Gravidez heterotópica espontânea: implicações de um diagnóstico tardio / Spontaneous heterotopic pregnancy: implications of a late diagnosis

A gestação heterotópica é uma entidade rara, principalmente se resultante de concepção natural. O diagnóstico é ultrassonográfico, porém a gestação intrauterina concomitante contribui para a dificuldade propedêutica. Neste relato de caso, a detecção foi tardia, a ultrassonografia não identificou a gestação heterotópica e apenas durante a avaliação intraoperatória, por meio de uma cirurgia de emergência devido a choque hemorrágico, houve o reconhecimento. A suspeita de uma gestação heterotópica deve ser sempre aventada quando sinais clínicos típicos (sangramento, dor abdominal) estão presentes, mesmo na ausência de fatores de risco ou imagens anômalas na ecografia. Assim, uma intervenção precoce menos invasiva pode ser realizada, reduzindo a morbimortalidade materna e do feto intrauterino. Este relato de caso destaca uma situação incomum dentro dessa patologia rara: diagnóstico tardio, apenas no segundo trimestre de gestação, sem evidência prévia ultrassonográfica, certificada apenas durante o intraoperatório. O manejo cirúrgico preciso permitiu a manutenção da gravidez intrauterina.(AU)

Heterotopic pregnancy is a rare entity, especially if it is resulted from natural conception. The diagnosis is ultrasonographic, but the concomitant intrauterine pregnancy contributes to the propaedeutic difficulty. In this case report, the detection was late, the ultrasonography did not identify heterotopic pregnancy and, only during intraoperative evaluation through emergency surgery, exploratory laparotomy, there was recognition. The suspicion of a heterotopic pregnancy should always be raised when typical clinical signs (bleeding, abdominal pain) are present, even in absentia of risk factors or anomalous images on ultrasound. Thus, a less invasive early intervention can be performed, reducing maternal and intrauterine fetus morbimortality. This case report highlights an unusual situation within this rare pathology: late diagnosis, only in the second trimester of pregnancy, without previous ultrasound evidence, certified only during the intraoperative period. Precise surgical management allowed the maintenance of intrauterine pregnancy.(AU)

Term delivery of a heterotopic pregnancy coexisting with ruptured tubal ectopic pregnancy: A case report

Pregnancies that occur in two different implantation sites simultaneously is described as Heterotopic pregnancy (HP). In the current study, a case of term delivery of a heterotopic pregnancy coexisting with ruptured tubal ectopic pregnancy, diagnosed by ultrasound (US) and clinical examination findings, which was managed successfully. A 25 year old Nigerian female, gravida 4, para 2 (2 term gestation, 1 spontaneous abortion) presented at the Emergency room with acute abdominal pain associated with vomiting. She had 8 weeks amenorrhea and a positive pregnancy test three weeks prior to presentation. Transvaginal ultrasound scan revealed a sixweeks viable intrauterine gestation. A diagnosis of possible ectopic pregnancy was made. Further trans-abdominal ultrasonography imaging revealed viable intrauterine pregnancy with evidence of an echogenic mass measuring 6.5 x 7.5cm in the abdominal cavity with significant fluid collection, and both ovaries were visualized and separate from the mass. An emergency exploratory laparotomy with right salpingectomy was performed with minimal handling of the uterus and other pelvic structures. At 37 weeks and 5 days gestation, she had an elective C/S for a transverse lying fetus and delivered a live normal birth weight baby girl with a good Apgar score. (Afr J Reprod Health 2022; 26[4]: 110-113).

Gestação heterotópica espontânea: relato de caso com diagnóstico e manejo oportunos / Spontaneous heterotopic pregnancy: a case report with appropriate diagnosis and management

Introdução: A gravidez heterotópica é um fenômeno obstétrico muito raro em concepções espontâneas no qual gestações tópica e ectópica coexistem. O diagnóstico é difícil, mas, se realizado precocemente, o prognóstico é favorável. Descrição do caso: Paciente do sexo feminino, de 35 anos de idade, admitida com quadro de dor abdominal e pequeno sangramento vaginal. Diagnosticada precocemente e tratada cirurgicamente por gravidez heterotópica naturalmente concebida. Como resultado, a gravidez tópica seguiu sem intercorrências. Conclusão: Esse caso enfatiza a necessidade de considerar esse diagnóstico diferencial e analisar clínica e ecograficamente as características globais da pelve, mesmo na ausência de fatores de risco em gestações tópicas.(AU)

