Management of a spontaneously conceived live unilateral twin ectopic pregnancy in Australia: A case report

Abstract

Introduction Unilateral twin ectopic pregnancies are exceedingly rare, occurring in one in every 250,000 pregnancies. While clear guidelines exist regarding the management of singleton ectopic pregnancies, no such recommendations exist for multi-gestational ectopic pregnancies. Case presentation A 36-year-old woman, gravida 3 para 1, presented to the emergency department at 6 weeks and 4 days of gestation with a live twin ectopic pregnancy diagnosed on a dating ultrasound scan. Given the high likelihood of rupture, she underwent a laparoscopic salpingectomy and was discharged home the following day. The patient was followed-up with weekly serum β-hCG tests, to ensure there was no remaining pregnancy. Discussion While the morbidity and mortality associated with singleton ectopic pregnancies has gradually declined, the risk of rupture is higher in twin ectopic pregnancies and rupture is estimated to occur in 30–50% of cases. Surgical intervention remains the mainstay of treatment for these pregnancies.

Unilateral Twin Tubal Ectopic Pregnancy after Intrauterine Insemination-Case Report

“…However, its etiology is unknown. Twin ectopic pregnancy has a 30%-50% greater chance of rupture when compared to a single ectopic pregnancy and is generally unilateral [8,9].…”

Unilateral Twin Ectopic Pregnancy: A Case Report from the Eastern Part of Ethiopia, Harar

“…The risk of rupture in tubal ectopic pregnancy is higher in twin unilateral tubal pregnancy than singleton tubal pregnancy occurring in 30-50% of cases. 10,16 Diagnosis of twin ectopic pregnancy depends on the clinical feature, laboratory tests and imaging. The definitive diagnosis will be made by demonstration of two alive cardiac activity fetuses outside of the uterus using sonography or confirmation of removed tissue by laparoscopy or laparotomy using pathologic evaluation.…”

“…Currently, arterial embolization is also used for twin ectopic pregnancy and found to be effective. 3,16,17,19,[23][24][25] In this case, laparotomy was done since there is no laparoscopy in the area and medical was not preferred since there was cardiac activity and poor adherence to it.…”

Spontaneous Twin Ectopic Pregnancy Managed Successfully With Methotrexate-Mediated Ultrasound-Guided Fetal Reduction: A Fertility-Preserving Approach

“…For unilateral tubal twin pregnancies, the surgical approach is usually the treatment of choice according to the literature, similar to singleton ectopic pregnancies. The rate of complications in twin ectopic pregnancy is reported to be more when compared to singleton ectopic pregnancy with chances of rupture in 30 to 50% of the cases [ 9 ]. In our case, the patient wanted to preserve fertility and was managed conservatively by ultrasound-guided direct injection of methotrexate into the fetal pole and surrounding gestational sac, and the patient was kept under 24 hours of observation and on antibiotics and was discharged the next day of hospital care.…”