The heterotopic pregnancy is a combination of an intrauterine and extrauterine pregnancy, at the same time. Cornual heterotopic pregnancy is an uncommon gynecological event. If quantitative serum betahcg is tubal heterotopic pregnancy include either laparoscopy or laparotomy for removal of the ectopic pregnancy, which may require salpingostomy or salpingectomy. Heterotopic pregnancy, abdominal pregnancy, laparoscopy the prevalence of heterotopic pregnancies after the use of assisted reproductive technology art is reportedly as high as 1% 1 x 1. All pregnancies had been conceived with intrauterine insemination, without the need for ovulation induction. We present an unusual case of a heterotopic pregnancy which was misdiagnosed in the first trimester as a dichorionic twin pregnancy. A possible pregnancy must be considered in any woman who has abdominal pain or abnormal vaginal bleeding.
To be able to identify cases in which heterotopic pregnancy must be considered. This was successfully treated with laparoscopic right salpingectomy. In each case, one of two techniques was usedtubal aspiration or. Heterotopic pregnancy presenting as spontaneous hemothorax. General principles of laparoscopic surgery are also applicable to pregnant women. A case of heterotopic pregnancy managed with laparoscopic surgery. Laparoscopic management of ectopic pregnancies is becoming more common. Laparoscopic management of ruptured heterotopic pregnancy after. Pdf ectopic pregnancy means implantation of fertilized ovum outside the endometrial lining of the uterus. She maintained a viable intrauterine pregnancy and was 32 weeks gestation with no. Human reproduction the role of laparoscopy in the diagnosis and management of heterotopic pregnancies c. Ppt ectopic pregnancy powerpoint presentation free to. The ectopic pregnancy was successfully treated via laparoscopic surgery.
Laparoscopic management of a spontaneous 12th week. Ectopic pregnancy, laparoscopy, methotrexate, tubal function, nontubal. Seventeen women underwent laparoscopic surgery for heterotopic pregnancy. Laparoscopic salpingectomy was done and patient delivered at 39 weeks. Cornual heterotopic pregnancy is a very rare condition. Heterotopic pregnancy after ovulation induction and assisted reproductive technologies a literature. An ectopic pregnancy occurs as the fertilized egg gets attached to the organs other than within the uterus. Laparoscopic treatment was successful in a previous case series, with most patients 10 of receiving salpingectomy. Diagnosis and management of ectopic pregnancy this guideline replaces the management of tubal pregnancy, which was published in 2004.
Understand the utility of laparoscopy in treatment of heterotopic pregnancy. Pdf on sep 1, 2016, gloria calagna and others published laparoscopic management of quadruplet heterotopic pregnancy after ovarian stimulation cycle find, read and cite all the research you. Laparoscopic tubepreserving surgical procedures for ectopic tubal. A cornual heterotopic pregnancy was diagnosed at 9 weeks of amenorrhoea in a 31yearold healthy woman. At weeks of gestation, the patient presented with an acute abdomen, she was diagnosed with a heterotopic pregnancy, and therefore was operated on, with the excision of the ruptured fallopian tube and the ectopic pregnancy performed. Blood tests and ultrasound can be used to differentiate these. Heterotopic pregnancy, ectopic pregnancy, natural conception, transvaginal ultrasonography. The coexistence of intrauterine and ectopic pregnancy heterotopic pregnancy occurs in 000 of spontaneous pregnancies. Laparoscopic management of heterotopic pregnancya rare. Laparoscopic treatment of cornual heterotopic pregnancy.
It is a potentially lifethreatening condition with diagnostic and therapeutic complexities. Sixty cases of ectopic pregnancy were treated by laparoscopy without laparotomy. If necessary, the doctor usually can remove the ectopic pregnancy. Heterotopic pregnancy is a rare clinical condition, but it is increasingly being diagnosed after the common use of ovarian stimulation and the advent of assisted reproductive techniques. Heterotopic gestation is defined as the coexistence of uterine and extrauterine gestation commonly in the fallopian tube and uncommonly in the cervix or ovary. Heterotopic pregnancy in a spontaneous conception is a rare and lifethreatening condition. Heterotopic pregnancy is defined as presence of coexisting ectopic and intrauterine gestations simultaneously. A 35yearold woman was referred to our department for the further management of a heterotopic interstitial pregnancy. Ectopic pregnancy, in which a fertilized ovum implants outside of the endometrial cavity, remains one of the leading causes of firsttrimester maternal morbidity and mortality in the developed world. However, it is getting more common at 1900 in clomiphene citrateinduced pregnancies and rises to 1% in assisted reproduction. Two cases of heterotopic pregnancy, successful laparoscopic removal of one ectopic pregnancy, and a subsequent favorable outcome of the intrauterine pregnancy, are presented. Winner of the standing ovation award for best powerpoint templates from presentations magazine. Pdf laparoscopic management of quadruplet heterotopic.
