Heterotopic pregnancy

In The Spot

Step 1: View clinicals

A 33 year old woman presents at 8 weeks of her first gestation complaining of cramping lower abdominal pain for 2 days, in a background of vague pelvic pain for the last week. She received in-vitro fertilization (IVF) to become pregnant, following 3 years of primary infertility attributed to asthenozoospermia in her husband. A total of 4 embryos were implanted. A transvaginal ultrasound scan performed at 6 weeks of gestation revealed a single live intrauterine pregnancy, while a serum beta-hCG assay was found to be 10,200 mIU/ml


Step 2: Order all relevant investigations

Full Blood Count

WBC/DC: 9,000/mm3 Hb: 12.5 g/dL Hematocrit (PCV): 34% Platelets: 260,000/mm3

Abdominal + Pelvic Ultrasound

The abdominal ultrasound scan reveals a moderate amount of echogenic free fluid in the pouch of douglas. Transvaginal scanning reveals a 30 mm intrauterine gestational sac with cardiac activity; another gestational sac of 25 mm with cardiac activity and a hyperechoic rim is noted in the right fallopian tube, close to the right ovary.

Serum beta-hCG

The serum beta-hCG is 35,600 mIU/ml.

GC+CT NAAT

Negative for both gonococcus and chlamydia.


Step 3: Select appropriate management

Laparoscopy
Doxycycline
Methotrexate
Blood Transfusion


Score: ★★☆