Heterotropik Gebelik: 7 Haftalık Kornual Rüptüre Ektopik Gebelik ve 38.Gebelik Haftasına Ulaşan İntrauterin Gebelik Olgu Sunumu:

Yıl 2018, , 166 - 168, 04.04.2018

Ünal Turkay , Fulya Demet Ayfer Özer Cora Hasan Terzi , Yasemin Çobanyıldızı

https://doi.org/10.16948/zktipb.323548

Öz

Giriş:İntrauterin
ve ekstrauterin gebeliğin birlikte olması olarak tanımlanan heterotopik gebelik
spontan olarak oldukça nadir görülmesine rağmen yardımcı üreme teknikleri (YÜT)
 ile oluşan gebeliklerde 100 de 1 olarak
görülmektedir.

Olgu: 26
yaşında gravida 1 Parite 0 olan hasta şiddetli karın ağrısı şikayeti ile acil
polikliniğimize başvurdu. Özgeçmişinde geçirilmiş batın operasyonu ,
endometriozis ve pelvik inflamatuvar hastalık tespit edilmedi. YÜT ile oluşan
gebeliği olan  hastanın yapılan transvajinal
usg sinde  7 haftalık intrauterin canlı
gebelik ve yaygın serbest sıvı tespit edildi. Akut batın tespit edilen
hastaya   acil laparatomi cerrahi  uygulandı.Operasyonda   literatürdede oldukça nadir görülen kornual
rüptüre ektopik gebelik (heterotopic gebelik) tanısı  konuldu.  Kornual onarım yapılan ve operasyon sonrası
intrauterin gebeliği 38. gebelik haftasına ulaşan ve nihayetinde sağlıklı bir
bebek doğuran bu olgumuzu sizlerle paylaşmayı amaçladık.

Sonuç: YÜT
oluşan gebeliklerde  heterotopik gebelik
açısından kapsamlı transvaginal ultrasonografi yapılmalı. Akut batın tablosu
ile başvuran hastalarda  maternal
mortalite açısından cerrahi konusunda tereddüt edilmemelidir. 

Anahtar Kelimeler

Heterotopik gebelik, Rüptüre Cornual Gebelik, İntrauterin gebelik, Laparatomi

Heterotopic Pregnancy: 7th Week Cornual Ruptured Ectopic Pregnancy and Intrauterine Pregnancy Reaching 38th Gestational Week

Öz

Introduction: Heterotopic pregnancy, defined as
the coexistence of intrauterine and extrauterine gestation, is rarely seen
spontaneously, but is seen as 1 in 100 pregnancies with assisted reproductive
techniques (ART)

Case: 26 years old gravida 1 Parity 0
patient applied to our emergency polyclinic with severe abdominal pain. Past
history  were not detected such as abdominal
operation, endometriosis and pelvic inflammatory disease. In the transvaginal
ultrasound of the pregnant patient with ART, 7 weeks of intrauterine live
pregnancy and common free fluid were detected. Emergency laparotomy was applied to the patient who
was diagnosed as acute abdomen. In operation, a rarely seen cornual ruptured
ectopic pregnancy (heterotopic pregnancy) in the literature was diagnosed. We
aimed to share with you our patient who has delivered a healthy baby after
reaching the gestational week of 38th week of intrauterine pregnancy which has
been treated with cornual repair.

Conclusion:
Comprehensive
transvaginal ultrasonography should be performed for heterotopic pregnancy in
pregnancies with ART. Patients presenting with an acute abdomen should not be
hesitated about surgery in terms of maternal mortality



ndometriosis and pelvic inflammatory disease. In the transvaginal
ultrasound of the pregnant patient with ART, 7 weeks of intrauterine live
pregnancy and common free fluid were detected. Emergency laparotomy was applied to the patient who
was diagnosed as acute abdomen. In operation, a rarely seen cornual ruptured
ectopic pregnancy (heterotopic pregnancy) in the literature was diagnosed. We
aimed to share with you our patient who has delivered a healthy baby after
reaching the gestational week of 38th week of intrauterine pregnancy which has
been treated with cornual repair.

