Citation, DOI & article data
Heterotopic pregnancy is a rare situation when there is an intra-uterine and extra-uterine (i.e. ectopic) pregnancy occurring simultaneously.
The estimated incidence in the general population is estimated at 1:30,000 (for a naturally conceived pregnancy 7). The incidence among patients with assisted reproduction is higher and is thought to be around 1-3:100 2. Due to this, the overall incidence has increased over the years.
Heterotopic pregnancies have been diagnosed from 5-34 weeks of gestation with up to 70% diagnosed between 5-8 weeks of gestation, 20% between 9-10 weeks, and only 10% after the 11th week 6.
Recognized risk factors predisposing to this condition include:
- assisted reproductive techniques: multiple embryo transfer and ovulation induction 8
- use of an intrauterine contraceptive device
- prior tubal surgery
- history of pelvic inflammatory disease
- history of a previous ectopic pregnancy
Treatment and prognosis
An ultrasound-guided ablation or laparoscopic removal of the extra-uterine fetus can be considered in patients who have a known heterotopic pregnancy to permit the intrauterine pregnancy to continue normally.
Medical management, although used successfully for an ectopic pregnancy, has a limited role in the management of heterotopic pregnancy as one must try to preserve and protect the intrauterine pregnancy.
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