New Delhi, Oct 19 Doctors at a Gurugram hospital have successfully treated a 32-year-old woman with a ruptured ectopic pregnancy alongside an ongoing pregnancy inside the uterus following in-vitro fertilisation (IVF), removing the ruptured fallopian tube while preserving the intrauterine pregnancy.
The woman, who was 11 weeks pregnant, was diagnosed with heterotopic pregnancy, a rare condition in which an intrauterine pregnancy and an ectopic pregnancy occur simultaneously.
The rupture had caused nearly 800 ml of blood and clots to accumulate in her abdomen, necessitating emergency surgery, Artemis Hospital said.
The condition occurs in approximately one in 30,000 pregnancies in the general population, though its incidence is higher among women who conceive through assisted reproductive techniques such as IVF, according to the hospital.
Doctors performed emergency laparoscopic surgery to remove the ruptured right fallopian tube and evacuate the accumulated blood and clots from the abdominal cavity.
The procedure was complicated by endometriosis-related adhesions, which had obscured the fallopian tube and ovary behind the uterus.
The surgical team carefully removed the ruptured tube, controlled the bleeding and minimised manipulation of the uterus to protect the ongoing pregnancy.
“The primary challenge in a heterotopic pregnancy is to manage the ectopic pregnancy while preserving the ongoing intrauterine pregnancy,” Dr Renu Sehgal, chairperson of the Department of Obstetrics and Gynaecology at Artemis Hospital, Gurugram, said.
The case was particularly complex because the patient was already 11 weeks pregnant, when the uterus is significantly enlarged and the tubal pregnancy is also well developed, she said.
“Once the tubal pregnancy ruptures, bleeding can be torrential and immediate surgical intervention becomes necessary,” Sehgal said, adding that the endometriosis-related adhesions had made it more difficult to identify the affected tube and perform the surgery.
The patient’s recovery was uneventful. She was mobilised after the procedure, her catheter was removed on the first postoperative day and she was discharged in stable condition. Follow-up examinations and ultrasound scans were advised to monitor the ongoing pregnancy.
Doctors said early diagnosis, particularly around six to eight weeks of pregnancy, can make surgical management comparatively easier because the uterus and the ectopic pregnancy are smaller.
Heterotopic pregnancy can be difficult to identify because confirmation of a pregnancy inside the uterus may create the impression that an ectopic pregnancy has been ruled out. However, an intrauterine pregnancy does not exclude the possibility of a simultaneous ectopic pregnancy, particularly in women who conceive through IVF.
The case highlights the importance of promptly evaluating persistent or severe abdominal pain, bleeding and other concerning symptoms during early pregnancy, even when an intrauterine pregnancy has already been confirmed, doctors said.
(PTI News)