Conclusion: Comprehensive transvaginal ultrasonography
should be performed for heterotopic pregnancy in pregnancies with ART. Patients
presenting with an acute abdomen should not be hesitated about surgery in terms
of maternal mortality

Anahtar Kelimeler

Heterotopic pregnancy, Ruptured cornual pregnancy, Intrauterine pregnancy, Laparatomy

Kaynakça

• Referans1:. Brunette DD, Roline C. Heterotopic pregnancy resulting from in vitro fertilization. Am J Emerg Med 2011;29:960.
• Referans2: Ebner T, Yaman C, Moser M, Sommergruber M, Polz W, Tews G. Embryo fragmentation in vitro and its impact on treatment and pregnancy outcome. Fertil Steril. 2001;76:281–5. [PubMed]
• Referans3. Pan HS, Chuang J, Chiu SF, Hsieh BC, Lin YH, Tsai YL, et al. Heterotopic triplet pregnancy: Report of a case with bilateral tubal pregnancy and an intrauterine pregnancy. Hum Reprod. 2002;17:1363–6. [PubMed]
• Referans4. Maruotti GM, Sarno L, Morlando M, Sirico A, Martinelli P, Russo T. Heterotopic pregnancy: it is really a rare event? The importance to exclude it not only after in vitro fertilization but also in case of spontaneous conception.Fertil Steril. 2010;94:e49.
• Referans5. Habana A, Dokras A, Giraldo JL, Jones EE. Cornual heterotopic pregnancy: contemporary management options. Am J Obstet Gynecol 2000;182:1264–70.
• Referans6. Surbone A, Cottier O, Vial Y, Francini K, Hohlfeld P, Achtari C. Interstitial pregnancies’ diagnosis and management of interstitial pregnancy – a series of eleven cases. Swiss Med Wkly 2013;143:w13736.
• Referans7. Refaat B, Dalton E, Ledger WL. Ectopic pregnancy secondary to in vitro fertilisation-embryo transfer: pathogenic mechanisms and management strategies. Reprod Biol Endocrinol 2015;13:30.
• Referans8. Khan KS, Wojdyla D, Say L, et al. WHO analysis of causes of maternal death: a systematic review. Lancet 2006;367:1066-74.
• Referans9. Kwok TC, Morgan G. Think heterotopic: a case report of heterotopic pregnancy detected on thorough ultrasonography. J Med Cases 2012;3:326–8.
• Referans10. Shah Y, Zevallos H, Moody L. Combined intra and extrauterine pregnancy: a diagnostic challenge. J Reprod Med. 1980;25:290e292.
• Referans11. Soriano D, Vicus D, Schonman R, et al. Long-term outcome after laparoscopic treatment of heterotopic pregnancy: 19 cases. J Min Invas Gynecol. 2010;17:321e324.
• Referans12. Lam PM, Lok IH, Yip SK. Two cases of heterotopic cornual pregnancy with initially missed diagnosis. Aust N Z J Obstet Gynaecol 2004;44:256–9.
• Referans13. Reece ED, Petrie RH, Sirmons MF, Finster M, Todd WD. Combined intrauterine and extrauterine gestation: a review. Am J Obstet Gynecol, 1983;146:323-330.
• Referans14. Y. Yu , W. Xu , Z. Xie , Q. Huang , S. Li. Management and outcome of 25 heterotopic pregnancies in Zhejiang, China. European Journal of Obstetrics & Gynecology and Reproductive Biology 2014; 180 : 157–161
• Referans15.Glassner MJ, Aron E, Eskin BA. Ovulation induction with clomiphene and rise in heterotopic pregnancies: a report of two cases. J Reprod Med, 1990;35:175-178.