Hypovolemic shock following induced abortion and spontaneous heterotopic pregnancy

Abstract

Spontaneous heterotopic pregnancy is a rare clinical condition in which intrauterine and extrauterine pregnancies occur at the same time. It is rare, estimated to occur in 1 in 30,000 pregnancies. The case was a 38-year-old woman with spontaneously conceived heterotopic pregnancy. She was admitted to our center with hypovolemic shock. Focused assessment sonography for trauma examination in emergency department showed large amount of free fluid in peritoneal cavity. She was managed surgical laparotomy. Considering spontaneous pregnancies, physician should be aware of the possibility of heterotopic pregnancy in all reproductive age women, especially those with history of recent abortion. It can occur without any predisposing risk factors. Patients should be informed about possible side effects of nonprescription medicines, and also the health care centers must be safe peaceful environment for them without severe legal consequences.

Spontaneous Heterotopic Pregnancy as an Uncommon Clinical Problem

“…HP is not a rare entity within certain recognized subgroups of the obstetric population and should be high on the list of differential diagnoses. However, more recent data indicate that the rate is higher owing to assisted reproduction technologies; in general it is approximately 1 in 7000 and as high as 1 in 100 with assisted reproduction technologies [3,7].…”

“…It occurs in various forms, such as a bilateral or unilateral tubal, abdominal, cervical, or ovarian pregnancy and even a caesarean scar pregnancy. The most frequent form is tubal HP [3,6]. The rate of occurrence has been thought to be 1:30 000 pregnancies [5].…”

“…In general, it is considered that transvaginal sonography presents an important aid in the diagnosis of HP, but ultrasonographic identification of ectopic pregnancy is low in its sensitivity [3]. An adnexal mass is detected in 80 % of ectopic pregnancies by sonography.…”

“…The other two options include the expectative management of spontaneous ectopic pregnancy resolution and the medicament treatment with potassium chloride or hyperosmolar glucose injected directly into the intact HP gestational sac under transvaginal sonography guidance [6] or via laparoscopy, but they carry a high risk of complications and ectopic pregnancy rupture with subsequent hemoperitoneum, hemorrhagic shock, and possible death. Instillation of RU 486, methotrexate, and prostaglandins cannot be used because of the possibility of harmful effects on a viable intrauterine pregnancy [3].…”

“…The assisted reproduction technologies are in constant rise, which presents a serious problem because the diagnosis of this potentially fatal condition is often difficult [1]. Early in its course, HP presents non-specifically and is often confused with other normal or abnormal pregnancy manifestations [3]. Consequently, clinicians might not always consider a diagnosis of HP [4] because the demonstration of a viable intrauterine pregnancy is often taken as an exclusion of ectopic pregnancy.…”