An unexpected quadruplet heterotopic pregnancy after bilateral salpingectomy and replacement of three embryos

Objective: To report a case of combined intrauterine and interstitial twin pregnancies after bilateral salpingectomy and IVF with replacement of three embryos. Design: Case report. Setting: University hospital. Patient(s): A 31-year-old woman known to have bilateral salpingectomy for ectopic pregnancies who underwent IVF. Intervention (s): Laparotomy. Main Outcome Measure(s): Postoperation intrauterine monozygotic twins survival and birth. Result(s): After removing the interstitial monozygotic twin pregnancy, the patient had an uneventful postoperative course and delivered two healthy girls by cesarean section at 38 weeks' gestation. Conclusion(s): Heterotopic pregnancy can still occur in women treated by IVF after bilateral salpingectomy. The early sonography follow-up of IVF pregnancy would be of value because of the reported higher incidence of pathological pregnancies and especially monozygotic twinning. (C)2003 by American Society for Reproductive Medicine.