SIMULTANEUS INTRAUTERINE AND EXTRAUTERINE PREGNANCY
Aim: The aim of this report is to present a rare case of early recognized intrauterine and extrauterine pregnancy where pathohistological determination of extrauterine pregnancy in a patient was confirmed.
Case report: Patient as an emergency case, in a shock condition was taken to hospital in view of acute abdomen, hypotension with heardly measurable pressure, an accelerated pulse that is difficult to palpate, and severe anemia. Emergency laparatomy confirmed that the patient had an extrauterine ruptured tubal pregnancy. Salpingectomy was performed and the intrauterine pregnancy was allawed to contiunue. Pathohystological finding confirmed the tubal pregnancy. She was given 700 ml of blood transfusion. Intrauterine pregnancy neatly passed with the birth of a live child.
Conclusion: Heterotopic pregnancy can occur in the absence of any predisposing risk factors, and the detection of an intrauterine pregnancy does not exclude the possibility of the simultaneous existence of an ectopic pregnancy. The pathohistological confirmation of the operative material from the salpinghectomy that it is a tubal pregnancy confirmed the suspicion that it is a simultaneus extrauterine and intrauterine pregnancy.
Key words: pregnancy, ectopic pregnancy, diagnosis, pathohistological finding
2.Hillis SD, Owens LM, Marchbanks PA, et al. Recurrent chlamydial infections increase the risks of hospitalization for ectopic pregnancy and pelvic inflammatory disease. Am J Obstet Gynecol. 1997;176:103-107
3.Mukul LV, Teal SB. Current management of ectopic pregnancy. Obstet Gynecol Clin N Am. 2007; 34:403-419
4.M. S. Kamath, T. K. Aleyamma, K. Muthukumar, R. M. Kumar,andK.George,“Ararecasereport:ovarianheterotopic pregnancy after in vitro fertilization,” Fertility and Sterility, vol. 94, no. 5, pp. 1910.e9–1910.e11, 2010.
5. J. Tal, S. Haddad, G. Nina, and I. Timor-Tritsch, “Heterotopic pregnancy after ovulation induction and assisted reproductive technologies: a literature review from 1971 to 1993,” Fertility and Sterility, vol. 66, no. 1, pp. 1–12, 1996
6. G. Barrenetxea, L. Barinaga-Rementeria, D. E. Lopez, J. A. Agirregoikoa, M. Mandiola, and K. Carbonero, “Heterotopic pregnancy: two cases and a comparative review,” Fertility and Sterility, vol. 87, no. 2, pp. 417.e9–417.e15, 2007.
7. De Voe RW, Pratt JH: Simultaneous intrauterine and extrauterine pregnancy. Am J Obstet Gynecol 1948;56:1119–1123
8. J. Bontis, G. Grimbizis, B. Tariatzis et al., “Ovarian pregnancy after ovulation induction/intrauterine insemination: pathophysiological aspects and diagnostic problems,” Human Reproduction, vol. 12, pp. 376–378, 1997.
9.Reece EA, Petrie RH, Sirmans MF, Finster M, Todd WD. Combined intrauterine and extrauterine gestations: a review. Am J Obstet Gynecol.1983;146(3):323–30
10.Nabia .H, Zakia.Z, et al. Risk factors, Clinical presentation, And Management of 62 Cases of Ectopic Pregnancy at Tertiary Care Centre. Journal of Liaquat University of Medical And Health Sciences. Sep-Dec 2009.
11.Ankum WM, Mol BW, Van der Veen F, Bossuyt PM. Risk factors for ectopic pregnancy: a meta-analysis. Fertil Steril 1996;65:1093–9.
12. D. O. Selo-Ojeme and C. F. GoodFellow, “Simultaneous intrauterine and ovarian pregnancy following treatment with clomiphenecitrate,”ArchivesofGynecologyandObstetrics,vol. 266, no. 4, pp. 232–234, 2002.
13. Bouyer J, Coste J, Shojaei T, Pouly JL, Fernandez H, Gerbaud L, Job-Spira N. Risk factors for ectopic pregnancy: a comprehensive analysis based on a large case-control, population-based study in France. Am J Epidemiol. 2003 Feb 1;157(3):185-94
14. Talbot K, Simpson R, Price N, Jackson SR. Heterotopic pregnancy. J Obstet Gynaecol. 2011;31(1):7-1
15. Lin EP, Bhatt S, Dogra VS. Diagnostic clues to ectopic pregnancy. Radiographics. 2008 Oct;28(6):1661-7
16. Kaplan BC, Dart RG, Moskos M, et al. Ectopic pregnancy: prospective study with improved diagnostic accuracy. Ann Emerg Med. 1996;28:10–17.
17. A. J. Headley and V. Adum, “Naturally occurring heterotopic pregnancy in a multiparous patient: a case report,” Journal of ReproductiveMedicine,vol.58,no.11-1
18.Mandiola M, Carbonero K. Heterotopic pregnancy: two cases and a comparative review. Fertil Steril. 2007 Feb;87(2):417.e9-15.
19.M.Varras,C.Akrivis,G.Hadjopoulos,andN.Antoniou,“Heterotopic pregnancy in a natural conception cycle presenting with tubal rupture: a case report and review of the literature,” European Journal of Obstetrics Gynecology and Reproductive Biology,vol.106,no.1,pp.79–82
20.Nabia .H, Zakia.Z, et al. Risk factors, Clinical presentation, And Management of 62 Cases of Ectopic Pregnancy at Tertiary Care Centre. Journal of Liaquat University of Medical And Health Sciences. Sep-Dec 2009