Spontaneous Heterotopic Triplet Pregnancy with a Two Viable Intrauterine Embryos and an Ectopic One with Right Tubal Rupture

Overview

Journal Rev Bras Ginecol Obstet

Specialty Gynecology & Obstetrics

Date 2019 Apr 11

PMID 30970384

Citations 6

Authors

Adriano Carvalho Guimaraes

Luciano Dias de Oliveira Reis

Fabio Chaves Leite

Cassiana Franco Dias Dos Reis

Alex Paula Costa

Walter Junior Boim de Araujo

Affiliations

Soon will be listed here.

Abstract

Heterotopic pregnancy (HP) is defined as the simultaneous development of an intra- and an extra uterine gestation. The occurrence of a spontaneous triplet HP is an exceptionally rare medical condition. We report the case of a young woman with spontaneous heterotopic triplets at 8 weeks of gestation, with a misdiagnosis of topic twins and acute appendicitis. The ectopic tubal pregnancy was ruptured and a salpingectomy was performed by laparotomy. The intrauterine pregnancy progressed uneventfully. The two healthy babies were delivery by cesarean section at 36 ± 2 weeks of gestation. Heterotopic triplets with ruptured tubal ectopic pregnancy represent a special diagnostic and therapeutic challenge for the obstetrician. A high rate of clinical suspicion and timely treatment by laparotomy or laparoscopy can preserve the intrauterine gestation with a successful outcome of the pregnancy.

Citing Articles

Spontaneous Heterotopic Triplet Pregnancies With Single Intrauterine and Twin Tubal Pregnancies Post-Levonorgestrel Use: Case Report and Literature Review.

Tarafdari A, Eshraghi N, Shbeeb H, Poorabdoli M, Ghaemi M, Parsaei M Clin Case Rep. 2025; 13(1):e70080.

PMID: 39764270 PMC: 11702392. DOI: 10.1002/ccr3.70080.

Spontaneous Heterotopic Cesarean Scar Triplet Gestation Following Uterine Ablation.

Aldrich Z, Ow R, Modii K, OLeary T AJP Rep. 2024; 14(1):e91-e95.

PMID: 38370332 PMC: 10874689. DOI: 10.1055/s-0044-1779654.

Heterotopic pregnancy after assisted reproductive techniques with favorable outcome of the intrauterine pregnancy: A case report.

Wang Y, Zheng L, Fu L, Xu Y, Zhang X World J Clin Cases. 2023; 11(3):669-676.

PMID: 36793642 PMC: 9923848. DOI: 10.12998/wjcc.v11.i3.669.

Spontaneous ovarian and intrauterine non-viable heterotopic pregnancy at 12 weeks of gestation: A case report.

Maree G, Mohammad S, Moualla Z, Alshoumary L, Makhos R, Alfarra A Case Rep Womens Health. 2022; 35:e00423.

PMID: 35646609 PMC: 9136120. DOI: 10.1016/j.crwh.2022.e00423.

Evaluation of the recurrence and fertility rate following salpingostomy in patients with tubal ectopic pregnancy.

Poordast T, Naghmehsanj Z, Vahdani R, Alamdarloo S, Ashraf M, Samsami A BMC Pregnancy Childbirth. 2022; 22(1):2.

PMID: 34979988 PMC: 8721972. DOI: 10.1186/s12884-021-04299-y.

