Heterotopic Quadruplet Pregnancy: Conservative Management with Ultrasonographically-Guided KCl Injection of Cornual Pregnancy and Laparoscopic Operation of Tubal Pregnancy

Park, Hea-Ree; Moon, Myoung-Jin; Ahn, Eun Hee; Baek, MinJung; Choi, Dong Hee

doi:10.1159/000238109

Cited by 12 publications

(3 citation statements)

References 21 publications

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“…The treatment of HP with a tubal implantation can be performed by laparotomy or laparoscopy and the removal of EP is usually done by salpingectomy and occasionally by salpingostomy [ 170 - 174 ]. For interstitial HP, either medical treatment with local injection of a feticide/embryo reduction for small non-ruptured EP [ 158 , 175 , 176 ] or cornual resection by laparoscopy or laparotomy in ruptured cases has been used with rescue of the IUP [ 177 - 180 ]. A few studies have also reported the use of expectant management for tubal and interstitial HP [ 181 , 182 ].…”

Section: Resultsmentioning

confidence: 99%

Ectopic pregnancy secondary to in vitro fertilisation-embryo transfer: pathogenic mechanisms and management strategies

Refaat

Dalton

Ledger

2015

Reprod Biol Endocrinol

107

108

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BackgroundEctopic pregnancy (EP) is the leading cause of maternal morbidity and mortality during the first trimester and the incidence increases dramatically with in vitro fertilisation and embryo transfer (IVF-ET). The co-existence of an EP with a viable intrauterine pregnancy (IUP) is known as heterotopic pregnancy (HP) affecting about 1% of patients during assisted conception. EP/HP can cause significant morbidity and occasional mortality and represent diagnostic and therapeutic challenges, particularly during fertility treatment. Many risk factors related to IVF-ET techniques and the cause of infertility have been documented. The combination of transvaginal ultrasound (TVS) and serum human chorionic gonadotrophin (hCG) is the most reliable diagnostic tool, with early diagnosis of EP/HP permitting conservative management. This review describes the risk factors, diagnostic modalities and treatment approaches of EP/HP during IVF-ET and also their impact on subsequent fertility treatment.MethodsThe scientific literature was searched for studies investigating EP/HP during IVF-ET. Publications in English and within the past 6 years were mostly selected.ResultsA history of tubal infertility, pelvic inflammatory disease and specific aspects of embryo transfer technique are the most significant risk factors for later EP. Early measurement of serum hCG and performance of TVS by an expert operator as early as gestational week 5 can identify cases of possible EP. These women should be closely monitored with repeated ultrasound and hCG measurement until a diagnosis is reached. Treatment must be customised to the clinical condition and future fertility requirements of the patient. In cases of HP, the viable IUP can be preserved in the majority of cases but requires early detection of HP. No apparent negative impact of the different treatment approaches for EP/HP on subsequent IVF-ET, except for risk of recurrence.ConclusionsEP/HP are tragic events in a couple’s reproductive life, and the earlier the diagnosis the better the prognosis. Due to the increase incidence following IVF-ET, there is a compelling need to develop a diagnostic biomarker/algorithm that can predict pregnancy outcome with high sensitivity and specificity before IVF-ET to prevent and/or properly manage those who are at higher risk of EP/HP.

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Section: Resultsmentioning

confidence: 99%

Ectopic pregnancy secondary to in vitro fertilisation-embryo transfer: pathogenic mechanisms and management strategies

Refaat

Dalton

Ledger

2015

Reprod Biol Endocrinol

107

108

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“…Compared with surgical treatment, the medical approach is less expensive, less invasive with minimal blood loss and quicker recovery. Therefore, medical embryo reduction of interstitial gestation has been recommended in the patient with hemodynamically stable status [ 12 , 13 ]. It consists of injecting methotrexate, prostaglandin, or KCL directly into ectopic gestational sac under the guidance of transvaginal ultrasonography.…”

