| Background:Heterotopic pregnancy is one kind of pathological pregnancy in which both extra-uterine and intrauterine pregnancy occur simultaneously.In recent years,the incidence of heterotopic pregnancy has increased progressively,estimated to be 1%.due to the increased incidence of risk factors of ectopic pregnancy,such as widespread application of assisted reproductive technology and induction of ovulation,as well as pelvic inflammatory disease and pelvic surgery history.Diagnosis and management of heterotopic pregnancy remains controversial with the desire for preserving the viable intrauterine gestation and resolving the ectopic pregnancy to avoid the potentially fatal bleeding at the same time.Objective:To analyze the clinical features and diagnostic criteria of heterotopic pregnancy.evaluate different therapeutic options and its pregnant outcomes.provide a basis for early diagnosis and clinical therapy.Materials and methods:Clinical data of 24 patients with heterotopic pregnancy diagnosed and treated in Qilu Hospital of Shandong University from January 2010 to April 2016 were analyzed retrospectively.including clinical characteristics,ultrasound findings,therapy regimens and outcomes of pregnancy were analyzed.Results:1.Among the 24 patients with heterotopic pregnancy reviewed in our study,2 patients(8.3%)were conceived spontaneously and the other 22 were conceived via assisted reproductive technology.Previous pelvic inflammatory disease and/or pelvic surgery history were presented in 79.2%(19/24)of patients.The major clinical manifestations were non-specific abdominal pain(58.3%,14/24)and vaginal bleeding(50.0%,12/24).2.23 patients(95.8%,23/24)were diagnosed at a mean gestational age of 7.3±1.5weeks by transvaginal ultrasound examination.A yolk sac or fetal pole was visible in 10 patients,of which 8 patients were with fetal cardiac activity,7 patients were presented with a bagel sign and 6 patients were with an inhomogeneous adnexal mass.The ectopic embryos of the 24 patients were all located in tube,among which 2 patients were interstitial portion(8.3%,2/24).3.Surgical treatment was adopted in 14 patients(58.3%)due to hemodynamic instability,detected ectopic fetal cardiac activity,intense pain and significant hemoperitoneum.Among which 2 patients with unstable hemodynamics and another 2 patients who received laparoscopic procedures received operations under general anesthesia.Another 10 patients(41.7%)received laparotomy under combined spinal-epidural anesthesia.Expectant management was adopted for 10 patients(41.7%)and repeated ultrasound examination and close monitoring were performed.Gradual regression of the ectopic pregnancy was presented in 9 patients,while surgery was performed subsequently for 1 patient.4.Miscarriage occurred in five patients(20.8%.5/24),meanwhile 15 patients(62.5%,15/24)delivered live infants without congenital anomalies,and the remaining four patients have ongoing pregnancies until the last follow-up.No statistical differences were observed between the surgery group and the expectant group in abortion rate,preterm delivery rate,Apgar score in 1 min and 5 min and birth weight.Adverse outcomes like congenital anomalies were not observed among the live-birth deliveries in both groups.Conclusions1.Medical history of pelvic inflammatory disease and tubal surgery were risk factors for heterotopic pregnancy,assisted reproductive technology leads to the increased incidence.2.Surgical procedure and anesthesia led to no increase of abortion rate,preterm rate,and adverse outcomes like congenital anomalies.3.Expectant management can be an appropriate therapy for heterotopic pregnancy by following stringent inclusion criteria and close monitoring,therefore the complications associated with surgery and anesthesia can be avoided. |
PDF Full Text Request