Ultrasound diagnosis and laparoscopic treatment of a heterotropic pregnancy

Heterotropic pregnancy is a rare condition in which both intrauterine and extrauterine pregnancies are present at the same time. This rare condition is a serious emergency that can be life-threatening due to bleeding in cases of delayed diagnosis. The main goal of treatment is to maintain the intrauterine pregnancy while terminating the extrauterine pregnancy. Termination of extrauterine pregnancy can be carried out using either surgical treatments or non-surgical treatments. The management remains controversial. In case of a diagnosis of heterotopic pregnancy is hemodynamically stable, conservative management may be considered. Non-surgical treatments consists of administration of several drugs to the extrauterine gestational sac under ultrasonographic or laparoscopic guidance. Surgical treatment is warranted when conservative treatment fails or there is accompanying hemoperitoneum. Surgery can be performed either with laparotomy or laparoscopic approach. Since laparoscopic approach has several advantages over laparatomy including reduced recovery time, reduced requirement for antibiotics and analgesics. We report a case of a 31 year old woman who was admitted through emergency department with delayed menstruation and vaginal bleeding. Her ultrasound scan revealed heterotopic pregnancy with one intrauterin fetus of about 7 weeks and the second fetus of about 7 weeks in the left tubal area, both with fetal cardiac activity. She was hemodynamically stable at the time of presentation. After the patient and her husband were given informed consent she underwent laparoscopy and left salpingo-oophorectomy was performed. On the second day after surgery she was discharged from the hospital. Two weeks after the surgery the patient was called for control and her ultrasound revealed an ongoing intrauterine live pregnancy.

Keywords

Heterotopic pregnany, laparoscopic surgery

	File/Dsecription
	Figure 1 2d vaginal ultrasound of heterotopic pregnancy
	Figure 2 3d vaginal ultrasound of heterotopic pregnancy
	Figure 3 Laparoscopic image of left tubal ectopic pregnancy