. Heterotopic pregnancy is a rare complication usually seen in populations at risk for ectopic pregnancy or those undergoing fertility treatments. It is a potentially dangerous condition occurring in only 1 in 30,000 spontaneous pregnancies. With the advent of Assisted Reproduction Techniques (ART) and ovulation induction, the overall incidence of heterotopic pregnancy has risen to approximately 1 in 3,900 pregnancies. Other risk factors include a history of pelvic inflammatory disease (PID), tubal damage, pelvic surgery, uterine Mullerian abnormalities, and prior tubal surgery. Heterotopic pregnancy is a potentially fatal condition, rarely occurring in natural conception cycles. Most commonly, heterotopic pregnancy is diagnosed at the time of rupture when surgical management is required. Case. This paper represents two cases of heterotopic pregnancies as well as a literature review. Conclusion. Heterotopic pregnancy should be suspected in patients with an adnexal mass, ...
Spontaneous Heterotopic Pregnancy
Journal of SAFOG, 2015
The prevalence of heterotopic pregnancy is increasing worldwide, due to the widespread practice of assisted reproductive technology and the availability of more precise diagnostic techniques. However, spontaneous heterotopic pregnancy is a rare clinical condition where it occurs in a natural conception. It has a historic incidence of 1 in 30,000. We report a case of 30 years old women, gravida 6, para 3, abortion 2 without having any risk factor for ectopic pregnancy who conceived spontaneously and was diagnosed ultrasonographically as heterotopic pregnancy, i.e. with concomitant right tubal pregnancy and intrauterine gestation. The patient presented with pain in lower abdomen and was managed laparoscopically. Due to its rarity, a high degree of clinical suspicion is required to make a diagnosis of heterotopic pregnancy. Thus, we infer that the diagnosis of heterotopic pregnancy should be suspected in all women in the reproductive age, reporting with early pregnancy.