It was a great day in Mr. & Mrs. Reddy’s (names changed) life, finally the pregnancy test was positive. They have been married for 7 long years. They underwent IVF earlier too, however, in 2023 it was just a biochemical pregnancy (blood test showed positive pregnancy but sac never appeared). They were elated this time. But soon their happiness turned into a nightmare when they underwent a scan which revealed heterotopic pregnancy.
A Real Story of Heterotopic Pregnancy
Scan revealed two pregnancy sacs- one in usual location inside the cavity of the uterus and the other in an unusual abnormal location near the corner of the uterus where the left fallopian tube attaches a cornual ectopic pregnancy. Both the sacs contained tiny embryos and both had heart beats. Such a combination is extremely rare and known as Heterotopic pregnancy. Their doctor told them the problem- the ectopic pregnancy ruptures and threatens the mother’s life. What was worse was that they would lose the normal pregnancy as well. The surgical option to remove the ectopic pregnancy was also discussed, but that would almost certainly lead to loss of the normal pregnancy. They seemed out of option & time – mother’s life was at risk and they did not want to lose the long-waited pregnancy.
What is Heterotopic pregnancy?
“Heterotopic pregnancy is a rare and potentially life-threatening condition when an intrauterine and ectopic pregnancy occurs at the same time, that means one pregnancy sac will be at the usual site inside the uterus, the other occurs at an abnormal site. The ectopic site pregnancy can be anywhere outside the uterus like in the fallopian tube, ovary or rarely in an unusual location in the uterus – like cornual (one corner of the uterus), previous caesarean scar or in cervix,” answers Dr Gouri Shankar Rudrapal, Consultant Perinatology & Fetal Intervention at Narayana Health City, Bengaluru.
Continuing the story......
Finally, the couple was referred to the Fetal Medicine & Intervention department at Narayana Health City, Bengaluru. The doctor assessed her pregnancy and offered them intervention to reduce the ectopic pregnancy and leave the normal pregnancy untouched. An ultrasound guided minimally invasive intervention was performed – a special needle was carefully introduced into the ectopic pregnancy sac under ultrasound guidance.
Also Read: Ectopic Pregnancy Causes, Symptoms, And Treatment
The contents of the sac were aspirated, blood mixed fluid came out of the sac through the needle. A very small amount of medicine was then injected into the collapsed sac to make sure no further growth happens into the pregnancy sac. The needle was removed and the intervention went uneventful. A scan was repeated the next day that showed intact intrauterine pregnancy with an embryo with heart beat. On the other hand, the other ectopic sac had collapsed and there was no viable pregnancy inside that. She was discharged from the hospital.
The couple went back home carrying a normal intrauterine pregnancy with a single baby & eagerly waiting for the day when they can hold the sweet loved one in their hands.
What are risks and complications in Heterotopic pregnancy?
The risk of ectopic pregnancy is rupture which not only poses threat to mother’s life, but as a result the normal intrauterine pregnancy is also lost.
How can Heterotopic pregnancy be managed and/or treated?
Traditional treatment of ectopic pregnancy with medicine cannot be used for treating a heterotopic pregnancy as the same medicine will remove or destroy the normal intrauterine pregnancy also. Traditionally, surgical removal of ectopic pregnancy is performed leaving the intrauterine pregnancy intact. However, complications related to surgical treatment remain, also there is some chance of miscarriage of normal intrauterine pregnancy after the surgery. On the other hand, surgical treatment of an ectopic pregnancy at difficult sites like uterine corn, cervix or previous caesarean scar is virtually impossible because there is high probability of losing the normal intrauterine pregnancy due to surgical intervention.