The importance of accurate evaluation of the adnexa to diagnose a heterotopic pregnancy: A retrospective case-series

Heterotopic pregnancy is the contemporary presence of intrauterine and ectopic (most frequently tubal) pregnancy. This condition is rare; yet, recently, it has been reported increasingly, due to diffusion of both assisted reproduction techniques and pelvic inflammatory disease following sexually transmitted infections. Although difficult, diagnosis is crucial. Currently, diagnosis is most frequently posed at ultrasound, provided that accurate evaluation of adnexa is performed, even after demonstration of the intrauterine location of a pregnancy. Treatment and outcome are highly influenced by the intrauterine component of heterotopic pregnancy. Conservative treatment, involving use of potassium chloride or a hyperosmolar solution injection, may be chosen to selectively terminate the ectopic pregnancy. Methotrexate may be utilised, if the intrauterine pregnancy evolves to miscarriage spontaneously or following the patient’s decision. Expectant management may be considered in some cases. Survival of the intrauterine component reaches approximately 70%; the outcome of live births does not differ from that of singleton pregnancies. This article analyses the world literature about the topic and reports on a series of five cases diagnosed and treated at Sandro Pertini Hospital in Rome.