Areys Hassen Mohammed, Abdi Mahamed Sheikahmed, Omer Nour Hies, Osman Osman Ali, Bore Tariku Mulatu
Department of Obstetrics and Gynecology, Institute of Health Sciences, Jigjiga University, Jigjiga, Ethiopia.
Institute of Health Sciences, Jigjiga University, P.O. box 1020, Jigjiga, Ethiopia.
J Med Case Rep. 2025 Jul 9;19(1):329. doi: 10.1186/s13256-025-05392-y.
Heterotopic pregnancy is the simultaneous existence of intrauterine and extrauterine pregnancies. This is a rare obstetric case, with an incidence of 1 in 30,000 in naturally conceived pregnancies and 1 in 100 pregnancies achieved through in vitro fertilization. Early diagnosis of heterotopic pregnancy is challenging in developing countries with no high-resolution ultrasound.
A 22-year-old multigravida Somali mother presented to our hospital on her tenth week of gestation with the complaint of progressively worsening abdominal pain of 7 days' duration. The patient had type III female genital mutilation at the age of 7 years. The patient presented with tachycardia, but her overall hemodynamic status remained stable. Obstetric ultrasound showed a right-sided adnexal mass, a hemoperitoneum, and an intrauterine pregnancy at 10 weeks + 2 days of gestation. Two units of screened, cross-matched whole blood were prepared, and the patient underwent an exploratory laparotomy. Intraoperative findings revealed a right-sided ruptured tubal ectopic pregnancy at the ampulla with active bleeding, a hemoperitoneum of approximately 900 mL with clots, and a bulky uterus about 10 weeks in size with a normal left tube and ovary. The patient had a brisk recovery postoperatively, and the intrauterine pregnancy was conservatively monitored until term gestation. An alive female neonate weighing 3000 gm was delivered via spontaneous vertex delivery with an Apgar score of 8 and 9 in the first and fifth minutes, respectively.
Heterotopic pregnancy is a rare obstetric condition that can occur through natural conception. Female genital mutilation might be an independent risk factor for heterotopic pregnancy that occurs via natural conception. The presence of an intrauterine gestation does not rule out a concomitant extrauterine gestation, so a high index of suspicion and timely diagnosis should be made for a pregnant woman presenting with acute abdominal pain and an adnexal mass. A routine early-first-trimester antenatal ultrasound scan of the adnexa by an experienced obstetrician or sonographer is paramount to obtaining an accurate and timely diagnosis.
异位妊娠是指宫内妊娠和宫外妊娠同时存在。这是一种罕见的产科病例，自然受孕妊娠的发生率为30000分之一，体外受精妊娠的发生率为100分之一。在没有高分辨率超声的发展中国家，早期诊断异位妊娠具有挑战性。
一名22岁的索马里经产妇母亲在妊娠第10周时因持续7天的腹痛逐渐加重前来我院就诊。患者7岁时接受了III型女性生殖器切割术。患者出现心动过速，但总体血流动力学状态保持稳定。产科超声显示右侧附件区有包块、腹腔积血，妊娠10周+2天的宫内妊娠。准备了两单位经过筛查和交叉配血的全血，患者接受了剖腹探查术。术中发现右侧输卵管壶腹部异位妊娠破裂并伴有活动性出血，腹腔积血约900毫升并有血凝块，子宫增大如孕10周大小，左侧输卵管和卵巢正常。患者术后恢复良好，对宫内妊娠进行保守监测直至足月妊娠。一名体重3000克的活产女婴通过自然头位分娩出生，出生后第1分钟和第5分钟的阿氏评分分别为8分和9分。
异位妊娠是一种可通过自然受孕发生的罕见产科情况。女性生殖器切割可能是自然受孕发生异位妊娠的一个独立危险因素。宫内妊娠的存在并不排除同时存在宫外妊娠，因此对于出现急性腹痛和附件区包块的孕妇应保持高度怀疑并及时诊断。由经验丰富的产科医生或超声检查人员在孕早期常规进行附件区超声扫描对于准确及时的诊断至关重要。
