Harzif Achmad Kemal, Hyaswicaksono Purnomo, Kurniawan Riyan Hari, Wiweko Budi
Department of Obstetrics and Gynecology, Reproductive Immunology and Endocrinology Division, Faculty of Medicine, Dr. Cipto Mangunkusumo General Hospital , Universitas Indonesia, Jakarta, Indonesia.
Department of Obstetrics and Gynecology, Faculty of Medicine, Dr. Cipto Mangunkusumo General Hospital, Universitas Indonesia, Jakarta, Indonesia.
Gynecol Minim Invasive Ther. 2021 Jan 30;10(1):53-56. doi: 10.4103/GMIT.GMIT_92_19. eCollection 2021 Jan-Mar.
Heterotopic pregnancy (HP) is the coexistence of extrauterine and intrauterine pregnancies. This case is rare, difficult to diagnose, and threatening if left untreated. Incidental rate is estimated 1 in 30,000 spontaneous pregnancies and higher in assisted reproductive techniques. HP is often missed because of the detection of intrauterine sacs; therefore, comprehensive and systematic ultrasonography (USG) is needed, especially when there is ectopic pregnancy suspicion or when there is free fluid in the pelvis. A 46-year nulligravida with 13-year primary infertility history underwent frozen embryo transfer process with positive beta-human chorionic gonadotropin 2 weeks after the procedure. Clinical pregnancy is expressed by gestational sac findings at 6-week gestation. Two weeks later, she complained of lower right abdominal pain accompanied by spots from the birth canal. USG showed intrauterine pregnancy and sac appropriate to 8-week gestation and adnexal mass accompanied by a ring of fire image. The patient underwent right salpingectomy, recovered well, and continued her pregnancy. fertilization is the main risk factor for multiple and ectopic pregnancies. Clinical manifestations are similar to pregnancy loss or ectopic pregnancy. Specific risk factor must be acknowledged by the physician prior initial examination to rule out HP. Transvaginal ultrasound is useful in making the diagnosis of HP, especially in early pregnancy.
异位妊娠（HP）是指子宫外妊娠与子宫内妊娠同时存在。这种情况较为罕见，诊断困难，若不治疗会有生命危险。据估计，自然妊娠中的发生率为1/30000，在辅助生殖技术中发生率更高。由于子宫内孕囊的检出，HP常常被漏诊；因此，需要进行全面、系统的超声检查（USG），尤其是在怀疑有异位妊娠或盆腔有游离液体时。一名46岁的原发性不孕13年的未孕女性在接受冻融胚胎移植术后2周，β-人绒毛膜促性腺激素呈阳性。妊娠6周时通过孕囊表现确诊为临床妊娠。两周后，她主诉右下腹疼痛并伴有阴道点滴出血。超声检查显示宫内妊娠，孕囊符合8周妊娠大小，附件区有包块并伴有环状血流信号。患者接受了右侧输卵管切除术，恢复良好，并继续妊娠。辅助生殖技术是多胎妊娠和异位妊娠的主要危险因素。其临床表现与流产或异位妊娠相似。医生在初次检查前必须了解特定的危险因素，以排除HP。经阴道超声对于诊断HP很有用，尤其是在妊娠早期。