A small telescope called a laparoscope is placed into the abdominal cavity through a small incision cut in the navel. Given the diagnostic complexities of ectopic and failed pregnancies and the fact that diagnostic laparoscopy yields up to 2% falsepositive and 4. Heterotopic pregnancy is a dangerous condition if it is not caught early on. To report a case of laparoscopic treatment of a heterotopic primary abdominal pregnancy after ivf with preservation of the concurrent intrauterine pregnancy. Laparoscopic management of heterotopic interstitial. Heterotopic pregnancy with successful pregnancy outcome. Successful laparoscopic management of heterotopic pregnancy at. Heterotopic pregnancy is the existence of two simultaneous pregnancies with separate implantation sites, one of which is a viable intrauterine pregnancy occurring in the uterus and the other of which is a nonviable ectopic pregnancy occurring outside of the uterus, usually in a fallopian tube. Characteristics of patients with heterotopic pregnancy the absence of any clinical abnormality, in 54% of our cases, case age history actual pregnancy and 30% of the cases reported by others rizk et al. Pituitary downregulation with luteal leuprolide acetate, ovulation induction with menotropins, ivfet, progesterone in oil for luteal support, laparoscopy, and resection of the abdominal gestation. Most patients do not see a doctor until the fallopian tube ruptures. We report a case of cornual heterotopic pregnancy managed by laparoscopy and guided methotrexate injection into the cornual sac.
More than 100,000 cases occur annually in the united states with the vast majority 99% of eps. All of the 14 cases were followed up for 8 years after surgery. Laparoscopic management of ruptured heterotopic pregnancy. In our case, laparoscopy turned out to be an adequate treatment modality for a heterotopic pregnancy of 12 weeks of gestation. Worlds best powerpoint templates crystalgraphics offers more powerpoint templates than anyone else in the world, with over 4 million to choose from. Heterotopic pregnancy presenting as spontaneous hemothorax tracey h deyoung1, julie r whittington2 and timothy e sayles1 1department of obstetrics and gynecology, naval medical center portsmouth, portsmouth, va, usa 2department of obstetrics and gynecology, university of arkansas for medical sciences, little rock, ar, usa corresponding author.
Duverney was the first to report heterotopic pregnancy, in 1708, after finding an intrauterine pregnancy during the autopsy of a woman who had died from a ruptured ectopic pregnancy. Full textpdf international journal of womens health and. Laparoscopy is emerging as an alternative to laparotomy for definitive diagnosis and treatment of surgical conditions arising in pregnancy. A heterotopic pregnancy may have similar signs and symptoms as a normal intrauterine pregnancy, a normal intrauterine pregnancy and a ruptured ovarian cyst, a corpus luteum, or appendicitis. In all, 60% of intrauterine pregnancies that were viable at the time of diagnosis of the heterotopic pregnancy had a favourable outcome. Introduction heterotopic pregnancy is the coexistence of intrauterine pregnancy iup and extrauterine gestation 1,2. The spontaneous heterotopic pregnancy is a rare illness with an estimated frequency below one per 20,000 and one per 30,000 3. Laparotomy may be the treatment of choice in cases with serious intraabdominal bleeding or in patients with hemodynamic instability due to hemorrhagic shock. Management and outcome of heterotopic pregnancy insight. The fi rst case was reported in france by duverney in 1708 during an autopsy 4.
Medical therapy any pregnancy located outside of the uterine cavity is defined as an ectopic pregnancy ep which occur approximately in 1. Pdf role of laparoscopy in management of ectopic pregnancy. Ectopic pregnancy of hp can be treated by potassium chloride injection and or methotrexate in the gestational sac, laparoscopic surgery and laparotomy. Theyll give your presentations a professional, memorable appearance the kind of sophisticated look that todays audiences expect. To present our experience with laparoscopic tubepreserving surgery for ectopic tubal pregnancy and evaluate its.
Treatment of ectopic pregnancy by means of laparoscopy. Laparoscopy allows both diagnosis and treatment, and the outcome of the intrauterine pregnancy is comparable to that obtained with laparotomy. The role of laparoscopy in the diagnosis and management of. They can be removed safely by laparoscopic surgery. Pdf laparoscopic salpingectomy for heterotopic pregnancy. Case report a 28yearold gravida 1, parity 0 woman was admitted to the emergency department for acute abdomenal pain. The patient presented with both a sonographically confirmed intrauterine pregnancy and concomitant cornual pregnancy. In this report we present a case of spontaneously developed 12th week heterotopic tubal pregnancy that was successfully treated by salpingectomy by laparoscopy. Spontaneous heterotopic pregnancy successfully treated via. Meisch abstract the increasing frequency of pelvic inflammatory disease and use of ovulationinduction agents has resulted in a corresponding increase in the frequency of heterotopic pregnancy. The management of heterotopic pregnancy is laparoscopy or laparotomy for the tubal pregnancy.
Heterotopic abdominal pregnancy treated at laparoscopy. Laparoscopy in heterotopic pregnancy the role of laparoscopy in the diagnosis and management of hetertopic pregnancy is very important as heteropic pregnancy rate increase with ivf. The patient was provisionally diagnosed as having an appendicular mass and was managed conservatively, however a diagnostic laparoscopy revealed the presence of an ectopic tubal pregnancy. Laparoscopy for ectopic pregnancy is the most used surgery chosen by obstetrics and gynecologists for its treatment. Laparoscopy is an outpatient surgical procedure requiring general anesthesia. What you should know about heterotopic pregnancy mdedge. Laparoscopic cornuostomy or cornual repair appears to be an effective treatment for chp. Introduction a heterotopic pregnancy is multiple pregnancies with one or more intrauterine pregnancies coexisting with an. This heterotopic pregnancy was the first episode of pregnancy after the patient received an ivf for primary infertility due to previous surgeries which included right salpingectomy and left tubal pregnancy, respectively. A woman with a heterotopic abdominal pregnancy after ivfet. Triplet and quadruplet heterotopic gestation have also been reported, though the incidence was extremely rare pregnancy.
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