Background: Heterotopic pregnancy is a rare clinical condition, but it is increasingly being diagnosed after the common use of ovarian stimulation and the advent of assisted reproductive techniques. Two cases of heterotopic pregnancy, successful laparoscopic removal of one ectopic pregnancy, and a subsequent favorable outcome of the intrauterine pregnancy, are presented. Cases: The first case was associated with ovarian hyperstimulation syndrome following in vitro fertilization and embryo transfer, and the second case occurred after intrauterine insemination. Results: Via laparoscopy, both cases were diagnosed with ruptured tubal ectopic pregnancy, and laparoscopic salpingectomy after evacuation of the hemoperitoneum was performed. The first patient, at 39 and 1/7 weeks of gestation, was delivered of healthy newborn, weighing 3910 g. In the second patient, at 9 and 4/7 weeks of gestation, an ultrasound scan confirmed a viable intrauterine pregnancy. Since then, the patient has been lost to follow-up. Conclusions: Laparoscopy allows for both a differential diagnosis in an uncertain condition during pregnancy, and a favorable outcome of an intrauterine pregnancy. In the light of this, laparoscopy may be the treatment of choice for patients with heterotopic pregnancies. (J GYNECOL SURG 30:305)
Get full access to this article
View all access options for this article.
References
1.
ChinHY, ChenFP, WangCJ, ShuiLT, LiuYH, SoongYK. Heterotopic pregnancy after in-vitro fertilization-embryo transfer. Int J Gynecol Obstet, 2004; 86:411.
2.
BugattoF, Quintero-PradoR, Kirk-GroharJ, Melero-JiménezV, Hervias-VivancosB, BarthaJL. Heterotopic triplets: tubal ectopic and twin intrauterine pregnancy: A review of obstetric outcomes with a case report. Arch Gynecol Obstet, 2010; 282:601.
MarcusSF, MacnameeM, BrinsdenP. Heterotopic pregnancies after in-vitro fertilization and embryo transfer. Hum Reprod, 1995; 10:1232.
5.
VarrasM, AkrivisC, HadjopoulosG, AntoniouN. Heterotopic pregnancy in a natural conception cycle presenting with tubal rupture: A case report and review of the literature. Eur J Obstet Gynecol Reprod Biol, 2003; 106:79.
6.
AnkumWM, Van der VeenF, HamerlynckJV, LammesFB. Transvaginal sonography and human chorionic gonadotrophin measurements in suspected ectopic pregnancy: A detailed analysis of a diagnostic approach. Hum Reprod, 1993; 8:1307.
7.
Louis-SylvestreC, MoriceP, ChapronC, DubuissonJB. The role of laparoscopy in the diagnosis and management of heterotopic pregnancies. Hum Reprod, 1997; 12:1100.
8.
TalJ, HaddadS, GordonN, Timor-TritschI. Heterotopic pregnancy after ovulation induction and assisted reproductive technologies: A literature review from 1971 to 1993. Fertil Steril, 1996; 1.
9.
Garcia OliveiraF, AbdelmassihV, EigenheerAL, BalmacedaJP, AbdelmassihS, AbdelmassihR. Rare association of ovarian implantation site for patients with heterotopic and with primary ectopic pregnancies after ICSI and blastocyst transfer. Hum Reprod, 2001; 16:2227.
10.
BarrenetxeaG, Barinaga-RementeriaL, Lopez de LarruzeaA, AgirregoikoaJA, MandiolaM, CarboneroK. Heterotopic pregnancy: Two cases and a comparative review. Fertil Steril, 2007; 87:417.e9.
11.
SorianoD, YefetY, OelsnerG, GoldenbergM, MashiachS, SeidmanDS. Is operative laparoscopy contraindicated in women with ectopic pregnancy and hypovolemic shock?. J Am Assoc Gynecol Laparosc, 1996; 3:547.
12.
OdejinmiF, SangrithiM, OlowuO. Operative laparoscopy as the mainstay method in management of hemodynamically unstable patients with ectopic pregnancy. J Minim Invasive Gynecol, 2011; 18:179.
13.
FernandezH, LelaidierC, DoumercS, FournetP, OlivenneSF, FrydmanR. Nonsurgical treatment of heterotopic pregnancy: a report of six cases. Fertil Steril, 1993; 60:428.
