Should expectant management of heterotopic pregnancy be considered?

Mohr–Sasson, Aya; Tamir, Mordechai; Mugilevsky, Dimitry; Meyer, Raanan; Mashiach, Roy

doi:10.1007/s00404-022-06628-8

Cited by 3 publications

(5 citation statements)

References 27 publications

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“…In addition to conservative management and progress monitoring, interventional options in this case include local injection with potassium chloride, hyperosmolar glucose, or MTX followed by aspiration of the ectopic pregnancy [4,6,11,12]. Far more frequently, surgical intervention has been described as a therapeutic modality in various studies and is the necessary intervention in the case of hemoperitoneum, as occurred in this respective case study [3,4,6]. Laparoscopy should be preferred over laparotomy in hemodynamically stable patients because of shorter recovery time, less need for antibiotics and analgesia, and fewer wound healing problems [12,13].…”

Section: Discussionmentioning

confidence: 99%

“…However, the intent is often to remove the EUG while minimizing the risk to the mother and the intact IUG. In addition to conservative management and progress monitoring, interventional options in this case include local injection with potassium chloride, hyperosmolar glucose, or MTX followed by aspiration of the ectopic pregnancy 4 6 11 12 . Far more frequently, surgical intervention has been described as a therapeutic modality in various studies and is the necessary intervention in the case of hemoperitoneum, as occurred in this respective case study 3 4 6 .…”

Section: Discussionmentioning

confidence: 99%

“…While heterotopic pregnancy via natural insemination, as scrutinized during this paper, is a very rare phenomenon with an incidence of 0.003% 2 , the risk of heterotopic pregnancy increases due to risk factors such as in vitro fertilization or pelvic inflammatory disease as well as previous pelvic surgery 4 . The increasing number of heterotopic pregnancies can be mainly attributed to the increased use of assisted reproductive techniques (ART) and ovarian stimulation and has been described as having an incidence of 1% 3 5 6 .…”

Section: Discussionmentioning

confidence: 99%

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Spontaneous Heterotopic Pregnancy with Ovarian Localization: Case Report

Lober,

Zafarnia,

Kupec

et al. 2024

Z Geburtshilfe Neonatol

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Heterotopic pregnancies are a rare phenomenon defined by the simultaneous occurrence of intrauterine and extrauterine pregnancy. The incidence of heterotopic pregnancy occurring through natural fertilization is low but is increased by risk factors such as assisted reproductive techniques or pelvic inflammatory disease increase. We report the case of a 36-year-old female patient in the 6th week of pregnancy who presented to the emergency unit with severe acute lower abdominal pain. Laboratory chemistry and sonography revealed a suspected heterotopic pregnancy. The patient was admitted for observation. The sonographic reevaluation on the next day confirmed the suspicion of extrauterine gravidity with intact intrauterine gravidity with additional decreasing hemoglobin and hematoperitoneum, so that laparoscopy was indicated. Intraoperatively, the mass on the left ovary was removed without complications. The patient could be discharged quickly postoperatively after a complication-free course and gave birth to a healthy child by spontaneous partus in the 38th week of gestation. Due to their rarity, there is limited research related to heterotopic pregnancies, and most scientific articles are case studies. Diagnostically, the most important thing in clinical practice is to think about the possibility of EUG even if there is evidence of an intact IUG. Transvaginal sonography is of particular importance in diagnostics. The performance of prospective cohort studies is desirable for the evidence-based diagnosis and therapy of affected patients in the future.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Spontaneous Heterotopic Pregnancy with Ovarian Localization: Case Report

Lober,

Zafarnia,

Kupec

et al. 2024

Z Geburtshilfe Neonatol

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“…Expectant management could be used for patients with a stable hemodynamic state and who are asymptomatic; however, strict periodic monitoring is mandatory. It avoids potential risks associated with surgery and transabdominal sonographic-guided aspiration of the ectopic gestational embryo [ 11 , 12 ]. Surgical management includes either laparotomy or laparoscopy as viable therapy options for heterotopic pregnancy [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

