Korean J Obstet Gynecol.  2012 Dec;55(12):982-985. 10.5468/KJOG.2012.55.12.982.

Full-term delivery in patient with heterotopic cornual pregnancy via selective fetal reduction with potassium chloride

• Choi HJ
• Moon MJ
• Park BK
• Kim MS
• Lee JW
• Jung MC
• Noh JH
• Kim YB

• KMID: 2274210
• DOI: http://doi.org/10.5468/KJOG.2012.55.12.982

Abstract

Heterotopic pregnancy is defined as simultaneous intrauterine and ectopic pregnancy. Natural occurrence rate is very low occuring 1/30,000. However, with the use of assisted reproductive technology (ART), the risk increases up to 1/7,000. It is important to continuously monitor the patient using ultrasonography after ART for early detection of heterotopic pregnancy. Treatment options include surgical and medical interventions for the maintenance of intrauterine pregnancy. This is a case of full-term birth following selective fetal reduction using potassium chloride in a heterotopic pregnancy along with relevant literature review.

Keyword

Heterotopic pregnancy; Cornual pregnancy; Selective fetal reduction; Potassium chloride

MeSH Terms

Female
Humans
Organothiophosphorus Compounds
Parturition
Potassium
Potassium Chloride
Pregnancy
Pregnancy Reduction, Multifetal
Pregnancy, Ectopic
Pregnancy, Heterotopic
Reproductive Techniques, Assisted
Organothiophosphorus Compounds
Potassium
Potassium Chloride

Figure

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  Fig. 1 Heterotopic pregnancy; intrauterine and cornual pregnancy.

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  Fig. 2 Heterotopic pregnancy in right cornus, crown-rump length (6.9 mm), with heart beat.

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  Fig. 3 Right cornual gestational sac, 1 day after selective fetal reduction.

Reference

1. Steadman HE. Combined intrauterine and extrauterine pregnancy. Obstet Gynecol. 1953. 2:277–280.

2. DeVoe RW, Pratt JH. Simultaneous intrauterine and extrauterine pregnancy. Am J Obstet Gynecol. 1948. 56:1119–1126.

3. Mukul LV, Teal SB. Current management of ectopic pregnancy. Obstet Gynecol Clin North Am. 2007. 34:403–419.

4. Habana A, Dokras A, Giraldo JL, Jones EE. Cornual heterotopic pregnancy: contemporary management options. Am J Obstet Gynecol. 2000. 182:1264–1270.

5. Tal J, Haddad S, Gordon N, Timor-Tritsch I. Heterotopic pregnancy after ovulation induction and assisted reproductive technologies: a literature review from 1971 to 1993. Fertil Steril. 1996. 66:1–12.

6. Dor J, Seidman DS, Levran D, Ben-Rafael Z, Ben-Shlomo I, Mashiach S. The incidence of combined intrauterine and extrauterine pregnancy after in vitro fertilization and embryo transfer. Fertil Steril. 1991. 55:833–834.

7. Clayton HB, Schieve LA, Peterson HB, Jamieson DJ, Reynolds MA, Wright VC. A comparison of heterotopic and intrauterine-only pregnancy outcomes after assisted reproductive technologies in the United States from 1999 to 2002. Fertil Steril. 2007. 87:303–309.

8. Chin HY, Chen FP, Wang CJ, Shui LT, Liu YH, Soong YK. Heterotopic pregnancy after in vitro fertilization-embryo transfer. Int J Gynaecol Obstet. 2004. 86:411–416.

9. Wright A, Kowalczyk CL, Quintero R, Leach RE. Selective embryo reduction in a heterotopic pregnancy using potassium chloride injection resulting in a hematosalpinx. Fertil Steril. 1996. 66:1028–1030.

10. Tanaka T, Hayashi H, Kutsuzawa T, Fujimoto S, Ichinoe K. Treatment of interstitial ectopic pregnancy with methotrexate: report of a successful case. Fertil Steril. 1982. 37:851–852.

11. Timor-Tritsch IE, Monteagudo A, Matera C, Veit CR. Sonographic evolution of cornual pregnancies treated without surgery. Obstet Gynecol. 1992. 79:1044–1049.

12. Ghazeeri GS, Phillips OP, Emerson DS, Kutteh WH, Ke RW. Live birth after treatment of a heterotopic cornual pregnancy with fetal intrathoracic KCI. A case report. J Reprod Med. 2002. 47:1038–1040.

13. Gherman RB, Stitely M, Larrimore C, Nevin K, Coppola A, Wiese D. Low-dose methotrexate treatment for interstitial pregnancy. A case report. J Reprod Med. 2000. 45:142–144.

14. Ross R, Lindheim SR, Olive DL, Pritts EA. Cornual gestation: a systematic literature review and two case reports of a novel treatment regimen. J Minim Invasive Gynecol. 2006. 13:74–78.