Author:
Utalo Tadiwos,Getu Jenenu
Abstract
Abstract
Background
The term heterotopic pregnancy is defined as a uterine pregnancy coexisting with a second pregnancy in an extrauterine location. Spontaneous, full-term heterotopic pregnancy with alive birth is very rare. The diagnosis and management of such exceptionally unique case is difficult. When the patient presented with an advanced labor with no antenatal care follow up and with no risk factors is even more challenging for poorly equipped facilities like ours.
Case presentation
A 25 years old gravida 3, para 2 (both are alive) mother presented to the labor and delivery ward of Bele Primary Hospital, Southern Ethiopia with the complaint of pushing down pain of 18 h duration. Immediately after arrival, she gave birth to a 3300gm female neonate spontaneously. After delivery, an abdominal mass was recognized and manual exploration of the uterus was done to look for the presence of after coming second twin but the uterus was empty. On ultrasound examination, there was an alive fetus in transverse lie outside the uterus. With the impression of 2nd twin in a separate horn of bicornuate uterus and to rule out abdominal pregnancy, laparotomy was done. On laparotomy, there was abdominal pregnancy in the Pouch of Douglas with an intact amniotic sac. The sac was attached with the left broad ligament, left ovary, small bowel mesentery, and posterior wall of the uterus. The sac opened, a 1600gm alive female neonate with features of fetal growth restriction and left club foot was delivered. The placenta was detached spontaneously and removed without any complication.
Conclusions
The coexistence of spontaneous full-term intrauterine with advanced abdominal ectopic pregnancy is one of the rarest forms of heterotopic pregnancy. Every health professional should bear in mind that intrauterine and extrauterine pregnancy may happen simultaneously and it can progress to term without any symptoms. Ultrasound is the diagnostic method of choice but the existence of an intra-uterine pregnancy cannot rule out ectopic pregnancy. The life-threatening complication of abdominal ectopic pregnancy is bleeding from the detached placental site. Therefore, the decision to remove the placenta should be individualized.
Publisher
Springer Science and Business Media LLC
Subject
Obstetrics and Gynecology
Reference30 articles.
1. Cunningham FG, Leveno KJ, Catherine Y, Dashe JS, Barbara L, et al. Williams’s Obstetrics. 24th edition. New York, USA: McGraw-Hill Education; 2014.
2. Hassani KI, Bouazzaoui AE, Khatouf M, Mazaz K. Heterotopic pregnancy: A diagnosis we should suspect more often. J Emerg Trauma Shock. 2010;3:304.
3. Tal J, Haddad S, Gordon N, Timor-Tritsch I. Heterotopic pregnancy after ovulation induction and assisted reproductive technologies: a literature review from 1971 to 1993. Fertil Steril. 1996;66(1):1–12. https://doi.org/10.1016/s0015028216583782.
4. Ludwig M, Kaisi M, Bauer O, Diedrich K. The forgotten child: a case of heterotopic, intra-abdominal and intrauterine pregnancy carried to term. Hum Reprod. 1999;14:1372–4.
5. Maaita ME, Murad N, Dabbas M. Advanced heterotopic pregnancy. J Obstet Gynaecol. 1999;19(6):677–8. https://doi.org/10.1080/01443619964120.
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