Successful Management of diverse types of
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).
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
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.
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.
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