Talat Naz, Bilquis Afridi.
Heterotopic Pregnancy.
J Coll Physicians Surg Pak Jan ;12(9):565-6.

A 30 years old G5P3+1 with three months amenorrhea and pain in right iliac fossa was diagnosed having heterotopic pregnancy. Laparotomy and right salpingectomy were performed leaving the intrauterine pregnancy to progress. Heterotopic pregnancy, though is rare, early diagnosis and proper treatment allows intrauterine pregnancy to a successful outcome. A 30 years old woman, gravida 5, para 3, abortion 1, presented with amenorrhoea of 3 months and pain in right iliac fossa for 3 days. There was no history of bleeding per vaginum, syncopial attacks, fever or bowel irregularity. Symptoms of early pregnancy like morning sickness and vomiting sometimes were same as in her other pregnancies. On abdominal examination, there was tenderness in the right iliac fossa, no mass was palpable, uterus was also not palpable. Pelvic examination revealed a 10 weeks size uterus with a well-defined mass of about 5 cms size in the right formix. Cervical excitation was minimal and there was no bleeding or discharge. Her vital signs were stable with a blood pressure of 120/70 mmHg, pulse 102/min., temperature of 99oF and she was looking pale. Ultrasound examination revealed a single intrauterine gestatoinal sac with a single embryo of 3.9cms CRL corresponding to 11 weeks of gestation and active cardiac pulsation. Another gestational sac with a single embryo with cardiac pulsation was seen out of the endometrial canal, right and posterior to the uterus suggestive of ectopic pregnancy that could be in the cul-de-sac or right adnexa. On Laparotomy, uterus was 8-10 weeks size. Right tube was ruptured in the ampulary region with a well-formed fetus extruded from the tube and the placenta still attached to the tubal lumen. Right ovary was normal looking. Right salpingectomy was performed and 200cc blood and clots were removed from the peritoneal cavity. Corpus luteum was present in the left ovary, left tube was normal looking. Postoperatively the patient was put on progesterone support for 4 weeks. Histopathological examination confirmed the presence of chorionic villi.

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