Introduction: Heterotopic pregnancy (HP) is a rare obstetric phenomenon in spontaneous conceptions in which intrauterine and ectopic pregnancies coexist. The diagnosis is difficult, but, if performed early, the prognosis is favorable. Case description: A 35-year-old woman was admitted with abdominal pain and light vaginal bleeding. She was early diagnosed and surgically treated for a naturally conceived heterotopic pregnancy. As a result, the intrauterine pregnancy went on healthily. Conclusion: This case emphasizes the need to regard HP as a differential diagnosis and analyze the global pelvis characteristics both clinically and in ultrasound scans, even in the absence of risk factors when dealing with intrauterine pregnancies.(AU)

Cervical heterotopic pregnancy: A case report / 中南大学学报(医学版)

Heterotopic pregnancies are rare and difficult to be diagnosed early. A patient with combined intrauterine pregnancy and cervical pregnancy was admitted in Qingdao Municipal Hospital in 2019. The patient complained of abnormal vaginal bleeding after menopause and was misdiagnosed as simple intrauterine pregnancy. She underwent artificial abortion and suffered intraoperative hemorrhage. To stop bleeding, she received the treatment of uterine artery embolization immediately. Afterwards, cervical residual pregnancy tissues started necrosis, blood β-human chorionic gonadotropin level and the cervix appearance gradually returned to normal. This report suggests that cervical heterotopic pregnancy inclines to be mis diagnosed. Correct diagnosis should be made as soon as possible. Selective uterine artery embolization is an effective measure to prevent and treat massive bleeding.

Embarazo heterotópico: reporte de un caso / Heterotopic pregnancy: a case report

Se presenta el caso clínico de una paciente de sexo femenino de 36 años de edad, natural de Cochabamba, con embarazo ectópico tubárico en la trompa derecha, asociado a un embarazo intrauterino de 6.4 semanas de gestación por FUM, sin antecedentes patológicos personales ni familiares de relevancia clínica; fue tratada quirúrgicamente en el Hospital Obrero Nro 2 CNS, optándose por la laparotomía con salpinguectomía; se realizó prevención de aborto del saco intrauterino con resultados satisfactorios.

The case of a female patient 36 years old, born in Cochabamba, with tubal ectopic pregnancy in the fallopian right, associated with an intrauterine pregnancy of 6.4 weeks LMP, with no personal or family history of disease clinical relevance is presented; He was treated surgically in the CNS Hospital Obrero No. 2, whichever laparotomy with salpingectomy and prevention of intrauterine sac abortion was performed with satisfactory results.

Gestação heterotópica associada a torção de anexo contralateral em gestação não planejada / Heterotopic management associated with the torment of contralateral apparatus in unplugged management

A gestação heterotópica se define como uma gravidez intra e uma extraútero, nesse caso, a gravidez que se encontra extraútero, em tuba uterina. Foi descoberta após a paciente apresentar dor abdominal, ainda não relatando atraso menstrual e sem a paciente apresentar desejo de engravidar. O diagnóstico foi feito por meio do exame de ultrassonografia com a visualização de massa anexial íntegra à esquerda. A torção de ovário, que é definida pela rotação parcial ou total do pedículo vascular ovariano, causando estase circulatória que pode causar progressivamente edema e gangrena e progredir para necrose, causando danos irreversíveis aos ovários, também foi descoberta por meio do exame de ultrassom e dos sintomas da paciente. A clínica apresentou-se por abdome agudo. No intraoperatório, foi feito o diagnóstico de gestação heterotópica e também apresentou torção de ovário contralateral, caso esse sobre o qual, em conjunto, não há relatos na literatura.(AU)

Heterotopic gestation is defined as an intrauterine pregnancy and an extrauterine pregnancy, in this case the extrauterine pregnancy in the uterine tube. It was discovered after the patient presented abdominal pain, still not reporting menstrual delay and without the patient presenting desire to become pregnant. The diagnosis was made through the ultrasound examination with the visualization of complete adnexal mass on the left. Ovarian torsion, which is defined by partial or total rotation of the ovarian vascular pedicle, causing a circulatory stasis that can progressively cause edema, gangrene and progress to necrosis, causing irreversible damage to the ovaries, was also discovered by ultrasound examination and of the patient's symptoms. The clinic presented with an acute abdomen. n the intraoperative period, the diagnosis of heterotopic gestation was made and also presented contralateral ovary torsion, in which case, there are no reports in the literature.(AU)

