Spontaneous Heterotopic Pregnancy Simultaneous Ovarian And Intrauterine: A Case Report
1Department of Obstetrics and Gynecology, Catholic University of Sacred Heart, Largo A. Gemelli 8, 00168 Rome, Italy
Spontaneous heterotopic pregnancy is a rare clinical condition in which intrauterine and extrauterine pregnancies occur at the same time. The occurrence of an ovarian heterotopic pregnancy is a singular event as it comprises only 2.3% of all heterotopic pregnancies, extremely rare among women who conceive naturally. A case of a 28-year old patient was treated for spontaneously conceived heterotopic pregnancy. The patient was admitted to our center with lower abdominal pain and amenorrhoea. A transvaginal ultrasound scan showed an ovarian and an intrauterine heterotopic pregnancy. This was managed laparoscopically. Considering spontaneous pregnancies, every physician treating women of reproductive age should be aware of the possibility of heterotopic pregnancy. It can occur in the absence of any predisposing risk factors only with an early diagnosis and treatment the intrauterine pregnancies will reach viability with a great chance of a favorable obstetric outcome.
2. Case ReportTransvaginal ultrasound of uterus showing a gestational sac of approximately 7 weeks.
3. Operative Procedure
Desire To Continue The Pregnancy
If the woman wishes to continue with the pregnancy, a doctor will perform a pelvic examination. If the IUD strings are visible, the doctor will remove the IUD gently.
If the IUD strings are not visible, a woman may need to undergo an ultrasound to determine its location. The next course of action depends on the location, as below:
- No IUD found: The woman will need an X-ray to locate the device.
- IUD within the cervix: The doctor will remove the IUD by pulling the strings.
- IUD above the cervix: The doctor will talk about the risks and complications of continuing the pregnancy.
Is Intrauterine Pregnancy A Normal Pregnancy
Its when a baby is born in your uterus at an earlier stage. You are carrying a fetus that is too small to survive outside the womb, and you are at a very early point in your pregnancy, which is known to occur for one of two possible reasons.
Or, you have a chromosomal abnormality, such as Down syndrome or trisomy 18, which means that your baby is born with an extra copy of chromosome 21. In this case, the baby will not be able to develop normally in its mothers womb, so it must be delivered by cesarean section.
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Is Iup A Normal Pregnancy
A normal IUP can be visualized on transvaginal ultrasound 4 weeks and 3 days after the onset of the last menstrual period in women with regular 28day cycles4. However, common etiologies for firsttrimester bleeding, such as implantation bleeding or subchorionic hematoma, can occur before this time.
Whats The Difference Between Miscarriage And Ectopic Pregnancy
Miscarriages are a fact of life for millions of women. ectopicpregnancies can be life threatening to the baby and the mother. An ectopicpregnancy almost always ends the babys life because of its inability to survive outside the mothers body. In the United States, there are an estimated 1.5 million to 2.3 million abortions each year.
The vast majority of these abortions are performed on women in their 20s and 30s who have been diagnosed with a severe fetal abnormality, such as Down syndrome or Downs syndrome. These women are often referred to as viable fetuses because they are capable of surviving outside of their mothers bodies.
However, many of the women who undergo this type of abortion are not able to carry a pregnancy to term and are therefore unable to give birth to a healthy baby. In fact, a recent study by the Guttmacher Institute found that more than half of all abortions performed in the U.S. occur in women between the ages of 20 and 24.
This means that many women under the age of 24 are forced to undergo an abortion in order to save their own lives.
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Fertilitysmarts Explains Intrauterine Pregnancy
With spontaneous conception, once an egg is fertilized it continues traveling down the fallopian tube propelled by little finger-like projections called fimbriae towards the uterus where it is likely to implant in the uterine lining.
The uterus is designed specifically to house a growing pregnancy. It has a sufficient blood supply to nourish a pregnancy and the capacity and flexibility to enlarge with the growing fetus.
In some situations, the fertilized egg becomes implanted in places other than the uterus and this is known as an extrauterine or ectopic pregnancy. The fallopian tube is the most common ectopic site and the tubes are not designed to expand or grow or otherwise house a pregnancy.
A fertilized egg is designed to be naturally invasive. It has a developmental timeline that is triggered regardless of location. If there is a delay or inability of the fimbriae to move a fertilized egg out of the tube, the process of implantation can start in the incorrect location.
As the embryo grows and tries to form a placenta, there is inadequate space and the tube does not have the ability to expand which can cause the tube to burst. This rupture can cause abdominal pain with bleeding and requires immediate medical attention as it can be life-threatening.
Early Confirmation Of Intrauterine Pregnancy
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Department of Gynecology, Salford Royal Hospital, UK
Correspondence: Sudipta Paul, Consultant Obstetrician & Gynecologist, Freelance author and researcher, Department of Gynecology, Salford Royal Hospital, Salford, UK
Received: August 29, 2016 | Published: September 19, 2016
Citation: Paul S. Early confirmation of intrauterine pregnancy- is color doppler useful? Obstet Gynecol Int J. 2015 5:281-282. DOI: 10.15406/ogij.2016.05.00147
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How Do Iuds Work
Both copper IUDs and hormonal IUDs prevent pregnancy by changing the way sperm cells move so they can’t get to an egg. If sperm cant make it to an egg, pregnancy cant happen.
