Heterotopic pregnancy

Abstract

Heterotopic pregnancy is a life-threatening condition. A recent case at our institution prompted a systematic review of the literature from 2005 to 2010. In the majority (71%) of cases reviewed, risk factors for a heterotopic pregnancy were present. However, in several instances (33%), previous sonographic reports of a normal intrauterine pregnancy gave false reassurance. These results highlight the complexity of diagnosis. In addition, our findings were compared with two previous reviews covering cases from 1971 to 2004. This comparison highlighted two important trends: first, the increasing role of ultrasound in the definitive diagnosis of a heterotopic pregnancy, and second, the development of conservative approaches to management. Medical knowledge and technology may be improving, but ultimately, even in the presence of a known intrauterine pregnancy, the simple dictum 'think ectopic' must not be forgotten.

A case of spontaneous heterotopic pregnancy presenting with heart activity of both embryos

“…Although spontaneous simultaneous intrauterine and ectopic pregnancy was an extremely rare event in the past, it is increasingly being diagnosed since the rate of assisted reproductive technique increased. As in our case, when previous ectopic pregnancy has been treated with methotrexate, future pregnancy is associated with an increased risk for ectopic pregnancy and potentially heterotopic pregnancy [5].…”

An unanticipated case of heterotopic pregnancy

“…10 Though there is a high index of suspicion in women undergoing fertility treatments, it is often not considered for spontaneous conceptions. 2,9 In a recent systematic review it was noted that nearly a third of their cases were diagnosed after a spontaneous conception. 2 A major factor implicated in causation of ectopic and heterotopic pregnancy is tubal damage that may be unrecognised from PID in early reproductive life.…”

“…1,2 Other types of heterotopic pregnancies include intrauterine pregnancy in addition to location of a pregnancy in unusual sites such as interstitial portion of the fallopian tube, rudimentary horn associated with a unicornuate uterus, ovary, cervix, pregnancy at the site of a previous caesarean section scar or intra-abdominal. [3][4][5][6][7] Traditionally the incidence of spontaneous heterotopic pregnancy has been quoted as 1 in 30,000 but more recent literature estimates this to be of the order of 2.5/10,000 pregnancies and it can be as high as 1 in 100 with assisted reproduction treatments.…”

“…[3][4][5][6][7] Traditionally the incidence of spontaneous heterotopic pregnancy has been quoted as 1 in 30,000 but more recent literature estimates this to be of the order of 2.5/10,000 pregnancies and it can be as high as 1 in 100 with assisted reproduction treatments. 2,[8][9][10][11] The incidence of heterotopic pregnancy is rising and that can be attributed to a rise in its risk factors namely pelvic inflammatory disease, ovulation induction treatments and assisted reproduction treatment. [11][12][13] We report a case of a heterotopic pregnancy where the initial presentation was that of an acute abdomen due to haemoeritoneum caused by leakage from a tubal ectopic pregnancy.…”

Heterotopic Pregnancy with Tubal Rupture Accompanied with Severe Anemia: Case Presentation

“…The optimal management consists surgical penetration with immediate treatment of the tubal rupture and the hemodynamic disorder respectively. Blood transfusion and hydration with crystalloid and colloid solutions are mandatory [13]. Constantly counselling and proper follow up of the patient consists essential components.…”