腹腔鏡下手術により生児獲得に至った卵巣妊娠と子宮内妊娠による子宮内外同時妊娠の1例

抄録

Introduction: Heterotopic pregnancies are rare, with an incidence of approximately 0.003% in a natural ovulation cycle. We report a case of combined ovarian and intrauterine pregnancies, in which laparoscopic surgery confirmed the diagnosis and enabled successful pregnancy.

Case Report: A 31-year-old nulliparous primigravida had received ovulation-inducing treatment, and pregnancy was successful. At 5 weeks of gestation, one gestational sac was found in the uterus, but at 6 weeks of gestation, a gestational-sac-like structure was found in the right adnexa, and the patient was referred to our hospital. Upon admission, her serum hCG level was 76,303 mIU/mL, and transvaginal ultrasonography revealed the presence of a gestational sac inside the uterus, a gestational-sac-like structure in contact with the right adnexa, and an echo-free space around the uterus. As intraperitoneal bleeding and heterotopic pregnancy were suspected, the risks and benefits of general anesthesia and laparoscopic surgery were explained to the patient, and an emergency laparoscopic surgery was performed.

  Her intraoperative findings revealed intraperitoneal bleeding and enlargement of the right adnexa, with a 9.3-cm gestational sac adhered to the surface. A diagnosis of ovarian pregnancy with concomitant intrauterine pregnancy was confirmed, and the gestational sac on the right adnexa was removed. The postoperative course was uneventful.

  A spontaneous vaginal delivery occurred at 39 weeks of gestation and resulted in a live birth.

Conclusions: We report a case of combined ovarian and intrauterine pregnancies. Pregnancy can be adequately continued with appropriate diagnosis and treatment, and laparoscopic surgery may be a useful treatment option.