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- Title
Spontaneous heterotopic pregnancy with ampullar location of the ectopic pregnancy - case report and literature review.
- Authors
Dinu, Marina; Hodorog, Andreea-Denisa; Drăgușin, Roxana-Cristina; Șorop-Florea, Maria; Tudorache, Ștefania; Stăncioi-Cismaru, Andreea-Florentina
- Abstract
Heterotopic pregnancy (HP) is defined as the coexistence of an ectopic and an intrauterine pregnancy. It is a biovular twin pregnancy characterized by a difference in migration between the two embryos. Although the overall prevalence is increasing due to the wide use of techniques for ovulation induction and assisted reproduction techniques, spontaneous HP remains a very rare condition. In most spontaneous heterotopic pregnancies, the suspicion index is low, and the ectopic one is implanted in the ampullary segment of the tubes (80% of cases). We present herein a case with this rare condition: spontaneously conceived HP with an ampullar tube location of the ectopic pregnancy. We also reviewed the published literature, describing this specific variety of high-risk pregnancies, to raise the clinicians' awareness. Most patients present with acute abdominal pain, and heterotopic pregnancy is diagnosed following the tubal rupture. The surgical management is usually required, even in yet uncomplicated HP. The preferred approach is minimally invasive surgery. In most cases, the goal of medical intervention is to remove the ectopic pregnancy and to ensure the uneventful evolution of the eutopic one. The unit's facilities, the practitioner skills and the given case features are paramount. The case we describe is of a 32-year-old multigravida. She presented with acute, intense abdominal pain, in the context of secondary amenorrhea for seven weeks. The transvaginal ultrasound scan revealed a large amount of free fluid in the cul-de-sac, a live intrauterine pregnancy, and a left tubal ectopic live pregnancy. As in most spontaneous heterotopic pregnancies, our patient had no known risk factors for ectopic/heterotopic pregnancy. Emergency laparotomy and left salpingectomy were performed. Subsequently, the medical termination of the intrauterine pregnancy was performed at the couple's request.
- Subjects
ECTOPIC pregnancy; LITERATURE reviews; HIGH-risk pregnancy; ABORTION; MULTIPLE pregnancy; PREGNANCY
- Publication
Obstetrică şi Ginecologie, 2023, Vol 71, Issue 4, p165
- ISSN
1220-5532
- Publication type
Article