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A 29-year-old gravida 10, para 3 (1 term gestation, 1 preterm gestation of twins, 1 stillbirth at 5 months, 2 spontaneous abortions, and 4 elective abortions) presented to the clinic at about 5 weeks’ gestation with abdominal pain and vaginal bleeding.
Dr Pippitt is a visiting instructor and Dr Stoesser is assistant professor both in the department of family and preventive medicine at University of Utah School of Medicine. As a busy clinician, balancing work life and home life and personal time generally means that something gives.
She described the pain as sporadic, mostly on the left side, exacerbated by movement, and resolving with rest, and the bleeding as initially intermittent but then heavier “like a period.” Abdominal and bimanual findings were normal. Recurrent chlamydial infections increase the risks of hospitalization for ectopic pregnancy and pelvic inflammatory disease.
Rare association of ovarian implantation site for patients with heterotopic and with primary ectopic pregnancies after ICSI and blastocyst transfer.
HETEROTOPIC PREGNANCY: AN OVERVIEW Heterotopic pregnancy (HP) is the existence of 2 (or more) simultaneous pregnancies with separate implantation sites, one of which is ectopic. In a review of 66 cases of combined intrauterine and extrauterine gestations, abdominal pain alone was found to be the most common presenting symptom of HP.8 The combination of lower abdominal pain, an adnexal mass, peritoneal irritation, and an enlarged uterus most strongly supported the existence of HP.
The main concern in this patient, with her continued vaginal spotting and known IUP, was threatened abortion. However, an EP can also have a normal hCG rise.12 In a normal spontaneous gestation, once an IUP has been identified, hCG levels are typically unnecessary.
This patient underwent emergent laparoscopy; however, because of a large hemoperitoneum, open laparotomy was necessary. This revealed a rupture in the middle third of the right fallopian tube; the entire tube was edematous and ecchymotic.
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