当院で治療を行った正所異所同時妊娠の4例

抄録

Objective: Heterotopic pregnancy is relatively rare and clinical features are nonspecific, the diagnosis is often delayed and can be fatal. We report 4 cases of heterotopic pregnancy.

Patients: Case1: A 27-year-old woman conceived naturally. At 6 weeks gestation, she visited a previous hospital for lower abdominal pain and a small amount of genital bleeding. She was referred to our institution for suspicion of heterotopic pregnancy. In emergency laparoscopic surgery, right salpingectomy was performed for a right tubal pregnancy.

  Case2: A 38-year-old woman conceived after artificial insemination with husband's semen (AIH) with use of clomiphene citrate. At 8 weeks gestation, she entered shock and was transported by ambulance to our institution. In emergency laparoscopic surgery, right salpingectomy was performed for a right tubal pregnancy.

  Case3: A 27-year-old woman conceived after AIH. At 9 weeks gestation, she was rushed to our institution for lower abdominal pain and a large amount of genital bleeding. In emergency laparoscopic surgery, right salpingectomy was performed for a right tubal pregnancy. Intrauterine pregnancy became a miscarriage at the same time.

  Case4: A 40-year-old woman conceived after AIH. She was diagnosed as a miscarriage at 6 weeks of pregnancy. After 1week, she was rushed to a previous hospital for lower abdominal pain. She was referred to our institution for suspicion of heterotopic pregnancy and hemorrhagic shock. In emergency laparoscopic surgery, right salpingectomy was performed for a right tubal pregnancy.

Conclusion: We should always be alert to the possibility of heterotopic pregnancy even in the natural ovulation cycles.