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- Title
HETEROTOPIC PREGNANCY DIAGNOSIS AND TREATMENT - CASE REPORT.
- Authors
Munteanu, Marius Andrei; Gorga, Simona Madalina; Nacu, Andrada Georgiana; Cadar, Ana Elena; Moraru, Petronela Ana-Maria; Muntean, Mihai
- Abstract
Background: Heterotopic pregnancy is a rare condition in which both intrauterine and extrauterine pregnancies occur simultaneously. It was reported to be very rare in normal conceived pregnancy - 1:30000. However, with the considerable progress of the assisted reproductive techniques, the incidence of heterotopic pregnancy increased to 1:7000. Furthermore, the incidence also increases in previous abortions, pelvic inflamatory disease history (Chlamidia) and high levels of beta-HCG after an abortion. Objective: Our aim is to present a case of heterotopic pregnancy, thus highlighting the importance of diagnosing it before any complications occur, extrauterine pregnancy being the most common cause of maternal death in the first trimester. Material and methods: 36-year-old patient, smoker, 6 weeks pregnant, presented herself to the emergency room accusing sustained pain in the left iliac fossa and minimal brown vaginal bleeding. We found out that her last normal menstruation was on 3.12.2016 and a second vaginal bleeding occurred on 12.12.2016. Abdominal ultrasound showed an intrauterine pregnancy in evolution of 6 weeks. Using transvaginal ultrasound, an ectopic, tubar pregnancy was found. The laboratory tests were in normal range and the pacient was haemodinamically and respiratory stable. Right and left laparoscopic salpingectomy was performed as well as manual vacuum aspiration for terminating the intrauterine pregnancy - at patients' request. Results: The histopathological examination showed distension of the tube with ruptured wall, intraluminal chorionic villi and extravillous trophoblast, with fetal parts and hematosalpinx thus confirming the diagnosis of a ruptured ampullary ectopic pregnancy. Patient is stable and free of disease. Conclusions: Although the incidence of heterotopic pregnancy is quite low, abdominal pain and/or vaginal bleeding associated with the presence of an intrauterine pregnancy, might suggest further investigation of the anexial areas. Therefore, our case proves the importance of clinical symptomatology and transvaginal ultrasound in diagnosing this pathology as well as the oportunity of using minimally invasive surgery in stable patients.
- Subjects
ECTOPIC pregnancy; MINIMALLY invasive procedures; CHORIONIC villi; PREGNANCY; UTERINE hemorrhage; ABDOMINAL pain
- Publication
Acta Medica Marisiensis, 2019, Vol 65, p54
- ISSN
2068-3324
- Publication type
Article