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1.
JBRA Assist Reprod ; 23(3): 290-296, 2019 08 22.
Article in English | MEDLINE | ID: mdl-31091055

ABSTRACT

Heterotopic cervical pregnancy is an uncommon condition, with a rising incidence due to the increasing number of pregnancies resulting from in-vitro fertilization (IVF). Although it is associated with maternal-fetal complications, there is no consensus in the literature about the best approach for this condition. This study aims to report a case of cervical heterotopic gestation after IVF in which the intrauterine pregnancy was preserved, with spontaneous elimination of the cervical gestational sac after patient sedation and introduction of the vaginal speculum. In addition, we reviewed the literature on the subject, which demonstrated that most cases have a favorable outcome, especially after treatment with surgical excision of the cervical pregnancy. The growing body of evidence is still scarce to define the best treatment for this condition.


Subject(s)
Cervix Uteri/pathology , Fertilization in Vitro/adverse effects , Pregnancy, Heterotopic/diagnosis , Pregnancy, Heterotopic/etiology , Adult , Female , Humans , Pregnancy , Pregnancy, Heterotopic/pathology , Pregnancy, Heterotopic/therapy
2.
Rev. cuba. obstet. ginecol ; 45(1): 86-95, ene.-mar. 2019. graf
Article in Spanish | LILACS, CUMED | ID: biblio-1093626

ABSTRACT

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)


Subject(s)
Humans , Female , Pregnancy , Adult , Pregnancy, Heterotopic/pathology , Pregnancy, Heterotopic/diagnostic imaging , Hemoperitoneum/surgery
3.
Int J Gynecol Pathol ; 36(5): 428-432, 2017 Sep.
Article in English | MEDLINE | ID: mdl-28800576

ABSTRACT

We report a rare case of heterotopic pregnancy with intrauterine normal gestation alongside tubal complete hydatidiform mole (CHM) that resulted in a viable pregnancy after removal of molar tissue. Because of their rarity and inherent complexity, such cases represent a significant challenge in diagnosis and management. A 34-year-old female in her 10th week of gestation presented with nausea, vomiting, and intermittent abdominal pain that progressively worsened. Imaging studies revealed a normal intrauterine fetus and an 11-cm heterogenous mass in the left adnexal region. The patient's serum human chorionic gonadotropin was higher than the reference range. Diagnostic laparoscopy revealed a large hemorrhagic mass involving the left adnexa that was removed completely. The mass was composed of blood clots admixed with necrotic tissue of vesicular appearance on gross inspection. Microscopic examination revealed large chorionic villi with circumferential trophoblastic proliferation and cisterns, all of which are characteristic of CHM. An implantation site was identified at the tubal fimbriae. Immunohistochemistry p57 demonstrated negative staining in the villous stromal and cytotrophoblastic cells, supporting the diagnosis of CHM. Chromosomal karyotyping and cytogenetic analysis were performed on chorionic villi samples from the intrauterine gestation and reported as normal (46, XX). The patient elected to continue the intrauterine pregnancy, delivering a healthy female infant at 39 weeks. Our case reaffirms that to successfully manage this rare yet life-threatening condition, heterotopic pregnancy should be included in the differential diagnosis for any gravid women presenting with persistent abdominal pain and/or extrauterine mass.


Subject(s)
Hydatidiform Mole/diagnostic imaging , Pregnancy, Heterotopic/diagnostic imaging , Uterine Neoplasms/diagnostic imaging , Adult , Chorionic Villi/diagnostic imaging , Chorionic Villi/pathology , Female , Humans , Hydatidiform Mole/pathology , Pregnancy , Pregnancy Outcome , Pregnancy, Heterotopic/pathology , Trophoblasts/pathology , Uterine Neoplasms/pathology
4.
J Radiol Case Rep ; 9(7): 38-46, 2015 Jul.
Article in English | MEDLINE | ID: mdl-26629296

ABSTRACT

Heterotopic pregnancy is the occurrence of simultaneous intrauterine and extrauterine pregnancies. Heterotopic pregnancy most commonly occurs during the first trimester of pregnancy in women who have significant risk factors including assisted reproductive therapy, prior ectopic pregnancy, and prior pelvic surgery or pelvic inflammatory disease. Although rare, heterotopic pregnancy must be recognized using ultrasound so as to provide appropriate treatment to the extrauterine pregnancy with the goal of preserving the intrauterine pregnancy. The case presented describes a patient with a pathologically proven (figure 8A and 8B), surgically treated 1st trimester heterotopic pregnancy.