Embarazo heterotópico / Heterotopic Pregnancy

El embarazo heterotópico es aquella entidad en la que coexisten gestación intra- extrauterina. La incidencia es baja en embarazos espontáneos, que ha aumentado con técnicas de reproducción asistida. Su diagnóstico precisa un elevado índice de sospecha y tener en consideración los factores de riesgo. Se describen las características de un caso ocurrido en el Hospital Docente Ginecobstétrico de Guanabacoa en La Habana. Cuba. Se presenta una paciente de 26 años de edad con amenorrea de 9 semanas, que acude por dolor intenso a Cuerpo de Guardia con diagnóstico ultrasonográfico de hemoperitoneo. Se sometió a laparotomía exploratoria donde se constató un útero que impresionó grávido y estallamiento del cuerno derecho del útero. No fue posible realizar hemostasia, por lo que se realizó histerectomía total abdominal sin anexectomía. El diagnóstico anátomopatológico fue embarazo heterotópico(AU)

Heterotopic pregnancy is that entity in which intra- and extra-uterine gestation coexist. The incidence is low in spontaneous pregnancies; however, it has increased with assisted reproduction techniques. Its diagnosis requires high index of suspicion and the consideration of risk factors. We describe the characteristics of a case of a 26-year-old patient with 9 weeks amenorrhea who came to the Obstetric Teaching Hospital in Guanabacoa, Havana, Cuba. This patient presented with intense pain and ultrasonography diagnosis of hemoperitoneum. She underwent exploratory laparotomy where the gravid uterus and bursting of the right horn of the uterus were confirmed. It was not possible to perform hemostasis, so total abdominal hysterectomy was performed without adnexectomy. The anatomopathological diagnosis was heterotopic pregnancy(AU)

Une grossesse hétérotopique de 36 semaines de découverte fortuite au centre hospitalier universitaire régional de Ouahigouya (Burkina Faso)

Nous rapportons un cas de découverte fortuite chez une patiente de 26 ans, reçue pour douleurs abdomino-pelviennes sur grossesse présumée gémellaire de 33 SA. Aucune échographie obstétricale n'avait été réalisée avant son admission. Deux échographies tardives ont objectivé une grossesse gémellaire intra utérine avec hydramnios. Une césarienne à 36 semaines indiquée pour grossesse gémellaire avec hydramnios et anémie sévère a été réalisée au cours de laquelle nous avons découvert une grossesse intra-utérine et une grossesse abdominale avec insertion du placenta au niveau du ligament large gauche avec adhérence sur l'annexe gauche, l'épiploon et les anses grêles.Les nouveau-nés étaient bien portant. J1 intra utérin avait un poids de 2650 g et J2 abdominal de 2000g. Les suites ont été simples

Gestação heterotópica: diagnóstico ultrassonográfico com gravidez ectópica não rota em serviço de emergência - Relato de caso / Heterotopic pregnancy: ultrasonographic diagnosis with non - route ectopic pregnancy in emergency service - Case report

A gravidez heterotópica é uma entidade rara, caracterizada por uma gravidez tópica associada a uma gravidez ectópica, sobretudo quando ocorre de forma espontânea. Os fatores de risco são semelhantes aos vistos em ectópicas, sendo a maior incidência nas mulheres que se submetem a técnicas de reprodução assistida. O diagnostico é feito com ß-HCG positivo e exame ultrassonográfico, geralmente após quadro de abdome agudo hemorrágico decorrente do rompimento da prenhez ectópica, com o tratamento divergindo em relação ao quadro e da idade gestacional da paciente. (AU)

The heterotopic pregnancy is a rare disease characterized by a topical pregnancy associated with an ectopic pregnancy, especially when it occurs spontaneously. Risk factors are similar to those seen in ectopic pregnancy, with the highest incidence in women undergoing assisted reproduction techniques . Diagnosis is made with a positive ß -HCG and ultrasound examination, usually after hemorrhagic acute abdomen due to the rupture of the ectopic pregnancy, with treatment differing in relation to the frame and the gestational age of the patient. (AU)

Expectant management of heterotopic pregnancy

@#Heterotopic pregnancy or the coexistence of an intrauterine and an extrauterine pregnancy occurs in about 1 out of 30,000 pregnancies. Between assisted reproductive techniques and ovulation induction, it is said to occur more commonly with the former. The patient presented in this case is a 29 year old primigravid who underwent ovulation induction with clomiphene citrate and was later on diagnosed to have both an intrauterine and a non-viable extrauterine pregnancy. The management for this kind of pregnancy can be medical, surgical or expectant. The patient in this case was managed expectantly. This case study presents a review of literature on heterotopic pregnancy, and describes how this rare type of pregnancy developed in this index patient, how it is diagnosed and managed, and to showcase how expectant management can be a safe option for cases of heterotopic pregnancy.

