Heterotopic triplet pregnancy. Report of a case with successful twin intrauterine gestation.

BACKGROUND

Reports of coexisting multiple intrauterine pregnancies and ectopic pregnancy are extremely rare. We present one case with early sonographic diagnosis of heterotopic pregnancy, successful laparoscopic treatment and a subsequent normal pregnancy course and outcome of the intrauterine twin gestation.

CASE: A 29-year-old woman, gravida 1, para 0, presented for her first prenatal visit at 5 weeks of gestation with pelvic pain. She had conceived with 75 IU leutinizing hormone and follicle-stimulating hormone and homologous intrauterine insemination. The sonogram confirmed a dichorionic twin intrauterine pregnancy and left tubal pregnancy at 7 weeks of gestation. The patient underwent a laparoscopic left salpingostomy and removal of the ectopic pregnancy. Level II sonogram showed a grossly unremarkable twin gestation at 20 weeks. Labor was induced at 37 weeks of gestation due to mild preeclampsia and underwent vaginal delivery without difficulties. The first twin was a girl, weighing 2,722 g, with Apgar scores of 9/9. The second twin, a boy, was delivered 10 minutes later, weighing 2,863 g, with Apgar scores of 9/9.

CONCLUSION

Early sonography is essential for the diagnosis of heterotopic pregnancy, and timely surgical intervention can save the intrauterine twin gestation, with a subsequent normal pregnancy course and outcome.