Long-term Outcome After Laparoscopic Treatment of Heterotopic Pregnancy: 19 Cases

Study Objective: To determine the long-term outcome of intrauterine pregnancies after treatment of heterotopic pregnancies. Design: Retrospective cohort study (Canadian Task Force classification II-3). Setting: Tertiary center university hospital. Patients: All women who underwent surgery because of heterotopic pregnancy over 12 years. Intervention: Laparoscopic surgery. Measurements and Main Results: Infant development and future pregnancy. Extrauterine pregnancies were located in the tube (n = 13), uterine cornua (n = 3), ovary (n = 1), and tubal stump (n = 2). During laparoscopy, a ruptured tube was found in 6 tubal pregnancies (46%), blood transfusion was needed in 7 heterotopic pregnancies (37%), and salpingectomy was performed in 12 women with tubal pregnancies (91.7%). The pregnancy outcome consisted of 13 babies (term and preterm) taken home and 5 miscarriages. Long-term follow up demonstrated that 10 of 13 infants (76.9%) exhibited normal development. Three infants, all from 1 triplet pregnancy, exhibited borderline to normal development. Ten of 15 women achieved additional pregnancies, with 10 deliveries and only 1 extrauterine pregnancy in the tubal stump. Conclusions: Women with a heterotopic pregnancy are at high risk for late diagnosis and at risk for hypovolemic shock at diagnosis, and may require blood transfusion. The outcome of intrauterine pregnancy in association with heterotopic pregnancy requiring surgical intervention is good, and most complications were associated with multifetal pregnancy and preterm delivery.