Unsuccessful Laparoscopic Management of a Spontaneous Second Trimester Heterotopic Pregnancy

Abstract

Abstract

Background: Heterotopic pregnancy is a rare clinical condition whereby both intrauterine and extrauterine gestations occur at the same time. Its incidence is increased with the use of assisted reproductive techniques but is still extremely difficult to diagnose accurately on ultrasound scans. This article describes a case of a spontaneous midtrimester heterotopic pregnancy that was unsuccessfully managed via laparoscopy. Case: A 29-year-old primigravida patient was suspected of having a dermoid cyst after an ultrasound scan at 12 weeks' gestation revealed a right adnexal mass. She was scheduled for a laparoscopic cystectomy at 14 weeks of pregnancy. There was excessive bleeding intraoperatively and a heterotopic pregnancy was suspected. The surgery was converted to a laparotomy and a total salpingectomy was performed, with preservation of the intrauterine pregnancy. Results: The pregnancy progressed smoothly postoperatively. Conclusions: Heterotopic pregnancy is a rare but perilous condition and a high index of suspicion is needed for the detection of such a pregnancy on ultrasound scans. It is possible to manage heterotopic pregnancies laparoscopically, but in unstable patients, laparotomy takes priority, with the ultimate aim of bringing the intrauterine pregnancy to term. (J GYNECOL SURG 27:107)