Heterotopic pregnancy
Citation, DOI & article data
- Concurrent intra uterine and extra uterine pregnancy
- Simultaenous intra uterine and extra uterine pregnancy
- Combined intra uterine and extra uterine pregnancy
Heterotopic pregnancy is a rare situation when there is an intra-uterine and extra-uterine (i.e. ectopic) pregnancy occurring simultaneously.
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Epidemiology
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.
Pathology
Risk factors
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
Radiographic features
Ultrasound
Classically shows features of an intra-uterine pregnancy as well as an 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.
Differential diagnosis
Considerations include:
- ectopic pregnancy with an intra-uterine pseudogestational sac
- intra-uterine gestation with a hemorrhagic corpus luteum
References
- 1. Lin EP, Bhatt S, Dogra VS. Diagnostic clues to ectopic pregnancy. Radiographics. 2008;28 (6): 1661-71. doi:10.1148/rg.286085506 - Pubmed citation
- 2. Levine D. Ectopic pregnancy. Radiology. 2007;245 (2): 385-97. doi:10.1148/radiol.2452061031 - Pubmed citation
- 3. Kaakaji Y, Nghiem HV, Nodell C et-al. Sonography of obstetric and gynecologic emergencies: Part I, Obstetric emergencies. AJR Am J Roentgenol. 2000;174 (3): 641-9. AJR Am J Roentgenol (full text) - Pubmed citation
- 4. Talbot K, Simpson R, Price N et-al. Heterotopic pregnancy. J Obstet Gynaecol. 2011;31 (1): 7-12. doi:10.3109/01443615.2010.522749 - Pubmed citation
- 5. Faschingbauer F, Mueller A, Voigt F et-al. Treatment of heterotopic cervical pregnancies. Fertil. Steril. 2011;95 (5): 1787.e9-1787.e13. doi:10.1016/j.fertnstert.2010.10.043 - Pubmed citation
- 6. Hassani KI, Bouazzaoui AE, Khatouf M et-al. Heterotopic pregnancy: A diagnosis we should suspect more often. J Emerg Trauma Shock. 2010;3 (3): 304. doi:10.4103/0974-2700.66563 - Free text at pubmed - Pubmed citation
- 7. Mj G, R R. Heterotopic pregnancy in natural conception. J Hum Reprod Sci. 2008;1 (1): 37-8. J Hum Reprod Sci (link) - Free text at pubmed - Pubmed citation
- 8. Ghandi S, Ahmadi R, Fazel M. Heterotopic pregnancy following induction of ovulation with clomiphene citrate. (2011) Iranian journal of reproductive medicine. 9 (4): 319-21. Pubmed
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