Omental and peritoneal secondary trophoblastic implantation - an unusual complication after IVF.
Omental pregnancy is an uncommon form of abdominal pregnancy; it has never been previously reported after IVF. A 35-year-old patient underwent IVF for tubal factor infertility. The treatment cycle was uneventful, but 3 weeks following embryo transfer the patient was diagnosed with a right tubal ectopic pregnancy on ultrasound. A laparoscopic salpingectomy was performed and the patient was discharged home. Two weeks later, the patient presented with abdominal pain and rising serum beta-human chorionic gonadotrophin (beta-HCG). A repeat laparoscopy showed omental and peritoneal trophoblastic implants. These were excised laparoscopically and confirmed on histology to be trophoblastic tissue. The HCG returned to < 3 IU/l, 1 week post-operatively. This case emphasizes the importance of intra-operative care during laparoscopic surgery for ectopic pregnancy and the need for post-operative surveillance of serum beta-HCG. An abdominal pregnancy, though rare, has a seven times higher mortality rate than non-abdominal pregnancies. Early diagnosis and treatment can prevent intra-abdominal haemorrhage, as haemorrhagic shock is the commonest cause of mortality from omental pregnancy.
Ali
C Rubina
CR
Department of Assisted Reproduction, St Mary's Hospital, Whitworth Park, Manchester M13 0JH, UK. Rubina.ali@cmmc.nhs.uk
Fitzgerald
C
C
D000328:Adult; D004624:Embryo Transfer / Q000009:adverse effects; D005260:Female; D005307:Fertilization in Vitro / Q000009:adverse effects*; D006801:Humans; D010535:Laparoscopy; D009852:Omentum / Q000473:pathology; D010537:Peritoneum / Q000473:pathology; D011247:Pregnancy; D011269:Pregnancy, Abdominal / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D011274:Pregnancy, Tubal / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D012422:Rupture, Spontaneous