Diagnosis And Management Of 49 Heterotopic Pregnancies: A Retrospective Analysis

ObjectiveTo characterize general attributes of women with heterotopic pregnancy (HP) in order to establish an optimal diagnostic and therapeutic strategy.Study DesignA retrospective analysis was conducted on 49 HPs recorded at the Women’s Hospital of Medicine Zhejiang University from 2010 to 2014.45 patients that obtained pregnancy via assisted reproductive technology were randomly selected as the controls. Data on patients’ symptoms, risk factors, diagnostic features, treatment and delivery rates were collected and analyzed.ResultAmong forty-nine HPs, two patients were natural pregnancy; the remaining forty- seven patients were obtained pregnancy via assisted reproductive technology.65.3% of them had a history of pelvic inflammatory disease,49% had ectopic pregnancy at least once,49.6% had a history of abortion, and 61.2% had suffered adnexal surgery. Both the rate of ectopic pregnancy and the rate of adnexal surgery were higher in HPs than those of the control group; however, there was no significant difference in morbidity of pelvic disease and abortion rates.61.3% HPs complained about abdominal pain and/or vaginal bleeding. All patients were diagnosed by transvaginal sonography (TVS) at approximately week 6-8 of gestation; only 24.5% showed direct pregnant sign. Thirty-seven patients underwent surgical treatment and six patients underwent interventional therapy, the others underwent expectant management. No significant difference was found in terms of the delivery rates across the three treatments (77.1%vs. 83.3% vs.85.7%, p>0.05).ConclusionRoutine transvaginal ultrasound examination at approximately Week 6-8 of the pregnancy could facilitate the diagnosis of HP, and repeat examination was necessary to be carried out on those suspected patients with risk factors. Surgical treatment was the main and effective treatment; expectant management and medical therapy could be applied under monitoring. The outcomes were satisfactory.