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Oct 23, 2019

The 27th World Congress on Controversies in Obstetrics, Gynecology & Infertility

HETEROTOPIC PREGNANCY AFTER INTRA-CYTOPLASMATIC SPERM INJECTION: WHEN IDENTIFYING AN INTRAUTERINE PREGNANCY IS NOT ENOUGH

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heterotopic pregnancy

extrauterine pregnancy

simultaneous pregnancy

Abstract

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Abstract

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Keywords

heterotopic pregnancy

extrauterine pregnancy

simultaneous pregnancy

Abstract

Problem statement: Heterotopic pregnancy is a rare condition, consisting on simultaneous pregnancies in two implantation sites, mainly one intrauterine and one ectopic site. It is a potentially dangerous condition occurring in only 1 in 30,000 spontaneous pregnancies. Although rare in healthy general population, its incidence increases in women undergoing fertility treatments and those with risk factors for ectopic pregnancy. Therefore, with the introduction of Assisted Reproduction Techniques (ART), its overall incidence has risen. It is a difficult diagnosis to establish, as the identification of an intrauterine evolving pregnancy may tranquilize physicians and obliviate further investigation, making diagnosis usually late and at an emergency setting. Methods: We present a case report and literature review. Case Report: A 28 year-old woman, undergoing ART for primary infertility (male factor), was submitted to ovulation induction and later intra-cytoplasmatic sperm injection and transference of two frozen embryos. She was admitted to the emergency department for pelvic pain, more intense at the right iliac fossa (RIF), with nausea. On physical examination, she demonstrated mucocutaneous pallor and pain at RIF compression, without peritoneal irritation signs. Serum levels of human chorionic gonadotrophin (hCG) were 13.000 mUI/mL. Transvaginal ultrasound revealed an intrauterine gestational sac with 15 mm and a vitelin vesicle, no embryo visible. Further sonographic evaluation demonstrated a right adnexial mass, with 13,4 mm and peripheral flow on collor Doppler, suggestive of right tubal ectopic pregnancy. Explorative laparoscopy further supported heterotopic pregnancy diagnosis, with hemoperitoneum and a right fallopian tube mass, compatible with tubal pregnancy. Laparoscopic salpingectomy was performed, and the material sent to anatomical pathology examination. To our knowledge, at the time being, the intrauterine pregnancy is evolving. Conclusion: In light of the growing ART and consequent increase in heterotopic pregnancy risk, all physicians should be aware of this diagnosis. A high index of suspicion is needed, and confirming an intrauterine pregnancy should not be enough to exclude a co-existing pregnancy. Timely diagnosis is imperative in order to result in less maternal morbidity and better obstetric outcomes.

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© Copyright 2019 Morressier GmbH.
All rights reserved.