Dr. Poonam Khera
Senior Consultant
Obstetrics and Gynaecology
BLK Super Speciality
Hospital, New Delhi


Dr. Kanika Garg
Attending Consultant
Obstetrics and Gynaecology
BLK Super Speciality
Hospital, New Delhi

Heterotopic Pregnancy is defined as the presence of multiple gestations, one being in the uterine cavity and the other outside the uterus commonly in the fallopian tube, and sometimes in the cervix or ovary. It can be a life threatening condition and can be easily overlooked during diagnosis. Timely diagnosis and intervention can save the life of the patient and also the intrauterine pregnancy. Three cases of Heterotopic Pregnancy were managed with successful outcomes (have mentioned first two succsessful cases here).

THE CASES

First Case: A 25 year old woman having 5.4 weeks of amenorrhea came in with right sided pelvic pain and clinical features of shock. Transvaginal ultrasound revealed single intrauterine live pregnancy of 5 weeks 5 days with a large complex heterogeneous irregular mass approximately 5.8 x 4.7 cm in the right adnexal region with moderate amount of free fluid in pelvis, suggestive of ruptured ectopic pregnancy.

THE PROCEDURE

The patient underwent emergency Laparotomy. There was ruptured right-sided tubal pregnancy with approximately 1000 cc of haemoperitoneum. A right Salpingectomy was performed and the patient received 2 units of blood. The intrauterine live gestation was allowed to continue. The patient delivered a healthy live baby at full term through caesarean section.

Second Case: A 23 year old woman was admitted with 8 weeks of amenorrhea, pain in abdomen and bleeding per vaginum since day one. Trans-abdominal ultrasound revealed single live foetus 6 weeks 2 days old with small subchorionic bleed and a small solid mass adjacent to the left ovary. The patient underwent serial ultrasound on 7th and 15th day, which showed an increase in the size of the solid mass from 3.4 x 2.4 cm to 6.7 x 4.3 cm with intra uterine 8 weeks 4 days live pregnancy. In view of increasing size of left tubo-ovarian mass and patient being haemodynamically stable, a decision for ‘Laparotomy and Proceed’ was taken on the same day.

THE PROCEDURE

Excision of the tubo-ovarian mass with left side Salpingectomy and removal of blood clots was done. The tissue was sent for histopathology which confirmed conception thus corroborating the diagnosis of Heterotopic Pregnancy. The patient subsequently delivered a full term baby through vaginal route.

THE RESULT

With timely diagnosis and management, life-threatening complications of Heterotopic Pregnancy can be avoided and normal intrauterine pregnancy can be continued for a healthy mother and foetus.

Full article “Successful Management of diverse types of Heterotopic Pregnancies” is published in ‘Astrocyte’, April - June, 2016, Issue1, Vol.3