2011 Volume 63 Issue 4 Pages 499-504
The spontaneous development of heterotopic pregnancy is rare (1/30,000 pregnancies). However, with the widespread application of ART, the incidence has increased in patients undergoing in ART (1/670 pregnancies). With this tendency, the incidence of interstitial heterotopic pregnancy has also increased. In the treatment of interstitial heterotopic pregnancy, cornuostomy and cornual resection by laparotomy have commonly been performed. However, it is important to minimize the influence on intrauterine pregnancy. If possible, laparoscopic surgery should be selected. In this case, we performed laparoscope-assisted cornuostomy to treat interstitial heterotopic pregnancy after embryo transplantation, leading to a successful outcome. A 39-year-old primigravida underwent frozen embryo transplantation with 2 blastocysts for idiopathic infertility in another hospital. As heterotopic pregnancy was suspected on gestational age of 6 weeks and 1 day, the patient was referred to our hospital. A fetus with heartbeat was observed in the uterus and a gestational sac alone in the right interstitial region. Therefore, the patient was admitted to wait for the growth of the intrauterine pregnancy and abortion of the interstitial pregnancy. However, a fetus with heartbeat appeared in right interstitial region, and right lower abdominal pain was also noted. On gestational age of 7 weeks and 0 day, emergency laparoscopic surgery was performed. There was no intraperitoneal hemorrhage. In the pelvic cavity, marked endometriosis-related adhesion was observed. Cornuostomy was conducted employing the external method. The postoperative course was favorable. On gestational age of 9 weeks and 0 day, the patient was transiently discharged. As there was a case report on uterine rupture after surgery for interstitial pregnancy, supervisory admission was started at gestational age of 29 weeks. On gestational age of 35 weeks and 6 days, cesarean section was performed because it was difficult to inhibit contraction and right-flank pain was increased. A girl weighing 1994 g, with an Apgar score of 9 (5 minutes), was born. The neonatal course was favorable. Growth and development were normal. Advances in transvaginal ultrasonic equipment and precautions regarding heterotopic pregnancy following ART have increased the number of patients diagnosed with heterotopic pregnancy in the early stage. For treatment, surgery is primarily performed. However, some studies reported conservative and topical drug therapies in which the influence of surgical invasiveness on the maternal condition and intrauterine pregnancy is reduced. When performing surgery, laparoscopic surgery should be recommended to reduce the influence on intrauterine pregnancy in patients with a favorable general condition in the absence of rupture. [Adv Obstet Gynecol, 63(4) : 499-504, 2011(H23.11)]
