CASE REPORT   

Minerva Obstetrics and Gynecology 2021 April;73(2):268-71

DOI: 10.23736/S2724-606X.21.04772-9

Copyright © 2021 EDIZIONI MINERVA MEDICA

lingua: Inglese

Live birth after laparoscopic management of a ruptured myomectomy site pregnancy and unruptured tubal gestation in a double ectopic heterotopic gestation

Aradhana KALRA ¹ ✉, Prem KUMAR ², Deepika PARWAN ³

¹ Department of Reproductive Medicine, Milann Fertility, Delhi, India; ² Department of General Surgery, Sarvodaya Hospital, Faridabad, India; ³ Department of Pathology, Sarvodaya Hospital, Faridabad, India

Myomectomy scar pregnancy is a rare intramural pregnancy in which gestational sac is implanted in the myometrium, in the previous myomectomy scar separate from endometrial cavity and fallopian tubes. Heterotopic pregnancy is presence of simultaneous gestation at two or more implantation sites. Our patient presented at 7 weeks, in-vitro fertilization (IVF) conception with previous four IVF failures and myomectomy 3 months prior. Transvaginal sonography revealed twin live pregnancies, one intrauterine and another in the posterior wall of the uterus distinctly separate from the endometrial cavity. Laparoscopy revealed a ruptured intramural pregnancy, another unruptured tubal pregnancy which was initially missed by USG. After laparoscopic management, intrauterine pregnancy continued resulting in live birth at 35 weeks. This case adds to the literature and highlights the importance of early diagnosis and timely intervention of a rare form of an ectopic gestation. This is the only reported case in literature with a heterotopic gestation and a coexistent myomectomy scar pregnancy and the only one resulting in successful live birth after laparoscopic management of a ruptured myomectomy scar pregnancy in a heterotopic gestation. Early diagnosis is important for salvaging the intrauterine gestation and one should actively look for them at viability scan especially in assisted reproductive technology (ART) conception and scarred uterus.

KEY WORDS: Pregnancy, heterotopic; Uterine myomectomy; Gynecology