Department of Reproductive Health, Centre of Postgraduate Medical Education, 90 Żelazna St, 01-044, Warsaw, Poland.
Department of General, Oncologic and Trauma Surgery, Wolski Hospital, Kasprzaka 17, 01- 211, Warsaw, Poland.
BMC Pregnancy Childbirth. 2021 Jan 18;21(1):61. doi: 10.1186/s12884-020-03465-y.
Heterotopic pregnancy (HP) is a rare condition when at least two pregnancies are present simultaneously at different implantation sites and only one located in the uterine cavity. The majority of cases are diagnosed in the first trimester.
We present a unique case of HP diagnosed at 26 weeks of spontaneous pregnancy in a patient without any relevant risk factors. We performed an extensive review of HP cases from MEDLINE (PUBMED) published in English between 2005-2019 to prove this case's uniqueness. A 24-year-old woman presented because of threatened preterm birth. Despite treatment, pain aggravated, without progression of labor. An emergency ultrasound exam revealed free fluid in the abdominal cavity. Suspicion of active bleeding prompted the medical team to perform an exploratory laparotomy. The surgery team found a ruptured heterotopic pregnancy. This was an unexpected cause of nontraumatic hemoperitoneum at such advanced gestational age. The postoperative period was uneventful, and the intrauterine pregnancy continued to term. The final review included 86 out of 124 records. A total number of 509 cases were identified, but not all of them had complete data. The maximum reported gestational age at the time of diagnosis was 16 weeks of pregnancy, while our case became symptomatic and was diagnosed at 26 weeks of pregnancy.
Regardless of pregnancy age, HP can be a cause of hemoperitoneum, and it should be included in the differential diagnosis of acute abdomen in the second trimester.
异位妊娠（HP）是一种罕见的情况，即至少有两个妊娠同时存在于不同的着床部位，且只有一个位于子宫腔内。大多数病例在妊娠早期被诊断出来。
我们报告了一例独特的 HP 病例，该病例在自发性妊娠 26 周时被诊断出来，患者没有任何相关的危险因素。我们对 2005 年至 2019 年间在 MEDLINE（PUBMED）上发表的英文 HP 病例进行了广泛的回顾，以证明该病例的独特性。一名 24 岁的女性因早产威胁而就诊。尽管进行了治疗，但疼痛加剧，且无临产进展。紧急超声检查显示腹腔内有游离液体。怀疑有活动性出血，促使医疗团队进行了剖腹探查术。手术团队发现了一处异位妊娠破裂。这是如此晚期妊娠非创伤性血腹的意外原因。术后恢复顺利，宫内妊娠继续至足月。最终的回顾包括 124 份记录中的 86 份。共确定了 509 例病例，但并非所有病例都有完整的数据。报告的最大诊断时妊娠周数为 16 周，而我们的病例在妊娠 26 周时出现症状并被诊断出来。
无论妊娠年龄如何，HP 都可能是血腹的原因，应纳入妊娠中期急性腹痛的鉴别诊断。
