In a normal pregnancy, the embryo is inside the uterus. but if it is implanted outside this area it is called ‘ectopic pregnancy’, a phenomenon that occurs in 1% of pregnancies, and is most frequently located in the fallopian tube. But there are still more rare cases of pregnancies described, which would be the coexistence of a pregnancy inside the uterus and another outside, which is what is known as a heterotopic pregnancy.
«A heterotopic pregnancy is something exceptional, an extraordinary and very serious case, if it is not diagnosed and treated as soon as possible, it usually affects one in every 30,000 pregnancies, although its incidence has increased in recent years, mainly due to some treatments used. in assisted reproduction techniques. If not treated in time, it can have a fatal outcome and endanger the life of the future mother,” warns Dr. Juan Vidal Peláez, director of the Women’s Unit at the Ruber International Hospital in Madrid.
“It is a situation that is not usually observed in the first examinations when the embryo is already found in good condition inside the uterus, so it is not searched outside,” highlights this renowned gynecologist.
But one of the dangers of this situation is the difficulty in diagnosing it; one of the most frequent symptoms can be pain, and it is often difficult to know its cause. «In these situations, the pregnancy that is located outside the uterus grows and there comes a time when the fallopian tube can rupture, since it is a narrow conduit that does not give itself like the uterus, and a hemorrhage, giving rise to a serious and serious condition, which endangers the life of the mother, and which has been the cause of maternal deaths.
The time of diagnosis
Meanwhile, Dr. Sara Rubio Muñoz, an associate physician at the same hospital service, emphasizes that a heterotopic pregnancy represents a diagnostic challenge.
Recognize at this point that the diagnosis of suspected heterotopic pregnancy can be very complex at first, especially knowing that the symptoms described by the patient may be due to this situation. The patient may report nonspecific abdominal pain, which may be a common symptom in the first months of pregnancy. “They can be contractions of the uterus and/or changes that occur at the beginning of pregnancy, without being able to differentiate if it is something normal.”
In the case of a heterotopic pregnancy, the clinical symptoms manifested by the patient may be more evident if the rupture of the pregnancy outside the uterus occurs (mainly in the fallopian tube). In these cases, this gynecologist details, general discomfort usually occurs. , paleness, weakness, the woman has hardly any strength, and with a lot of abdominal pain (peritoneal irritation); “All of them signs that should make you think that there is something serious,” he points out.
In a first examination, he says that the usual thing is that everything seems to be normal, but some symptoms such as intense pain make us suspect that there may be an important cause, more tests must be carried out, as we have said: the clinical examination of the patient and Ultrasound will be essential to suspect the diagnosis. In this type of pregnancies, through ultrasound we will confirm the normality of the intrauterine pregnancy, the heartbeat of the embryo and we must assess the presence of ultrasound signs suspicious of other situations. For example, in the case of heterotopic pregnancy, the presence of another gestational sac outside the uterus, the presence of free fluid outside the uterus, the intense pain reported by the patient during the abdominal and vaginal examination, etc.
The impossibility of testing
It is important to note that certain tests cannot be performed during a pregnancy, given the effect they may have on fetal development, such as a CT scan or an MRI. In this sense, Dr. Julio Álvarez Bernardi, head of surgery at the Women’s Unit of the Ruber International Hospital in Madrid, emphasizes that when faced with abdominal pain and suspicion of hemoperitoneum (blood in the abdominal cavity) coinciding with a pregnancy Emergency surgery must be performed to achieve an early diagnosis, which will be essential to preserve the viability of the pregnancy and the health of the mother. This is an extremely serious situation, which in the past, due to lack of diagnostic means, was the cause of numerous maternal deaths.
Nowadays, if you have knowledge and experience in minimally invasive surgery techniques, such as laparoscopy (using a telescope connected to a high-definition camera), it is introduced into the abdominal cavity and surgical procedures can be performed through small incisions with high precision and safety for the patient.
In the case of heterotopic pregnancy, the embryo from the tube may have been discarded by the patient’s body, leading to a tubal abortion and in some cases rupturing the fallopian tube. In these cases, the patient’s tube is removed, which is then sent for analysis, to confirm that, indeed, the tissue is consistent with the presence of a pregnancy in a location outside the uterus.
Meanwhile, Alejandro Ruíz Pereza, assistant doctor of the anesthesiology and resuscitation service, emphasizes that anesthesia carries an additional risk in these cases since the patient is pregnant, drugs that do not affect fetal development must be used and in addition the anesthetist will have to have special control of the patient’s vital signs, accurately monitoring blood loss and in this way complications for the mother and the normal development of her pregnancy can be prevented.
After the intervention, the viability of the intrauterine pregnancy will be checked through an ultrasound that will confirm that the embryo is well and is progressing favorably, so follow-up for the pregnancy is scheduled, making it possible to give birth to a healthy newborn. , and in the future these women can perfectly well have other pregnancies, despite having only one tube.
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