martes, 10 de abril de 2012

DX: Heterotopic pregnancy with tubal rupture by ectopic embryo

This is the continuation of the case, here are the pictures:

Gross path specimen (ectopic embryo):


A heterotopic pregnancy is a rare complication of pregnancy in which both extra-uterine (ectopic pregnancy) and intrauterine gestation occur simultaneously.

Synonyms: Combined ectopic pregnancy, simultaneous intra‑ and extrauterine pregnancy, coexistent intra- and extrauterine pregnancy, multiple‑sited pregnancy, coincident pregnancy, concomitant intrauterine and extrauterine pregnancy.

Prevalence: 0.6‑2.5:10,000 pregnancies. There is a significant increase in the incidence of heterotopic pregnancy in women undergoing ovulation induction. An even greater incidence of heterotopic pregnancy is reported in pregnancies following assisted reproduction techniques such as In Vitro Fertilization (IVF) and Gamete Intra‑Fallopian Transfer (GIFT).

The normal implantation of a fertilized ovum within the uterine cavity and an abnormal implantation of a fertilized ovum outside the uterine cavity.

In the general population the major risk factors for heterotopic pregnancy are the same as those for ectopic pregnancy. For women in an assisted reproductive program there are additional factors: a higher incidence of multiple ovulation, a higher incidence of tubal malformation and/or tubal damage, and technical factors in embryo transfer which may increase the risk for ectopic and heterotopic pregnancy.

Differential diagnosis: Normal intrauterine pregnancy, a normal intrauterine pregnancy and a ruptured ovarian cyst, a corpus luteum, or an appendicitis.

Prognosis: The prognosis for the extrauterine fetus is very poor, having an estimated 90‑95% mortality rates. The mortality rate for the intrauterine pregnancy is approximately 35%.

Management: Surgical removal of the ectopic gestation by salpingectomy or salpingostomy. Expectant management has been successfully applied in select cases. Successful salpingocentesis has also been reported.

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