Embarazo heterotópico tubo-abdominal / Tube-Abdominal Heterotopic Pregnancy

El embarazo heterotópico es una rara gestación múltiple en donde un embarazo intrauterino coexiste con uno ectópico.La incidencia de embarazo heterotópico es de 1 cada 10 000 a 50 000 embarazos espontáneos. El aumento de los tratamientos por técnicas de reproducción asistida, ha incrementado la incidencia de embarazo heterotópico, ha llegado hasta 1 por ciento de los embarazos logrados por estas técnicas. El objetivo del trabajo es presentar el caso de una paciente con un embarazo heterotópico que resulta poco frecuente. Se presenta una paciente de 32 años, primípara, con antecedentes de salud que acudió por amenorrea de 10,2 semanas, dolor en bajo vientre con intensificación y sangramiento genital a manchas oscuras persistente. En el examen físico se constata un útero aumentado de tamaño que coincide con la amenorrea y el fondo de saco de Douglas abombado y doloroso. El examen ultrasonográfico fue concluyente en el diagnóstico de embarazo heterotópico. Se realizó una laparotomía y una salpingectomía total izquierda y exéresis de la placenta. El posoperatorio inmediato fue satisfactorio; el ultrasonido realizado tres semanas después, mostró la existencia de un embrión intrauterino de aproximadamente 12 semanas, vivo. La paciente fue seguida en consulta de Obstetricia y tuvo un parto eutócico a las 36,2 semanas con recién nacido vivo, en buen estado y bajo peso(AU)

Heterotopic pregnancy is a rare multiple pregnancy where an intrauterine pregnancy coexists with an ectopic pregnancy. The incidence of heterotopic pregnancy is 1 in 10,000 to 50,000 spontaneous pregnancies. The increase of assisted reproductive techniques has increased the incidence of heterotopic pregnancy, up to 1 % of the pregnancies achieved by these techniques. The objective of this study is to present the case of a patient with a heterotopic pregnancy that is rare. We present a 32-year-old female patient, primiparous, with a history of health. She came to consultation due to 10.2-week amenorrhea, low pain with intensification and genital persistent dark bleeding. The physical examination shows an enlarged uterus that coincides with amenorrhea and the plump and painful the bottom of Douglas sac. Ultrasonography was conclusive in the diagnosis of heterotopic pregnancy. A laparotomy and total left salpingectomy and excision of the placenta were performed. The immediate postoperative was satisfactory. The ultrasound performed three weeks later showed the existence of an intrauterine alive embryo of approximately 12 weeks. The patient was followed in consultation with obstetrics and she had a eutocic delivery at 36.2 weeks with alive newborn, in good condition and underweight(AU)

Embarazo heterotópico espontáneo. Reporte de caso / Heterotopic spontaneous pregnancy. Report of case

Fundamento. La combinación de un embarazo intrauterino con uno extrauterino se conoce como embarazo heterotópico, esta es una patología poco reportada cuando se presenta en forma espontánea (1 caso cada 20 000 o 30 000 embarazos). Objetivo: Reportar un caso la infrecuencia de la forma en que se presenta la combinación de los dos embarazos y la emergencia de cuando uno está roto. Presentation of the case: Paciente de 26 años de edad, con el antecedente de tres gestaciones previas (tres partos a término); presentó una historia de amenorrea de tres meses asociada a dolor hipogástrico de 24 horas de evolución. Al examen físico tenía la TA de 90/50 mHg, el pulso de 120 pulsaciones por minutos, frialdad y sudoración, la temperatura axilar de 36,4 °C. Su abdomen estaba levemente distendido, blando, depresible, con ruidos hidroaéreos, sensible a la palpación profunda en hipogastrio y en fosa ilíaca derecha con Blumberg negativo. Se le realizó una laparotomía exploradora con el diagnóstico presuntivo de embarazo ectópico derecho, y se observó en ésta un hemoperitoneo de 500 ml, útero, ovario y trompa izquierdas normales. Se le realizó una ecografía que informó un embarazo intrauterino de primer trimestre, que al momento de la cirugía tenía una edad gestacional estimada de 15 semanas. Conclusiones: El diagnóstico del embarazo heterotópico no es fácil definirlo debido a las diversas manifestaciones clínicas y a la existencia del embarazo intrauterino que continúa; se debe tener en cuenta que la ecografía es un pilar importante en el diagnóstico e identificación temprana de esta patología.

