Spontaneous Heterotopic Triplet Pregnancy with a Two Viable Intrauterine Embryos and an Ectopic One with Right Tubal Rupture

Guimarães, Adriano Carvalho; Reis, Luciano Dias de Oliveira; Leite, Fabio Chaves; Reis, Cassiana Franco Dias dos; Costa, Alex Paula; Araújo, Walter Junior Boim de

doi:10.1055/s-0039-1683910

Cited by 8 publications

(10 citation statements)

References 19 publications

(21 reference statements)

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“…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].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2020

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Background and objective: Spontaneous heterotopic pregnancy (SHP) is a rare condition represented by the synchronous coexistence of an intrauterine and an ectopic pregnancy. It rarely occurs with natural conception and is usually a consequence of assisted reproductive techniques. Diagnosis of SHP can be a challenge for the clinician. The evolution of the intrauterine pregnancy is dependent on many factors, such as the location of the heterotopic pregnancy, gestational age at the time of diagnosis, the surgical procedure, the presence of other risk factors, early or delayed management. The aim of this systematic review of the literature was to extract existing evidence on spontaneous heterotopic pregnancy with otherwise unaffected intrauterine pregnancy. Materials and Methods: From a total of 1907 database entries identified in PubMed, EMBASE and Cochrane reviews, we selected 18 papers for narrative synthesis, for which we explored the diagnostic options, treatment, and outcome of these extremely rare epidemiologic occurrences. Manuscripts were assessed using the CARE guidelines for reporting case reports. Results: The main symptom was abdominal pain, and the preferred treatment approach was surgical, more precisely, using a laparoscopic approach. Most cases presented no risk factors, and the diagnosis was mostly made in the first semester. Conclusions: Normal follow-up and evolution of intrauterine pregnancy have been observed regardless of surgical approach (open or laparoscopic). Early diagnosis and treatment are advised, as they impact maternal and fetal outcomes. Evidence on this topic is scarce, predominantly comprised of case reports with variable degrees of adherence to dissemination guidelines. More studies on this topic are required to optimize care protocols for this type of pregnancy.

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Section: Discussionmentioning

confidence: 99%

“…Medical treatment is described in the literature, such as ultrasound-guided injections of saline solutions in the ectopic sack [31] but none of the articles included in our review described using this technique.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2020

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“…As intervenções nestes casos, devem ser as menos invasivas possíveis, a fim de preservar a gravidez intrauterina, mantendo uma mínima manipulação uterina. Neste sentido, a salpingectomia por laparoscopia vem sendo o procedimento cirúrgico mais adotado, segundo alguns estudos recentes 2,17 . Quanto à fertilidade, estudo de 2015 identificou não haver diferença entre a salpingostomia e a salpingectomia ².…”

Section: Discussionunclassified

“…Todavia, mesmo com sintomas que evoluem para uma condição clínica grave de forma abrupta, a GH é considerada um caso raro, sendo em sua maioria, diagnosticada tardiamente e, em 80% dos casos, identificada somente após a rotura da gravidez ectópica 6 . Isto deve-se a baixa suspeita clínica de GE, devido à existência concomitante de uma gravidez intrauterina 7,8 . Entretanto, o atraso no diagnóstico da GE pode acarretar em complicações para a saúde da gestante e para a gravidez intrauterina 9,8 . Sendo assim, o profissional enfermeiro deve conhecer a GH, saber identificar seus sintomas e fatores de risco, tendo em vista que cabe ao mesmo realizar consultas de pré-natal de gestantes classificadas como de baixo risco ou de risco habitual, intercaladas com o profissional médico, a fim de assegurar uma assistência qualificada e integral 10,11 .…”

Section: Introductionunclassified

Discutir um caso de gravidez heterotópica para empoderamento do profissional enfermeiro

Wachekowski

Figueiredo

Silva

et al. 2020

RICSB

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Objetivo: relatar um caso de gravidez heterotópica vivenciado por acadêmicas de enfermagem durante as atividades práticas da disciplina de enfermagem no cuidado à saúde da mulher. Método: trata-se de um estudo qualitativo, do tipo estudo de caso, frente a um caso de gravidez heterotópica. A coleta de dados ocorreu por meio de uma entrevista e os dados foram analisados por meio da análise de conteúdo das falas. Obteve-se a aprovação no comitê de ética em pesquisa da URI, campus Santo Ângelo, através do número 3.257.732 e respeitou os preceitos éticos da resolução 466/12. Resultados: a usuária apresentou intercorrências clinicas em sua segunda gestação de gemelares, decorrente de gravidez heterotópica, localizada na tuba uterina esquerda. Realizado salpingectomia da tuba uterina esquerda, conseguindo preservar a gestação uterina. Conclusão: O enfermeiro precisa estar empoderado acerca de sinais e sintomas de complicações que podem estar presentes durante uma gestação, como a gravidez heterotópica, tendo em vista que o mesmo realiza consultas de pré-natal, orientações e trabalha com uma equipe multiprofissional. A escassez de trabalhos científicos voltados para a atuação do profissional enfermeiro frente a casos como estes, dificultou a discussão e o embasamento teórico voltados para a área.

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“…EP occurs in about 2% of pregnancies [ 2 ] and is one of the leading causes of pregnancy-related death [ 3 , 4 ]. The ampullary part of the fallopian tube is the most common site of EP implantation [ 5 ]. Other sites, including ovary, cervix, cesarean scar, and abdominal cavity, have been reported in several studies [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the recurrence and fertility rate following salpingostomy in patients with tubal ectopic pregnancy

Poordast

Naghmehsanj

Vahdani

et al. 2022

BMC Pregnancy Childbirth

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Background Ectopic pregnancy is one of the leading causes of pregnancy-related mortality; the treatment strategies associated with this condition entail complications, such as recurrence of ectopic pregnancy or infertility. The objective of this study was to evaluate the recurrence and fertility rate after salpingostomy in patients with tubal ectopic pregnancy. Methods This cross-sectional retrospective study was conducted at four referral centers of Obstetrics and Gynecology, under the supervision of Shiraz University of Medical Sciences (Iran). The medical records of 125 patients with tubal pregnancy were reviewed. These patients underwent laparoscopic salpingostomy from April 2009 to March 2016.Data on maternal age, BMI, history of previous EP, genital tract infection, IUD insertion, history of previous surgery, and infertility were further obtained. The patients were followed up for approximately 1 to 7 years. The recurrence of EP and subsequent pregnancy rate were assessed during the follow-up period. Results There was no statistically significant relationship between post-salpingostomy recurrence and maternal age, previous abdominopelvic surgery, and history of infertility(P = .425); however, the post-salpingostomy recurrence of EP was correlated with BMI (P = 0.001), previous history of EP (P = 0.001), genital tract infection (P = 0.001), and IUD insertion (P = 003). Among 95 women who had no contraception, pregnancy occurred in 51 cases (53.6%) and recurrence of EP was observed in 16 patients (12.8%). Conclusions Our results suggest that salpingostomy is a safe method with a low risk of recurrence and good fertility outcomes for women who consider future pregnancy.

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Spontaneous Heterotopic Triplet Pregnancy with a Two Viable Intrauterine Embryos and an Ectopic One with Right Tubal Rupture

Cited by 8 publications

References 19 publications

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

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

Discutir um caso de gravidez heterotópica para empoderamento do profissional enfermeiro

Evaluation of the recurrence and fertility rate following salpingostomy in patients with tubal ectopic pregnancy

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