Page 58 - WJOLS - Journal of Laparoscopic Surgery

WJOL S
WJOLS

10.5005/jp-journals-10033-1323
Heterotopic Pregnancy
CaSe RepORt

Heterotopic Pregnancy: Successful Management by

Laparoscopic Salpingectomy in First Trimester and
Continuation of Intrauterine Pregnancy until Term

2
3
1 Rajendra Shitole, Sharankumar Kavalgi, Hemant Deshpande
ABSTRACT essential to save the intrauterine pregnancy and avoid
Introduction: We report a case of a heterotopic pregnancy (HP) maternal morbidity and mortality related to hemoperito-
4
with resultant normal intrauterine pregnancy after laparoscopic nium due to ruptured ectopic pregnancy. Laparoscopy
salpingectomy. A heterotrophic pregnancy is defined as the with minimal or no manipulation of uterus can be used
coexistence of intrauterine and extrauterine gestation. Incidence as an effective minimal invasive treatment tool to salvage
is more common in infertility patients conceived after treatment
than natural conception. A 20-year-old primigravida presented intrauterine pregnancy and prevent morbidity related
with 7 weeks amenorrhea, pain in abdomen, and per vaginal to hemoperitonium and laparotomy. Here, we present a
spotting. The ultrasound (USG) report was suggestive of a right- case of a 20-year-old primigravida with HP (7 weeks live
sided adnexal mass indicative of either tubal ectopic along with intrauterine pregnancy with ruptured right tubal ectopic
an intrauterine live gestation of 7 weeks and hemoperitoneum.
Emergency laparoscopy was done and right salpingectomy pregnancy) managed by laparoscopic salpingectomy and
was done in view of right ruptured tubal ectopic pregnancy. with successful continuation of intrauterine pregnancy
The intrauterine pregnancy then continued subsequently to until term.
35 weeks of gestation as on September 18, 2017. Early diagno-
sis and prompt intervention are essential to save the intrauterine
pregnancy and avoid maternal morbidity and mortality related CASE REPORT
to hemoperitonium due to ruptured ectopic pregnancy.
A 20-year-old primigravida presented with 7 weeks
Keywords: Hemoperitonium, Heterotopic pregnancy, Lapa- amenorrhea, pain in abdomen, and per vaginal spotting.
roscopy, Salpingectomy.
The USG report was suggestive of a right-sided adnexal
How to cite this article: Shitole R, Kavalgi S, Deshpande H. mass indicative of tubal ectopic pregnancy along with an
Heterotopic Pregnancy: Successful Management by Lapa-
roscopic Salpingectomy in First Trimester and Continua- intrauterine single live gestation of 7 weeks and hemo-
tion of Intrauterine Pregnancy until Term. World J Lap Surg peritoneum (Figs 1 and 2).
2017;10(3):139-141. It was spontaneous conception. There was no risk
Source of support: Nil factor present, e.g., infertility treatment, pelvic infec-
Conflict of interest: None tion, or contraceptive use. A diagnosis of live intrauter-
ine pregnancy with rupture of the extrauterine (tubal)
INTRODUCTION pregnancy was made. Hemodynamically, patient was
stable. Routine laboratory tests and serum beta human
A heterotrophic pregnancy is defined as the presence of chorionic gonadotropin (hCG) were ordered. Adequate
1,2
an intrauterine and extrauterine pregnancy together.
It is common with assisted reproductive techniques like
ovulation induction and in vitro fertilization (1:7,000) and
3
is very rare in natural conception (1:30,000). Diagnosis
and management of HP are great challenges for obste-
tricians. Early diagnosis and prompt intervention are

3
1-2 Senior Resident, Head
1-3 Department of Obstetrics and Gynecology, Dr. D. Y. Patil
Medical College, Hospital & Research Centre, Dr. D. Y. Patil
Vidyapeeth, Pune, Maharashtra, India
Corresponding Author: Rajendra Shitole, Senior Resident
Department of Obstetrics and Gynecology, Dr. D. Y. Patil
Medical College, Hospital & Research Centre, Dr. D. Y.
Patil Vidyapeeth, Pune, Maharashtra, India, Phone:
+919096313251, e-mail: raj110785@gmail.com Fig. 1: Ultrasound suggestive of intrauterine pregnancy with
right tubal ectopic pregnancy with hemoperitonium
World Journal of Laparoscopic Surgery, September-December 2017;10(3):139-141 139