Background: The combination of an intra-uterine pregnancy with an extra uterine one is known as heterotopic pregnancy, this is a pathology little reported when it is presented in an spontaneous form (1 case each 20 000 or 30 000 pregnancies). Objective: To report a case the seldomness in the way in that it is presented the combination of the two pregnancies and the emergency of when one is broken. Report of case: Patient of 26 years old, with the antecedent of three previous pregnancies (three childbirths to term);she presented a history of a three months amenorrhea associated to hypogastria pain of 24 hours of evolution. To the physical exam she had the TA of 90/50 mHg, the pulse of 120 pulsations for minutes, indifference and sweating, the axillary temperature of 36, 4 °C. Her abdomen was slightly loosened, soft, depressive, with noises hydro air, sensitive to the deep palpation in hypogastrium and in grave right iliac with negative Blumberg. It was carried out an exploratory laparotomy with the presumptive diagnosis of right ectopic pregnancy, and it was observed in this a hemoperitoneum of 500 ml, uterus, lefts ovary and trumpet normal. It was carried out an ultrasound that informed an intra-uterine pregnancy of first trimester that had an estimated gestational age of 15 weeks at the moment of the surgery. Conclusions: The diagnosis of the heterotopic pregnancy is not easy to define due the diverse clinical manifestations and the existence of the intra-uterine pregnancy that continues; it should be kept in mind that the ultrasound is an important pillar in the diagnosis and early identification of this pathology.

Gestación heterotópica: dos casos con gestación intrauterina viable a término / Heterotopic pregnancy: two cases with viable intrauterine pregnancy at term

Se presentan dos casos de gestación heterotópica, el primero de ellos espontáneo y el segundo tras técnicas de fecundación in vitro. En ambos la gestación intrauterina evolucionó de forma favorable, con control gestacional normal y llegando a término, con el nacimiento de recién nacidos sanos. La gestación heterotópica se define como la presencia simultánea de gestación en dos lugares de implantación distintos, lo más frecuente una gestación intrauterina acompañada de otra ectópica. Se trata de una situación poco frecuente, con una incidencia de 1/8000 embarazos espontáneos según la bibliografía más reciente.

We report two cases of heterotopic pregnancy, the first one spontaneous and the second one after in vitro fertilization techniques. In both, the intrauterine gestation evolved favorably, normal pregnancy control and coming to terms with the birth of healthy newborns. Heterotopic pregnancy is defined as the simultaneous presence of gestation at two different locations, most often in utero accompanied by another ectopic pregnancy. This is a rare situation, with an incidence of spontaneous pregnancies 1/8000 according to the most recent literature.

Tratamiento exitoso de un embarazo heterotópico cervical luego de un procedimiento de fecundación in vitro / Successful treatment of a cervical heterotopic pregnancy following an in vitro fertilization procedure

Mujer nulípara infértil de 37 años presentó un embarazo heterotópico cervical luego de tratamiento por fecundación in vitro. Una intervención temprana durante la 6ta semana de gestación logró remover el saco cervical mediante un aspirador manual. Para prevenir una posible hemorragia, se realizó la ligadura de las ramas cérvico-uterinas y se colocó un cerclaje cervical, antes de la aspiración. Se logró extraer el embarazo cervical con mínima hemorragia. El embarazo intrauterino progresó sin complicaciones, resultando en el parto de un varón de 2740 g, a las 35.4 semanas.

