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CC BY-NC-ND 4.0 · AJP Rep 2024; 14(01): e91-e95
DOI: 10.1055/s-0044-1779654
Case Report

Spontaneous Heterotopic Cesarean Scar Triplet Gestation Following Uterine Ablation

Zane Frazer Aldrich
1   Obstetrics and Gynecology and Maternal Fetal Medicine, Winnie Palmer Hospital for Women and Babies, Orlando, FL
,
Rena Ow
1   Obstetrics and Gynecology and Maternal Fetal Medicine, Winnie Palmer Hospital for Women and Babies, Orlando, FL
,
Khyaati Modii
1   Obstetrics and Gynecology and Maternal Fetal Medicine, Winnie Palmer Hospital for Women and Babies, Orlando, FL
,
Timothy O'Leary
1   Obstetrics and Gynecology and Maternal Fetal Medicine, Winnie Palmer Hospital for Women and Babies, Orlando, FL
› Institutsangaben Funding None.
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Abstract

Heterotopic triplet pregnancy, cesarean scar ectopic pregnancy, and pregnancy following uterine ablation are all rare events that confer significant morbidity including spontaneous abortion, intrauterine fetal demise, preterm labor, abnormal placentation, and uterine rupture. A woman in her 30s, G6P4014, with a history of uterine ablation presented with delayed menses and vaginal spotting with imaging showing two intrauterine pregnancies (one with cardiac activity) and one live pregnancy at the cesarean scar. The patient was extensively counseled on risk to her and to the pregnancies; treatment options were discussed including expectant management and termination of pregnancy. The patient underwent an uncomplicated dilation and curettage with bilateral salpingectomy and was discharged home the day of the procedure in stable condition. This case highlights the potential compound effect of comorbid conditions that can pose difficulty in counseling and management.

Key Points

  • Patients undergoing endometrial ablation should be carefully selected and counseled extensively on highly effective contraception.

  • Suspected cesarean scar pregnancies should be carefully evaluated early in gestation. Management should include thorough counseling and may be indivisualized.

  • Many conditions pose a significant threat to maternal health and warrant a discussion of termination, which should be widely availaible and safe for all who need and/or desire it.

Keywords

ectopic pregnancy - heterotopic pregnancy - triplet gestation - cesarean scar - uterine ablation - abortion


Publikationsverlauf

Eingereicht: 04. Oktober 2023

Angenommen: 18. Oktober 2023

Artikel online veröffentlicht:
18. Februar 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Felekis T, Akrivis C, Tsirkas P, Korkontzelos I. Heterotopic triplet pregnancy after in vitro fertilization with favorable outcome of the intrauterine twin pregnancy subsequent to surgical treatment of the tubal pregnancy. Case Rep Obstet Gynecol 2014; 356131
    PubMedGoogle Scholar
  • 2 Guimarães AC, Reis LDO, Leite FC, Reis CFDD, Costa AP, Araujo WJB. Spontaneous heterotopic triplet pregnancy with two viable intrauterine embryos and an ectopic with right tubal rupture. Rev Bras Ginecol Obstet 2019; 41 (04) 268-272
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 3 Inion I, Gerris J, Joostens M, De Vree B, Kockx M, Verdonk P. An unexpected triplet heterotopic pregnancy after replacement of two embryos. Hum Reprod 1998; 13 (07) 1999-2001
    CrossrefPubMedGoogle Scholar
  • 4 Litwicka K, Greco E, Prefumo F. et al. Successful management of a triplet heterotopic caesarean scar pregnancy after in vitro fertilization-embryo transfer. Fertil Steril 2011; 95 (01) 291.e1-291.e3
    CrossrefPubMedGoogle Scholar
  • 5 Authreya AJ, Agrawal P, Makam A. Ultrasound-guided procedures in the management of heterotopic caesarean scar pregnancy: a review of case reports and case series. Australas J Ultrasound Med 2021; 24 (02) 70-77
    CrossrefPubMedGoogle Scholar
  • 6 Nkurunziza C, Rurangwa T, Ngendahimana V, Magriples U. Second trimester heterotopic triplet pregnancy with intrauterine twin pregnancy and ruptured interstitial pregnancy: a maternal near-miss case report. Case Rep Obstet Gynecol 2020; 5240848
    PubMedGoogle Scholar
  • 7 Miller R, Timr-Tritch I, Gyamfi-Bannerman C. Society for Maternal Fetal Medicine. Society for Maternal Fetal Medicine (SMFM) consult series #49: cesarean scar pregnancies. Am J Obstet Gynecol 2020; 222 (05) B2-B14
    CrossrefPubMedGoogle Scholar
  • 8 Endometrial Ablation. ACOG practice bulletin # 81. American College of Obstetrics and Gynecology. Obstet Gynecol 2007; 109: 1233-1248
    PubMedGoogle Scholar
  • 9 Fernandez H, Toth D, Descamps P, Capmas P, Lamarsalle L. Post procedural pregnancy occurrence risk after endometrial ablation. J Gynecol Obstet Hum Reprod 2022; 51 (01) 102259
    CrossrefPubMedGoogle Scholar
  • 10 Ibiebele I, Nippita TA, Baber R, Torvaldsen S. A study of pregnancy after endometrial ablation using linked population data. Acta Obstet Gynecol Scand 2021; 100 (02) 286-293
    CrossrefPubMedGoogle Scholar
  • 11 Ouyang Y, Chen H, Lin G. et al. Heterotopic cesarean scar pregnancy: an analysis of 20 cases following in vitro fertilization-embryo transfer. J Ultrasound Med 2021; 40 (10) 2239-2249
    CrossrefPubMedGoogle Scholar
  • 12 Hsieh BC, Hwang JL, Pan HS, Huang SC, Chen CY, Chen PH. Heterotopic caesarean scar pregnancy combined with intrauterine pregnancy successfully treated with embryo aspiration for selective embryo reduction: case report. Hum Reprod 2004; 19 (02) 285-287
    CrossrefPubMedGoogle Scholar