PDF(Pubmed)
Abstract：
Heterotopic pregnancy is a rare, difficult to diagnose and life-threatening pathology, which requires timely decisions made by an experienced multidisciplinary team. In this type of multiple pregnancy there are both intrauterine and ectopic pregnancies present. Its incidence increases in pregnancies conceived by assisted reproductive technology or in pregnancies with ovulation induction. This article presents an angular heterotopic pregnancy case in a 34-year-old multigravida. The patient was admitted on the 14th week of gestation due to abdominal pain on the left side with suspicion of heterotopic pregnancy. Transabdominal ultrasound and magnetic resonance imaging (MRI) were performed to confirm the diagnosis of heterotopic angular pregnancy in the left cornu of the uterus. Multidisciplinary team made a decision to keep monitoring the growth of both pregnancies by ultrasound while maternal vitals were stable. Due to intensifying abdominal pain, diagnostic laparoscopy was performed. No signs of uterine rupture were observed, and no additional surgical procedures were performed. Maternal status and ultrasonographic findings were closely monitored. The mass in the left cornu of the uterus did not change significantly and the fetal growth of the intrauterine pregnancy matched its gestational age throughout pregnancy. At the 41st week of gestation, a healthy female neonate was born via spontaneous vaginal delivery. The incidence rate of heterotopic pregnancy tends to grow due to an increased number of pregnancies after assisted reproductive technology and ovulation induction. It is important to always assess the risk factors. The main methods for diagnosing heterotopic pregnancies are ultrasonography and MRI. The main management tactics for heterotopic pregnancy include expectant management as well as surgical or medical termination of the ectopic pregnancy. Expectant management may be chosen as an option only in a limited number of cases, if the clinical situation meets the specific criteria. When applicable, expectant management may reduce the frequency of unnecessary interventions and help to prevent patients from its complications.
摘要：
异位妊娠是罕见的，难以诊断和危及生命的病理，这需要经验丰富的多学科团队及时做出决定。在这种类型的多胎妊娠中，存在宫内妊娠和异位妊娠。在辅助生殖技术怀孕或排卵诱导怀孕中，其发病率增加。本文介绍了一个34岁的多胎妊娠患者的角度异位妊娠病例。患者在妊娠第14周因左侧腹痛入院，怀疑异位妊娠。进行了经腹超声和磁共振成像（MRI）以确认子宫左角异位妊娠的诊断。多学科团队决定在产妇生命体征稳定的情况下继续通过超声监测两次怀孕的生长。由于腹部疼痛加剧，进行了诊断性腹腔镜检查.没有观察到子宫破裂的迹象，并且没有进行额外的外科手术.密切监测产妇状况和超声检查结果。子宫左角的质量没有显着变化，宫内妊娠的胎儿生长与整个妊娠期间的胎龄相匹配。在妊娠第41周,一名健康的女性新生儿通过自然阴道分娩出生。由于辅助生殖技术和排卵诱导后的妊娠次数增加，异位妊娠的发生率趋于增长。始终评估风险因素非常重要。诊断异位妊娠的主要方法是超声检查和MRI。异位妊娠的主要管理策略包括期待管理以及手术或药物终止异位妊娠。只有在有限的情况下，可以选择预期管理作为一种选择，如果临床情况符合特定标准。如果适用,预期管理可以减少不必要干预的频率，并有助于防止患者并发症。
