ABSTRACT
The expected trend in serum beta-human chorionic gonadotropin (ß-hCG) following treatment of an undesired heterotopic pregnancy with uterine aspiration and systemic methotrexate is not known. Thus, monitoring for treatment success is challenging. We describe an undesired heterotopic pregnancy treated with aspiration and two-dose methotrexate and report the observed ß-hCG trend.
Subject(s)
Abortifacient Agents, Nonsteroidal , Pregnancy, Heterotopic , Chorionic Gonadotropin , Chorionic Gonadotropin, beta Subunit, Human , Female , Humans , Methotrexate , Pregnancy , Pregnancy, Heterotopic/diagnostic imaging , Pregnancy, Heterotopic/drug therapy , Retrospective Studies , UterusABSTRACT
Introducción: la gestación heterotópica consiste en la coexistencia de una gestación intraútero y otra ectópica. La incidencia se ha multiplicado, debido especialmente a las técnicas de reproducción asistida. Es un cuadro infradiagnosticado. El diagnóstico será ecográfico o laparoscópico. Caso clínico: mujer de 27 años gestante en la semana 5 tras tratamiento con clomifeno que acude a urgencias por abdominalgia. En ecografía, saco gestacional intraútero y en anejo izquierdo saco de 5,73 mm con vesícula vitelina y líquido libre en Douglas. Ante la sospecha de gestación heterotópica se indica laparoscopia diagnóstico- terapéutica: trompa izquierda dilatada con embarazo tubárico. Se realiza salpinguectomía (AU)
Blackground: A heterotopic pregnancy is defined by the coexistence of an intrauterine pregnancy and ectopic pregnancy. The incidence of heterotopic pregnancy has increased due to Assisted Reproduction Therapy and it tends to be underdiagnosed. The diagnosis is made by Ultrasound and Laparoscopy. Case report: A 27-year-old woman in her fifth week of pregnancy, after treatment with Clomiphene comes to the emergency room for abdominal pain. A routine ultrasound finds an intrauterine gestational sac, along with a left adnexal mass resembling a gestational sac with vitelline vesicle and a collection in Douglas. A diagnostictherapeutic laparoscopy was performed, finding a left tubaric pregnancy which was removed by salpinguectomy (AU)
Subject(s)
Humans , Female , Pregnancy , Adult , Ovulation Induction/instrumentation , Ovulation Induction/methods , Pregnancy, Heterotopic/drug therapy , Clomiphene/therapeutic use , Reproductive Techniques, Assisted/instrumentation , Laparoscopy/methods , Salpingectomy/methods , Pregnancy, Tubal/chemically induced , Amenorrhea/complications , Amenorrhea/etiology , Ovary/pathology , Ovary , Gestational SacABSTRACT
OBJECTIVE: The aim of this study is to share a valuable experience of heterotopic pregnancy following in vitro fertilization. CASE REPORT: A 37-year-old, gravida 3, para 2 (cesarean section 2 times), woman underwent in vitro fertilization with three embryos transferred. On Day 23 after the embryo transfer, right tubal pregnancy with a 0.7-cm gestational sac was found by ultrasound, and her serum ß-human chorionic gonadotropin level was 81,388 mIU/mL. She underwent a laparotomy with right salpingectomy. On Day 43 after the embryo transfer, intermittent abdominal pains developed. A live fetus with a crown-rump length of 2.0 cm was found in the cul-de-sac. Under the diagnosis of abdominal pregnancy, she was admitted for sona-guided KCl and methotrexate injections. She received four units of packed red blood cells due to a drop in hemoglobin level from 12.5 g/dL to 8.6 g/dL. The patient recovered well, and the serum ß-human chorionic gonadotropin declined to <10 mIU/mL. CONCLUSION: Various forms of ectopic pregnancy should be kept in mind in early pregnancy following in vitro fertilization.
Subject(s)
Pregnancy, Heterotopic/diagnostic imaging , Pregnancy, Tubal/diagnostic imaging , Adult , Douglas' Pouch , Female , Fertilization in Vitro , Humans , Pregnancy , Pregnancy, Heterotopic/drug therapy , Pregnancy, Tubal/surgery , UltrasonographyABSTRACT
Introducción: La administración intraarterial de metotrexato junto a la embolización de arterias uterinas es una práctica segura, eficaz y con buenos resultados perinatales en el tratamiento de embarazo heterotópico cervical. Objetivo: Descripción de un embarazo heterotópico cervical y su tratamiento mediante administración intraarterial de metotrexato en las arterias uterinas. Sujetos y métodos: Mujer de 44 años, con gestación heterotópica después de transferencia de 2 embriones. La ecografía transvaginal reveló 2 embarazos viables: uno en el canal cervical y otro en la cavidad uterina. Se administra metotrexato intraarterial en las arterias uterinas por radiología intervencionista. Resultados: Finalización de ambas gestaciones con éxito, con una baja morbilidad materna y preservación de fertilidad futura. Conclusiones: El embarazo heterotópico cervical es un suceso muy infrecuente que se da particularmente después de tratamientos de reproducción asistida, pero presenta alta morbilidad materna. Factores como la infertilidad de la pareja o la presencia de otra gestación intrauterina dificultan tomar una decisión terapéutica. En nuestro caso, la paciente decidió finalizar ambas gestaciones y realizamos un tratamiento con metotrexato intraarterial, con una baja morbilidad materna y preservación del útero para gestación posterior (AU)
Introduction: Intra-arterial administration of methotrexate together with uterine artery embolization is safe, effective and has got good perinatal outcomes in the treatment of cervical heterotopic pregnancy. Objective: To describe a case of cervical heterotopic pregnancy and its treatment by intra-arterial methotrexate administration in the uterine arteries. Subjects and methods: A 44-year-old woman presented with a heterotopic pregnancy after transfer of 2 embryos. Transvaginal ultrasound revealed two viable pregnancies, one in the cervical canal and the other in the uterine cavity. Intraarterial methotrexate was administered in the uterine arteries by an interventional radiologist. Results: Both pregnancies were successfully terminated with low maternal morbidity and preservation of future fertility. Conclusions: Cervical heterotopic pregnancy is a very rare event that occurs particularly after assisted reproduction treatments and has high maternal morbidity. Therapeutic decision-making is complicated by factors such as infertility of the couple or the presence of another intrauterine pregnancy. In our case, the patient decided to terminate both pregnancies and intraarterial methotrexate was administered, with low maternal morbidity and preservation of the uterus for subsequent pregnancy (AU)
Subject(s)
Adult , Female , Humans , Methotrexate/administration & dosage , Pregnancy, Heterotopic/drug therapy , Injections, Intra-Arterial , Embolization, Therapeutic/methods , Patient Safety , Pregnancy Complications/drug therapyABSTRACT
BACKGROUND: Heterotopic abdominal pregnancies with coexisting intrauterine pregnancies pose unique therapeutic challenges, and management options, particularly nonsurgical approaches, are limited. CASE: We present a case in which selective reduction of a heterotopic abdominal pregnancy during the second trimester using fetal intracardiac injection with potassium chloride enabled subsequent vaginal delivery of the intrauterine pregnancy at term. In addition, we summarize nine cases of nonsurgical management of heterotopic abdominal pregnancies, four of which involve potassium chloride selective reduction. Our case is unique in that the abdominal fetus remained as a stable lithopedion, allowing the uncomplicated conception and vaginal delivery of a second intrauterine pregnancy without need for surgical intervention. CONCLUSION: Our case report and literature review demonstrate the use of selective potassium chloride reduction in managing heterotopic abdominal pregnancy nonsurgically.
