Diagnosis, Management and Outcomes of Heterotopic Pregnancies: About 28 Cases with Literature Review

Objective: To identify the diagnostic difficulties and to assess heterotopic pregnancy outcomes.
Patients and methods: A retrospective bi-centric study over 28 cases of heterotopic pregnancies was conducted at both Obstetrics and Gynecology Departments of the University Hospitals of Farhat Hached, Sousse (Tunisia) and Hedi Chaker, Sfax (Tunisia) between 2001 and 2014. Data on patients’ symptoms, risk factors, diagnostic features, treatment and outcome were collected and analysed.
Results: The average age was 32.2 years. The frequency of heterotopic pregnancies was 1/8567. A history of pelvic surgery, pelvic infection and infertility was identified in respectively 46.4%, 32.1% and 32.1% of cases. More than the third of patients (39.3%) conceived after ovarian stimulation. The diagnosis was delayed in 75% of cases. thirteen patients (46.4% of cases) presented a hypovolemic shock and were managed surgically by laparotomy. The rupture of ectopic pregnancy was found in 53.6% of cases. Salpingectomy was performed in 84.6% of cases and 60.7% of the intra uterine pregnancies have been pursued, giving birth to 17 healthy newborns.
Conclusion: The systematic screening by transvaginal ultrasonography at the first consultation could allow early diagnosis and improve prognosis.