Volume 10, Issue 2 (2025)
SJMR 2025, 10(2): 103-108 |
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Nateghi M R, Bahrami H. Successful Management of a Case of Heterotopic Pregnancy at Sarem Women’s Hospital. SJMR 2025; 10 (2) : 8
URL: http://saremjrm.com/article-1-371-en.html
URL: http://saremjrm.com/article-1-371-en.html
1- Sarem Gynecology, Obstetrics and Infertility Research Center, Sarem Women’s Hospital, Iran University of Medical Sciences, Tehran, Iran. & Sarem Cell Research Center (SCRC), Sarem Women’s Hospital, Tehran, Iran.
2- Sarem Gynecology, Obstetrics and Infertility Research Center, Sarem Women’s Hospital, Iran University of Medical Sciences, Tehran, Iran.
2- Sarem Gynecology, Obstetrics and Infertility Research Center, Sarem Women’s Hospital, Iran University of Medical Sciences, Tehran, Iran.
Abstract: (27 Views)
Introduction: Heterotopic pregnancy (HP), defined as the simultaneous occurrence of intrauterine and ectopic pregnancies, is extremely rare in natural conception. However, its incidence has been increasing with the widespread use of ovulation induction agents and assisted reproductive technologies (ART). HP poses a significant diagnostic challenge, as the confirmation of an intrauterine pregnancy may lead clinicians to overlook the possibility of a concurrent ectopic pregnancy. Failure to establish an early diagnosis can result in tubal rupture, intra-abdominal hemorrhage, maternal morbidity or mortality, and loss of the intrauterine pregnancy.
Case Presentation: We report the case of a 29-year-old primigravida with a history of clomiphene citrate use, who presented on September 24, 2021, to the emergency department of Sarem Subspecialty Hospital with acute severe abdominal pain, nausea, and two episodes of syncope. A twin intrauterine pregnancy at 12 weeks’ gestation had been documented on ultrasound one day earlier. On admission, she was hemodynamically unstable, with a blood pressure of 60/80 mmHg, cold sweating, and tachycardia. Emergency ultrasonography revealed a large amount of free intraperitoneal fluid. The patient was immediately taken for laparotomy, during which approximately 500 mL of blood and clots were evacuated. The uterus and right adnexa appeared normal; however, a fetus with its placenta was identified adjacent to the left ovary with active bleeding. Following removal of the ectopic gestation and hemostasis, a left salpingectomy was performed. The patient was transferred to the ICU and discharged three days later in good general condition, with a viable intrauterine singleton pregnancy confirmed by ultrasound. The pregnancy progressed uneventfully, and at 37 weeks, she underwent cesarean section due to marginal placenta, resulting in the delivery of a healthy male infant weighing 3200 g with Apgar scores of 9 and 10.
Conclusion: This case highlights the importance of maintaining a high index of suspicion for heterotopic pregnancy, even in the presence of a confirmed intrauterine pregnancy. Prompt diagnosis and timely surgical intervention are crucial for maternal survival and preservation of the intrauterine gestation. Reporting such cases contributes to greater clinical awareness, facilitates earlier recognition, and supports optimal management strategies in similar scenarios.
Case Presentation: We report the case of a 29-year-old primigravida with a history of clomiphene citrate use, who presented on September 24, 2021, to the emergency department of Sarem Subspecialty Hospital with acute severe abdominal pain, nausea, and two episodes of syncope. A twin intrauterine pregnancy at 12 weeks’ gestation had been documented on ultrasound one day earlier. On admission, she was hemodynamically unstable, with a blood pressure of 60/80 mmHg, cold sweating, and tachycardia. Emergency ultrasonography revealed a large amount of free intraperitoneal fluid. The patient was immediately taken for laparotomy, during which approximately 500 mL of blood and clots were evacuated. The uterus and right adnexa appeared normal; however, a fetus with its placenta was identified adjacent to the left ovary with active bleeding. Following removal of the ectopic gestation and hemostasis, a left salpingectomy was performed. The patient was transferred to the ICU and discharged three days later in good general condition, with a viable intrauterine singleton pregnancy confirmed by ultrasound. The pregnancy progressed uneventfully, and at 37 weeks, she underwent cesarean section due to marginal placenta, resulting in the delivery of a healthy male infant weighing 3200 g with Apgar scores of 9 and 10.
Conclusion: This case highlights the importance of maintaining a high index of suspicion for heterotopic pregnancy, even in the presence of a confirmed intrauterine pregnancy. Prompt diagnosis and timely surgical intervention are crucial for maternal survival and preservation of the intrauterine gestation. Reporting such cases contributes to greater clinical awareness, facilitates earlier recognition, and supports optimal management strategies in similar scenarios.
Article number: 8
Keywords: Heterotopic Pregnancy, Ectopic Pregnancy, Clomiphene Citrate, Laparotomy, Salpingectomy, Maternal and Neonatal Outcomes.
Article Type: Case Report |
Subject:
Pregnancy Care
Received: 2025/09/6 | Accepted: 2025/09/16 | Published: 2025/09/17
Received: 2025/09/6 | Accepted: 2025/09/16 | Published: 2025/09/17
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