Early diagnosis and surgical management of heterotopic pregnancy allows us to save the intrauterine pregnancy

Abstract

Heterotopic pregnancy is a rare but intriguing disease, which poses a high risk for pregnant women and for intrauterine pregnancy. Clinically, it is mainly characterized by pain and vaginal bleeding. b-hCG serum dosage is used to detect the pregnancy, but transvaginal ultrasound is needed to diagnose heterotopic pregnancy. From all the risk factors, the assisted reproductive treatments represent the most important, especially when multiple embryos are transferred. Patients with a heterotopic pregnancy are at risk of having a spontaneous or medically induced abortion, and for this reason appropriate and tailored treatment should be considered, pursuing the optimal risk/benefit ratio. Although conservative treatments are available in the case of only extrauterine pregnancy, such as methotrexate, often the laparoscopic approach seems unavoidable in heterotopic pregnancy. To preserve the intrauterine pregnancy, a conservative treatment is remarkable, both salpingotomy or salpingostomy. In this case report, we present a successful laparoscopic treatment of an extrauterine pregnancy with the prosecution of the intrauterine pregnancy up to the third trimester. In particular, a 25-year-old girl referred to the Villa Sofia Cervello Hospital complaining of abdominopelvic pain and vaginal bleeding for 2 days. The salpingectomy approach was performed, and every anatomical piece was sent for histopathology.

Expectant management of tubal pregnancies with human chorionic gonadotropin up to 2000 mIU/mL

“…In addition, heterotopic pregnancy must be ruled out, especially following IVF treatment and even uterus transplantation, where the risk is higher, because then the management is different and seldom includes EM. [19][20][21] Some professional committees suggest that patients must be asymptomatic for considering EM as management for tubal pregnancy; 1 however, in our study most of the individuals managed expectantly were symptomatic. Moreover, clinical symptoms were not associated with EM failure or eventual surgical treatment.…”

Disordered hypothalamus-pituitary-ovary axis in heterotopic extraovarian sex cord-stromal proliferation: a case report of fallopian tube serous adenofibroma

“…Thus, fallopian tube tumors, whether benign or malignant, deserve close attention. Regarding young women suffering from pelvic mass requiring resection of the ovaries and/or fallopian tubes due to either neoplasm or heterotopic pregnancy, counselling should foster access to fertility preservation procedures [ 52 , 53 ]. Moreover, the management of pelvic cyst/neoplasm requires a holistic approach focused on reducing overall inflammation, increasing detoxification with the introduction of antioxidant vitamins, the influence of lifestyle including diets and various nutritional factors, and attenuating troublesome symptoms [ 54 ].…”

Spontaneous Heterotopic Pregnancy: Diagnosis and Management

“…At around 6 weeks gestation, the hCG range could vary from 105 to 106,520 mIU/mL [ 4 , 5 ]. A review of the literature shows a wide range of hCG levels for heterotopic pregnancies at similar gestational ages [ 6 , 7 ]. With in vitro fertilization studies, hCG levels tend to be lower in heterotopic pregnancies compared to intrauterine twin pregnancies, but tend to be higher than intrauterine single pregnancies [ 8 ].…”