This poster was originally presented at the RANZCR Annual Scientific Meeting 2010, October 14-17, in Perth/AU.
Congress:
RANZCR ASM 2010
Type:
Educational Exhibit
Keywords:
Obstetrics, Foetus, Diagnostic procedure, Ultrasound-Colour Doppler, Ultrasound, Pelvis, Obstetrics (Pregnancy / birth / postnatal period), Genital / Reproductive system female
Authors:
T. Mathews, J. Hanson, R. Rattan, T. Durrance, S. Hiscock; NSW/AU
DOI:
10.1594/ranzcr2010/R-0062
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 population.The historical reported incidence is 1% to 3%.
More recent reviews indicate the following -
a)2.5 to 6.25 per 10,000 for patients with pelvic inflammatory
disease
b)33 per 10,000 for patients in ovarian induction programs
c)100 per10,000 for patients after assisted reproductive
technology.
Within these subgroups of the obstetric population,
heterotopic
pregnancy should be high on the list of differential diagnoses.
- Unlike primary ectopic pregnancy,
Beta HCG levels in heterotopic pregnancy are deceptively normal,
due to the presence of a concurrent intrauterine pregnancy.
- The treatment of heterotopic pregnancy differs from that of ectopic pregnancy.
Surgical management,
including salpingectomy,
salpingostomy by laparotomy/laparoscopy,
is the mainstay of treatment.
The use of expectant management and successful salpingocentesis have been reported.
- The diagnosis of a heterotopic pregnancy presents a diagnostic dilemma.The detection rate by ultrasound varies between 41% and 84%.
A meticulous sonographic assessment of the adnexa is necessary.
- We present two cases to highlight the role of the Sonologist and the imaging findings in this clinical situation.