Diagnosis and management of a spontaneous heterotopic pregnancy: Rare case report

Abstract

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 pregnancy in a rural area in Haiti: case report

“…12 Although, in the presence of shock, laparotomy remains indicated with caution not to manipulate the uterus to preserve the intrauterine pregnancy. 13 Transvaginal ultrasound has superior diagnostic accuracy than transabdominal ultrasound. 14 We don't have a vaginal probe in our maternity ward and don't have access to laparoscopy in the operating room.…”

Spontaneous Heterotopic Pregnancy: As One of the Most Challenging Emergency Cases in Obstetrics

“…The TVUS showed (IUP, adnexal mass and free fluid) raising suspision for a HP: the TVUS is the gold standard for diagnosis a HP, However its sensitivity has been found to range from 26,3% to 92.4%, [5], therefore, we must always link between the results of ultrasound images and the clinical findings.…”

“…It is usually a consequence of Assisted Reproductive Technologies "ART" such as IVF and induction of ovulation, with an estimated incidence at between 1 to 3 in 100 pregnancies [1,2]. But there are cases that occur in the absence of any risk factor, in these cases, a spontaneous heterotopic pregnancy "SHP" represents a huge diagnostic challenge due to the rarity of the condition on the one hand (its incidence in the natural conceptions is: 1 per 30000 pregnancies) [1,2] and on the other hand it is a life-theratening condition that may be fatal to the mother if the diagnosis is delayed.…”

Heterotopic Pregnancy with Ipsilateral Adnexal Cyst Causing a Diagnostic Dilemma: A Case Report

“…It is also important to note that, as in our case, laparotomy retains its indications especially in forms with hemorrhagic shock. 22 Preservation of the ovarian tissue, including in situations of extrauterine gestation implantation in the ovaries, has been reported. 23 During either laparoscopy or laparotomy, if conditions allow, it is prudent that priority be given to preserve the future fertility of the women.…”