The Paragard IUD uses copper to prevent pregnancy. Sperm doesnt like copper, so the Paragard IUD makes it almost impossible for sperm to get to that egg.
The hormones in the Mirena, Kyleena, Liletta, and Skyla IUDs prevent pregnancy in two ways: 1) they thicken the mucus that lives on the cervix, which blocks and traps the sperm, and 2) the hormones also sometimes stop eggs from leaving your ovaries , which means theres no egg for a sperm to fertilize. No egg, no pregnancy.
One of the awesome things about IUDs is that they last for years but theyre not permanent. If you decide to get pregnant or you just dont want to have your IUD anymore, your nurse or doctor can quickly and easily take it out. Youre able to get pregnant right after the IUD is removed.
Signs Of Ectopic Pregnancy
- Failure to identify an IUP is the first indication that an ectopic may be present.
- Other signs include: Free fluid in the pelvis and/or masses in the adnexa
- An ectopic pregnancy in the tube or ovary often has a ring of fire with color Doppler imaging. However, most ectopic pregnancies are not visible with transabdominal ultrasound.
- Free intraperitoneal fluid in Morisons pouch is a sign of a ruptured ectopic that will likely require operative intervention.
Figure 3: Empty fluid-filled sac within the endometrium. Given the absence of contents, you cannot differentiate gestational vs pseudogestational sac. This is not diagnostic of an IUP.
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What Is A Failed Intrauterine Pregnancy
Fetal heart rate of less than 60 beats per minute is considered to be a Fetal heart rate of less than 60 beats per minute is considered to be a Fetal heart rate of less than 30 beats per minute is considered to be a Fetal heart rate of less than 30 beats per minute is considered to Statistical analysis.
Data were analyzed using SPSS version 19.0 . The significance level was set at P < 0.05. The results are presented as means ± SDs unless otherwise stated.
Can Iuds Be Used As Emergency Contraception
Yes! The Paragard, Mirena, and Liletta IUDs work super well as emergency contraception. If you get one of these IUDs put in within 120 hours after unprotected sex, its more than 99% effective. Its actually the most effective way to prevent pregnancy after sex.
Another great thing about using an IUD as emergency contraception: you can keep it and have really effective birth control that you can use for up to 7 to12 years . The other kind of emergency contraception is the morning-after pill. You can take it up to 5 days after unprotected sex to reduce the risk of pregnancy.
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How Do Doctors Know If Its An Ectopic Pregnancy
Your doctor can use a Pelvic exam to identify areas of pain, tenderness, or a mass in the fallopian tube or ovary. Your doctor cannot diagnose an ectopicpregnancy by examining you. You will need to have your blood tested to find the cause of your symptoms. If you have symptoms that dont respond to treatment, you may need to go to a hospital emergency room.
Supporting The Academic Success Of Pregnant And Newborn
Title IX of the Education Amendments of 1972 protects students in all academic, educational, extracurricular, athletic, and other programs or activities of schools. This includes prohibiting discrimination against pregnant and newborn-parenting students. Specifically, Title IX prohibits schools from excluding a pregnant student from participating in any part of an educational program, including the admissions process, attending classes, and completing coursework. This prohibition applies to all university policies, including the practices of individual instructors.
So that they will not be disadvantaged in their courses of study or research, reasonable academic accommodations can be granted to students affected by pregnancy, pregnancy-related conditions, childbirth, and post-partum parenting. Accommodations may include alternatives for making up missed work and exams and/or alternative assignments to make up for class participation points or attendance requirements. The Title IX coordinator can work directly with a student who identifies herself as pregnant in order to require and retain the medical documentation necessary to identify an approved absence.
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Why Early Confirmation Is Important
With the advent of expected and medical treatment and conservative laparoscopic treatment for ectopic pregnancy, early diagnosis has become more important.
Confirmation of an intrauterine pregnancy will quickly avoid too much confusion, unnecessary examinations and intrusion into early pregnancy problems.
This will reduce patient anxiety associated with uncertainty about diagnosis, examination, and intervention. This will also save resources and costs in the long run.
Obgyn Concerns Surrounding Puls
There are issues with both over treating and under treating PULs. If a PUL is identified as ectopic too late, it could become life-threatening for the woman. Resolving a pregnancy of unknown location has the potential to terminate what could have been a viable intrauterine pregnancy.
With this in mind, it is important to provide individualized care for each patient. A woman with risk factors for an ectopic pregnancy, such as experiencing a previous ectopic pregnancy or a previous tubal surgery, may have an increased chance of having a PUL become ectopic.
Close monitoring of human chorionic gonadotropin levels and regular ultrasounds may help physicians better understand when to act, or not.
Are you a patient who has experienced an ectopic pregnancy and has questions? Contact us today or schedule an appointment online.
