Author(s): JÃZEF KRAWCZYK, DARIUSZ BOROWSKI, KRZYSZTOF DREWS,MIROSÅAW WIELGOÅ
Heterotopic pregnancy is defined as co-occurrence of intrauterine and extrauterine pregnancy and is an exceptionally rare example of twin pregnancy. Heterotopic pregnancy is particularly rare in women who had not been subjected to techniques of assisted reproduction. This case report describes a heterotopic, spontaneously conceived pregnancy in a primagravida. On the first gynaecological examination the patient was found to be at 7 weeks and 5 day of pregnancy based on the date of the last menstruation. Transvaginal ultrasonographic examination confirmed intrauterine pregnancy with suspected concurrent extrauterine pregnancy located in the adnexes. The patient was subsequently consulted at Obstetrics and Gynaecology Clinic of Poznan University of Medical Sciences where laparoscopy confirmed the preliminary diagnosis of extrauterine pregnancy located in the uterine tube isthmus. As a result, laparoscopic salpingotomy and removal of the ectopic pregnancy were performed. Post-laparoscopic course was uneventful and the development of intrauterine pregnancy during subsequent weeks was normal. On week 35 the patient was hospitalised because of premature uterine contractions and on week 36, following ineffective tocolysis, the woman gave premature, natural birth to a 2300 g baby with Apgar 9. Failure to diagnose heterotopic pregnancy or too late diagnosis usually results in rupture of extrauterine pregnancy with concurrent hypovolemic shock. Early diagnosis is therefore a key element determining the safety of the mother and the foetus. With early diagnosis prognosis is usually good and intrauterine pregnancy can be saved in about 70% of cases.