Dubbewar Avinash, Srivastava Ajai, Hiremath Ravishekar N, Ghodke Sandhya, Chourey Niraj, Sreenivas Audukoori
Department of Obstetrics and Gynaecology, AFMS, New Delhi, India.
Department of Community Medicine, AFMS, New Delhi, India.
J Family Med Prim Care. 2022 Jul;11(7):3996-3998. doi: 10.4103/jfmpc.jfmpc_2448_21. Epub 2022 Jul 22.
A simultaneous presence of intrauterine and extrauterine gestation is called as heterotopic pregnancy (HP). The incidence of spontaneous HP is 1: 30000, which is very rare. In this case report, we are reporting a rare case of spontaneous HP in a 40-year-old lady with intrauterine gestational trophoblastic neoplasia (GTN) and ruptured tubal ectopic pregnancy in a remotely located secondary care hospital. The lesson learnt from our case report is that detection of intrauterine gestation does not rule out the possibility of the presence of ectopic pregnancy. Also, HP can occur without any obvious risk factors like in our case. It should be always kept in mind that HP can occur in any woman of reproductive age group. In the end, our patient was fortunate that she presented to us in a stable haemodynamic condition in spite of having ruptured tubal ectopic with spontaneous stoppage of bleeding from the ruptured tube. Hence, to achieve a great chance of favourable obstetric outcome, all treating doctors including family physicians should have a high index of suspicion to have accuracy in early diagnosis and treatment of a various variety of HP as these can occur with or without predisposing risk factors.
子宫内妊娠和子宫外妊娠同时存在被称为异位妊娠（HP）。自然发生的HP发生率为1:30000，非常罕见。在本病例报告中，我们报告了一例罕见的自然发生的HP病例，患者为一名40岁女性，患有子宫内妊娠滋养细胞肿瘤（GTN），且在一家偏远的二级护理医院发生了输卵管异位妊娠破裂。从我们的病例报告中吸取的教训是，检测到子宫内妊娠并不排除存在异位妊娠的可能性。此外，HP可以在没有任何明显危险因素的情况下发生，就像我们的病例一样。应该始终牢记，HP可发生于任何育龄期女性。最后，我们的患者很幸运，尽管输卵管异位妊娠破裂且破裂的输卵管自发停止出血，但她就诊时血流动力学稳定。因此，为了获得良好产科结局的巨大机会，包括家庭医生在内的所有治疗医生都应保持高度的怀疑指数，以便在早期准确诊断和治疗各种HP，因为这些情况无论有无易感危险因素都可能发生。
