Ectopic pregnancy: a single-center experience over ten years.

PURPOSE: The aim of this study was to investigate characteristics associated with ectopic pregnancy (EP) that could be utilized for predicting morbidity or mortality. METHODS: This was a retrospective analysis of pregnancy-related records from a tertiary center over a period of ten years. Data on age, gravidity, parity, EP risk, amenorrhea duration, abdominal pain presence and location, ß-human chorionic gonadotropin (ß-HCG) level, ultrasound findings, therapeutic intervention, exact EP implantation site and length of hospital stay (LOS) were obtained from the database. The LOS was used as a proxy for morbidity and was tested for an association with all variables. All statistical analyses were conducted with Stata® (ver. 16.1, Texas, USA). RESULTS: The incidence of EP in a cohort of 30,247 pregnancies over a ten-year period was 1.05%. Patients presented with lower abdominal pain in 87.9% of cases, and the likelihood of experiencing pain was tenfold higher if fluid was detectable in the pouch of Douglas. Only 5.1% of patients had a detectable embryonic heartbeat, and 18.15% had one or more risk factors for EP. While most EPs were tubal, 2% were ovarian. The LOS was 1.9 days, and laparoscopic intervention was the main management procedure. The cohort included one genetically proven dizygotic heterotopic pregnancy (incidence, 3.3 × 10- 5) that was diagnosed in the 7th gestational week. The only association found was between the ß-HCG level and LOS, with a linear regression ß coefficient of 0.01 and a P-value of 0.04. CONCLUSION: EP is a relatively common condition affecting approximately 1% of all pregnancies. ß-HCG correlates with EP-related morbidity, but the overall morbidity rate of EP is low regardless of the implantation site. Laparoscopic surgery is an effective therapeutic procedure that is safe for managing EP, even in cases of heterotopic pregnancy.

Acute abdomen or life-threatening heterotopic pregnancy with tubal rupture: where does imaging play a role?

Heterotopic pregnancy (HP) is a rare, potentially life-threatening complication of an intrauterine pregnancy with a simultaneous ectopic pregnancy. There is a higher incidence with assisted reproduction techniques (ART) and radiology can be pivotal in its diagnosis. A 28-year-old woman underwent ART and at 7 weeks' gestation presented with acute right iliac fossa pain. Transvaginal ultrasound (US) imaging confirmed a viable intrauterine pregnancy. The patients' pain persisted however, and transabdominal US demonstrated a complex, heterogeneous right adnexal mass. Subsequent magnetic resonance imaging (MRI) confirmed an HP with a ruptured ectopic and haemoperitoneum. Emergency laparoscopic surgery and right salpingo-oopherectomy were performed without complication. We highlight the importance of considering HP as a diagnosis in the acute gravid abdomen, especially when initial investigations have confirmed a viable intrauterine pregnancy. Furthermore, this case highlights MRI as a useful modality in complex cases due to its high soft tissue contrast resolution using non-ionising radiation.

Heterotopic Pregnancy: A Challenge in Early Diagnosis.

Heterotopic pregnancy is the simultaneous existence of intrauterine and extrauterine gestation. It is usually seen in women at risk for ectopic pregnancy or those undergoing fertility treatments. The incidence has dramatically risen to 1 in 3900 of pregnancies via assisted reproductive techniques or ovulation induction, compared to 1 in 30000 of spontaneous conception. Besides this, history of pelvic inflammatory disease (PID), tubal damage, pelvic surgery and prior tubal surgery can increase its risk. Here we present a case of heterotopic pregnancy which was diagnosedafter ectopic gestation ruptured along with compromised intrauterine gestation and maternal condition. Earlier diagnosis before this life-threatening event could have saved the intrauterine fetus. Keywords: Extrauterine pregnancy; heterotopic pregnancy; ruptured ectopic.

Successful management of heterotopic cornual pregnancy with laparoscopic cornual resection.

OBJECTIVE: To examine the feasibility of laparoscopic cornual resection for the treatment of heterotopic cornual pregnancy. STUDY DESIGN: Women who underwent laparoscopic cornual resection for heterotopic cornual pregnancy at our hospital between January 2003 and March 2015 were retrospectively analyzed. We evaluated significant parameters such as operative complications and postoperative pregnancy outcomes of concomitant pregnancy. RESULTS: Thirteen patients with heterotopic cornual pregnancy were included in the study. All were pregnant through assisted reproductive technology, and the diagnosis was made at a median of 6+6 weeks (range 5+4-10+0). They were successfully treated with laparoscopic cornual resection and admitted for a median of 4 days (range, 2-7) postoperatively. The median operative time was 65min (range, 35-145min) and estimated blood loss was 200mL (range, 10-3000mL). There was a spontaneous abortion at 7+6 gestational weeks in a patient who received bilateral cornual resection. Seven patients delivered babies at term and 3 at preterm. All 10 women delivered without any maternal or neonatal complications. Two were lost to follow-up. CONCLUSIONS: Laparoscopic cornual resection is a feasible primary approach for the management of heterotopic cornual pregnancy.

Gestación heterotópica accidentada / Ruptured heterotopic pregnancy

La gestación heterotópica es una circunstancia rara y de difícil diagnóstico, puesto que en ciclos de concepción natural su incidencia es muy baja. Por ello es importante descartar su diagnóstico en aquellas pacientes con una gestación intrauterina y dolor abdominal y hemoperitoneo. Presentamos el caso clínico de una primigesta de 35 años, sin antecedentes, con gestación actual espontánea, que consultó por metrorragia. Tras la sospecha de gestación heterotópica, se realizaron una salpingectomía laparoscópica y un legrado evacuador del aborto en curso. La anatomía patológica confirmó el diagnóstico (AU)

Heterotopic pregnancy is a rare event. Because the incidence is very low in natural conception cycles, this entity is difficult to diagnose. Therefore, it is important to rule out this diagnosis in patients with an intrauterine pregnancy, abdominal pain and hemoperitoneum. We report the case of a 35-year-old woman with no relevant medical history and a spontaneous pregnancy, who presented with metrorrhagia. Due to suspicion of a heterotopic pregnancy, laparoscopic salpingectomy and curettage of the abortion in progress were performed. The diagnosis was confirmed by pathological analysis (AU)

Bilateral tubal and intrauterine pregnancies diagnosed at laparoscopy.

A 32-year-old woman had bilateral tubal and intrauterine pregnancies after hyperovulation with clomiphene citrate and subsequent artificial insemination with husband's semen. Laparoscopic surgery revealed bilateral tubal pregnancies. Salpingectomy was performed on the left tube and linear salpingotomy was performed on the right tube. The postoperative course was uneventful. The patient delivered a healthy girl vaginally at 39 weeks' gestation. Only eight cases with bilateral and intrauterine pregnancy have been reported. The live birth rate of bilateral tubal pregnancy and intrauterine pregnancy is 60% (6/10), which is similar to that of heterotopic pregnancy. Laparoscopic surgery is effective for confirming the diagnosis and treating heterotopic pregnancy.