title: Diagnosis and treatment of heterotopic pregnancy compared with ectopic pregnancy.
abstract: OBJECTIVE
  To compare the diagnosis and management of ectopic (EP) and heterotopic pregnancies (HP).
  
  
  METHODS
  Retrospective comparative study (Canadian Task Force classification II-2).
  
  
  METHODS
  University tertiary referral center for endoscopic surgery.
  
  
  METHODS
  Twelve women with HP and 210 women with laparoscopically confirmed EP.
  
  
  METHODS
  Laparoscopic treatment.
  
  
  RESULTS
  Among the 12 women with HP, all but 1 had received ovulation induction, 10 underwent in vitro fertilization-embryo transfer, and 1 conceived with clomiphen citrate. In the EP group 33 patients (15.7%) conceived spontaneously (p <0.05). Six women (50%) with HP had had previous pelvic surgery and three had a history of EP and salpingectomy. Four patients (33.4%) with HP and 29 (13.8%) with EP suffered from hypovolemic shock and required blood transfusion (p <0.05). Three of these four women with HP experienced physician and patient delays before admission. The sonographic diagnosis was correct in all women with HP and in 94.3% of women with EP. The median gestational age at diagnosis was 7.5 and 7.2 weeks for HP and EP, respectively. Six (50%) women with HP had evidence of fetal pulse in the ectopic gestation compared with 17 (8.1%) with EP (p <0.05). In addition, 66.7% and 24.7%, respectively, had ruptured tube (p <0.05). Mean +/- SD hemoperitoneum was 833.4 +/- 777 and 305 +/- 121 ml, respectively (p <0.05). Conversion to laparotomy was required in one (8.3%) and eight (3.8%) women, respectively (p <0.05). No major operative or postoperative maternal complications occurred in either group. Two women with HP had miscarriages, two have a continuing pregnancy, and eight delivered healthy newborns.
  
  
  CONCLUSIONS
  Women with HP are at significantly greater risk for hypovolemic shock and requiring blood transfusion than those with EP. The diagnosis of EP in cases of HP is difficult due to the presence of an intrauterine gestational sac and hyperstimulated ovaries. A greater level of suspicion may allow early laparoscopic intervention before life-threatening intraabdominal bleeding has occurred.
authors.affiliation: Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer 52621, Israel.
authors.forename: David
authors.initials: D
authors.lastname: Soriano
authors.forename: Alon
authors.initials: A
authors.lastname: Shrim
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Seidman
authors.forename: Mordechai
authors.initials: M
authors.lastname: Goldenberg
authors.forename: Shlomo
authors.initials: S
authors.lastname: Mashiach
authors.forename: Gabriel
authors.initials: G
authors.lastname: Oelsner
mesh_terms: D000028:Abortion, Induced / Q000379:methods*; D000328:Adult; D004624:Embryo Transfer; D005260:Female; D006801:Humans; D010535:Laparoscopy; D011247:Pregnancy; D011256:Pregnancy Outcome; D011271:Pregnancy, Ectopic / Q000150:complications / Q000175:diagnosis* / Q000601:surgery*; D012189:Retrospective Studies; D012769:Shock / Q000209:etiology; D016216:Ultrasonography, Prenatal