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An Embryo With Fetal Heart Activity
- Before 6.3 weeks a rate below 80 bpm carries a poor prognosis with an increased risk of miscarriage during the first trimester.
- Between 6.3-7 weeks 120 bpm has a poor prognosis while under 100bpm is considered to be especially poor and at an increased risk of miscarriage.
Citation Doi & Article Data
- Pregnancy of unknown location
- Pregnancy of uncertain location
- Gestation of unknown location
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Is Iep The Same As Special Ed
The Individualized Education Program, often called the IEP , is a legal document under United States law that is developed for each public school child in the U.S. who needs special education . It is created through a team of the childs parent and district personnel who are knowledgeable about the childs needs.
Clinical Approach To Intrauterine Pregnancy & Ectopic Pregnancy Puls
A pregnancy of unknown location occurs when a woman has a positive pregnancy test but no signs of the two types of PULS, intrauterine pregnancy and ectopic pregnancy , are found on transvaginal ultrasound. According to the National Institutes of Health, the reported rates of pregnancy of unknown location varies widely from 5-42%.
A PUL is not a diagnosis, but a classification term for this occurrence. Sometimes there is no final diagnosis, and the pregnancy is assumed to spontaneously resolve.
Many women with a pregnancy of unknown location will have abdominal pain and/or vaginal bleeding. A PUL may be indicated by passing of pregnancy tissue from the vagina or other symptoms of pregnancy loss, as can a hemodynamic instability.
The initial ultrasound can come up with four possibilities:
- A true PUL, with no sign of pregnancy anywhere.
- A likely ectopic pregnancy.
- An IUP, which is just too early to make the diagnosis.
- A miscarriage is likely due to conception products in the endometrial cavity.
Most women with a true PUL or an IUP will not need treatment because the pregnancy will not last. These women will have a spontaneous miscarriage or resorb an ectopic pregnancy. Because of this, the location of the pregnancy may never be determined.
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Transvaginal Ultrasound Of Intrauterine Pregnancy
This image is brought to us by Drs. Anna Yaffe and Sean Lowe. They used transvaginal ultrasound to evaluate a 28-year-old G2P0 with multiple obstetric complaints and a positive urine pregnancy test. Vaginal bleeding and pelvic pain are common complaints in first-trimester pregnancy. When formulating a differential, always have ectopic pregnancy at the front of your mind.
Remember our job as emergency physicians is to rule out ectopic pregnancy by finding an intrauterine pregnancy . In the simplest terms: if the patient has a + ß-hCG and you cannot find an IUP, it is an ectopic pregnancy until proven otherwise. Intrauterine pregnancy is defined as a gestational sac that contains either a yolk sac or a fetal pole.
This image shows the uterus in the longitudinal plane using an intracavitary probe with a clear yolk sac, making this a definitive IUP.
What Does Intrauterine Pregnancy Mean
An intrauterine pregnancy occurs when a fertilized egg implants and starts to develop within the uterus, where it is supposed to be. The uterus is the only place where a pregnancy can develop and progress to full term.
An ultrasound finding of an intrauterine pregnancy means that the pregnancy is developing in the proper location.
Pregnancies that develop elsewhere within the female reproductive tract are known as ectopic pregnancies are not viable, meaning they will not result in the birth of a child.
Possible concerning symptoms in early pregnancy including abdominal or pelvic pain and vaginal bleeding should be investigated to determine the location of the pregnancy and rule out any complications.
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For Obgyns: Pregnancy Of Unknown Location
Our practice liaison often fields referral questions from OB/GYNs about pregnancy of unknown location in their patients. As infertility specialists, we are familiar with problematic embryo implantations, such as ectopic pregnancies or pregnancies in the wrong part of the uterus. Also, OB/GYNs often need to refer these patients to us, as a PUL may indicate a fertility issue we can treat.
We hope the following information on PUL will be of help to OB/GYNs.
Trophoblastic Interval The Earliest Vascular Changes
During early embryonic development, trophoblastic gaps develop from spiral arteries at 9 , when vacuoles open within the vaculitio-trophoblast .
The uterine circulation is established on the 21st day and by the 22nd day the heart starts beating .
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What Is An Early Intrauterine Pregnancy
What does intrauterine pregnancy mean? Its when a gestational sac forms in your womb at an earlier stage in your pregnancy. Early intrauterine pregnancy is known to occur for one of two possible reasons:
- You are, in fact, at a very early point in your pregnancy, and your embryo needs more time to grow and initiate a heartbeat. This frequently happens when the mother is unsure of her conception date, displays a history of irregular menstruation, or recently stopped taking birth control.
- Your pregnancy and your babys growth rate are not progressing at a standard pace. Once again, this happens when the mother is uncertain of her conception date, and the size of the fetus is inconsistent with how far along her pregnancy is.
Struggling With The Exam
Cant visualize the uterus?
- Perform the ultrasound before the patient urinates. If unable to visualize key structures, proceed to a transvaginal ultrasound.
Cant find a yolk sac or fetal pole?
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