Study on diagnosis and management strategies on heterotopic pregnancy: a retrospective study

Abstract

Heterotopic pregnancy (HP) is a rare but potentially life-threatening event with a high risk of maternal death, which also jeopardise the coexisting intrauterine pregnancy (IUP), thus an early accurate diagnosis and prompt treatment can decrease adverse complications. We aimed to explore the early predictors for pregnancy outcomes of HP. We reviewed patients with HP following assisted reproductive technology in our institution between January 2013 and December 2020. The relationships between pregnancy outcomes and clinical features were analysed by logistic regression. We found that 29 patients (72.5%) of HP were accurately diagnosed by transvaginal ultrasonography (TVS). Eighteen patients in the surgery group had live births, three of whom delivered preterm. Additionally, the miscarriage rate was lower for patients with IUP cardiac activity than those without (16.7% vs. 90.0%, p < .001). Further by logistic regression analysis, an IUP with cardiac activity at HP diagnosis was identified as favourable independent predictor of live birth (p < .001). Therefore, early diagnosis and prompt surgical intervention are recommended to prevent the development of HP.

Impact of statement

• What is already known on this subject? Heterotopic pregnancy (HP) has long been thought to be a rare but potentially life-threatening event with a high risk of complications. The early diagnosis of HP is challenging due to the co-existence of a viable intrauterine pregnancy (IUP) and the absence of typical clinical symptoms.

• What do the results of this study add? This stduy showed that symptoms combined with routine transvaginal ultrasonography (TVS) scans reduce the rates of misdiagnosis of HP and prompt surgical intervention after diagnosis may minimise the incidence of miscarriage of the IUP.

• What are the implications of these findings for clinical practice and/or further research? An IUP with cardiac activity at HP diagnosis is a predictor of a favourable prognosis of HP, and laparoscopy under general anaesthesia is effective and safe during the first trimester of pregnancy. Awareness, assessment and early interventions in view of symptoms combined with routine TVS is recommended to reduce the risk of miscarriage and ensure a favourable live birth rate.

Keywords:

• Diagnosis
• treatment
• heterotopic pregnancy
• pregnancy outcome
• embryo transfer

Acknowledgements

The authors acknowledge all of the people who have contributed to this paper in some manner and the participants who participated in this study.

Author contributions

YZ: project development, data collection and manuscript writing. XC: project development and manuscript editing. YL: data collection. CL: data collection. XX: data collection. All authors contributed to the article and approved the submitted version.

Ethical approval

This study was approved by the Ethics Committee of the Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University (no. 2021KLRD09014).

Consent form

Written informed consent was obtained from the patient for publication of this case report and any accompanying images.

Disclosure statement

The authors declare that they have no competing interests.

Data availability statement

The patients’ clinical data that support the findings of this study are not publicly available due to privacy or ethical restrictions.

Additional information

Funding

This research was supported by the Startup Fund for Scientific Research, Fujian Medical University (Grant Number: 2020QH1196) and Sponsored by Fujian Provincial Health Technology Project (Grant Number: 2020QNB012).