Subject(s)
Hemorrhage/pathology , Pregnancy, Heterotopic/pathology , Pregnancy, Tubal/pathology , Sterilization Reversal , Sterilization, Tubal , Adult , Diagnosis, Differential , Female , Hemorrhage/diagnostic imaging , Hemorrhage/surgery , Humans , Pregnancy , Pregnancy Trimester, First , Pregnancy, Heterotopic/diagnostic imaging , Pregnancy, Heterotopic/surgery , Pregnancy, Tubal/diagnostic imaging , Pregnancy, Tubal/surgery , Risk Factors , Ultrasonography, Prenatal
5.
Akush Ginekol (Sofiia) ; 52(4): 33-7, 2013.
Article in Bulgarian | MEDLINE | ID: mdl-24283077

ABSTRACT

The authors describe a rare case of bilateral tubal pregnancy after IVF. The patient is with secondary infertility. The preceding diagnostic laparoscopy excluded the presence of tubal factor. The results of the spermogram show average to severe form of Oligoasthenozoospermia. Short protocol with GnRH-antagonist was performed and two embryos were transferred on the third day. On the 36th day after the embryo transfer the patient was hospitalized with abdominal pain in the right hypogastric region, clinical and ultrasound indications for hemoperitoneum. Urgent laparotomy was performed followed by salpingectomy dextra due to hemoperitoneum caused by tubal abortion. The examination of the left adnexa reveals uruptured tubal pregnancy in the isthmic part of the tube and the decision for salpingectomy sinistra was taken. Histological examinations confirmed the diagnosis of ectopic pregnancy in both tubes. The frequency of some rare forms and localizations of ectopic as well as heterotopic pregnancies increase after ART.


Subject(s)
Fallopian Tubes/surgery , Fertilization in Vitro/adverse effects , Pregnancy, Heterotopic/etiology , Pregnancy, Heterotopic/surgery , Pregnancy, Tubal/etiology , Pregnancy, Tubal/surgery , Adult , Embryo Transfer/adverse effects , Fallopian Tubes/pathology , Female , Humans , Laparotomy , Pregnancy , Pregnancy, Heterotopic/diagnosis , Pregnancy, Heterotopic/pathology , Pregnancy, Tubal/diagnosis , Pregnancy, Tubal/pathology , Salpingectomy
6.
J Reprod Med ; 58(11-12): 541-4, 2013.
Article in English | MEDLINE | ID: mdl-24568051

ABSTRACT

BACKGROUND: Heterotopic pregnancy, or simultaneous intrauterine and extrauterine pregnancy, occurs rarely. Consequently, clinicians might not always consider a diagnosis of heterotopic pregnancy. Transvaginal ultrasound or other imaging modalities cannot be completely relied upon to exclude heterotopic pregnancy from the differential diagnosis of pregnant patients with abdominal pain. CASE: A 32-year-old woman, G5 P3105, presented to the emergency room with acute onset of diffuse abdominal pain. Ultrasound demonstrated an approximately 8-week intrauterine pregnancy. The patient underwent exploratory laparotomy for suspected torsion of a right ovarian cyst. Repeat exploratory laparotomy was required due to symptomatic anemia. The patient underwent exploratory laparotomy and right salpingo-oophorectomy. Pathology results demonstrated a right tubal ectopic pregnancy. CONCLUSION: Surgical and medical options exist for heterotopic pregnancy management. Despite negative heterotopic pregnancy results for transvaginal ultrasound, the possibility of heterotopic pregnancy should remain within the differential diagnosis of any pregnant patient with either natural or assisted reproduction technology intrauterine pregnancy who presents with abdominal pain and/or clinical signs of ectopic pregnancy.


Subject(s)
Pregnancy, Heterotopic/diagnosis , Pregnancy, Heterotopic/surgery , Abdominal Pain , Adult , Female , Gestational Age , Humans , Ovariectomy , Parity , Pregnancy , Pregnancy, Heterotopic/pathology , Salpingectomy , Ultrasonography, Prenatal
7.
Pan Afr Med J ; 16: 106, 2013.
Article in English | MEDLINE | ID: mdl-24876895

