Spontaneous heterotopic pregnancy as acute abdomen: management and successful outcome of intrauterine pregnancy. Case Report.

Abstract

Introduction: Heterotopic pregnancy corresponds to the coexistence of an ectopic pregnancy and an intrauterine pregnancy, its incidence is low and it is extremely rare for it to occur spontaneously since it is mostly related to medically assisted pregnancy, despite this it corresponds to an important cause of maternal mortality during the first trimester of pregnancy.

Objective: Describe heterotopic pregnancy as a diagnostic possibility, taking into account risk factors, clinical manifestations, evaluation and therapeutic management.

Case presentation: The case of a pregnant woman is presented at the San Vicente de Paúl General Hospital in the city of Ibarra-Ecuador with a spontaneous heterotopic pregnancy diagnosed at 18.3 weeks of gestation without risk factors, who presents with an acute abdomen. surgery with symptoms of pain on palpation in the left iliac fossa and positive ureteral points, a mass was evident in the left annex that would confirm the diagnosis; The intrauterine pregnancy began with labor at 37.3 weeks. When dynamic dystocia occurred, a cesarean section was performed, reaching the end of the pregnancy.

Discussion: The current management of heterotopic pregnancy varies according to the time of diagnosis, the severity of the patient and the viability of the products. The gold standard in diagnosis and treatment is laparoscopy, and its alternative is laparotomy; That is to say, the treatment of heterotopic pregnancy is essentially surgical with the intention of removing the extrauterine pregnancy.

Conclusions: Although it is important to know the risk factors associated with heterotopic pregnancy and its clinical manifestations for adequate diagnostic guidance and prompt resolution, this case reminds us that rare diagnoses must be taken into account in all patients, aiming to preserve intrauterine pregnancy and carrying it to term, the most useful diagnostic elements will be ultrasound and in many cases exploratory laparotomy and laparoscopy with histopathology of the ectopic product, management will depend on the time of pregnancy, the state and location of the products being in mostly surgical.