A Case of Heterotopic Pregnancy Resulting in a Live Birth Through Laparoscopic Surgery

TL;DR

A rare case of heterotopic pregnancy was successfully diagnosed and treated with laparoscopic surgery, leading to a healthy live birth.

Contribution

This case highlights the successful use of laparoscopic surgery for managing heterotopic pregnancy while preserving the intrauterine pregnancy.

Findings

Laparoscopic surgery diagnosed and treated a left tubal pregnancy at seven weeks of gestation.

The patient delivered a healthy baby at 38 weeks after successful management of the heterotopic pregnancy.

Early diagnosis and careful management are crucial for preserving intrauterine pregnancy in cases of HP.

Abstract

Heterotopic pregnancy (HP) is a condition in which intrauterine and ectopic pregnancies occur simultaneously and is extremely rare. However, its incidence has markedly increased with the use of assisted reproductive technology (ART). HP can be life-threatening due to intraperitoneal bleeding; therefore, accurate diagnosis is crucial. The coexistence of intrauterine pregnancy complicates the detection of ectopic pregnancy, making HP one of the most challenging diagnoses in modern gynecological practice. Here, we describe a case in which HP was diagnosed through laparoscopic surgery, followed by a live birth. Based on a literature review, we also discussed appropriate strategies for the diagnosis and management of HP, as well as the importance of providing adequate preoperative information.

The patient was a 34-year-old, G1P0, with no significant medical history. After five cycles of timed therapy without conception, hysterosalpingography revealed severe stenosis of both fallopian tubes, and bilateral salpingoscopic salpingoplasty was performed. Oral clomiphene citrate was initiated, timing guidance was provided on day 16 after the last menstrual period, and pregnancy was established. At seven weeks and one day of pregnancy, a hematoma was detected in the left adnexal region, and she was referred to our hospital. Intrauterine pregnancy with ovarian bleeding from a corpus luteum cyst or heterotopic pregnancy (HP) was suspected. The patient and her husband initially preferred observation; however, by the third day of hospitalization, the hematoma had not reduced, and they requested surgery. For diagnostic and therapeutic purposes, laparoscopic surgery under general anesthesia was performed at seven weeks and four days of pregnancy. A diagnosis of left tubal pregnancy was made, and a left salpingectomy was performed. The pregnancy progressed smoothly, and spontaneous cephalic vaginal delivery occurred at 38 weeks and six days of gestation. The baby weighed 3,200 g at birth.

HP is extremely rare; however, its incidence has increased with the widespread use of infertility treatments. Delayed diagnosis can be life-threatening for both the mother and the intrauterine fetus; therefore, even after intrauterine pregnancy is confirmed, evaluation for HP using transvaginal ultrasound is essential. Careful management is required to preserve an intrauterine pregnancy while treating ectopic pregnancy. Patients and their families must also be provided with accurate information when laparoscopic surgery is performed under general anesthesia.

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