Valencia Vladimir, Worcester Rachel M, Abedi Afrah S, Majewski Emma, Pham Vy, Eliz Natasha
School of Medicine, Lake Erie College of Osteopathic Medicine, Bradenton, USA.
Obstetrics and Gynecology, St. Vincent's Medical Center, Jacksonville, USA.
Cureus. 2024 Aug 22;16(8):e67488. doi: 10.7759/cureus.67488. eCollection 2024 Aug.
Heterotopic pregnancy involves the coexistence of both an intrauterine and an extrauterine pregnancy occurring simultaneously. The spontaneous incidence of heterotopic pregnancy in the general population has been estimated to be 1/30,000. This report discusses the case of a 37-year-old female who presented to the emergency department with vaginal bleeding and lower abdominal pain. Upon workup, a transabdominal and transvaginal ultrasound demonstrated a heterotopic pregnancy with an estimated gestational age of seven weeks. The ultrasounds confirmed an intrauterine pregnancy with fetal cardiac activity and a fetal pole along with a right adnexal ectopic pregnancy with fetal cardiac activity and a fetal pole. Additionally, a right paratubal cyst was incidentally found. The patient subsequently underwent exploratory laparotomy with a right salpingectomy for the removal of the right tubal pregnancy and a right paratubal cyst. This case denotes the significance of a carefully performed ultrasound examination, especially in the early weeks of pregnancy. Even when a standard pregnancy is visualized with ultrasound examination, it remains imperative for the examiner to meticulously examine the adnexa and interstitial portion of the fallopian tube. A heterotopic pregnancy has the potential to be life-threatening and can often go undetected, resulting in missed diagnoses.
异位妊娠是指宫内妊娠和宫外妊娠同时并存。据估计，一般人群中异位妊娠的自然发生率为1/30000。本报告讨论了一名37岁女性的病例，该女性因阴道出血和下腹痛就诊于急诊科。经检查，经腹和经阴道超声显示为异位妊娠，估计孕周为7周。超声证实宫内妊娠有胎心搏动和胎芽，同时右侧附件区异位妊娠也有胎心搏动和胎芽。此外，还偶然发现了一个右侧输卵管旁囊肿。患者随后接受了剖腹探查术，切除了右侧输卵管妊娠及右侧输卵管旁囊肿。该病例表明了仔细进行超声检查的重要性，尤其是在妊娠早期。即使超声检查显示为正常妊娠，检查者仍必须仔细检查附件区和输卵管间质部。异位妊娠有可能危及生命，且常常不易被发现，从而导致漏诊。
