Advanced Heterotopic Pregnancy: A Case Report

Abstract

Heterotopic pregnancy is a pathological form of biovular dizygotic twin pregnancy. This is a rare disease, but its incidence has increased sharply in recent years due to the development of medically assisted procreation and the resurgence of pelvic infections. Diagnosis and therapeutic management of heterotopic pregnancy are essential to improve maternal prognosis and proper conduct of the intrauterine pregnancy. The authors report a new advanced heterotopic pregnancy in a woman treated for infertility. Through the literature data, they focus on the different aspects of this rare form of pregnancy.

Spontaneous ovarian heterotopic pregnancy

“…TVS now showed some free fluid in the cul-de-sac. Similarly, as noted by Mohamed,4 patients often present early asymptomatically with some signs such as minimal bleeding. Later as the ectopic pregnancy progresses, they show further clinical indications of coexisting intrauterine pregnancy such as the classic triad of amenorrhoea, vaginal bleeding and pelvic pain 4.…”

“…Similarly, as noted by Mohamed,4 patients often present early asymptomatically with some signs such as minimal bleeding. Later as the ectopic pregnancy progresses, they show further clinical indications of coexisting intrauterine pregnancy such as the classic triad of amenorrhoea, vaginal bleeding and pelvic pain 4. The finding of free fluid in the pelvis combined with the adnexal mass now raised the suspicion of HP which is extremely rare to begin with and an even rarer occurrence in a spontaneous conception.…”

“…However, in our case the ectopic pregnancy was located in the ovary. Relevant to practice, the patient in our case had persistent bleeding and pelvic pain after supposed miscarriage which according to Mohamed4 should draw the clinician to suspect the possibility of HP in his or her differential diagnoses 4…”

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“…3,4 Risk factors such as sexual transmited infections, tubal surgery, and also ovulation induction with gonadotropin and clomiphene citrate could also increase the incidence of heterotopic pregnancy. 5,6 This confirms that the significance of detection of risk in pregnant woman in order to increase awareness of diagnosing this rare condition. In this written case, there were no risk factors, in other words it is concluded that this case is a spontaneus HP, which is a very rare condition.…”

“…While more than 50% of HP cases are asymptomatic, abdominal pain, adnexal mass, peritoneal irritation, and also an enlarged uterus could also be the manifestation of heterotopic pregnancy. 6,7 Early and proper diagnosis of heterotopic pregnancy could significantly reduce the patient's mortality rate. 7 This becomes a challenging problem for Obstetricians in achieving an accurate diagnosis by facing obscure clinical symptoms from patients, in order to reduce the mortality rate.…”