Blog
About

  • Record: found
  • Abstract: found
  • Article: found
Is Open Access

Spontaneous Heterotopic Triplet Pregnancy With Tubal Rupture : A Case Report and Literature Review

, MBBS, BBMedSci , 1 , , MBBS, RANZCOG MRCOG 2

Journal of Investigative Medicine High Impact Case Reports

SAGE Publications

heterotopic pregnancy, laparoscopy, ectopic pregnancy, transvaginal ultrasound

Read this article at

Bookmark
      There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

      Abstract

      The recent increase in heterotopic pregnancies has been largely attributed to the increased use of assisted reproduction technologies. We report the rare case of a multiparous woman with a spontaneous conception resulting in a triplet heterotopic pregnancy: a twin intrauterine pregnancy and a single right tubal ectopic pregnancy. Heterotopic pregnancy is a rare and potentially life-threatening condition in which simultaneous gestations occur at 2 or more implantation sites. It is infrequent in natural conception cycles, occurring in 1:30 000 pregnancies. However, the prevalence is rising with the increased use of assisted reproduction techniques to that of 1:100 to 1:500 in these patient subgroups, highlighting the need to incorporate it into a clinician’s diagnostic algorithm.

      Related collections

      Most cited references 22

      • Record: found
      • Abstract: found
      • Article: not found

      Heterotopic pregnancy after ovulation induction and assisted reproductive technologies: a literature review from 1971 to 1993.

      To review and analyze records on heterotopic pregnancy occurring after ovulation induction and assisted reproductive technologies. Case reports in the English literature related to the topic were identified through a computerized bibliography search up to December 1993. The incidence of heterotopic pregnancies increased in recent years because of the escalating use of new reproductive technologies in infertile patients and has stabilized at approximately 1:100 pregnancies with these procedures. The main reasons for development of such a condition in these patients are past tubal or pelvic disease and multiple ovulations or multiple ET. Progress has been made in diagnosis of heterotopic pregnancy during the last two decades, mainly because of development of ultrasonographic techniques, especially transvaginal ultrasonography. Treatment of heterotopic pregnancy should be prompt to avoid maternal morbidity and mortality from extensive intraperitoneal bleeding. No increased intrauterine fetal mortality due to hemoperitoneum has been proven in the present review, except in advanced cornual pregnancies. More experience is needed for application of new treatment modalities such as salpingocentesis, which are used successfully for ectopic pregnancy, in treatment of heterotopic pregnancy. With early diagnosis and skillful treatment, the outcome of the intrauterine pregnancy is favorable and its survival rate should increase in the future.
        Bookmark
        • Record: found
        • Abstract: found
        • Article: not found

        Risk factors for ectopic pregnancy in assisted reproduction.

        To identify risk factors for ectopic pregnancy (EP) after IVF-ET. Retrospective cohort study. In vitro fertilization clinic at a university hospital. A total of 725 women who conceived after IVF were studied with regard to background factors, indications for IVF, and factors related to the IVF procedure through review of their medical charts. The rate of EP was 4%, corresponding with 29 EPs, of which 2 were heterotopic. None. Pregnancy outcome, defined as intrauterine pregnancy or EP. Background factors, indications for IVF, and factors related to the IVF procedure were analyzed for possible correlation with the outcome of EP. Risk factors for EP were identified by logistic regression analysis. Tubal factor infertility, various previous abdominal surgeries, previous EP or pelvic infection, presence of a hydrosalpinx or fibroid, and type of transfer catheter used showed a positive correlation with EP as outcome. Logistic regression analysis identified two factors with predictive power: tubal factor infertility and previous myomectomy. Tubal factor infertility was the most prominent risk factor for EP after IVF. Previous myomectomy appeared to be another important risk factor, but this is a new finding that needs to be confirmed by further study.
          Bookmark
          • Record: found
          • Abstract: found
          • Article: not found

          Cornual heterotopic pregnancy: contemporary management options.

          This review covers the clinical presentations, treatments, and outcomes of cornual heterotopic pregnancies reported in the literature. Infertile women with a history of ectopic pregnancy, tubal surgery, or disease are at increased risk for cornual heterotopic pregnancy when they undergo in vitro fertilization. Women who have undergone bilateral salpingectomy also seem to be predisposed to this condition when they undergo in vitro fertilization. We recommend that these patients be followed up closely after a successful in vitro fertilization cycle with monitoring of serum beta-human chorionic gonadotropin levels and serial transvaginal ultrasonography because of the high associated morbidity. Laparotomy remains the treatment of choice for rupture of a cornual heterotopic pregnancy. In the absence of cornual rupture, however, medical management is an option that eliminates the risk of surgery and anesthesia and results in outcomes similar to those associated with surgical treatment. Currently there is insufficient evidence to recommend any single treatment modality, and the decision should be based on such factors as clinical presentation, surgeon's expertise, side effects, overall cost, and the patient's preference.
            Bookmark

            Author and article information

            Affiliations
            [1 ]Royal Women’s Hospital, Melbourne, Victoria, Australia
            [2 ]Latrobe Regional Hospital, Traralgon, Victoria, Australia
            Author notes
            Lima Arsala, Royal Women’s Hospital, 20 Flemington Rd, Parkville, Victoria 3052, Australia. Email: l.arsala1@ 123456gmail.com
            Journal
            J Investig Med High Impact Case Rep
            J Investig Med High Impact Case Rep
            HIC
            sphic
            Journal of Investigative Medicine High Impact Case Reports
            SAGE Publications (Sage CA: Los Angeles, CA )
            2324-7096
            16 April 2014
            Apr-Jun 2014
            : 2
            : 2
            4528884
            10.1177/2324709614531556
            10.1177_2324709614531556
            © 2014 American Federation for Medical Research

            This article is distributed under the terms of the Creative Commons Attribution 3.0 License ( http://www.creativecommons.org/licenses/by/3.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page ( http://www.uk.sagepub.com/aboutus/openaccess.htm).

            Categories
            Article
            Custom metadata
            April-June 2014

            Comments

            Comment on this article