Angular Heterotopic Pregnancy: Successful Differential Diagnosis, Expectant Management and Postpartum Care

Heterotopic pregnancy is a rare, difficult to diagnose and life-threatening pathology, which requires timely decisions made by an experienced multidisciplinary team. In this type of multiple pregnancy there are both intrauterine and ectopic pregnancies present. Its incidence increases in pregnancies...

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Autores principales:	Gabija Didziokaite, Monika Vitaityte, Gerda Zykute, Virginija Paliulyte, Arturas Samuilis
Formato:	article
Lenguaje:	EN
Publicado:	MDPI AG 2021
Materias:	heterotopic pregnancy angular pregnancy pregnancy after ovulation induction expectant management interstitial pregnancy follow-up Medicine (General) R5-920
Acceso en línea:	https://doaj.org/article/d59435d407bd48fdba1efba8688e1981
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spelling	oai:doaj.org-article:d59435d407bd48fdba1efba8688e19812021-11-25T18:18:34ZAngular Heterotopic Pregnancy: Successful Differential Diagnosis, Expectant Management and Postpartum Care10.3390/medicina571112071648-91441010-660Xhttps://doaj.org/article/d59435d407bd48fdba1efba8688e19812021-11-01T00:00:00Zhttps://www.mdpi.com/1648-9144/57/11/1207https://doaj.org/toc/1010-660Xhttps://doaj.org/toc/1648-9144Heterotopic pregnancy is a rare, difficult to diagnose and life-threatening pathology, which requires timely decisions made by an experienced multidisciplinary team. In this type of multiple pregnancy there are both intrauterine and ectopic pregnancies present. Its incidence increases in pregnancies conceived by assisted reproductive technology or in pregnancies with ovulation induction. This article presents an angular heterotopic pregnancy case in a 34-year-old multigravida. The patient was admitted on the 14th week of gestation due to abdominal pain on the left side with suspicion of heterotopic pregnancy. Transabdominal ultrasound and magnetic resonance imaging (MRI) were performed to confirm the diagnosis of heterotopic angular pregnancy in the left cornu of the uterus. Multidisciplinary team made a decision to keep monitoring the growth of both pregnancies by ultrasound while maternal vitals were stable. Due to intensifying abdominal pain, diagnostic laparoscopy was performed. No signs of uterine rupture were observed, and no additional surgical procedures were performed. Maternal status and ultrasonographic findings were closely monitored. The mass in the left cornu of the uterus did not change significantly and the fetal growth of the intrauterine pregnancy matched its gestational age throughout pregnancy. At the 41st week of gestation, a healthy female neonate was born via spontaneous vaginal delivery. The incidence rate of heterotopic pregnancy tends to grow due to an increased number of pregnancies after assisted reproductive technology and ovulation induction. It is important to always assess the risk factors. The main methods for diagnosing heterotopic pregnancies are ultrasonography and MRI. The main management tactics for heterotopic pregnancy include expectant management as well as surgical or medical termination of the ectopic pregnancy. Expectant management may be chosen as an option only in a limited number of cases, if the clinical situation meets the specific criteria. When applicable, expectant management may reduce the frequency of unnecessary interventions and help to prevent patients from its complications.Gabija DidziokaiteMonika VitaityteGerda ZykuteVirginija PaliulyteArturas SamuilisMDPI AGarticleheterotopic pregnancyangular pregnancypregnancy after ovulation inductionexpectant managementinterstitial pregnancyfollow-upMedicine (General)R5-920ENMedicina, Vol 57, Iss 1207, p 1207 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	heterotopic pregnancy angular pregnancy pregnancy after ovulation induction expectant management interstitial pregnancy follow-up Medicine (General) R5-920
spellingShingle	heterotopic pregnancy angular pregnancy pregnancy after ovulation induction expectant management interstitial pregnancy follow-up Medicine (General) R5-920 Gabija Didziokaite Monika Vitaityte Gerda Zykute Virginija Paliulyte Arturas Samuilis Angular Heterotopic Pregnancy: Successful Differential Diagnosis, Expectant Management and Postpartum Care
