Heterotopic pregnancy: explanation of a real case
A heterotopic pregnancy is an extremely rare case that, if not treated promptly, can be fatal.
Thus, in the third episode of Quirónsalud's recently launched podcast, 'LetraDeMédico', the Director of the Women's Unit at Ruber Internacional , Juan Jose Vidal, along with Julio Álvarez Bernardi and Sara Rubio Muñoz , both gynecologists at the UDM, and Dr. Alejandro Ruíz Pereza , attending physician in the Anesthesiology and Resuscitation Service at Ruber Internacional, explain the real case of a heterotopic pregnancy, a condition that affects, on average, 1 in every 30 pregnancies.
The development of the case
We are dealing with a pregnant patient, approximately 6-7 weeks along , who presents with signs of extreme weakness, malaise, very little strength, and severe abdominal pain , prompting a visit to the emergency room. An initial examination appears normal, but due to the intense pain, they decide to seek a second opinion at the Women's Unit of Ruber Internacional , where she is admitted given her condition.
During the tests, peritoneal irritation was discovered , indicating a potentially serious condition. An ultrasound showed the embryo was developing normally, making it necessary to determine the source of the intense pain. During the same ultrasound, Dr. Sara Rubio, who had been treating the patient from the beginning, observed two significant issues: first, a small cyst on one ovary, difficult to diagnose with ultrasound alone ; and second, fluid in the abdomen , indicating blood , making it urgent to identify the source of the bleeding . Furthermore, blood tests revealed the patient already had anemia.
It is important to note that during pregnancy, a CT scan or MRI cannot be performed. Therefore, given the possibility of a rapid deterioration of the patient's condition, surgery is considered necessary to see what is happening from the inside, trying to save the pregnancy, but above all, safeguarding the patient's health.
Thus, the patient undergoes a minimally invasive surgical procedure called laparoscopy , performed by Dr. Julio Álvarez Bernardi , a leading expert in this technique. Furthermore, at this stage, another factor to carefully consider is the type of anesthesia to be used, given that it is a very early pregnancy and the embryo is only 6-7 weeks old.
Finally, during the intervention they ruled out the options that had been initially considered, and that is when Dr. Álvarez began to assess the possibility of a heterotopic pregnancy.
What is a heterotopic pregnancy?
In a normal pregnancy, the embryo is inside the uterus. In an ectopic pregnancy, the embryo implants outside the uterus , most often in the fallopian tube. However, a heterotopic pregnancy is one in which two embryos develop, one inside the uterus and one outside. This is an extremely rare situation , and it is often not noticed initially, because when an embryo is found in the uterus, no further investigation is conducted outside the uterus.
This is, therefore, a highly complex situation . The embryo, which is outside the uterus, begins to grow in the fallopian tube, a narrow duct, causing the tube to rupture, resulting in hemorrhaging and endangering the mother's life.
Diagnosis and procedure
Finally, the findings suggest that this is a heterotopic pregnancy , and that the embryo in the fallopian tube has been expelled by the patient's body, a condition known as a tubal abortion . Furthermore, the fallopian tube is ruptured.
Therefore, the patient's fallopian tube is removed and sent for analysis, where it is confirmed that the tissue was indeed that of an embryo, thus confirming the diagnosis of heterotopic pregnancy.
After the procedure, an ultrasound is performed which confirms that the other embryo is doing well and developing favorably , so a follow-up plan is established for the pregnancy.
Finally, the patient gave birth to a healthy baby girl and, moreover, with one fallopian tube there is the possibility of getting pregnant again.
You can listen to the case, along with the interventions of the specialists, at this link :
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If you found this article interesting and would like to be seen by a specialist in Gynecology and Obstetrics, the Women's Unit at Ruber International Hospital has a specialized department in this area. You can request more information by calling 91 387 51 72/73/74 or schedule an in-person appointment with top specialists.
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