Learning Objectives
Heterotopic pregnancies are rare clinical occurrences definedas the concurrence of both intrauterine and extrauterine pregnancies .
The condition can be life threatening if overlooked.
AHeterotopic pregnancy presents a diagnostic challenge to both the Clinician and the Sonologist.
Sonographic assessment plays a pivotal role in the earlydiagnosis of the condition.
A high index of suspicion is needed in:
a) patients with risk factors for an ectopic pregnancy
b) low risk women with free fluid in the pelvis,
associated with an intrauterine gestation withor withoutan associated adnexal...
Background
Heterotopic pregnancies are defined as the presence of multiple gestations,with one being in the uterine cavity and the other outside the uterus.
Ectopic locations include the fallopian tube and less commonly the cervix or ovary.
Heterotopic pregnancies are becoming commoner following assisted conception techniques.The increase in incidence has been attributed to pelvic inflammatory disease,
the use of IUDs,
increase in the performance of microsurgery and pharmacological ovarian stimulation.
Each of these risk factors increases the incidence 2 to 7 times above that of the general...
Imaging Findings OR Procedure Details
We report two cases of heterotopic pregnancypresenting at our hospital.
Both were imaged by transabdominal and transvaginal ultrasound.
The diagnosis of heterotopic pregnancy was suspectedand appropriate management was instituted prior to the onset of complications.
Case 1
A 30 year old woman of Caucasian originpresented to theEmergency Department witha history of sudden generalised abdominal pain radiating to the right shoulder.
She was 8 weeks pregnant by natural conception and there was no history of abortion,
infertility,
pelvic inflammatory disease or abdominal surgery.She was assessed clinically...
Conclusion
A heterotopic pregnancy can occur in the absence of predisposing risk factors and the detection of an intrauterine pregnancy does not preclude a co-existent extrauterine gestation.
As these two cases demonstrate,
the presence ofabnormal adnexal findingsmust raise the possibility of a heterotopic pregnancy (in addition to the imaging differential diagnosis of a haemorrhagic corpus luteum,
a ruptured ovarian cyst or appendicitis).
It follows that in all patients of reproductive age,evenwhen an intrauterine pregnancy is seen,diligent sonographicevaluation of theentire pelvis ismandatory to rule out the presence...
Personal Information
All authors are from the Department ofMedical Imaging,
Gosford Hospital,Gosford,NSW 2250Australia
T.Mathews FRANZCR,
Department of Medical Imaging,
Gosford Hospital,
Gosford,2250
NSW,Australia.
contact email-
[email protected]
J.
Hanson FRANZCR;
R.Rattan MD;
T.Durrance RT;
S.Hiscock RT;
Department of Medical Imaging,
Gosford Hospital,
Gosford,2250
NSW,Australia.
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