description	Heterotopic pregnancy is a rare, difficult to diagnose and life-threatening pathology, which requires timely decisions made by an experienced multidisciplinary team. In this type of multiple pregnancy there are both intrauterine and ectopic pregnancies present. Its incidence increases in pregnancies conceived by assisted reproductive technology or in pregnancies with ovulation induction. This article presents an angular heterotopic pregnancy case in a 34-year-old multigravida. The patient was admitted on the 14th week of gestation due to abdominal pain on the left side with suspicion of heterotopic pregnancy. Transabdominal ultrasound and magnetic resonance imaging (MRI) were performed to confirm the diagnosis of heterotopic angular pregnancy in the left cornu of the uterus. Multidisciplinary team made a decision to keep monitoring the growth of both pregnancies by ultrasound while maternal vitals were stable. Due to intensifying abdominal pain, diagnostic laparoscopy was performed. No signs of uterine rupture were observed, and no additional surgical procedures were performed. Maternal status and ultrasonographic findings were closely monitored. The mass in the left cornu of the uterus did not change significantly and the fetal growth of the intrauterine pregnancy matched its gestational age throughout pregnancy. At the 41st week of gestation, a healthy female neonate was born via spontaneous vaginal delivery. The incidence rate of heterotopic pregnancy tends to grow due to an increased number of pregnancies after assisted reproductive technology and ovulation induction. It is important to always assess the risk factors. The main methods for diagnosing heterotopic pregnancies are ultrasonography and MRI. The main management tactics for heterotopic pregnancy include expectant management as well as surgical or medical termination of the ectopic pregnancy. Expectant management may be chosen as an option only in a limited number of cases, if the clinical situation meets the specific criteria. When applicable, expectant management may reduce the frequency of unnecessary interventions and help to prevent patients from its complications.
format	article
author	Gabija Didziokaite Monika Vitaityte Gerda Zykute Virginija Paliulyte Arturas Samuilis
author_facet	Gabija Didziokaite Monika Vitaityte Gerda Zykute Virginija Paliulyte Arturas Samuilis
author_sort	Gabija Didziokaite
title	Angular Heterotopic Pregnancy: Successful Differential Diagnosis, Expectant Management and Postpartum Care
title_short	Angular Heterotopic Pregnancy: Successful Differential Diagnosis, Expectant Management and Postpartum Care
title_full	Angular Heterotopic Pregnancy: Successful Differential Diagnosis, Expectant Management and Postpartum Care
title_fullStr	Angular Heterotopic Pregnancy: Successful Differential Diagnosis, Expectant Management and Postpartum Care
title_full_unstemmed	Angular Heterotopic Pregnancy: Successful Differential Diagnosis, Expectant Management and Postpartum Care
title_sort	angular heterotopic pregnancy: successful differential diagnosis, expectant management and postpartum care
publisher	MDPI AG
publishDate	2021
url	https://doaj.org/article/d59435d407bd48fdba1efba8688e1981
work_keys_str_mv	AT gabijadidziokaite angularheterotopicpregnancysuccessfuldifferentialdiagnosisexpectantmanagementandpostpartumcare AT monikavitaityte angularheterotopicpregnancysuccessfuldifferentialdiagnosisexpectantmanagementandpostpartumcare AT gerdazykute angularheterotopicpregnancysuccessfuldifferentialdiagnosisexpectantmanagementandpostpartumcare AT virginijapaliulyte angularheterotopicpregnancysuccessfuldifferentialdiagnosisexpectantmanagementandpostpartumcare AT arturassamuilis angularheterotopicpregnancysuccessfuldifferentialdiagnosisexpectantmanagementandpostpartumcare
_version_	1718411349055242240

Angular Heterotopic Pregnancy: Successful Differential Diagnosis, Expectant Management and Postpartum Care

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