Chapter 32 - Heterotopic pregnancy and assisted reproduction

Summary

The increase of heterotopic pregnancy (HP) is attributed to the widespread use of ovulation induction and assisted reproduction techniques. Treatment of HP should be tailored to the patient and is thus dependent on several factors, such as the location of the ectopic pregnancy, previous ectopic in the same tube, the condition of the contralateral tube, and the general condition of the patient and the status of the pelvis. Ultrasound-guided management is becoming increasingly common. It can be performed safely in an outpatient setting and thereby obviates the need for laparoscopy or laparotomy, and eliminates the morbidity associated with both surgery and general anesthesia. Expectant management of HP in hemodynamically stable patients with an intact ectopic pregnancy has been reported. Laparoscopy, in addition to making a diagnosis, allows the assessment of pelvic structures, presence of hemoperitoneum, and presence of other conditions, such as ovarian cysts and ovarian torsion.