Teka Hale, Yemane Awol, Gebremeskel Mebrihit, Kinfe Birhanu A, Kiros Sara, Kidanu Mizan
Department of Obstetrics and Gynecology, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia.
Department of Radiology, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia.
Int Med Case Rep J. 2023 Jan 9;16:27-34. doi: 10.2147/IMCRJ.S398563. eCollection 2023.
Heterotopic pregnancy is the coexistence of intrauterine and extrauterine (ectopic) pregnancies. This is a relatively rare phenomenon with an incidence of 1 in 30,000 in spontaneously conceived pregnancies and 1 in 100 pregnancies achieved through assisted reproduction. Due to its relative rarity, diagnosis can be challenging. The presence of adnexal cystic masses complicating pregnancies can obscure the examination of the pelvis to rule in/out heterotopic pregnancy further adding to the complexity of the diagnosis.
In this study, we present a 26-year-old primigravid, ethnic Tigrayan lady from the Tigray region of Ethiopia. She presented to our hospital with the complaint of progressively worsening abdominal pain of three days duration. She also had a subjective period of amenorrhea of 2 months duration. Pregnancy test was positive a few days prior to her current presentation. She reported that she had a history of treatment for pelvic inflammatory disease three months prior to her current conception. At presentation to our hospital, she was acutely ill-looking in pain, tachycardic, and hypotensive. Pelvic ultrasound showed an adnexal mass, hemoperitoneum, and an intrauterine pregnancy at 7 weeks + 5 days gestation. With the impression of ruptured ovarian cyst to rule out heterotopic pregnancy emergency, an explorative laparotomy was done which was pertinent for significant hemoperitoneum, ruptured left tubal ectopic pregnancy, and intact left ovarian cyst.
Physicians should consider a broad range of differential diagnosis in pregnant mothers who present with acute abdominal pain. Moreover, in the presence of an adnexal mass and hemoperitoneum, there is a need to maintain a low threshold for rare but life-threatening complications such as heterotopic pregnancy. The presence of an intrauterine gestation does not rule out extrauterine gestation. Thus, the presence of a viable intrauterine gestation should not stop physicians from carefully examining patients for the coexistence of an ectopic pregnancy.
异位妊娠是指宫内妊娠和宫外（异位）妊娠同时存在。这是一种相对罕见的现象，自然受孕妊娠的发生率为30000分之一，辅助生殖妊娠的发生率为100分之一。由于其相对罕见，诊断具有挑战性。妊娠合并附件囊性包块会使盆腔检查难以明确是否存在异位妊娠，进一步增加了诊断的复杂性。
在本研究中，我们介绍一位来自埃塞俄比亚提格雷地区的26岁初产妇，提格雷族女性。她因持续三天的腹痛逐渐加重前来我院就诊。她还有两个月的主观闭经史。在此次就诊前几天，妊娠试验呈阳性。她报告说在本次受孕前三个月有盆腔炎治疗史。在我院就诊时，她看起来病得很重，疼痛、心动过速且血压降低。盆腔超声显示有附件包块、腹腔积血以及妊娠7周+5天的宫内妊娠。考虑到卵巢囊肿破裂以排除异位妊娠紧急情况，进行了剖腹探查术，发现有大量腹腔积血、左侧输卵管异位妊娠破裂以及完整的左侧卵巢囊肿。
对于出现急性腹痛的孕妇，医生应考虑广泛的鉴别诊断。此外，在存在附件包块和腹腔积血的情况下，对于异位妊娠等罕见但危及生命的并发症，需要保持较低的诊断阈值。宫内妊娠的存在并不排除宫外妊娠。因此，有存活的宫内妊娠不应阻止医生仔细检查患者是否并存异位妊娠。
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