Heterotopic pregnancies after controlled ovarian hyperstimulation and assisted reproductive techniques.
Eight cases of heterotopic pregnancy following assisted reproductive techniques (ART) were reviewed. One cervical, three cornual and four tubal pregnancies were combined with intrauterine pregnancies. The cervical ectopy was successfully treated with a local injection of potassium chloride (KCl) into the gestational sac. A viable baby was produced from the intrauterine gestation. Cornual metroplasties were performed on two ruptured and one unruptured cornual heterotopic pregnancies. One of these three cases was maintained till term. All four tubal heterotopic pregnancies were aborted. Widespread application of ART in recent years has meant that heterotopic pregnancies are no longer a rarity. Both physicians and patients should be made aware that the existence of an intrauterine gestation does not preclude the risk of nidation of other fetuses in ectopic sites. The authors recommend that detailed ultrasound studies, preferably via the vaginal route, should be performed on patients in ART programs. During the examination, the adnexae should be carefully evaluated, even if an intrauterine gestational sac is already present. If a heterotopic pregnancy is diagnosed, the appropriate treatment depends on the location of ectopic pregnancy. Local injection with KCl or methotrexate is effective in certain types of cervical or cornual ectopic pregnancy, as it may allow the conservation of the intrauterine pregnancy.
Department of Obstetrics and Gynecology, College of Medicine, National Taiwan University Hospital, Taipei, ROC.
M Y
MY
Wu
H F
HF
Chen
S U
SU
Chen
K H
KH
Chao
Y S
YS
Yang
S C
SC
Huang
T Y
TY
Lee
H N
HN
Ho
D000328:Adult; D004624:Embryo Transfer / Q000009:adverse effects; D005260:Female; D005307:Fertilization in Vitro / Q000009:adverse effects; D006801:Humans; D010062:Ovulation Induction / Q000009:adverse effects; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000209:etiology*; D012099:Reproductive Techniques / Q000009:adverse effects*