Pan Lin, Wang Shanshan, Huang Yan, Feng Ting, Shao Huaguo
Department of Ultrasound, Hangzhou Xixi Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou City, Zhejiang Province, China.
Institute of Hepatology and Epidemiology, Hangzhou Xixi Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou City, Zhejiang Province, China.
Medicine (Baltimore). 2025 Jul 4;104(27):e43148. doi: 10.1097/MD.0000000000043148.
The coexistence of intrauterine and extrauterine pregnancies is termed heterotopic pregnancy (HP). Most reported cases of HP occur after assisted reproductive technology, and HP in a natural pregnancy (NP) is very rare, often discovered intraoperatively. HP is a significant challenge for obstetricians, gynecologists, and sonographers.
A 30-year-old nulliparous woman presented to the emergency department of a local tertiary hospital on day 66 of amenorrhea with abdominal pain, nausea, and vomiting without an obvious cause.
Transabdominal gynecological ultrasonography revealed coexisting left ectopic pregnancy (EP) and intrauterine pregnancy (IP) in the NP, both with measurable fetal heart activity. In addition, abdominal fluid and extensive pelvic hematoma were observed.
Given a ruptured EP with hemorrhage, the obstetrician-gynecologist performed an emergency surgery, finding approximately 500 mL of blood and blood clots in the abdominal and pelvic cavities. The left tubal ampullary segment was dilated and thickened, with a visible rupture and active bleeding. Therefore, the left fallopian tube was resected, and IP was managed with therapy.
The patient recovered well postoperatively and delivered a male infant by cesarean section at full term.
The presence of IP does not exclude the coexistence of EP, even in NP. Although HP is rare and the symptoms of EP may not be obvious, sometimes masked by IP, obstetricians, gynecologists, and sonographers must remain vigilant in this regard to reduce the rate of missed diagnoses, provide early intervention, and safeguard the health of the pregnant woman and fetus.
宫内妊娠和宫外妊娠同时存在被称为异位妊娠（HP）。大多数报道的HP病例发生在辅助生殖技术之后，自然妊娠（NP）中的HP非常罕见，通常在手术中发现。HP对产科医生、妇科医生和超声检查医生来说是一个重大挑战。
一名30岁未生育的女性在闭经第66天因腹痛、恶心和呕吐无明显原因就诊于当地一家三级医院的急诊科。
经腹妇科超声检查显示NP中同时存在左侧异位妊娠（EP）和宫内妊娠（IP），两者均有可测量的胎心活动。此外，还观察到腹腔积液和广泛的盆腔血肿。
鉴于EP破裂并出血，妇产科医生进行了急诊手术，在腹腔和盆腔中发现约500毫升血液和血凝块。左侧输卵管壶腹部扩张并增厚，可见破裂和活动性出血。因此，切除了左侧输卵管，并对IP进行了相应治疗。
患者术后恢复良好，足月行剖宫产分娩一名男婴。
即使在NP中，IP的存在也不能排除EP的共存。虽然HP罕见且EP的症状可能不明显，有时会被IP掩盖，但产科医生、妇科医生和超声检查医生在这方面必须保持警惕，以降低漏诊率，提供早期干预，保障孕妇和胎儿的健康。
