Laparoscopic Removal of Heterotopic Pregnancy with Subsequent Term Delivery of Intrauterine Fetus; A Case Report

Introduction: Heterotopic pregnancy has a reported incidence of 1 in 30,000 spontaneous pregnancies and 1 in 100 pregnancies using In-Vitro Fertilization.⁽¹⁾  Although rare, the incidence is rising and a consensus for management has yet to be published. Expectant management, laparoscopy, laparotomy, and fetal reduction are current management methods, yet each presents unique risks to the mother and intrauterine pregnancy.⁽²⁾  Due to the lack of guidance, clinicians are left to decide the best route based on the clinical scenario and their individual comfort.

Case Presentation: A 42-year-old G5P3023 Hispanic female presented to the Emergency Department (ED) for vaginal bleeding and lower abdominal cramping. ß-hCG on presentation was 15,000 mIU/mL. A transvaginal ultrasound (TVUS) showed an irregularly shaped sac within the endometrial cavity and a cystic structure adjacent to the right ovary. She was hemodynamically stable and instructed to return in 48 hours for reevaluation. Repeat ß-hCG was 53,000 mIU/mL and the TVUS noted intrauterine and right-sided ectopic pregnancies consistent with gestational ages of 5 weeks and 6 days. She underwent a laparoscopic right salpingectomy without complications. She ultimately delivered a term neonate with no consequences from the early gestation laparoscopy.

Discussion: A Heterotopic pregnancy is defined as a multifetal pregnancy containing one conceptus with normal uterine implantation that coexists with one implanted ectopically.⁽³⁾ Consistent with numerous prior published data, our case report confirms laparoscopy as a safe and effective method for management of the extrauterine pregnancy of a heterotopic pregnancy while maintaining the integrity of the intrauterine pregnancy.^(4-9)