title: Management and outcome of 25 heterotopic pregnancies in Zhejiang, China.
abstract: OBJECTIVE
  To characterize general attributes of women with heterotopic pregnancy (HP) in order to establish an optimal management regimen.
  
  
  METHODS
  A retrospective analysis was conducted on 25 HPs recorded at the Women's Hospital of Zhejiang University between 2007 and 2011. Data on patients' symptoms, risk factors, diagnostic features, treatment and outcome were collected and analysed.
  
  
  RESULTS
  All patients had conceived via assisted reproductive technology (ART), 72% had a history of pelvic inflammatory disease and 68% of patients were symptomatic. Fifty-six percent of patients were diagnosed with HP via routine transvaginal ultrasound examination at approximately 6-7 weeks of gestation. Eighty percent of patients underwent surgical treatment (35% laparoscopic salpingectomy, 65% laparotomy), and 20% of patients underwent medical treatment with local injection of methotrexate (MTX) or MTX in combination with potassium chloride (KCl) into ectopic sites such as the cervix or interstitium. Eighty-eight percent of patients delivered live infants without congenital anomalies, and three patients (all of whom underwent surgical treatment) miscarried.
  
  
  CONCLUSIONS
  Routine transvaginal ultrasound examination at approximately 6-7 weeks of gestation could facilitate the diagnosis of HP, although repeat ultrasound is necessary to avoid misdiagnosis. Prompt diagnosis and correct treatment, including local injection of MTX or MTX in combination with KCl into various ectopic sites, led to favourable prognoses.
authors.affiliation: Department of Gynaecology, Women's Hospital, School of Medicine, Zhejiang University, PR China.
authors.forename: Y
authors.initials: Y
authors.lastname: Yu
authors.affiliation: Department of Gynaecology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, PR China.
authors.forename: W
authors.initials: W
authors.lastname: Xu
authors.affiliation: Department of Gynaecology, Women's Hospital, School of Medicine, Zhejiang University, PR China. Electronic address: zjudoctor@sina.com.
authors.forename: Z
authors.initials: Z
authors.lastname: Xie
authors.affiliation: Department of Gynaecology, Women's Hospital, School of Medicine, Zhejiang University, PR China.
authors.forename: Q
authors.initials: Q
authors.lastname: Huang
authors.affiliation: Department of Gynaecology, Women's Hospital, School of Medicine, Zhejiang University, PR China.
authors.forename: S
authors.initials: S
authors.lastname: Li
mesh_terms: D000020:Abortifacient Agents, Nonsteroidal / Q000627:therapeutic use*; D000022:Abortion, Spontaneous; D000328:Adult; D002584:Cervix Uteri; D002681:China; D015331:Cohort Studies; D004624:Embryo Transfer; D005260:Female; D005307:Fertilization in Vitro; D006801:Humans; D015552:Injections, Intralesional; D050498:Live Birth; D008727:Methotrexate / Q000627:therapeutic use*; D010062:Ovulation Induction; D011189:Potassium Chloride / Q000627:therapeutic use*; D011247:Pregnancy; D011256:Pregnancy Outcome; D011271:Pregnancy, Ectopic / Q000000981:diagnostic imaging / Q000628:therapy; D063192:Pregnancy, Heterotopic / Q000000981:diagnostic imaging / Q000628:therapy*; D065167:Pregnancy, Interstitial / Q000000981:diagnostic imaging / Q000628:therapy; D011274:Pregnancy, Tubal / Q000000981:diagnostic imaging / Q000628:therapy*; D012189:Retrospective Studies; D058994:Salpingectomy; D014463:Ultrasonography; D055815:Young Adult
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D011189:Potassium Chloride; D008727:Methotrexate
keywords: Diagnosis; Heterotopic pregnancy; Retrospective study; Treatment