Heterotopic pregnancy: Five case reports diagnosed in 2021

Introduction and importance: Heterotopic pregnancy is the occurrence of pregnancies in at least two different implantation sites in the same time. The diagnosis is one of the most difficult of the gynecological emergencies. In 2021 this pathology still underdiagnosed and remains unknown by physicians. Most patients are admitted in critical stage. Cases presentations: We reported 5 cases of heterotopic pregnancies in symptomatic women admitted from January 2021 to December 2021, in maternity department, mother and child hospital abderrahim Harouchi, Ibn Rochd University Hospital of Casablanca. The frequency of this pathology in our hospital in 2021 is about 10% of ectopic pregnancies (5/52 cases of ectopic pregnancies). All the cases were received in critical phase of the pathology (vascular collapsus or hemodynamic shock). The mean diagnostic was suspected in gray scale ultrasound that show an intrauterine pregnancy associated with adnexal mass corresponding to hematosalpinx or gestational sac in the uterine tubes with medium to high abundance hemoperitoneum. All of our cases were treated by laparotomy in emergency after resuscitation measures. Clinical discussion: The existence of intrauterine pregnancy does not exclude an ectopic pregnancy and often confuses the physician who consults the patient in early stage of symptoms. The clinical symptomatology is often related to a threatened or ongoing abortion, the diagnosis of heterotopic pregnancy is usually made in the stage of hemoperitoneum secondary to a rupture of the ectopic pregnancy. The standard treatment is conservative surgery, preferably by laparoscopy. The manipulation of the uterus must be careful to preserve the intra uterine pregnancy. Laparotomy retains its indications especially in forms with hemorrhagic shock. The abortion is not rare after surgery. A progestin treatment is always indicated. Conclusion: The diagnosis of heterotopic pregnancy should not be delayed by the discovery of an intra-uterine gestational sac in symptomatic women and the adnexa must be systematically examined in the first trimester sonographic exam. The Diagnosis is often difficult and management should be initiated as soon as possible given the risk of maternal mortality.