Abstract
Introduction
Heterotopic triplets hardly take place, but nowadays the extended use of assisted reproductive technologies is increasing the ectopic pregnancies rate and subsequently the heterotopic pregnancies, leading to a potentially dangerous condition for the woman and the intrauterine pregnancy.
Material and methods
Fourteen cases previously reported in the literature of patients presenting an intrauterine twin pregnancy which became complicated by a tubal ectopic pregnancy have been reviewed. The case of a patient following a homologous intrauterine insemination treatment, resulting in live birth of both twins, is also described.
Conclusion
Although the diagnosis of heterotopic triplets with tubal ectopic is challenging, a timely surgical treatment will preserve intrauterine gestation with a great chance of a successful obstetric outcome for both twins.
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References
Richards SR, Stempel LE, Carlton BD (1982) Heterotopic pregnancy: Reappraisal of incidence. Am J Obstet Gynecol 142(7):928–930
Yovich JL, McColm SC, Turner SR, Matson PL (1985) Heterotopic pregnancy from in vitro fertilization. J In Vitro Fert Embryo Transf 2(3):143–150
Goldman GA, Fisch B, Ovadia J, Tadir Y (1992) Heterotopic pregnancy after assisted reproductive technologies. Obstet Gynecol Surv 47(4):217–221
Payne S, Duge J, Bradbury W (1971) Ectopic pregnancy concomitant with twin intrauterine pregnancy. A case report. Obstet Gynecol 38(6):905–906
Walker TA, Baden WF (1972) Tubal pregnancy complicating uterine twin pregnancy after ovulation-induction therapy. Surg Clin North Am 52(2):425–428
Sondheimer SJ, Tureck RW, Blasco L, Strauss J IIIrd, Arger P, Mennuti M (1985) Simultaneous ectopic pregnancy with intrauterine twin gestations after in vitro fertilization and embryo transfer. Fertil Steril 43(2):313–316
Berliner I, Mesbah M, Zalud I, Maulik D (1998) Heterotopic triplet pregnancy. Report of a case with successful twin intrauterine gestation. J Reprod Med 43(3):237–239
Inion I, Gerris J, Joostens M, De Vree B, Kockx M, Verdonk P (1998) An unexpected triplet heterotopic pregnancy after replacement of two embryos. Hum Reprod 13(7):1999–2001
Barnett A, Chipchase J, Hewitt J (1999) Simultaneous rupturing heterotopic pregnancy and acute appendicitis in an in vitro fertilization twin pregnancy. Hum Reprod 14(3):850–851
Nair P, Chauhan M (1999) Heterotopic pregnancy (triplets) following in vitro fertilisation: case report. Arch Gynecol Obstet 263(1–2):84–85
Nguyen-Tran C, Toy EC (2000) Case 3: obstetrical. Heterotopic pregnancy: viable twin intrauterine pregnancy with a viable right tubal ectopic pregnancy. J Ultrasound Med 19(5):355
Oliveira FG, Abdelmassih V, Abdelmassih Oliveira S, Abdelmassih R, Nagy ZP (2002) Heterotopic triplet pregnancy: report and video of a case of a ruptured tubal implantation with living embryo concurrent with an intrauterine twin gestation. Reprod Biomed Online 5(3):313–316
Cenk Sayin N, Yardim T (2003) Live birth of healthy twins after a heterotopic tubal and intrauterine twin pregnancy in a woman who was stimulated with clomiphene citrate. Fertil Steril 80(5):1265–1267
Strelec M, Dmitrovic R, Simunic V (2004) Heterotopic triplet pregnancy with laparoscopic resection of the ruptured tube at 10 weeks of gestation. Eur J Obstet Gynecol Reprod Biol 117(1):117–118
Childs AJ, Royek AB, Leigh TB, Gallup PG (2005) Triplet heterotopic pregnancy after gonadotropin stimulation and intrauterine insemination diagnosed at laparoscopy: a case report. South Med J 98(8):833–835
Muller Vranjes A, Popović Z, Vlahović I, Habek D, Kasac Z (2006) Heterotopic trigeminal pregnancy in infertile women after ovulation stimulation and embolisation of a uterine myoma. Fetal Diagn Ther 21(1):81–83
Cholkeri-Singh A, LaBarge A (2007) Spontaneous heterotopic triplets: a case report. Fertil Steril 88(4):968 e5–7
De Sutter P (2006) Rational diagnosis and treatment in infertility. Best Pract Res Clin Obstet Gynaecol 20(5):647–664
Fu J, Henne MB, Blumstein S, Lathi RB (2007) Rupture of ectopic pregnancy with minimally detectable beta-human chorionic gonadotropin levels: a report of 2 cases. J Reprod Med 52(6):541–542
Fernandez H, Lelaidier C, Doumerc S, Fournet P, Olivennes F, Frydman R (1993) Nonsurgical treatment of heterotopic pregnancy: a report of six cases. Fertil Steril 60(3):428–432
Ocal P, Erkan S, Cepni I, Idil MH (2007) Transvaginal ultrasound-guided aspiration and instillation of hyperosmolar glucose for treatment of unruptured tubal heterotopic pregnancy. Arch Gynecol Obstet 276(3):281–283
Goldstein JS, Ratts VS, Philpott T, Dahan MH (2006) Risk of surgery after use of potassium chloride for treatment of tubal heterotopic pregnancy. Obstet Gynecol 107(2 Pt 2):506–508
Fernandez H, Gervaise A (2004) Ectopic pregnancies after infertility treatment: modern diagnosis and therapeutic strategy. Hum Reprod Update 10(6):503–513
Tal J, Haddad S, Gordon N, Timor-Tritsch I (1996) Heterotopic pregnancy after ovulation induction, assisted reproductive technologies: a literature review from 1971 to 1993. Fertil Steril 66(1):1–12
Reedy MB, Källén B, Kuehl TJ (1997) Laparoscopy during pregnancy: a study of five fetal outcome parameters with use of the Swedish Health Registry. Am J Obstet Gynecol 177(3):673–679
Al-Fozan H, Tulandi T (2002) Safety and risks of laparoscopy in pregnancy. Curr Opin Obstet Gynecol 14(4):375–379
Jackson H, Granger S, Price R et al (2008) Diagnosis and laparoscopic treatment of surgical diseases during pregnancy: an evidence-based review. Surg Endosc 22(9):1917–1927
Louis-Sylvestre C, Morice P, Chapron C, Dubuisson JB (1997) The role of laparoscopy in the diagnosis and management of heterotopic pregnancies. Hum Reprod 12(5):1100–1102
Glassner MJ, Aron E, Eskin BA (1990) Ovulation induction with clomiphene and the rise in heterotopic pregnancies. A report of two cases. J Reprod Med 35(2):175–178
Leiserowitz GS (2006) Managing ovarian masses during pregnancy. Obstet Gynecol Surv 61(7):463–470
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Bugatto, F., Quintero-Prado, R., Kirk-Grohar, J. et al. Heterotopic triplets: tubal ectopic and twin intrauterine pregnancy. A review of obstetric outcomes with a case report. Arch Gynecol Obstet 282, 601–606 (2010). https://doi.org/10.1007/s00404-010-1577-z
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DOI: https://doi.org/10.1007/s00404-010-1577-z