References

Bugatto F, Quintero-Prado R, Kirk-Grohar J, Melero-Jimenez V, Hervias-Vivancos B, Bartha J . Heterotopic triplets: tubal ectopic and twin intrauterine pregnancy. A review of obstetric outcomes with a case report. Arch Gynecol Obstet. 2010; 282(6):601-6. DOI: 10.1007/s00404-010-1577-z. View

Basile F, Di Cesare C, Quagliozzi L, Donati L, Bracaglia M, Caruso A . Spontaneous heterotopic pregnancy, simultaneous ovarian, and intrauterine: a case report. Case Rep Obstet Gynecol. 2012; 2012:509694. PMC: 3444845. DOI: 10.1155/2012/509694. View

Kiely J, Kiely M . Epidemiological trends in multiple births in the United States, 1971-1998. Twin Res. 2001; 4(3):131-3. DOI: 10.1375/1369052012335. View

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; 2014:356131. PMC: 3913340. DOI: 10.1155/2014/356131. View

Jeong H, Park I, Yoon Y, Lee N, Kim H, Kim T . Heterotopic triplet pregnancy with bilateral tubal and intrauterine pregnancy after spontaneous conception. Eur J Obstet Gynecol Reprod Biol. 2008; 142(2):161-2. DOI: 10.1016/j.ejogrb.2008.10.013. View

Nikolaou D, Lavery S, Bevan R, Margara R, Trew G . Triplet heterotopic pregnancy with an intrauterine monochorionic diamniotic twin pregnancy and an interstitial pregnancy following in vitro fertilisation and transfer of two embryos. J Obstet Gynaecol. 2003; 22(1):94-5. DOI: 10.1080/01443610211123. View

Sun S, Araujo Junior E, Elito Junior J, Rolo L, Campanharo F, Sarmento S . Diagnosis of heterotopic pregnancy using ultrasound and magnetic resonance imaging in the first trimester of pregnancy: a case report. Case Rep Radiol. 2012; 2012:317592. PMC: 3521416. DOI: 10.1155/2012/317592. View

Simsek T, Dogan A, Simsek M, Pestereli E . Heterotopic triplet pregnancy (twin tubal) in a natural cycle with tubal rupture: case report and review of the literature. J Obstet Gynaecol Res. 2008; 34(4 Pt 2):759-62. DOI: 10.1111/j.1447-0756.2008.00921.x. View

Divry V, Hadj S, Bordes A, Genod A, Salle B . Case of progressive intrauterine twin pregnancy after surgical treatment of cornual pregnancy. Fertil Steril. 2006; 87(1):190.e1-3. DOI: 10.1016/j.fertnstert.2006.04.053. View

10.

Toy E . Case 3: obstetrical. Heterotopic pregnancy: viable twin intrauterine pregnancy with a viable right tubal ectopic pregnancy. J Ultrasound Med. 2000; 19(5):355. View

11.

Pan H, Chuang J, Hsieh B, Lin Y, Tsai Y, Huang S . Heterotopic triplet pregnancy: report of a case with bilateral tubal pregnancy and an intrauterine pregnancy. Hum Reprod. 2002; 17(5):1363-6. DOI: 10.1093/humrep/17.5.1363. View

12.

Arsala L, Danso D . Spontaneous Heterotopic Triplet Pregnancy With Tubal Rupture: A Case Report and Literature Review. J Investig Med High Impact Case Rep. 2015; 2(2):2324709614531556. PMC: 4528884. DOI: 10.1177/2324709614531556. View

13.

Alsunaidi M . An unexpected spontaneous triplet heterotopic pregnancy. Saudi Med J. 2005; 26(1):136-8. View

14.

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(7):1999-2001. DOI: 10.1093/humrep/13.7.1999. View

15.

Cholkeri-Singh A, LaBarge A . Spontaneous heterotopic triplets: a case report. Fertil Steril. 2007; 88(4):968.e5-7. DOI: 10.1016/j.fertnstert.2006.12.034. View

16.

Bataille P, Reynard A, Ducarme G . Spontaneous heterotopic triplets - A review of literature. J Gynecol Obstet Hum Reprod. 2017; 46(8):657-659. DOI: 10.1016/j.jogoh.2017.05.008. View

17.

Selo-Ojeme D, GoodFellow C . Simultaneous intrauterine and ovarian pregnancy following treatment with clomiphene citrate. Arch Gynecol Obstet. 2002; 266(4):232-4. DOI: 10.1007/s004040100213. View