A rare case of spontaneous live unilateral twin tubal pregnancy with both fetuses presenting with heart activities and a literature review

Kim, Chang-Ihll; Lee, Tae-Yeem; Park, Sung Taek; Kim, Hong Bae; Park, Sungho

doi:10.5468/ogs.2018.61.2.274

Cited by 6 publications

(7 citation statements)

References 12 publications

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“…First, it is a unilateral live spontaneous twin tubal ectopic pregnancy—similar cases are exceedingly rare, with very limited instances reported in medical literature worldwide thus far. [9] Second and more importantly, the patient presented on the cusp of her second trimester, much later than any of the prior reported cases. Such a presentation atypically late into the pregnancy represents a potential diagnostic pitfall in the ED, with EPs possibly missing such a diagnosis without MRI scans and placing the patient's life at risk.…”

Section: Discussionmentioning

confidence: 83%

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Unilateral live twin tubal ectopic pregnancy presenting at 12 weeks of gestation

et al. 2019

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RationaleAbdominal pain in pregnancy represents a demanding diagnostic challenge in the emergency department (ED) due to the extensive list of differential diagnoses to be considered, coupled with the possibility of each disease having nonclassical, atypical signs and symptoms, resultant from the patient's pregnant state. Additionally, emergency physicians (EPs) face limitations on investigative imaging modalities because of the need to minimize fetal radiation exposure. EPs have to tackle this diagnostic challenge while performing a balancing act to maximize both maternal and fetal outcomes in a time-sensitive manner, becauser any delays in decision-making at the ED may threaten the safety of mother and child. Two common causes of abdominal pain in pregnancy presenting to the ED are acute appendicitis and ectopic pregnancy. The latter is almost always diagnosed by 10 weeks of gestation. Here, we report an extremely rare case of unilateral live spontaneous twin tubal ectopic pregnancy presenting past 12 weeks of gestation, diagnosed after magnetic resonance imaging (MRI) of the abdomen.Patient concernsA 37-year-old gravida 2 para 1 at 12 weeks and 6 days of gestation presented to our ED with a 2-day history of right iliac fossa pain, not associated with vaginal bleeding, fever, diarrhea, and vomiting. On examination, she was tachycardic (pulse rate 124 beats/min) and hypertensive (blood pressure 142/88 mm Hg). There was marked tenderness and guarding at the lower abdomen.DiagnosesBlood investigations were unremarkable, while abdominal ultrasonography found a live twin gestation with foetal heartbeats of 185 and 180 beats/min. MRI of the abdomen revealed an empty uterine cavity; 2 amniotic sacs and fetuses of diameter 10 cm, and a single placenta were noted in the right uterine adnexa. The patient was diagnosed with right live monochorionic diamniotic twin tubal pregnancy.InterventionOur patient underwent emergency laparoscopic right salpingectomy.OutcomesThe operation was successful and her postoperative care remained uneventful up to discharge.LessonsEctopic pregnancy cannot be ruled out based on prior normal antenatal examinations and gestational age of >10 weeks. EPs should not hesitate to order MRI scans for further evaluation if ultrasonography and laboratory findings are equivocal.

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Section: Discussionmentioning

confidence: 83%

“…Spontaneous live unilateral tubal ectopic twin pregnancies are extremely rare, with prevalence estimated at 1 in 125,000 pregnancies. [19] Surgery is often the preferred mode of management in this subtype of ectopic pregnancies, [9] as was done for our patient.…”

Section: Discussionmentioning

confidence: 99%

Unilateral live twin tubal ectopic pregnancy presenting at 12 weeks of gestation

et al. 2019

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“…The serum β-HCG at diagnosis ranged from 3, 374 to 110, 774 units/L. Of all 21 cases in this series 16 were symptomatic with a combination of abdominal pain ( n = 15) [ 2 , 4 , [8] , [9] , [10] , [11] , [13] , [14] , [15] , [16] , 18 , 19 , [21] , [22] , [23] ] and vaginal bleeding ( n = 8) [ 2 , 11 , [13] , [14] , [15] , [19] , [20] , [21] ]. In comparison, only 45% of singleton ectopic pregnancies present with the clinical triad of amenorrhea, abdominal pain and vaginal bleeding [18)].…”

Section: Discussionmentioning

confidence: 98%

“…We identified 21 cases of live twin ectopic pregnancies [ 2 , 4 , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] ]. Of these, 14 were diagnosed between six and eight weeks of gestation [ 2 , 4 , 6 , [8] , [9] , [10] , [11] , [18] , [19] , [20] , [21] , [22] ], while one pregnancy was diagnosed at just four weeks of gestation after presenting with abdominal pain and vaginal bleeding [ 14 ]. Only three pregnancies progressed beyond eight weeks of gestation [ 13 , 16 , 23 ], and the gestational age of the remaining two was not reported [ 12 , 17 ].…”

Section: Discussionmentioning

confidence: 99%

“…All except three of the 21 live twin ectopic pregnancies underwent a salpingectomy of the affected tube. Kim et al [ 22 ] and Atye et al [ 10 ] both reported performing cornual wedge resections on interstitial, multi-gestational ectopic pregnancies. Atye et al also used postoperative intramuscular methotrexate and followed the serum β-hCG level to negative.…”

Section: Discussionmentioning

confidence: 99%

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Management of a spontaneously conceived live unilateral twin ectopic pregnancy in Australia: A case report

Martin

Balachandar

Bland

2021

Case Reports in Women's Health

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Introduction Unilateral twin ectopic pregnancies are exceedingly rare, occurring in one in every 250,000 pregnancies. While clear guidelines exist regarding the management of singleton ectopic pregnancies, no such recommendations exist for multi-gestational ectopic pregnancies. Case presentation A 36-year-old woman, gravida 3 para 1, presented to the emergency department at 6 weeks and 4 days of gestation with a live twin ectopic pregnancy diagnosed on a dating ultrasound scan. Given the high likelihood of rupture, she underwent a laparoscopic salpingectomy and was discharged home the following day. The patient was followed-up with weekly serum β-hCG tests, to ensure there was no remaining pregnancy. Discussion While the morbidity and mortality associated with singleton ectopic pregnancies has gradually declined, the risk of rupture is higher in twin ectopic pregnancies and rupture is estimated to occur in 30–50% of cases. Surgical intervention remains the mainstay of treatment for these pregnancies.

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Preoperative diagnosis of unilateral twin tubal pregnancy by enhanced magnetic resonance imaging

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A rare case of spontaneous live unilateral twin tubal pregnancy with both fetuses presenting with heart activities and a literature review

Cited by 6 publications

References 12 publications

Unilateral live twin tubal ectopic pregnancy presenting at 12 weeks of gestation

Unilateral live twin tubal ectopic pregnancy presenting at 12 weeks of gestation

Management of a spontaneously conceived live unilateral twin ectopic pregnancy in Australia: A case report

Preoperative diagnosis of unilateral twin tubal pregnancy by enhanced magnetic resonance imaging

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