A Case Report: Unusual Case of Heterotopic Pregnancy with Chronic Ectopic Pregnancy

Authors

  • Putri Embun Pagi Obstetrics and Gynecology Department, Faculty of Medicine, Andalas University, Dr. M. Djamil Central General Hospital Padang, West Sumatera, Indonesia
  • Haviz Yuad Endocrinology and Fertility Division of Obstetrics and Gynecology, Department of Obstetrics and Gynecology, RSUP Dr M. Djamil, Unversitas Andalas, Padang, Indonesia

DOI:

https://doi.org/10.25077/aoj.7.2.453-459.2023

Keywords:

heterotopic pregnancy, pars ampullaris tubal ectopic pregnancy

Abstract

Background : 

Heterotopic pregnancy describes the occurrence of two pregnancies in different implantation sites simultaneously, mostly manifested as intrauterine and ectopic pregnancies (ampullary in 80%). The  incidence has been documented due to the increase incidence of pelvic inflammatory diseases. 

Case: A 28-years-old primipara woman with suspected chronic ectopic pregnancy, differential diagnosed with ovarian cyst. Previously, the patient had complete abortion because abdominal and pelvic pain still present, she decided to seek treatment at RSUP dr. Mdjamil, from ultrasound was found suspected chronic ectopic pregnancy differentially diagnosed with ovarian cyst. Laparoscopy had done then,  the intraoperative findings found that there was a chronic ectopic pregnancy in the left ampullary tubal and then left salpingectomy was performed.

Conclusion: This case is one of the unusual clinical presentations of heterotopic pregnancy. This case highlights the importance of including heterotopic pregnancy in the differential diagnosis especially in patients with persistent abdominal and pelvic pain after complete abortion. 

References

Fernandez H, Gervaise A (2004) Ectopic pregnancies after infertility treatment: modern diagnosis and therapeutic strategy. Hum Reprod Update 10(6):503–513

Callen PW Ultrasonography in obstetrics and gynecology. In: Levine D (ed) Ectopic Pregnancy, 5th edn. Saunders Elsevier, Philadelphia, pp 1020–1047

Xiao HM, Gong F, Mao ZH, Zhang H, Lu GX (2006) Analysis of 92 ectopic pregnancy patients after in vitro fertilization and embryo transfer. J Cent South Univ 31(4):584–587

Louis-Sylvestre C, Morice P, Chapron C, Dubuisson JB (1997) The role of laparoscopy in the diagnosis and management of heterotopic pregnancies. Hum Reprod 12(5):1100–1102

Jeon HS, Shin HJ, Kim IH, Chung DY (2012) A case of spontaneous heterotopic pregnancy presenting with heart activity of both embryos. Kor J Obstet Gynecol 55:339–342

Elito NAMD, Montenegro M, Costa Soares RDA, Camano L (2008) Unruptured ectopic pregnancy—diagnosis and treatment. State of art. Revista Brasileira de Ginecologia e Obstetricia 30(3):149–154

Dündar Ö, Tütüncü L, Müngen E, Muhcu M, Yergök YZ (2006) Heterotopic pregnancy: tubal ectopic pregnancy and monochorionic monoamniotic twin pregnancy: a case report. Perinatal J 14:96–100

Tamai K, Koyama T, Togashi K (2007) MR features of ectopic pregnancy. Eur Radiol 17(12):3236–3246

Li XH, Ouyang Y, Lu GX (2013) Value of transvaginal sonography in diagnosing heterotopic pregnancy after in-vitro fertilization with embryo transfer. Ultrasound Obstet Gynecol 41:563–569

Tankou CS, Sama C, Nekame JLG. Occurrence of spontaneous bilateral tubal pregnancy in a low‑income setting in rural Cameroon: A case report. BMC Res Notes 2017;10:679

Damario, Ectopic Pregnancy. In: Rock Jr, Jones III. Te Linde’s Operative Gynecology. 10th. Philadelphia: Lippincott Williams and Wilkins; 2011. 794-795.

Li JB, Kong LZ, Yang JB, Niu G, Fan L, Huang JZ et al (2016) Management of heterotopic pregnancy: experience from 1 tertiary medical center. Medicine. 95:e2570

Baxi A, Kaushal M, Karmalkar H, Sahu P, Kadhi P, Daval B (2010) Successful expectant management of tubal heterotopic pregnancy. J Hum Reprod Sci 3:108–110

Deka D, Bahadur A, Singh A (2012) Neena Malhotra. Successful management of heterotopic pregnancy after fetal reduction using potassium chloride and methotrexate. J Hum Reprod Sci 5:57–60

Goldstein JS, Ratts VS, Philpott T, Dahan MH (2006) Risk of surgery after use of potassium chloride for treatment of tubal heterotopic pregnancy. Obstet Gynecol 107:506–508

Downloads

Published

2023-07-30

Issue

Section

CASE REPORT