Heterotopic Pregnancy

One of the several possible complications during pregnancy is heterotopic pregnancy. Usually in normal pregnancies, the fertilised egg sticks to the endometrial layer of the uterus. This is called intrauterine pregnancy. However, in some cases, the egg implants itself in the fallopian tube. This kind of egg implanting itself in any other place other than the uterus is called ‘ectopic pregnancy’. In an ectopic pregnancy, the egg can implant itself in the fallopian tube, cervix, ovaries or in the abdomen. However, the fallopian tube is the most common spot.

Heterotopic pregnancy is the combination of intrauterine pregnancy and ectopic pregnancy. This can happen more often when assisted reproduction techniques are used. As the fertilised egg grows into the baby, the fallopian tube may rupture and may lead to life threatening conditions.

What causes heterotopic pregnancy?

Most often, heterotopic pregnancy is caused when fertilised eggs are placed in the uterus during the IVF procedure. One fertilised egg implants inside the uterus while another fertilised egg implants outside the uterus.

Factors that can put you at risk of heterotopic pregnancy:

1. A history of ectopic pregnancy must be considered by your gynaecologist.
2. Any previous surgery related to repairing or reconnecting fallopian tubes
3. Infection to the organs of the female reproductive system – Pelvic Inflammatory Disease.
4. Usage of IUD – IntraUterine Device
5. Smoking
6. Hyper ovulation if you are undergoing assisted reproductive procedures.
7. Release of multiple embryos during IVF
8. Treatment for hormonal imbalance can also cause heterotopic pregnancy.

Symptoms of heterotopic pregnancy

1. Vaginal bleeding
2. Abdominal cramps that get bad as the second embryo grows
3. Nausea and/or vomiting
4. Dizziness and fainting

If you feel extremely dizzy and feel like you may faint, you must see your gynaecologist immediately. Severe pain, dizziness, vaginal bleeding may indicate the rupture of fallopian tube where the unwanted embryo has been growing.

Diagnosing heterotopic pregnancy

Most of the time, doctors may not suspect heterotopic pregnancy in normal circumstances. Occasional spotting and cramps are quite common and they may give the possibility of heterotopic pregnancy a miss until the fallopian tube bursts due to the growth of the embryo. It is advisable to get the fallopian tubes too scanned when you go for an ultrasound during the first few weeks of pregnancy.

In case of assisted reproduction, your doctor may keep the possibility in mind and may get you tested accordingly. In any case, if you have the above mentioned symptoms, you should get an ultrasound check up thoroughly.

How is heterotopic pregnancy treated?

An embryo usually doesn’t survive in any place other than the uterus. Any such embryos pose a life threatening condition as they grow. The only treatment option for heterotopic pregnancy is – removal of the embryo from the fallopian tube. It can either be a laparoscopic removal of the embryo, keeping the fallopian tube or a total removal of the fallopian tube (salpingectomy). Since there is another embryo implanted in the uterus, other types of procedures like injecting chemicals are not recommended.