Bataille P, Reynard A, Ducarme G
Department of Obstetrics and Gynecology, Centre Hospitalier Départemental, 85000 La Roche-sur-Yon, France.
Department of Obstetrics and Gynecology, Centre Hospitalier Départemental, 85000 La Roche-sur-Yon, France.
J Gynecol Obstet Hum Reprod. 2017 Oct;46(8):657-659. doi: 10.1016/j.jogoh.2017.05.008. Epub 2017 May 24.
Spontaneous heterotopic triplets, a tubal ectopic pregnancy and a twin pregnancy, are rare disorders. The study aimed to examine all available evidence regarding signs and symptoms, imaging findings, management and newborn outcome of spontaneous heterotopic triplets.
A literature search in Medline and EMBASE databases from 2000 to 2016 was conducted. The following key words were employed: 'spontaneous heterotopic pregnancy', OR 'heterotopic triplets'. Only cases of spontaneous heterotopic triplets without assisted reproduction techniques were included.
Six cases were identified and included in the present review. All cases presented with abdominal pain and one case presented in shock. Hemoperitoneum was present in five cases. Laterouterine mass with adnexal gestational sac is not systematically described (3 cases/6), but was a good ultrasonographic sign of heterotopic pregnancy. All patients had tubal rupture, but anyone had vaginal bleeding. The surgical treatment was made by salpingectomy in five cases to ensure successful treatment. The mean and median gestational age at delivery were 29.9 and 37.54 weeks, respectively (range 6-41 weeks). The neonatal outcome was good for 6 newborns.
Spontaneous heterotopic triplets are rare. Early surgical intervention is the key to successful treatment of heterotopic triplet pregnancy and allows good neonatal outcome.
自然发生的异期三胎妊娠，即一侧输卵管妊娠合并双胎妊娠，是一种罕见的疾病。本研究旨在审视关于自然发生的异期三胎妊娠的体征和症状、影像学检查结果、治疗方法及新生儿结局的所有现有证据。
对2000年至2016年期间Medline和EMBASE数据库进行文献检索。使用了以下关键词：“自然发生的异位妊娠”或“异期三胎妊娠”。仅纳入未采用辅助生殖技术的自然发生的异期三胎妊娠病例。
共识别出6例病例并纳入本综述。所有病例均出现腹痛，1例出现休克。5例存在腹腔积血。子宫外侧包块伴附件区妊娠囊未被系统描述（3例/6例），但这是异位妊娠的一个良好超声征象。所有患者均发生输卵管破裂，但均无阴道出血。5例患者通过输卵管切除术进行手术治疗以确保治疗成功。分娩时的平均孕周和中位孕周分别为29.9周和37.54周（范围6 - 41周）。6名新生儿的结局良好。
自然发生的异期三胎妊娠很罕见。早期手术干预是成功治疗异期三胎妊娠的关键，并可带来良好的新生儿结局。
