Rare heterotopic pregnancy after frozen embryo transfer: a case report and literature review
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(2020) 20:542
CASE REPORT
Open Access
Rare heterotopic pregnancy after frozen embryo transfer: a case report and literature review Xianping Wang1†, Ding Ma2†, Yangang Zhang2, Yanhua Chen1, Yuxia Zhang1, Zhongyu Liu3, Xingyu Bi1, Xueqing Wu1* and Junmei Fan1*
Abstract Background: Heterotopic pregnancy occurred after frozen embryo transfer with two D3 embryos, and the case had a history of bilateral salpingectomy due to salpingocyesis. An ectopic heterotopic pregnancy was implanted in the left psoas major muscle, which has not been previously reported. Case presentation: A 33-year-old woman presented with left back pain after curettage due to foetal arrest in the uterus without vaginal bleeding and spotting, and painkillers relieved the pain initially. When the painkillers ceased to work, the patient returned to the hospital. The β-human chorionic gonadotropin (β-hCG) level remained increased compared with the time of curettage, and a diagnosis of retroperitoneal abdominal pregnancy was suggested by ultrasonography and computerized tomography (CT) with the gestational sac implanted in the left psoas major muscle at the left hilum level. Laparotomy was performed to remove the ectopic pregnancy. During the operation, we carefully separated the adipose tissue between the space of the left kidney door and left psoas major muscle, peeled away the gestational sac that was approximately 50 mm × 40 mm with a 25-mm-long foetal bud, and gave a local injection of 10 mg of methotrexate in the psoas major muscle. Fifty days later, β-hCG decreased to normal levels. Conclusion: It is necessary to pay more attention to the main complaints to exclude rare types of ectopic pregnancies of the pelvis and abdomen after embryo transfer. Keywords: Heterotopic pregnancy, Retroperitoneal, Laparotomy, Case report, Frozen embryo transfer
Background Ectopic pregnancy is one of the most common acute abdominal diseases in obstetrics and gynaecology. It refers to a pregnancy in which the gestational sac is implanted outside of the uterine cavity, and the incidence of ectopic pregnancy is 2 ~ 3% [1]. Abdominal pregnancy accounts for 1% of ectopic pregnancies, and retroperitoneal pregnancy is a rare type of abdominal pregnancy, so only a few * Correspondence: [email protected]; [email protected] † Xianping Wang and Ding Ma are contributed equally to this work. 1 Children’s Hospital of Shanxi and Women Health Center of Shanxi, Department of Reproductive Medicine Center, Taiyuan, Shanxi, China Full list of author information is available at the end of the article
cases have been reported worldwide [2]. However, the mortality of intraperitoneal pregnancy was 8 times higher than that of common pregnancy [3]. Heterotopic pregnancy refers to the coexistence of intrauterine pregnancy and ectopic pregnancy. With the development of IVFassisted pregnancy technology, the incidence of heterotopic pregnancy has been increasing, accounting for 1% of IVF pregnancies [4]. This report describes a case of heterotopic pregnancy that occurred after embryo tran
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