Absztrakt
Background: Heterotopic pregnancy occurs when both intrauterine and ectopic pregnancies coexist simultaneously. Its occurrence in natural conception is qui t e rare , howe ve r, i t i s mor e frequently encountered following assisted conception, especially when multiple embryos are transferred [1,2,3]. Diagnosis in its early stage has been reported to be a dilemma due to the concomitant presence of an intrauterine gestation posing significant challenges with
management and clinical outcome [4,5]. Prognosis is noted to vary based on the time of diagnosis and option of management deployed [5], however, live birth rates of about 66.7% have been reported in literature [6]. This case report highlights the clinical
dilemma associated with a heterotopic pregnancy following in vitro fertilization (IVF) in a low-resource setting. Case presentation and management: A 35-year-old G3P1 (1 alive) civil servant who had IVF on account of secondary infertility of 3 years duration.
She had spontaneous vertex delivery of a life female neonate 6 years prior to presentation and left total salpingectomy following ruptured ectopic gestation about 3 years earlier. There was a history of pelvic inflammatory disease on at least 2 occasions. A
hysterosalpingogram (HSG) revealed absent left tube and patent right tube with perifimbrial adhesions. She had IVF using the long protocol. 8 metaphase II oocytes were aspirated and inseminated with her husband’s sperm. She had 2 blastocyts transferred, and a pregnancy test done 2 weeks later was positive. An obstetric scan done at 6 weeks revealed an intrauterine gestation compatible with her date and a concomitant right tubal ectopic gestation. She had transvaginal injection of potassium chloride as part
of conservative management. Resolut ion of the ectopic occurred, however she developed oped right hematosalpinx and persistent lower abdominal pain. She subsequently had a right total salpingectomy at a gestational age of 8 weeks. She continued luteal support till 14 weeks and pregnancy remained +1
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