Successful Management of Triplet Heterotopic Pregnancy (Interstitial) With an Intrauterine Monochorionic Diamniotic Twin Pregnancy Through Laparoscopy: A Case Report

Bhoi¹,

Chandra²,

Murdia³

et al. 2023

Cureus

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The simultaneous occurrence of intrauterine (IU) and extrauterine pregnancies is known as heterotopic pregnancy, an uncommon clinical condition that is challenging to manage. It can be a potentially fatal illness if it remains unnoticed. This is a case report of a woman who had heterotopic triplets after transferring two embryos produced through in vitro fertilization. An ultrasound scan diagnosed live interstitial heterotopic pregnancy and an intrauterine monochorionic twin pregnancy. Laparoscopic resection of interstitial heterotopic pregnancy was done. The monochorionic twin pregnancy was closely monitored by serial ultrasound, and at 36 weeks of gestation, two healthy twins were delivered by cesarean section. The fetal growth parameters were monitored, and a dopplers study was conducted to assess fetal blood flow. Even in heterotopic pregnancy, timely diagnosis and therapeutic intervention can preserve IU pregnancy with a successful outcome. Early meticulous monitoring and early detection can lead to a favorable outcome. Even in heterotropic pregnancy, a meticulous evaluation can lead to favorable outcomes by conserving IU pregnancy, and timely intervention can prevent maternal motility.

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“…In the context of natural conception, the incidence of HP is relatively low, ranging between 1 in 7,963 to 1 in 30,000 pregnancies 2,3 . However, a concerning trend has been observed with the utilization of IVF-ET 4,5 , where the incidence of HP escalates to approximately 1-3% 6, 7 . This augmented incidence in the IVF-ET population presents diagnostic and management challenges for clinicians, chie y due to the existence of a concomitant intrauterine pregnancy 8 .…”

Section: Introductionmentioning

confidence: 99%

Investigating Outcomes and Associated Risk Factors of Heterotopic Pregnancy Following In Vitro Fertilization-Embryo Transfer Cycles

Gao,

Dong,

Liu

et al. 2024

Preprint

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Research Question: To study the outcome of heterotopic pregnancy (HP) and related influencing factors after in vitro fertilization-embryo transfer (IVF-ET), and to provide clinical experience for the treatment of heterotopic pregnancy. Design: Observational study. Results Our data revealed a HP incidence of 1.27‰. Among the 66 patients with HP, 5 underwent conservative treatment (7.58%, 5/66) with a live birth rate of 25.00% (1/5). Laparoscopic surgery was performed on 61 cases (92.42%, 61/66), with a live birth rate of 77.05% (47/61). Further logistic regression analysis revealed that the average diameter of the intrauterine gestational sac prior to laparoscopic surgery, the absence of a fetal germ and fetal heartbeat within the intrauterine gestational sac, and an extended duration of laparoscopic surgery were risk factors affecting pregnancy outcomes (P < 0.05). Conclusion Laparoscopic surgery is an effective method for the treatment of HP, and laparoscopic ectopic resection of ectopic pregnancy lesion does not seem to affect the continuous pregnancy and live birth of the intrauterine gestational sac. The mean diameter of the intrauterine gestational sac on the day of surgery, the development of the intrauterine gestational sac, and the duration of surgery can affect the patient's pregnancy outcome.

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Should expectant management of heterotopic pregnancy be considered?

Cited by 3 publications

References 27 publications

Spontaneous Heterotopic Pregnancy with Ovarian Localization: Case Report

Spontaneous Heterotopic Pregnancy with Ovarian Localization: Case Report

Successful Management of Triplet Heterotopic Pregnancy (Interstitial) With an Intrauterine Monochorionic Diamniotic Twin Pregnancy Through Laparoscopy: A Case Report

Investigating Outcomes and Associated Risk Factors of Heterotopic Pregnancy Following In Vitro Fertilization-Embryo Transfer Cycles

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