Nonsurgical treatment of heterotopic pregnancy: a report of six cases.

OBJECTIVE

To evaluate nonsurgical management of heterotopic pregnancy.

DESIGN

Retrospective case series.

SETTING

Department of Obstetrics and Gynecology (Antoine Béclère Hospital, Clamart, France, Paris-Sud University).

PATIENTS: Six women with heterotopic pregnancy who conceived in four cases after ovulation induction.

INTERVENTION: Transvaginal ultrasound (US)-guided aspiration/injection of potassium chloride (KCl) was performed in three cornual pregnancies with alive embryo. Expectant management was realized in three other cases. The regression was followed by serial US examination.

MAIN OUTCOME MEASURES: Early and late complications related to the procedure, outcome of intrauterine pregnancy (IUP).

RESULTS

Five of six patients were treated successfully (3 with KCl and 2 after expectant management). Three of these five patients had a spontaneous vaginal delivery, and two abortions occurred in the remaining two patients. Salpingectomy had to be performed in one case 10 days after medical treatment. This twin pregnancy ended with an abortion at 23 weeks of amenorrhea. Four cornual heterotopic pregnancies were treated successfully. No complication occurred after the initial management.

CONCLUSION

Ultrasound permits a reliable and early diagnosis of heterotopic pregnancy. In such cases nonsurgical management is an efficient alternative with a good IUP prognosis.