Spontaneous Heterotopic Pregnancy
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Introduction
Heterotopic pregnancy is the simultaneous coexistence of an intrauterine and an extrauterine gestation. It is a rare and potentially dangerous condition occurring in only 1 in 30,000 spontaneous pregnancies. With the advent of Assisted Reproduction Techniques and ovulation induction, the overall incidence of heterotopic pregnancy has risen to approximately 1 in 3,900 pregnancies. However, obstetricians and emergency medicine physicians are unlikely to consider this diagnosis as a part of the differential in cases presenting with abdominal pain and vaginal bleeding.

Transvaginal ultrasound is the key to diagnosing heterotopic pregnancy. However, it continues to have a low sensitivity because the diagnosis is often missed or overlooked. Therefore the diagnosis is often delayed leading to serious consequences.

Surgical intervention plays a key role in the management of heterotopic pregnancy. The goal is to remove the ectopic pregnancy without jeopardizing the intrauterine pregnancy. Laparoscopic salpingectomy is the standard surgical approach of heterotopic pregnancy. Other management options mentioned in the literature include local injection of potassium chloride, hyperosmolar glucose, or methotrexate into the sac under ultrasound guidance followed by aspiration of the ectopic pregnancy. This paper represents two cases of heterotopic pregnancies as well as review of literature.....

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4930808/
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