Heterotopic pregnancy after a spontaneous conception a case report with a review of clinical, laboratory and imaging findings

• Published in: Clinical case reports Vol. 9; no. 8; pp. e04649 - n/a
• Main Authors: Abdelmonem, Ahmed H., Sayed, Gamal, Abugazia, Abd Elwahid, Kohla, Samah, Youssef, Reda
• Format: Journal Article
• Language: English
• Published: England John Wiley & Sons, Inc 01.08.2021; John Wiley and Sons Inc; Wiley
• Subjects: Abdomen; Case Report; Case reports; ectopic tubal pregnancy; Fallopian tubes; Hematoma; heterotopic pregnancy; heterotrophic pregnancy; Inflammatory diseases; Laboratories; Magnetic resonance imaging; Maternal mortality; Ovaries; Patients; Pelvic inflammatory disease; pelvic MRI; Pregnancy complications; Reproductive technologies; Stillbirth; transvaginal Ultrasound; Ultrasonic imaging; Uterus; Vagina; heterotrophic pregnancy; pelvic MRI; ectopic tubal pregnancy; heterotopic pregnancy; transvaginal Ultrasound
• ISSN: 2050-0904; 2050-0904
• DOI: 10.1002/ccr3.4649

Heterotopic pregnancy (HP) describes the simultaneous presence of two pregnancies at different implantation sites. Usually, one pregnancy is intrauterine and the other one is ectopic. The incidence of HP after assisted reproductive technologies reaches 1:3900, but is very rare after a spontaneous pregnancy, with a reported incidence of 1 to 30,000 pregnancies. Due to its rarity, complex clinical picture, and laboratory findings, it is challenging to diagnose HP. We present a case of spontaneous HP diagnosed in the first trimester by ultrasound (US) and magnetic resonance imaging (MRI) and subsequently managed successfully. We present an analysis of the clinical and laboratory findings as well as imaging, including MRI that we used to diagnose the condition. Additionally, we performed a literature review. Conclusions HP is a very rare condition frequently faced in obstetrics, gynecology, and emergency departments that requires a high index of clinical suspicion. US remains the imaging modality of choice in diagnosing a HP, however, in some cases, an MRI with a reported safety in the first trimester, can be used to provide additional information over US. Heterotrophic pregnancies are rare, and can be life threatening if the diagnosis is missed. Magnetic resonance imaging can be a helpful adjunct to complement ultrasound in the diagnosis of selected cases. Treatment is essentially surgical and is usually performed by salpingectomy rather than salphingotomy.