Section: Discussionmentioning

confidence: 99%

Management and obstetric outcomes of 17 heterotopic interstitial pregnancies

Jiang¹,

Chen²,

Zhou³

et al. 2018

BMC Pregnancy Childbirth

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BackgroundHeterotopic interstitial pregnancy is a rare variant of heterotopic pregnancies, and it poses challenges in treating the heterotopic pregnancy and preserving the intrauterine pregnancy. However, there is no clear consensus regarding the optimal management. The aim of this study was to investigate the pregnancy outcomes of women diagnosed with heterotopic interstitial pregnancy.MethodsA total of 17 women diagnosed with heterotopic interstitial pregnancy between July 2010 and December 2015 were included. General characteristics of each patient, including age, gravidity and parity, history of pelvic inflammatory disease or surgery, and especially the corresponding therapeutic interventions, were retrospectively analyzed. Moreover, pregnancy outcomes were further followed by face-to-face interview.ResultsOf the 17 patients, 10 (58.5%) underwent surgical treatment (7 laparoscopic cornual resection, and 3 laparotomy); and 3 cases simultaneously terminated the intrauterine pregnancy by suction evacuation. Compared with laparotomy, laparoscopic cornual section showed shorter operative time (median 40 vs. 70 min), less blood loss (150 vs. 400 ml) and shorter hospital stay (2 vs. 4 days). In addition, 4 (23.5%) patients underwent selective embryo reduction under transvaginal ultrasound guidance. Expectant management was chosen in the remaining 3 patients. In the follow-up study, other than a case of missed miscarriage, the other 13 women who remained committed to their pregnancies all delivered healthy babies either by caesarean section or vaginal birth. No congenital anomalies were reported, and all the infants were in good growth and development.ConclusionsLaparoscopic cornual resection is a feasible approach with favorable surgical and long-term pregnancy outcomes. Additionally, medical or expectant management may be a viable treatment option for selected symptom-free patient. Although the survival of the intrauterine pregnancy could not always be assured, the prognosis for a woman with heterotopic interstitial pregnancy is generally good.

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“…Ozgur et al [24] (IVF-ET) Tubal ligation or tuboplasty Free of symptoms (9) Cornual injection of KCl Uterus rupture at 11 weeks Ben-Ami et al [25] (IVF-ET) Bilateral salpingectomy Cornual rupture (7) Laparoscopy Term delivery Blazar et al [26] (IVF-ET) Bilateral salpingectomy Cornual rupture (6) Laparotomy Term delivery Divry et al [27] (IVF-ET) Tubal factor combined with a masculine factor Cornual rupture (6) Laparotomy Preterm birth at 31 weeks Parket al [28] (IVF-ET) Right salpingectomy Free of symptoms (6) Cornual injection of KCl…”

Section: Term Deliverymentioning

confidence: 99%

<b>Successfully Managing Cornual Heterotopic Pregnancies: A Case Report and Literature Review</b>

Chen¹,

Sun²,

Hao³

et al. 2019

Chinese Medical Sciences Journal

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Cornual heterotopic pregnancy is an extremely rare, life-threatening complication during pregnancy. Here, we report on a 33-year-old woman who suffered cornual heterotopic pregnancy after in vitro fertilization embryo transfer. To prevent rupture during heterotopic pregnancy, she received laparoscopic surgery to remove the ectopic gestational sac at 7 +2 weeks of gestation. Ultimately, she delivered a healthy boy at 38 +3 weeks of gestation. Here, we also review the clinical presentations, risk factors, treatment options and outcomes of cornual heterotopic pregnancy.Heterotopic pregnancy (HP) is a pathological pregnancy in which one or more viable embryos implant in the uterus and outside the uterine cavity. [1] Up to 98% of ectopic gestations are located in the fallopian tube. [2] The incidence of HP is approximately between 1/3900 to 1/30 000 in natural pregnancies. [3,4] Cornual heterotopic pregnancy (CHP), where the embryo implants in the lateral angle of the uterine cavity close to the internal ostium of the fallopian tube, is a rare event. [5] With increases in infertility and the wide use of assisted reproduction techniques (ART), the risk of CHP has increased to 1%-3% in some regions. [4,6] Women who have a history of

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Heterotopic Quadruplet Pregnancy: Conservative Management with Ultrasonographically-Guided KCl Injection of Cornual Pregnancy and Laparoscopic Operation of Tubal Pregnancy

Cited by 12 publications

References 21 publications

Ectopic pregnancy secondary to in vitro fertilisation-embryo transfer: pathogenic mechanisms and management strategies

Ectopic pregnancy secondary to in vitro fertilisation-embryo transfer: pathogenic mechanisms and management strategies

Management and obstetric outcomes of 17 heterotopic interstitial pregnancies

<b>Successfully Managing Cornual Heterotopic Pregnancies: A Case Report and Literature Review</b>

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