Monochorionic monoamniotic live twin ectopic pregnancy: a rarity
Keywords:Ectopic, Monochorionic, Monoamniotic, Pregnancy, Pelvic inflammatory disease, Twin, Tubal
The incidence of unilateral live twin ectopic pregnancy is approximately 1:1,25,000 but increased in last few decades due to increased use of fertility drugs for ovulation induction, superovulation and assisted reproductive technology. It is also associated with increased incidence of pelvic inflammatory diseases. Patient was 30 years old G3P2L2 who presented to OPD of this LLRM medical college, Meerut with complain of amenorrhoea of two and half months. Pelvic examination revealed tenderness in lower abdomen, left adnexal fullness and tenderness without any bleeding. On USG, left adnexal monochorionic monoamniotic ectopic twins with normal cardiac activity. Exploratory laparotomy followed by left sided salpingectomy was done and patient was discharged with satisfactory condition. This is a very rare case and PID is also among risk factors and may also cause twin ectopic pregnancy.
Bouyer J, Coste J, Fernandez H, Pouly JL, Job-Spira N. Sites of ectopic pregnancy: a 10 year population-based study of 1800 cases. Hum Repro. 2002;17:3224.
Murray H, Baakdah H, Bardell T, Tulandi T. Diagnosis and treatment of ectopic pregnancy. CMAJ. 2005;173:905.
Bouyer J, Coste J, Shojaei T, Pouly JL, Fernandez H, Gerbaud L, et al. Risk factors for ectopic pregnancy: a comprehensive analysis based on a large case-control, population-based study in France. Am J Epidemiol. 2003;157:185.
Li C, Zhao WH, Zhu Q, Cao SJ, Ping H, Xi X, et al. Risk factors for ectopic pregnancy: a multi-center case-control study. BMC Preg Childbirth. 2015;15:187.
Kamwendo F, Forslin L, Bodin L, Danielsson D. Epidemiology of ectopic pregnancy during a 28 year period and the role of pelvic inflammatory disease. Sex Transm Infect. 2000;76:28.
Summa B, Meinhold-Heerlein I, Bauerschlag DO, Jonat W, Mettler L, Schollmeyer T. Early detection of a twin tubal pregnancy by Doppler sonography allows fertility conserving laparoscopic surgery. Arch Gynecol Obstet. 2009;279:87-90.
Teresa T, Ali MD, Khazaei MD. Spontaneous unilateral dizygotic twin tubal pregnancy. J Clin Ultrasound. 2009;37:104-6.
Ectopic Pregnancy Foundation, Esher, UK. Registered charity no 1122286. Available www.ectopicpregnancy.co.uk. Accessed on 29 September 2014.
George M, Nadarajah S, Ong CL. Unilateral twin ectopic pregnancy. JHK Coll Radiol. 2010;12:186-9.
Ghike S, Somalwar S, Mitra K. A unilateral twin ectopic pregnancy (Diamniotic-Dichorionic): a rare case. J South Asian Federation Obstet Gynaecol. 2011;3:103-5.
Hanchate V, Garg A, Sheth R, Rao J, Jadhav PJ, Karayil D. Transvaginal sonographic diagnosis of live monochorionic twin ectopic pregnancy. J Clin Ultrasound. 2002;30:52-6.
Karadeniz RS, Dilbaz S, Ozkan SD. Unilateral twin tubal pregnancy successfully treated with methotrexate. Int J Gynaecol Obstet. 2008;102:171-8.
Eze JN, Obuna JA, Ejikeme BN. Bilateral tubal ectopic pregnancies: a report of two cases. Ann Afr Med. 2012;11:112-5.
Rolle CJ, Wai CY, Bawdon R, Santos-Ramos R, Hoffman B. Unilateral twin ectopic pregnancy in a patient with a history of multiple sexually transmitted infections. Infect Dis Obstet Gynaecol. 2006;2006:10306.
Kirk E, Bourne T. Diagnosis of ectopic pregnancy with ultrasound. Best Pract Res Clin Obstetr Gynaecol. 2009;23:501-8.
Kupesic S, Kurjac A. Color Doppler assessment of ectopic pregnancy. In: Kurjac A, Kupesic S (eds). An Atlas of Transvaginal Color Doppler. London: Parthenon Publishing; 2000:137-47.
Kurjac A, Zalud I, Shulman H. Ectopic pregnancy: transvaginal colour Doppler of trophoblastic flow in questionable adnexa. J Ultrasound Med. 1991;10:685-9.
Revicky V, Krishna A, Al-Taher H. Spontaneous monochorionic monoamniotic twin tubal ectopic pregnancy. J Obstet Gynaecol. 2009;29:447.