Case Report:Successful non-surgical management of a heterotopic abdominal pregnancy following embryo transfer with cryopreservedthawed embryos

Abstract

Heterotopic pregnancy is an increasingly common complication of assisted reproductive technology. Abdominal pregnancy is a rare and life-threatening form of ectopic pregnancy that can present as the extrauterine portion of a heterotopic pregnancy. We present the case of a cryopreserved-thawed embryo transfer that resulted in a simultaneous intrauterine and abdominal pregnancy first recognized at 10 weeks gestation. Ultrasound-guided transvaginal injection of potassium chloride into the abdominal pregnancy resulted in asystole and spontaneous resorption of the ectopic fetus, while the intrauterine pregnancy continued and resulted in a liveborn vaginal delivery at full term. Selective embryo reduction using a non-surgical approach in a haemodynamically stable patient can therefore be considered in the management of heterotopic abdominal pregnancy if diagnosed relatively early.

Heterotopic pregnancy, a hidden hazard of intrauterine pregnancy

“…If the fallopian tube with the ectopic pregnancy is found to be intact, potassium chloride can be applied locally. Methotrexate, RU486, or prostaglandins, however, cannot be used, because of the likely harm to the live intrauterine pregnancy (Scheiber and Cedars, 1999). Surgery may be performed by laparoscopy or laparotomy, and it is indicated in cases with rupture ectopic pregnancy or hemoperitoneum.…”

Heterotopic Pregnancy in a Natural Conception

“…Potassium chloride or hyper osmolar glucose can be injected locally into the intact heterotopic gestational sac or fetus via laparoscopy or transvaginal sonography. 4 Other drugs used in the medical treatment of ectopic pregnancy, such as methotrexate, RU486 and prostaglandins, cannot be used because of the possibility of harmful effects on an intrauterine pregnancy. 4 These two options are useful in very few cases.…”

“…4 Other drugs used in the medical treatment of ectopic pregnancy, such as methotrexate, RU486 and prostaglandins, cannot be used because of the possibility of harmful effects on an intrauterine pregnancy. 4 These two options are useful in very few cases. The last option is surgical removal of the ectopic gestation by salpingectomy or salpingostomy.…”

Spontaneous heterotopic pregnancy with tubal rupture and pregnancy progressing to term

“…The successful non-surgical management of six cases of HP using potassium chloride (KCl) injection into the tubal ectopic pregnancy has been reported. 12 Successful management of heterotopic pregnancy after fetal reduction using potassium chloride and methotrexate was also been reported. 13 Heterotopic pregnancy can occur in the absence of any predisposing risk factors like in our patient.…”

“…Surgical therapy has been the traditional mainstay but involves surgical and anesthetic risks to both the mother and IUP. 12 Studies suggest that laparoscopic management is preferred over laparotomy in patients with a suspected EP, and with a documented IUP because of minimal manipulation of the uterus. 7 A non-surgical approach can be used safely and effectively to manage patients who are clinically stable and where an HP is recognized relatively early in gestation.…”