by Priya Jadhav
~The 29-year-old patient’s pregnancy was heterotopic that is multiple gestations with one fetus inside the uterine cavity and the other outside the uterus ~
Pune: Motherhood Hospital, Kharadi successfully managed a young pregnant woman with an uncommon condition known as a Heterotopic pregnancy (HP). It is an uncommon condition and may lead to significant maternal morbidity and mortality if prompt diagnosis and appropriate interventions are not instituted at the right time.
A 29-year-old Meeta (name changed) approached Motherhood Hospital Kharadi, Pune with a Sonography report which showed a one-and-a-half month pregnancy, not just in the womb (uterus) but also another pregnancy in the tube (cornual portion of Fallopian Tube) at the same time. This condition is called Heterotopic Pregnancy.
Heterotopic pregnancy is wherein an intra-uterine and extra-uterine (ectopic) pregnancy tends to occur simultaneously. It may be seen in women undergoing fertility treatment . However, this pregnant mother had a spontaneous natural conception.
Dr Rajeshwari Pawar, Consultant Obstetrician & Fetal Medicine Speciaist, Motherhood Hospital, Kharadi, highlighted, “Normally, the pregnancy grows in the uterus. Once in a while, in about 1 per cent cases, tubal pregnancy may be seen. However, a pregnancy in the uterus and another in the tube is a rare occurence.
The natural history of a Cornual pregnancy is that, since it is in that portion of the tube where it joins the uterus and this portion has abundant blood supply a pregnancy in this portion of the tube can rupture and bleed profusely causing a condition called haemoperitoneum. The young pregnant mother can suddenly collapse, become pale, and pulse may not be felt and blood pressure may become very low.
Uncontrolled profuse bleeding due to rupture of a tubal pregnancy is one of the known common causes of maternal mortality.”
The conventional method of management is Laparoscopic Surgery and removal of the tube. However, with this method, the intraoperative blood loss can be enormous. The mother may also lose a vital portion of the uterus-tube and this poses a threat to her life and future pregnancies. Hence, the couple was counseled about the above.
They were also counselled about a new method of treating the pregnancy through sonography guided injection of a medication which will not allow the pregnancy to grow further and the degenerated tissue would be absorbed by the body. The only disadvantage of this procedure was that the pregnancy within the uterus could not be salvaged.
Dr Pawar said, “Since, the patient was young and this was a spontaneous natural conception, she was willing to opt for this novel method of treatment. This procedure was also minimally invasive (it involved inserting a fine needle through sonographic guidance) and done under local anaesthesia with the patient being told at every step of what was being done.”
Dr. Pawar added, “The needle inserted into the ectopic pregnancy was as fine as the needle normally used routinely for blood collection for laboratory tests, and a simple D & E (cleaning up of the uterus) for the intrauterine pregnancy was done. This was accomplished without any cut in the abdomen, no removing of the vital portion of the tube, no blood loss, no blood transfusion and no potential life-threatening complications in future pregnancies.
The whole procedure took 45 minutes and the patient was fit for discharge the same day. The follow-up was done through monitoring the levels of pregnancy hormone in the blood.
The most significant advantage is that since there was no cut on that portion of theuterus where the fallopian tube joins, the chance of complication like rupture of the uterus in her future pregnancies is totally avoided. Motherhood Hospital is the only one to successfully carry out this procedure in Pune.”
Meeta (name changed), said, “Though, I was happy that I conceived. I was pale, suffered from abdominal pain and dizziness. Soon, my world came crashing down after I came to know about my high-risk pregnancy. But, I found a ray of hope at Motherhood Hospital. I thank the doctors for their limitless efforts to ensure that my future pregnancy is safe.”
There was no blood loss, no blood transfusion, and no potential life-threatening complications like rupture of the uterus in future pregnancies.