ADVANCES IN OBSTETRICS AND GYNECOLOGY

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In this study, we report a patient with concurrent intrauterine/extrauterine pregnancy, and review the literature. The patient was a 35-year-old married female. This was her first pregnancy/delivery. On march 22,200X, she consulted our hospital for amenorrhea (start of the final menstruation : February 3,200X. Neither medical nor family history was contributory. The patient had not undergone infertility treatment including ovulation induction. On initial consultation, neither speculum nor internal examination revealed any abnormal findings. Transvaginal ultrasonography showed an echo-free space in the uterus, suggesting a gestationl sac. On april 4,200X, the patient consulted our hospital again for genital bleeding. Speculum examination revealed slight genital bleeding from the ostium uteri. Internal examination showed tenderness in the right adnexal region. Transvaginal ultrasonography revealed an echo-free space in the uterus and another one with fetal heart beats in the right adnexal region. Under a tentative diagnosis of concurrent intrauterine/extrauterine pregnancy (right tubal pregnancy and missed abortion), laparoscopic surgery was immediately performed after informed consent was obtained. In the abdominal cavity, retention of approximately 200 g of blood including clots was noted. The right fallopian tube was swollen, suggesting pregnancy at the same site. Right salpingectomy was performed. Simultaneously, transvaginal abortion surgery was performed. The postoperative course was good, and the patient was discharged 3 days after surgery. On histopathological examination of the extirpated tissue, the right fallopian tube suggested right fallopian tube pregnancy, and the intrauterine tissue suggested abortion. Along with recent marked advances in ART, the incidence of concurrent intrauterine/extrauterine pregnancy may be increasing. In the present case, ultrasonography confirmed a gestationl sac in the uterus on initial consultation, but did not reveal any abnormal findings of the right adnexa. On additional consultation, internal examination showed tenderness in the right adnexal region. Ultrasonography confirmed the presence of right fallopian tube pregnancy. We recognized that, even when a geatational sac can be confirmed in the uterus in clinical practice, close ultrasonography and internal examination of the adnexal region should be performed, considering the presence of concurrent extrauterine pregnancy.[Adv Obstet Gynecol, 59 (4) : 265-268, 2007 (H19.11)]

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