Ruptured ectopic in heterotopic pregnancy: Management and spontaneous vertex delivery of a live baby at term

Abstract

Spontaneous heterotopic pregnancy is an uncommon clinical condition in which there is a simultaneous development of intrauterine and extrauterine pregnancies. It is a life-threatening emergency when the ectopic ruptures. We present Mrs. EC, a 27-year-old GP + with a family history of multiple gestations who had a heterotopic pregnancy at a gestational age of 7 weeks. She presented with features of threatened miscarriage at early pregnancy with an ultrasound confirmation of intrauterine pregnancy. The diagnosis of ruptured ectopic pregnancy coexisting with intrauterine gestation was made with ultrasound findings as well as clinical features necessitating emergency exploratory laparotomy. Thereafter, pregnancy was carried to term, and she delivered a live male baby that weighed 3.0 kg. Heterotopic pregnancy should be sort for in all pregnancies during the early scan, especially in those with predisposing factors for multiple gestations and risk factors for ectopic gestation. A high index of suspicion is necessary for making a diagnosis in women with intrauterine pregnancy, with or without symptoms of ectopic gestation, and irrespective of the existence of risk factors for ectopic pregnancy.

Spontaneous Heterotopic Pregnancy with Unaffected Intrauterine Pregnancy: Systematic Review of Clinical Outcomes

“…Based on the identified evidence, there is no overarching pattern to suggest superiority of a particular surgical approach for SHP. Despite division across surgical techniques, minimal intraoperative manipulation of the uterus is advised in order to prevent ruptures and damage to the intrauterine pregnancy [40]. Emergency surgical treatment is advised in the presence of hemoperitoneum [4,18,19,21,23,[26][27][28]31,33,36,38,40].…”

Heterotopic pregnancy in a natural conception presenting as an acute abdomen: Management and delivery of a live baby at term

“…Heterotopic pregnancy (HP) refers to the simultaneous presence of intrauterine pregnancy and ectopic pregnancy, which is very rare but a potentially life-threatening condition [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15].…”

“…It can result from natural conception cycle or following assisted reproductive technology (ART) [4][5][6][7][8]. The incidence of heterotopic pregnancy was previously quoted to be 1 in 30,000 pregnancies; but recent publications have revised this to 1 in 3,889 pregnancies [2][3][4][5][6][7]. The incidence of heterotopic pregnancy may increase to as high as 1 in 100 pregnancies if assisted reproductive technologies (ART) are used [8,9].…”

“…The incidence of heterotopic pregnancy may increase to as high as 1 in 100 pregnancies if assisted reproductive technologies (ART) are used [8,9]. The actual etiology of HP is still unknown, although studies have shown that pelvic inflammatory disease, previous ectopic pregnancy, previous tubal surgery, pelvic adhesions, and ART are high risk factors of HP; however, some patients may not have obvious risk factors [1][2][3][4][5][6][7][8][9][10]. The most common site of ectopic gestation is the fallopian tube (95% to 97%).…”

“…Clinical presentations of HP are non-specific and may include abdominal pain, an adnexal mass, peritoneal irritation, and vaginal bleeding, as well as acute chest pain radiating to the shoulder [1][2][3][4][5][6][7][8][9]. Heterotopic pregnancy carries a considerable risk of maternal morbidity and mortality owing to the risk of rupture of the ectopic pregnancy, especially in developing countries where the diagnosis is difficult and delayed [11].…”