Aisha Babikir Taha

Princess Royal Maternity Hospital, Uk

Heterotopic pregnancy Case report poster

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Biography

Abstract

Introduction: Heterotopic pregnancy (HP) is presence of multiple gestations, one being present in the uterine cavity and the other extra-uterine, commonly in the fallopian tube and uncommonly in the cervix or ovary.  It is rare but potentially life-threatening. 

Incidence: The spontaneous incidence in the general population is < 1/30,000. It accounts for 0.08% of all pregnancies. Its frequency has increased to 1/100 - 1/500 with assisted reproduction technology. 

Clinical Presentation and Diagnosis: We reported heterotopic pregnancy in a 39yo primigravida with spontaneous pregnancy. The patient presented with brownish vaginal discharge and mild abdominal pain. This patient had risks of x2 laparoscopic cystectomies (one on each side), and blocked Left tube on recent HSG. Her abdomen was tender on examination with voluntary guarding. Tender adnexa, but no adnexal masses or cervical excitation. TVUSS showed viable IUP and another viable Left tubal ectopic pregnancy of 11wks+6days.  She was stable. Had normal HB and bloods. She underwent left laparoscopic surgery where small amount of bleeding seen in the left adnexa, and ectopic mass in Left adnexa, thus mass removed using Ligasure. Procedure was uncomplicated, 100mls blood loss. Had bedside USS post op which confirmed viable IUP.

Treatment: The treatment is tailored to the site of implantation and should utilize the least invasive therapy in order to preserve the intrauterine pregnancy.  Salpingectomy should be the first line of treatment in patients with hemodynamic instability or other signs of tubal rupture.  Medical management by KCL injection and expectant management can be adopted in some cases.