Pregnancy is a thing of joy, only when it occurs where it should be – the uterus. The embryo has to implant in the uterus for it to grow and develop properly. However, it does not always happen like this, leading to a heterotopic pregnancy.
The occurrence of heterotopic pregnancy is rare, with an estimated incidence of about 1 in 30,000 pregnancies. Nonetheless, the risk is higher in women who have undergone fertility treatments or have a history of pelvic
In this article, you will find out what heterotopic pregnancy is, the symptoms, causes, diagnosis, prevention, and treatment.
What is heterotopic pregnancy?
Heterotopic pregnancy is a rare and potentially life-threatening condition. It happens when a woman carries both an intrauterine pregnancy (a pregnancy in the uterus) and an ectopic pregnancy (a pregnancy outside the uterus, usually in the fallopian tube) at the same time.
Symptoms of heterotopic pregnancy
The symptoms of heterotopic pregnancy can vary from woman to woman, but they typically include:
- Vaginal bleeding: This can be light or heavy bleeding that is similar to a period.
- Abdominal pain: This pain can be mild or severe and in one side of the lower abdomen.
- Shoulder pain: This is a rare symptom of heterotopic pregnancy, but it can occur if the ectopic pregnancy ruptures and causes internal bleeding. The pain often occurs in the shoulder or neck area and may also cause dizziness or fainting.
- Nausea and vomiting: These symptoms can be a result of the hormonal changes that occur during pregnancy.
- Dizziness or fainting: This can occur if the ectopic pregnancy ruptures and causes internal bleeding.
Causes of heterotopic pregnancy
Heterotopic pregnancy is a relatively rare condition, but there are several factors that can increase the risk of developing this condition.
The use of fertility treatments, particularly assisted reproductive technologies such as in vitro fertilization (IVF), can increase the risk of heterotopic pregnancy. This is because fertility treatments can result in the development of multiple pregnancies, which increases the risk of both intrauterine and ectopic pregnancies.
Previous ectopic pregnancy
Women who have had a previous ectopic pregnancy are at a higher risk of developing a heterotopic pregnancy in a subsequent pregnancy.
Pelvic inflammatory disease
Pelvic inflammatory disease (PID) is an infection of the reproductive organs that can lead to scarring of the fallopian tubes. This scarring can increase the risk of ectopic pregnancy, including heterotopic pregnancy.
Surgery on the fallopian tubes, including tubal ligation and tubal re-anastomosis (reversal of tubal ligation), can increase the risk of ectopic pregnancy, including heterotopic pregnancy.
Rarely, structural abnormalities in the reproductive tract can increase the risk of heterotopic pregnancy.
Diagnosis of heterotopic pregnancy
The diagnosis of heterotopic pregnancy can be challenging, as the symptoms can be similar to those of a normal pregnancy or an ectopic pregnancy. However, there are several diagnostic tests that can help identify a heterotopic pregnancy, including:
Ultrasound: An ultrasound can detect both intrauterine pregnancy and ectopic pregnancy. Depending on the stage of pregnancy, the doctors may choose to perform a transvaginal or transabdominal ultrasound.
Blood tests: Usually, blood tests measure the level of human chorionic gonadotropin (hCG), a hormone produced by the placenta during pregnancy. A high level of hCG can indicate the presence of a heterotopic pregnancy.
Pelvic exam: A pelvic exam can detect tenderness or swelling in the fallopian tubes, which can indicate the presence of an ectopic pregnancy.
Laparoscopy: This is a minimally invasive surgical procedure that allows the doctor to visualize the pelvic area and confirm the diagnosis of a heterotopic pregnancy. Laparoscopy may be necessary if other diagnostic tests are inconclusive.
Prevention of heterotopic pregnancy
While it is not always possible to prevent heterotopic pregnancy, there are some steps that can be taken to reduce the risk of developing this condition. These include:
Regulating fertility treatments: If possible, regulating the use of fertility treatments like in-vitro fertilization (IVF), can reduce the risk of multiple pregnancies. By extension, this will lower the risk of heterotopic pregnancy.
Prompt treatment of pelvic inflammatory disease (PID): Treating PID promptly can reduce the risk of scarring in the fallopian tubes. As we mentioned earlier, this scarring can increase the risk of heterotopic pregnancy.
Use Barrier Contraceptives: Barrier methods of contraception, such as condoms or diaphragms, can reduce the risk of sexually transmitted infections, which can lead to PID and other complications that increase the risk of ectopic pregnancy.
Early detection and treatment of ectopic pregnancy: Early detection and treatment of ectopic pregnancy can reduce the risk of complications such as rupture and scarring of the fallopian tubes, which can increase the risk of future ectopic pregnancies, including heterotopic pregnancy.
Treatment of heterotopic pregnancy
The treatment of heterotopic pregnancy depends on the location and size of the intrauterine and ectopic pregnancies, as well as the overall health of the mother. The goal of treatment is to preserve the intrauterine pregnancy while removing the ectopic pregnancy to prevent complications.
The options for treatment may include:
Surgery: Surgery is the most common treatment for heterotopic pregnancy. It involves removing the ectopic pregnancy while preserving the intrauterine pregnancy. The procedure may involve laparoscopy (minimally invasive surgery) or laparotomy (open surgery).
Medications: In some cases, medications such as methotrexate may be used to treat ectopic pregnancy. However, this treatment is typically reserved for cases where the ectopic pregnancy is small and the intrauterine pregnancy is far enough along that it is unlikely to be affected by the medication.
Expectant management: In rare cases, expectant management (monitoring the pregnancy without intervention) may be an option if the ectopic pregnancy is small and not causing any symptoms. However, this approach is generally not recommended because of the risk of complications.
If you are undergoing fertility treatments, have a history of ectopic pregnancy, or are experiencing symptoms of heterotopic pregnancy, it is important to seek medical attention immediately.
Early diagnosis and treatment can prevent serious complications and improve the chances of a successful outcome for the intrauterine pregnancy.