A 37-year-old nulligravida infertile female had a cervical heterotopic pregnancy following an in vitro fertilization procedure. Early intervention on the 6th week of gestation with a manual vacuum aspirator reached to remove the cervical pregnancy. Ligation of the descending cervical branches of the uterine arteries and a cervical cerclage, were placed before the aspiration, for prevention of possible hemorrhage. Successful removal of the cervical pregnancy was achieved with only mild bleeding. An intrauterine pregnancy progressed to viability without complications, resulting in a vaginal delivery of a preterm live-birth at 35.4 weeks, of a male that weighted 2740 g.

Five cases of interstitial heterotopic pregnancy after IVF-ET treated by laparoscopic surgery / 中南大学学报(医学版)

To evaluate the efficency and safety of laparoscopic surgery in the treatment of interstitial heterotopic pregnancy (IHP) after IVF-ET, five patients with interstitial heterotopic pregnancy after IVF-ET treated by laparoscopy in our hospital from Jan. 2012 to Jan. 2015 were retrospectively analyzed. All operations were finished laparoscopically without any major complications and they successfully delivered. The results suggest that laparosccpic surgery is feasible and safe for IHP to maintain the trauterine pregnancy, and it can diagnose and treat IHP at early stage, which cause mininmal injuries and less disturbance to trauterine pregnancy and ensure rapid recovery.

The Risk Factors and Pregnancy Outcomes of 48 Cases of Heterotopic Pregnancy from a Single Center

The purpose of this study was to investigate risk factors that are associated with heterotopic pregnancy (HP) following in vitro fertilization (IVF)-embryo transfer (ET) and to demonstrate the outcomes of HP after the surgical treatment of ectopic pregnancies. Forty-eight patients from a single center, who were diagnosed with HP between 1998 and 2012 were included. All of the patients had received infertility treatments, such as Clomid with timed coitus (n = 1, 2.1%), superovulation with intrauterine insemination (n = 7, 14.6%), fresh non-donor IVF-ET (n = 33, 68.8%), and frozen-thawed cycles (n = 7, 14.6%). Eighty-four additional patients were randomly selected as controls from the IVF registry database. HP was diagnosed at 7.5 ± 1.2 weeks (range 5.4-10.3) gestational age. In six cases (12.5%), the diagnosis was made three weeks after the patients underwent treatment for abortion. There were significant differences in the history of ectopic pregnancy (22.5% vs. 3.6%, P = 0.002). There were no significant differences in either group between the rates of first trimester intrauterine fetal loss (15.0% vs. 13.1%) or live birth (80.0% vs. 84.1%) after the surgical treatment for ectopic pregnancy. The risk factors for HP include a history of ectopic pregnancy (OR 7.191 [1.591-32.513], P = 0.010), abortion (OR 3.948 [1.574-9.902], P = 0.003), and ovarian hyperstimulation syndrome (OHSS) (OR 10.773 [2.415-48.060], P = 0.002). In patients undergoing IVF-ET, history of ectopic pregnancy, abortion, and OHSS may be risk factors for HP as compared to the control group of other IVF patients. The surgical treatment of HP does not appear to affect the rates of first trimester fetal loss or live birth.

Heterotopic pregnancy after a single embryo transfer

Heterotopic pregnancy is a rare and life-threatening condition which is defined as coexistent intrauterine and ectopic gestation. The risk of ectopic and heterotopic pregnancy is increasing due to the increased risk of multiple pregnancies with the aid of assisted reproductive technologies. However, it hardly happens in the setting of single embryo transfer, since single embryo transfer significantly reduces the incidence of multiple pregnancies. Surprisingly, we experienced a case of heterotopic pregnancy after a single embryo transfer caused by coincidental natural pregnancy during assisted reproductive technologies. An infertile woman who underwent, during her natural cycle, transfer of a single embryo that had been cryopreserved for 3 years was found to be heterotopically pregnant. After an early and successful management with laparoscopic right salpingectomy, she finally reached at full-term vaginal delivery.

Abdomen agudo quirúrgico hemorrágico. Embarazo heterotópico. Reporte de un caso / Hemorrhagic surgical acute abdomen. Heterotopic pregnancy. A case report

