Heterotopic triplet pregnancy: report of a case with bilateral tubal pregnancy and an intrauterine pregnancy: Case report

Abstract

The first report of an ectopic pregnancy following IVF was published in 1976, and since then heterotopic pregnancies (HPs) have been reported at an increasing rate. Although cases of the co-existence of a bilateral tubal and an intrauterine pregnancy following IVF-embryo transfer have been reported, a case of heterotopic triplet pregnancy caused by unilateral tubal embryo transfer has not yet been published in the literature. Here we report on a 38-year-old women (gravida 3, para 1) with a history of infertility who presented to our infertility clinic for evaluation. Hysterosalpingography revealed bilaterally patent Fallopian tubes and stricture of the cervical canal. She conceived after receiving HMG combined with pure FSH, followed by IVF-tubal embryo transfer. Four embryos were replaced into the right tube. Approximately 5 weeks after tubal embryo transfer, the patient presented with lower abdominal tenderness and shock due to internal bleeding. She underwent an emergency laparotomy under the impression of HP. Bilateral tubal pregnancy with right tubal rupture was noted during the operation. The post-operative course was uneventful. Early intervention and thorough inspection of the peritoneal cavity in patients with haemodynamic instability can prevent jeopardizing the life of the mother as well as the ongoing pregnancy.

A Ruptured Cornual Ectopic Pregnancy at 17 Weeks Gestation: A Case Report

“…Peri-and intratubular adhesions, related or not related to endometriosis, are an additional risk factor. Some authors also consider the quality of the embryos and the hormonal milieu at the moment of transfer as possible causes 5 .…”

Asymptomatic rupture of cornual gestation presented as abdominal mass

“…The etiologic factors for cornual pregnancy are pelvic inflammatory disease, tumor, Assisted Reproductive Techniques, 2 Quality of the embryos and the hormonal milieu at the moment of embryo transfer, 3 bilateral salpingectomy 4 and peritubular and intratubular adhesions related or not related to endometriosis are the other additional risk factors. In our patient no other cause than PID could be implicated.…”

Case Report of Combined Twin Tubal and Intrauterine Pregnancies

“…12/37 reports presented triplets, where five intrauterine twins [11,[14][15][16][17] and three tubal twins [4,7,18] were coexisted with viseversa tubal or intrauterine single pregnancies. Interestingly there was coexistence of bilateral tubal and intrauterine single embryos in 4 cases among these triplets [19][20][21][22]. 25/37 reports described duplets, when 31 cases of HPs were presented with coexisting tubal and intrauterine single embryos [5,6,8,9,11,17,[23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38].…”