The simultaneous presence of two pregnancies both inside the
uterus and outside the uterus is called heterotopic pregnancy. Pregnancy
normally settles in the uterus after fertilization and develops here and
proceeds to birth. Rarely, if pregnancy is placed in a tube or other organ
outside the uterus, it is called an ectopic pregnancy. Ectopic pregnancy can
cause life-threatening conditions such as pain and bleeding into the abdomen.
Ectopic pregnancy is treated with medication or surgery, it is not possible for
pregnancy to grow and end with birth.
In heterotopic pregnancy, there is usually one or twin
pregnancy in the uterus and a pregnancy outside the uterus. Very rarely in
addition to the pregnancy in the uterus, a pregnancy can be found in both
tubes. So there are 3 pregnancies in total. More rarely, in addition to
pregnancy in the uterus, twin pregnancy can be found in one of the right or
left tubes. External pregnancies in heterotopic pregnancy can also occur in
areas such as ovaries, cervix and abdomen outside the tube.
Heterotopic
pregnancy frequency:
The frequency of heterotopic pregnancy has been reported as
thirty thousand in the old years. However, this rate is a rate of spontaneous,
that is, self-occurring heterotopic pregnancies. However, most of the
heterotopic pregnancies are occurring during IVF (ICF, ICSI, assisted
reproductive methods) applications and therefore its frequency has increased a
lot. The frequency of heterotopic pregnancy during IVF applications can be up to
1-2%. Especially when multiple embryos are transferred during IVF, this risk
increases more.
Reasons:
The factors that cause ectopic pregnancy also cause an
increased risk for heterotopic pregnancy. These are causes such as having
surgery in the abdomen, having a pelvic infection, having an ectopic pregnancy
before, endometriosis. The increase in IVF applications in recent years is the
main reason for frequent heterotopic pregnancy.
Diagnosis
and Symptoms:
In almost half of the heterotopic pregnancies, the diagnosis
is made after the appearance of an ectopic pregnancy after emergent conditions
related to ectopic pregnancy, that is, during emergency surgery. In a pregnant
patient with normal pregnancy, it is not always possible to monitor ectopic
pregnancy at the same time with ultrasound. Normal pregnancy makes it difficult
to monitor ectopic pregnancy. In addition, monitoring the beta-HCG hormone
level in the blood is the most important criterion in the diagnosis of ectopic
pregnancy. However, since the BHCG hormone will already be high in a patient
with normal pregnancy, this method cannot be used in the diagnosis of
heterotopic pregnancy. For this reason, early diagnosis is mostly not possible
and is noticed during the surgery when the patient presents with symptoms such
as abdominal pain and intra-abdominal bleeding. In some cases, especially in
patients who are pregnant with IVF, ectopic pregnancy can be detected early
with an ultrasound performed as a result of warning signs such as severe groin
pain.
Treatment:
In the event that both normal pregnancy and ectopic pregnancy
are at the same time, surgical treatment of ectopic pregnancy is required. In
this case, the opportunity to continue normal pregnancy in the uterus without
being touched is given. However, due to the effect of surgery and anesthesia,
pregnancy in a certain proportion can be lost. After the treatment of ectopic
pregnancy, it has been reported that 75% of pregnancies in the uterus result in
a healthy delivery. In heterotopic pregnancy, meterotrexate drug treatment
cannot be given for the treatment of ectopic pregnancy. Because this drug is
extremely harmful for normal pregnancy in the uterus. Surgery can be done by
open surgery or laparoscopic methods.
Rarely, it can be seen that the current ectopic pregnancy
regresses itself without treatment, that is, the self-development disappears by
stopping.
It is known that very few of the ectopic pregnancies can be
twins. It is known that twin pregnancies are encountered in a single tube in
approximately 200 ectopic pregnancies.
-ECTOPIC PREGNANCY
-HETEROTOPIC PREGNANCY
-SILENT MISCARRIAGE (MISSED MISCARRIAGE)
-MOLAR PREGNANCY
-OVARIAN PREGNANCY
-CERVICAL PREGNANCY
-CERVICAL INSUFFICIENCY