Métodos: Presentamos un caso de una paciente femenina de 31 años con dolor abdominal de fuerte intensidad, tipo punzante, en fosa iliaca derecha, de aparición brusca, con signos de irritación peritoneal y ß-HCG positiva, cuadro clínico de abdomen agudo quirúrgico por embarazo ectópico. Resultados: El resultado quirúrgico de la intervención arrojó una trompa derecha aumentada de tamaño, rota, sangrante y cuyo reporte de anatomía patológica fue un embarazo tubárico roto y aumento de volumen del útero de aspecto gestante. En el postoperatorio mediato se realiza ecosonograma transvaginal evidenciándose embarazo intrauterino de 7 semanas + 2 días, por lo cual fue egresada con el diagnóstico de embarazo heterotópico. Conclusión: Se define embarazo heterotópico como la gestación intrauterina y extrauterina que coexisten de forma simultánea. Este se manifiesta como cuadros de dolor abdominal, signos de shock hipovolémico y en raras ocasiones escaso sangrado genital. Es una patología poco frecuente cuando se presenta de manera espontánea(AU)

Methods: We present a case of a female patient aged 31 with abdominal pain of high intensity , sharp stabbing pain, right lower quadrant , with abrupt onset, with signs of peritoneal irritation and ß-HCG positive, disease pattern of acute abdomen ectopic pregnancy. Results: Surgical intervention resulted in a raised right Falopian tube, broken, bleeding and resulting pathology reported broken tubal pregnancy and increased uterine volume of pregnant look. In the immediate postoperative transvaginal sonogram is performed evidencing intrauterine pregnancy 7 weeks + 2 days, which was discharged with the diagnosis of heterotopic pregnancy. Conclusion: Heterotopic pregnancy is defined as intrauterine and extrauterine gestation coexisting simultaneously. This manifests as abdominal pain, signs of hypovolemic shock and rarely scarce genital bleeding. It is a rare disease when it occurs spontaneously(AU)

Misdiagnosis and delayed diagnosis for ectopic and heterotopic pregnancies after in vitro fertilization and embryo transfer / 华中科技大学学报（医学）（英德文版）

This study examined the misdiagnosis and delayed diagnosis factors for ectopic pregnancy (EP) and heterotopic pregnancy (HP) after in vitro fertilization and embryo transfer (IVF-ET) in an attempt to reduce the diagnostic error. Clinical data of patients who underwent IVF-ET treatment and had clinical pregnancy from 12463 cycles were retrospectively analyzed. Their findings of serum β-hCG test and transvaginal ultrasonography were also obtained during follow-up. These patients were divided into two groups according to the diagnosis accuracy of EP/HP: early diagnosis and misdiagnosis/delayed diagnosis. The results showed that the incidence of EP and HP was 3.8% (125/3286) and 0.8% (27/3286) respectively for IVF/ICSI-ET cycle, and 3.8% (55/1431) and 0.7% (10/1431) respectively for frozen- thawed embryo transfer (FET) cycle. Ruptured EP occurred in 28 patients due to initial misdiagnosis or delayed diagnosis. Related factors fell in 3 categories: (1) clinician factors: misunderstanding of patients' medical history, insufficient training in ultrasonography and unawareness of EP and HP; (2) patient factors: noncompliance with medical orders and lack of communication with clinicians; (3) complicated conditions of EP: atypical symptoms, delayed elevation of serum β-hCG level, early rupture of cornual EP, asymptomatic in early gestation and pregnancy of unknown location. All the factors were interwoven, contributing to the occurrence of EP and HP. It was concluded that complicated conditions are more likely to affect the diagnosis accuracy of EP/HP after IVF-ET. Transvaginal ultrasonography should be performed at 5 weeks of gestation. Intensive follow-up including repeated ultrasonography and serial serum β-hCG tests should be performed in patients with a suspicious diagnosis at admission.

Ruptured Heterotopic Tubal Pregnancy for a Patient with a History of Segmental Salpingectomy from Ectopic Pregnancy: A Case Report

Heterotopic pregnancy refers to the simultaneous development of an intrauterine pregnancy and an extrauterine pregnancy. We experienced a case of a ruptured heterotopic pregnancy for a patient with a history of a right segmental salpingectomy from an ectopic pregnancy. The 30-year-old patient with amenorrhea for six weeks complained of lower abdominal pain with hypovolemic shock. Transabdominal ultrasonography showed diffuse hemoperitoneum with a structure similar to an ectatic tube or a deformed cyst with no echogenic double ring or peripheral hypervascularity in the right adnexa and an intrauterine gestational sac. We considered a ruptured corpus luteum cyst as an ultrasonographic finding and found a ruptured tubal mass in the right salpinx and hemoperitoneum through an emergency laparotomy. We performed a right salpingectomy, and the histopathologic report confirmed ectopic pregnancy.