2019 Research Forum

Department of Obstetrics & Gynecology

Applicant & Principal Investigator: Julia Leigh Canders MD R4 Faculty Sponsor: Sally Marie Wonderly MD FACOG

Interesting Ectopic Study – Record Review Study

Julia Leigh Canders MD R4, Sally Marie Wonderly MD FACOG

INTRODUCTION Heterotopic pregnancies are rare clinical events that symptoms mimic those of threatened abortion, ruptured corpus luteum cyst, ectopic pregnancy at other locations, and other benign gyn phenomenon and are often misdiagnosed until more advanced gestational age, however with case review, and consideration of subjective and objective clinical findings these diagnoses may be able to made earlier and not missed. PURPOSE We present a case of subacute, clinically stable heterotopic pregnancy via natural conception with live IUP and partially ruptured left adnexal ectopic pregnancy at approximately 7wks gestation. HIPPA/IRB case review and approval were obtained. DISCUSSION Heterotopic pregnancy symptoms are often vague and can mirror those of other obstetric and gynecological conditions. Symptoms may include vaginal bleeding, abdominal or pelvic pain, presence of pelvic mass, and enlarged uterus. Due to the presence of an IUP on early imaging many heterotopic pregnancies are missed originally and are often not diagnosed until a more advanced gestational age, averaging around 16 weeks. Unfortunately, with the advancing gestation age brings a higher incidence of rupture and hemodynamic instability at the time of diagnosis. If clinical suspicious is low, after identifying an intrauterine pregnancy, the ectopic pregnancy may be falsely labeled a corpus luteum cyst. However advanced ectopic gestations containing a yolk sac or fetal pole with cardiac activity make this diagnosis easier to make. Similarly, the presence of free fluid within the abdomen may be a sign of tubal rupture, but also may be falsely labeled ascites associated with ovarian hyperstimulation syndrome. Unfortunately, HCG levels are not useful in diagnosing heterotopic pregnancy as they reflect primarily the IUP. CONCLUSION The incidence of heterotopic pregnancy used to be rare, 1: 30,000 pregnancies, however now with advanced reproductive technologies and consideration of subjective and objective clinical findings heterotopic diagnoses are being recognized more readily and made at earlier gestational ages accounting for the overall incidence of heterotopic pregnancy increasing significantly to ~1: 3900 pregnancies.

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