Spontaneous ovarian heterotopic pregnancy

Abstract

Heterotopic pregnancy is a simultaneous intrauterine and ectopic pregnancy. We report a case of a spontaneous ovarian heterotopic pregnancy. A 36-year-old woman, gravida 7 para 4-1-1-5 at 4 weeks gestation (spontaneous conception), presented to the emergency department with vaginal spotting, lower abdominal cramps with human chorionic gonadotropin(hCG) 10 772 mIU/mL (hCG at T0). Abdominal and pelvic examinations were benign. Transvaginal sonogram (TVS) showed an intrauterine gestational sac and yolk sac, no fetal pole visualised. She was discharged home with a diagnosis of threatened abortion. The patient returned to the emergency department 3 weeks later (T1) at 7 weeks gestation with recurrent vaginal bleeding and lower abdominal pain. Her TVS showed an empty uterus with small amount of free fluid in the cul-de-sac. A small 2 cm round mass noted in the adnexa with hCG of 4663 mIU/mL (hCG at T1). Laparoscopy revealed normal fallopian tubes bilaterally and a ruptured right ovarian ectopic pregnancy. Pathology was consistent with ectopic pregnancy. Abnormal hCG patterns should raise suspicion for heterotopic pregnancy.

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

“…Early management is essential in order to avoid severe maternal complications. SHP has a higher incidence in patients with a history of infertility, following assisted reproductive techniques [5] and represents the reason why many fertility clinics prefer single-embryo transfers and rigorous ultrasonographical post-implantation follow-up [32]. However, our review highlighted the possibility of encountering this pathology as a consequence of natural conception.…”

“…The cause of this is an ovulatory abnormality or a difference in the migration speed of the two embryos, due to a delay in the capture of the fertilized egg by the fallopian tube [2]. It is a rare condition with an incidence of approximately 1 per 30,000 pregnancies [3] and can be potentially fatal [4,5].…”

A case of heterotopic ovarian pregnancy after in vitro fertilization: early diagnosis and single-port access conservative laparoscopic treatment

“…Even one viable intrauterine pregnancy is already present, heterotopic pregnancy should be considered strongly when abdominal pain, adnexal mass, or free fluid collection around the adnexa exist. [ 8 ]…”

“…The presence of risk factors suggestive of the existence of heterotopic ovarian pregnancy may be helpful for diagnosis of heterotopic pregnancy; history of multiple embryo transfer or abnormally high β-hCG level or history of previous tubal surgery, history of ectopic pregnancy. [ 5 8 ] However, heterotopic pregnancy may commonly occur even in the absence of risk factors. [ 8 ]…”

“…[ 5 8 ] However, heterotopic pregnancy may commonly occur even in the absence of risk factors. [ 8 ]…”