A unique case of diagnosis of a heterotopic pregnancy at 26 weeks – case report and literature review

Abstract Background Heterotopic pregnancy (HP) is a rare condition when at least two pregnancies are present simultaneously at different implantation sites and only one located in the uterine cavity. The majority of cases are diagnosed in the first trimester. Case presentation We present a unique ca...

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Main Authors: Anna Kajdy, Katarzyna Muzyka-Placzyńska, Dagmara Filipecka-Tyczka, Jan Modzelewski, Marek Stańczyk, Michał Rabijewski
Format: Article
Language:English
Published: BMC 2021-01-01
Series:BMC Pregnancy and Childbirth
Subjects:
Online Access:https://doi.org/10.1186/s12884-020-03465-y
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spelling doaj-ef81de56c0434836b3702f327c8647282021-01-24T12:16:47ZengBMCBMC Pregnancy and Childbirth1471-23932021-01-012111610.1186/s12884-020-03465-yA unique case of diagnosis of a heterotopic pregnancy at 26 weeks – case report and literature reviewAnna Kajdy0Katarzyna Muzyka-Placzyńska1Dagmara Filipecka-Tyczka2Jan Modzelewski3Marek Stańczyk4Michał Rabijewski5Department of Reproductive Health, Centre of Postgraduate Medical EducationDepartment of Reproductive Health, Centre of Postgraduate Medical EducationDepartment of Reproductive Health, Centre of Postgraduate Medical EducationDepartment of Reproductive Health, Centre of Postgraduate Medical EducationDepartment of General, Oncologic and Trauma Surgery, Wolski HospitalDepartment of Reproductive Health, Centre of Postgraduate Medical EducationAbstract Background Heterotopic pregnancy (HP) is a rare condition when at least two pregnancies are present simultaneously at different implantation sites and only one located in the uterine cavity. The majority of cases are diagnosed in the first trimester. Case presentation We present a unique case of HP diagnosed at 26 weeks of spontaneous pregnancy in a patient without any relevant risk factors. We performed an extensive review of HP cases from MEDLINE (PUBMED) published in English between 2005-2019 to prove this case's uniqueness. A 24-year-old woman presented because of threatened preterm birth. Despite treatment, pain aggravated, without progression of labor. An emergency ultrasound exam revealed free fluid in the abdominal cavity. Suspicion of active bleeding prompted the medical team to perform an exploratory laparotomy. The surgery team found a ruptured heterotopic pregnancy. This was an unexpected cause of nontraumatic hemoperitoneum at such advanced gestational age. The postoperative period was uneventful, and the intrauterine pregnancy continued to term. The final review included 86 out of 124 records. A total number of 509 cases were identified, but not all of them had complete data. The maximum reported gestational age at the time of diagnosis was 16 weeks of pregnancy, while our case became symptomatic and was diagnosed at 26 weeks of pregnancy. Conclusions Regardless of pregnancy age, HP can be a cause of hemoperitoneum, and it should be included in the differential diagnosis of acute abdomen in the second trimester.https://doi.org/10.1186/s12884-020-03465-yAcute abdomenEctopic pregnancyHeterotopic pregnancySecond-trimester diagnosisCase report
collection DOAJ
language English
format Article
sources DOAJ
author Anna Kajdy
Katarzyna Muzyka-Placzyńska
Dagmara Filipecka-Tyczka
Jan Modzelewski
Marek Stańczyk
Michał Rabijewski
spellingShingle Anna Kajdy
Katarzyna Muzyka-Placzyńska
Dagmara Filipecka-Tyczka
Jan Modzelewski
Marek Stańczyk
Michał Rabijewski
A unique case of diagnosis of a heterotopic pregnancy at 26 weeks – case report and literature review
BMC Pregnancy and Childbirth
Acute abdomen
Ectopic pregnancy
Heterotopic pregnancy
Second-trimester diagnosis
Case report
author_facet Anna Kajdy
Katarzyna Muzyka-Placzyńska
Dagmara Filipecka-Tyczka
Jan Modzelewski
Marek Stańczyk
Michał Rabijewski
author_sort Anna Kajdy
title A unique case of diagnosis of a heterotopic pregnancy at 26 weeks – case report and literature review
title_short A unique case of diagnosis of a heterotopic pregnancy at 26 weeks – case report and literature review
title_full A unique case of diagnosis of a heterotopic pregnancy at 26 weeks – case report and literature review
title_fullStr A unique case of diagnosis of a heterotopic pregnancy at 26 weeks – case report and literature review
title_full_unstemmed A unique case of diagnosis of a heterotopic pregnancy at 26 weeks – case report and literature review
title_sort unique case of diagnosis of a heterotopic pregnancy at 26 weeks – case report and literature review
publisher BMC
series BMC Pregnancy and Childbirth
issn 1471-2393
publishDate 2021-01-01
description Abstract Background Heterotopic pregnancy (HP) is a rare condition when at least two pregnancies are present simultaneously at different implantation sites and only one located in the uterine cavity. The majority of cases are diagnosed in the first trimester. Case presentation We present a unique case of HP diagnosed at 26 weeks of spontaneous pregnancy in a patient without any relevant risk factors. We performed an extensive review of HP cases from MEDLINE (PUBMED) published in English between 2005-2019 to prove this case's uniqueness. A 24-year-old woman presented because of threatened preterm birth. Despite treatment, pain aggravated, without progression of labor. An emergency ultrasound exam revealed free fluid in the abdominal cavity. Suspicion of active bleeding prompted the medical team to perform an exploratory laparotomy. The surgery team found a ruptured heterotopic pregnancy. This was an unexpected cause of nontraumatic hemoperitoneum at such advanced gestational age. The postoperative period was uneventful, and the intrauterine pregnancy continued to term. The final review included 86 out of 124 records. A total number of 509 cases were identified, but not all of them had complete data. The maximum reported gestational age at the time of diagnosis was 16 weeks of pregnancy, while our case became symptomatic and was diagnosed at 26 weeks of pregnancy. Conclusions Regardless of pregnancy age, HP can be a cause of hemoperitoneum, and it should be included in the differential diagnosis of acute abdomen in the second trimester.
topic Acute abdomen
Ectopic pregnancy
Heterotopic pregnancy
Second-trimester diagnosis
Case report
url https://doi.org/10.1186/s12884-020-03465-y
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