ABSTRACT

Heterotopic pregnancy is very rare under natural circumstances. We report the case of a 28 year old Gravida2 Para1001 woman at 9 weeks of pregnancy who consulted in emergency for acute pelvic pain following metrorrhagia. Physical exam revealed hemoperitoneum without shock. An emergency ultrasonography revealed two gestational sacs, one intra-uterine and the other extra-uterine. Laparotomy was done and the findings were: a ruptured right tubal pregnancy with 1,300 milliliters of hemoperitoneum, type B left utero-adnexal adhesions and an increased uterus consistent with a 9 weeks pregnancy. Right total salpingectomy was done and the patient did well postoperatively. That intrauterine pregnancy evolved normally under progesterone supply and the woman delivered a termed live female baby weighing 3.1 kilogrammes. In our context where ultrasound is not always available, practitioners carrying out salpingectomy for ruptured ectopic pregnancies should bear in mind the plausibleness of heterotopic pregnancy in order to properly handle the uterus.


Subject(s)
Pregnancy Outcome , Pregnancy, Heterotopic/diagnosis , Pregnancy, Tubal/diagnosis , Adult , Cameroon , Female , Humans , Laparotomy , Pregnancy , Pregnancy, Heterotopic/diagnostic imaging , Pregnancy, Heterotopic/pathology , Pregnancy, Tubal/diagnostic imaging , Pregnancy, Tubal/pathology , Rupture, Spontaneous , Salpingectomy/methods , Ultrasonography, Prenatal/methods
8.
Prog. obstet. ginecol. (Ed. impr.) ; 54(5): 242-245, mayo 2011. ilus
Article in Spanish | IBECS | ID: ibc-142944

ABSTRACT

El embarazo heterotópico es una situación potencialmente fatal, que es raro que ocurra en una concepción natural, y más raramente todavía se diagnostica en ausencia de síntomas. Además, probablemente debido al bajo índice de sospecha de embarazo heterotópico en las gestaciones no estimuladas, el porcentaje de complicaciones clínicas graves (hemoperitoneo, rotura tubárica, abdomen agudo) es superior en este grupo de pacientes. En nuestro caso se trata de una paciente nulípara de 33 años de edad, con gestación espontánea, que acudió a las 6 semanas y 3 días de amenorrea para su primer control rutinario, en ausencia de síntomas. El estudio ecográfico evidenció una imagen gestacional intraútero y otra junto a ovario derecho. Se realizó una laparoscopia con salpingectomía, incluyendo el embarazo ectópico. A las 38 semanas de gestación dio a luz un recién nacido sano sin complicaciones. Es posible el diagnóstico de un embarazo heterotópico tras concepción natural, incluso en ausencia de síntomas. Es importante realizar una visualización sistema ́tica de los anexos en la primera ecografía, que además de descartar la presencia de enfermedad ovárica, puede diagnosticar la presencia de un embarazo heterotópico, incluso en ausencia de síntomas y complicaciones (AU)


Heterotopic pregnancy is a potentially fatal situation that rarely occurs in a natural conception. Diagnosis in the absence of symptoms is even more exceptional. Furthermore, due to the low index of suspicion of heterotopic pregnancy in natural conceptions, the incidence of serious clinical complications (hemoperitoneum, tubal rupture, acute abdomen) is greater in this group of patients. We report the case of a 33-year-old primigravida with a spontaneous pregnancy who attended her first prenatal visit at 6 weeks and 3 days of amenorrhea. The patient was asymptomatic. Vaginal ultrasound scan showed two gestational sacs, an intrauterine sac and an extrauterine sac next to the right ovary. A laparoscopic right salpingectomy was performed to remove the ectopic pregnancy. A healthy neonate was delivered at 38 weeks’ gestation without complications. Heterotopic pregnancy can be diagnosed after spontaneous conception, even in asymptomatic patients. It is important to carry out routine examination of the adnexae in the first ultrasound scan to exclude ovarian disease and diagnose (or exclude) the presence of asymptomatic heterotopic pregnancy (AU)


Subject(s)
Female , Humans , Pregnancy , Pregnancy, Heterotopic/genetics , Pregnancy, Heterotopic/pathology , Ultrasonography, Prenatal/methods , Ultrasonography, Prenatal/standards , Amenorrhea/metabolism , Amenorrhea/pathology , Shock, Septic/blood , Laparoscopy/methods , Pregnancy, Heterotopic/diagnosis , Pregnancy, Heterotopic/metabolism , Ultrasonography, Prenatal/classification , Ultrasonography, Prenatal , Amenorrhea/complications , Amenorrhea/diagnosis , Shock, Septic/metabolism , Laparoscopy/standards
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