Triplet heterotopic pregnancy following ovulation induction with clomiphene citrate: a case report and review of literature

Authors

  • Maheswari S Department of Obstetrics and Gynaecology, PSG Institute of Medical Sciences & Research, Coimbatore-641004, India
  • Seetha Panicker Department of Obstetrics and Gynaecology, PSG Institute of Medical Sciences & Research, Coimbatore-641004, India

Keywords:

Heterotopic pregnancy, Ovulation induction

Abstract

Heterotopic pregnancy, though rare is a combined pregnancy in which synchronous intrauterine and extra uterine pregnancy occur. An estimated incidence of between 1/8000 to 1/30,000 has been reported following spontaneous conception. After artificial reproductive techniques, the incidence is as high as 1/100 and after ovulation induction with clomiphene citrate, it is around 1/900. We are reporting a case of 26 year old gravida 2 who conceived after ovulation induction with clomiphene citrate and presented to the emergency department with acute abdominal pain. Ultrasound pelvis showed viable twin intrauterine gestation of 8 weeks along with ruptured ectopic pregnancy on the right tube. After stabilizing the patient, emergency laparotomy and right salpingectomy was performed. Fortunately, the intrauterine twin fetuses grew satisfactorily and patient was delivered by caesarean section at 36 weeks in view of previous lower segment caesarean section with preterm labour. Heterotopic pregnancy must be considered in a patient with amenorrhea, abdominal pain, adnexal mass and enlarged uterus particularly, conception following artificial reproductive techniques or fertility drugs, even though the intrauterine pregnancy has been documented. A high index of suspicion is important to avoid maternal morbidity, sometimes mortality and loss of intrauterine pregnancy.

References

Dumesic DA, Damario MA, Session DR: Interstitial heterotopic pregnancy in a women conceiving by invitro fertilization after bilateral salpingectomy. Mayo clin Proc 2001, 76:90-92.

Maalt ME, Murad Nand Dabbas M: Advanced heterotopic pregnancy. J obstet gynaecol 1999, 19:677-678.

Mistry BM, Balasubramaniam S, Silverman R, Sakabu SA, Troop BR: Heterotopic pregnancy presenting as an acute abdomen: A diagnostic masquerader. Am Surg 2000, 66(3):307-308.

Dessole S, Ruiu GA, Cherichi PL: Coexistene of a heterotopic pregnancy associated with a homolateral ovarian cyst in a patient subjected to elective abortion. Gynecol Obstet Invest 2000;49:277-278.

Hill J: Assisted reproduction and the multiple pregnancy: Increasing the risks for heterotopic pregnancy. J Diagn Med Sonogr 2003, 19:258-260.

Bello G, Schonholz D, Moshirpur J, Jeng DY, Berkowitz RL: Combined pregnancy: The mount Sinai experience. Obstet Gynecol Surv 1986, 41:603-613.

Perkins JD, Mitchell MR: Heterotopic pregnancy in a large inner city hospital: A report of 2 cases. J Natl Med Assoc 2004, 96:363-366.

Mishra A, Youssefzadeh D, Parente JT. Heterotopic pregnancy. Female patient 1998;23:39-42.

Scheiber MD, Cedars MI. Succesful non surgical management of a heterotopic pregnancy of an abdominal pregnancy following embryo transfer with cryo preserved-thawed embryos. Hum Reprod 1999, 14:1375-1377.

C. Louis-Sylvestre, P Morice, C Chapron and JB Dubuisson. “The role of laparoscopy in the diagnosis and management of heterotopic pregnancies”, Human Reproduction, Vol.12, no 5, pp 1100-1102, 1997.

Arcibong EI, Etuk SJ. Case report, heterotopic pregnancy following induction of ovulation. Trop J Obstet Gynecol 2002, 19:115-116.

Naki MM, Tekcan C, Uysal A, Guzin K, Yucel N. Arch Gynecol Obstet 2006 Jun;274(3):181-3.

Payne S, Duqe J, Bradbury W, Obstet Gynecol 1971 Dec; 38(6):905-6.

Dietz TU, Haenggi W, Birkhaeuser M, Gyr T, Dreher E, J Obstet Gynecol Reprod Biol. 1993 Jan;48(1):69-71.

Gruber I, Lahodny J, Illmensee K, Losch A: Wien Klin Wochenschr. 2002 Mar 28;114(5-6):229-32.

Raccuia JS, Neckles S, Butler D, Kahn M, Ibrahim IM. Surg Gynecol Obstet. 1989 May;168(5):417-20.

Glassner MJ, Aron E, Eskin BA. J Reprod Med 1990 Feb;35(2):175-8.

Kably Ambe A, Werner von der Medan Alarcon J, Garcia Leon JF, Reyes Cuervo H. Ginecol Obstet Mex. 1995 Aug;63:346-8.

Nguyen-Tran C, Toy EC. Heterotopic pregnancy: Viable twin intrauterine pregnancy with a viable right tubal ectopic pregnancy. Journal of Ultrasound in Medicine 2000;19(5):article 355.

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Published

2016-12-13