Management and outcome of heterotopic interstitial pregnancy: Case report and review of literature

Abstract

The majority of cases are diagnosed by detailed ultrasound in the setting of early follow-up after IVF-ET and are asymptomatic at diagnosis. Yet, a substantial number of patients present with cornual rupture. Risk factors are IVF-ET and a history of salpingectomy. Depending on clinical presentation, treatment options include watchful waiting, medical treatment, or surgery. Unfortunately, the interstitial pregnancy is generally lost, and only has a chance of survival in case of presentation at a viable gestational age. The outcome of the coexisting intrauterine pregnancy is generally good.

Live birth after treatment of a spontaneous ovarian heterotopic pregnancy: A case report

“…Although our patient had no risk factors for ectopic pregnancy, there are several to take into account. The most common risk factors associated with HP are previous history of ectopic pregnancy, pelvic inflammatory disease (PID), abdominal adhesions, tubal surgery and use of ART [[17], [18], [19]]. Due to the high risk of HP in an ART scenario, single-embryo transfer and ultrasound monitoring of early gestation are practised in many fertility clinics [17].…”

The Challenge in Diagnosing and Managing Heterotopic Interstitial Pregnancy in Natural Conception

“…Laparotomy holds the mainstay role in excision of interstitial pregnancy in haemodynamically unstable patient, where skilled laparoscopic surgeon or equipment is unavailable, and/or poor operative field secondary to presence of pelvic adhesions [7,20]. Expectant management of the coexisting interstitial pregnancy is reserved for cases with absent fetal cardiac activity and small gestational sac size, with close surveillance in place, and takes small proportion of 5.8% [6,12].…”

“…Serial β-hCG has roles in detecting persistent interstitial pregnancy and differentiating intrauterine pregnancy from ectopic pregnancy [11,17]. The typical doubling of serial β-hCG reading with viable intrauterine pregnancy may pose false reassurance to the clinician, resulting in missing the concomitant interstitial pregnancy in HIP [6]. Serial β-hCG was performed in the case study to guide the management option.…”

“…With interstitial pregnancy occurrence between 2.4 to 4% of all ectopic pregnancies, the incidence of HIP is said to be exceedingly rare [3][4][5]. On the other hand, HIP occurs in 80 -92% of the time following artificial reproductive technology [6,7].…”

“…Fifty percent of HIP cases have no apparent risk factors, making it difficult to suspect the diagnosis in natural conception based of background risk on its own [5]. In pregnancies conceived via in-vitro fertilisation, background history of previous uni-or bilateral salpingectomy is a significant risk factor that is evident in about 40% of HIP diagnosed in such setting [6]. The use of large embryo transfer medium, relaxed uterus from supraphysiological presence of progesterone released by multiple corpus lutea [10], together with multiple embryo transfer or presence of tubal infertility contribute to the increased risk of HIP in pregnancy conceived via artificial reproductive technology [6].…”