Therapeutic Approaches in Cases with Heterotopic Pregnancy: A Retrospective Analysis of Six Patients

Aim: To assess presenting complaints, diagnostic and therapeutic approaches and outcomes of pregnancy in cases with heterotopic pregnancy managed in our clinic. Material and Method: We screened the electronic database of our hospital for patients admitted to our clinic between January 1, 2010, and June 30, 2013, using diagnostic codes of pregnancy and ectopic pregnancy. Six patients with a heterotopic pregnancy who underwent either surgical or medical therapy were included in the study. Results: Six cases with a heterotopic pregnancy were detected who had been managed at the clinic during a 3-year period. The presenting complaints in 3 cases were abdominal pain and vaginal bleeding and in 2 case an acute abdomen due to a haemoperitoneum. A heterotopic pregnancy was detected by transvaginal sonography in one patient who presented to the clinic for routine control. Salpingectomy via laparotomy was performed in the 2 patients who presented with acute abdomen, and conservative surgery via laparoscopy was performed in 2 patients without haemodynamic instability and tubal rupture. The remaining 2 patients were treated with potassium chloride and methotrexate instillation into the gestational sac via ultrasound guidance. Of the 6 patients treated for heterotopic pregnancy, there were 3 live births and 3 foetal losses. Discussion: A careful pelvic examination for heterotopic pregnancy plays an important role in reducing both maternal and foetal mortality, particularly in cases in which pregnancy is achieved by assisted reproductive techniques, even in cases of detection of intrauterine pregnancy