Spontaneous Heterotopic Pregnancy: Diagnosis and Management

Abstract

Background. Heterotopic pregnancies albeit rare are conceivably life-threatening if missed. With the development of assisted reproductive techniques, the incidence has increased. Confirmation of an intrauterine pregnancy (IUP) should not preclude the existence of a heterotopic pregnancy. Case. A healthy 27-year-old patient (gravida 4, term 1, preterm 0, abortion 2, living 1) at approximately 5 weeks gestation through natural conception presented to the emergency room with acute abdominal pain and vaginal bleeding. Pelvic ultrasound showed evidence of an IUP and a right adnexal mass, raising suspicion for a heterotopic pregnancy. The patient underwent an uncomplicated laparoscopic right salpingectomy. An IUP was confirmed on ultrasound postoperatively. The patient had an early pregnancy loss at 8 weeks of gestation. Conclusion. With a high index of suspicion from clinical presentation and pelvic imaging, heterotopic pregnancy, while rare, should not be ruled out.

Spontaneous Heterotopic Pregnancy with Ovarian Localization: Case Report

“…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 . Furthermore, regarding the presented case, the patient received therapeutic laparoscopy with ablation of the EUG on the ovary and could be discharged on the second postoperative day with a rapid recovery and an uncomplicated postoperative course.…”

Heterotopic Pregnancy and Amniotic Embolism: a Case Report

“…The clinical presentation of AE may include hypoxemia, sudden maternal collapse, DIC, and acute fetal distress (2). The evolution of patients is typically biphasic, with pulmonary hypertension and right ventricular failure at the beginning, followed by left ventricular failure during or immediately after delivery (12).…”

“…The respiratory system is often compromised in the initial phase, progressing to acute respiratory distress syndrome or pulmonary edema. Coagulopathy is also a common feature, observed in 83% of patients, and may lead to the need for hysterectomy and massive transfusions (2).…”

“…The diagnosis of AE is one of exclusion, and the differential diagnosis includes obstetric conditions such as uterine rupture and eclampsia, as well as placental abruption, and non-obstetric conditions such as pulmonary embolism and pneumothorax (2). The de nitive diagnosis is usually established only after death, through the ndings found at the autopsy, as occurred in the case described above, and maternal mortality rates can reach 25% (12).…”

“…It is estimated that the incidence of spontaneous HP is 1:30,000 pregnancies, but when associated with in vitro fertilization, it can reach 1:100 pregnancies. Furthermore, the presence of an intrauterine pregnancy often delays its diagnosis and early intervention, as the increase in β-HCG ends up being attributed to the intrauterine pregnancy (2). Amniotic embolism (AE) occurs when amniotic uid or fetal tissue fragments enter the maternal circulation, which can cause pulmonary hypertension, cardiovascular collapse, disseminated intravascular coagulation (DIC), and high mortality rates (3).…”