Heterotopic pregnancy: still a diagnostic puzzle.

摘要

Heterotopic pregnancy is defined as the coincident existence of intrauterine and extrauterine gestations. The estimated incidence, without regard to the manner of conception, is 1 in 7,000 pregnancies (Tal et al. 1996). The most common localization of ectopic component is tubal. The greater awareness of risk factors, the use of biochemical markers and ultrasonography in suspected cases enables ectopic pregnancy to be identified in early stages. The cornerstone of diagnosis is the determination of the presence or absence of an intrauterine gestational sac correlated with quantitative serum ?-subunit hCG (betahCG) levels. Clearly, such criteria are not very reliable in the diagnosis of an ectopic pregnancy in relation to a normal intrauterine gestation. Therefore, the diagnosis remains a challenge. We present a patient with a heterotopic abdominal gestation. The definite diagnosis was made during the caesarean section.A 38-year-old nullipara in term twin pregnancy was admitted to our institution following the diagnosis of intrauterine death of a twin. She presented with no complaints and laboratory testing revealed only borderline iron-deficiency anemia.